Wiener klinische Wochenschrift
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In out of area military missions soldiers are potentially exposed to bacteria that are endemic in tropical areas and can be used as biological agents. It can be difficult to culture these bacteria due to sample contamination, low number of bacteria or pretreatment with antibiotics. Commercial biochemical identification systems are not optimized for these agents which can result in misidentification. ⋯ PCR results can be false negative due to inadequate clinical samples, low number of bacteria in samples, DNA degradation, inhibitory substances and inappropriate DNA preparation. Hence, it is crucial to cultivate the organisms as a prerequisite for adequate antibiotic therapy and typing of the agent. In a bioterrorist scenario samples have to be treated according to rules applied in forensic medicine and documentation has to be flawless.
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Wien. Klin. Wochenschr. · Jan 2007
Case ReportsContralateral stroke during carotid endarterectomy due to abnormalities in the circle of Willis.
Approximately 10-20% of patients will not tolerate cross-clamping of the common carotid artery for carotid endarterectomy procedures. The most frequent causes of neurological deficits are either embolization of particulate matter or cerebral hypoperfusion. Insufficient blood flow through primary collaterals of the circle of Willis is the main reason for hypoperfusion that requires immediate shunt placement. ⋯ We report a case where regional anesthesia allowed early detection of rapidly progressing signs of bi-hemispheric brain ischemia in a patient with diabetes and with at that time unknown severe abnormalities of the circle of Willis. Lack of adequate collateralization was detected only after surgery, in a combined perfusion-magnetic resonance imaging study. In symptomatic diabetics with low-grade stenosis of the internal carotid artery, preoperative assessment of the function of the circle of Willis may therefore be helpful in predicting any increased risk for intraoperative cerebral ischemia.
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Wien. Klin. Wochenschr. · Jan 2007
Practice Guideline[Austrian Guidelines for Prophylaxis of Venous Thromboembolism].
Venous thromboembolism occurs in a significant number of patients in typical risk situations (e.g. surgery or trauma). However, in these special high-risk situations anticoagulants, particularly low molecular weight heparin, allow for a decrease in the number of venous thromboses, pulmonary embolisms and deaths caused by pulmonary embolism. Only the wide-spread and adequate use of antithrombotics can safeguard against venous thromboembolism in these various risk situations. ⋯ The recommendations for the management of thrombosis prophylaxis in the fields of general surgery, orthopaedic and trauma surgery and internal medicine have been elaborated drawing on the Guidelines issued by the American College of Chest Physicians. Included are recommendations on indications as well as the choice of antithrombotics, dose and duration of therapy for the various conditions. The Austrian Guidelines for Venous Thromboembolism Prophylaxis are meant to be a basis for standardising procedures in the above-mentioned fields, thus contributing to an improved management of risk situations by physicians and health care staff and providing more safety for patients.
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Wien. Klin. Wochenschr. · Jan 2007
Comparative StudyCould we predict asymptomatic cardiovascular autonomic neuropathy in type 1 diabetic patients attending out-patients clinics?
Diabetic cardiovascular autonomic neuropathy (CAN) is associated with increased morbidity and mortality. This complication may be asymptomatic for a long time. The aim of this study was to assess the prevalence, severity and predictors of asymptomatic CAN in patients with type 1 diabetes mellitus (DM1). ⋯ According to our results, asymptomatic CAN is very frequent in patients with DM1. By using multifactorial logistic regression (step-wise) analysis we demonstrated that if albuminuria, peripheral neuropathy and elevated systolic BP are present simultaneously, there is a high probability that the patient also has CAN (84.9% of initial group correctly predicted, p < 0.001).