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
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).
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Wien. Klin. Wochenschr. · Jan 2007
Family medicine practice and research: survey of physicians' attitudes towards scientific research in a post-communist transition country.
Although the paradigm of modern medicine is evidence-based practice, there is a lack of research output and interest in research in family medicine. We investigated attitudes towards scientific research among family medicine practitioners in a country in post-communist socioeconomic transition, and related it to their attitudes towards alternative medicine and clinical knowledge relevant for their practice. ⋯ Family medicine practitioners in a transition country have a more positive attitude towards science than towards alternative medicine, despite the adverse situation in which they practice. To involve family medicine practitioners in research, interventions must be directed towards changes in behavior and practice and not only towards increasing positive attitudes.
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Wien. Klin. Wochenschr. · Jan 2007
Prediction of clinical outcome in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) using the TIMI risk score extended by N-terminal pro-brain natriuretic peptide levels.
N-terminal pro-brain natriuretic peptide (Nt-proBNP) is a strong independent predictor of death in acute coronary syndromes. In order to improve risk assessment in patients with unstable coronary artery disease we investigated the role of the additional determination of Nt-proBNP levels in patients sub-grouped into high-, medium- and low-risk groups according to the TIMI risk score. ⋯ Determination of plasma Nt-proBNP levels and incorporation of these into TIMI risk classification by creating a combined risk score significantly improves risk assessment of patients with unstable coronary artery disease.