Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Jan 1996
Review Comparative Study[Current treatment strategy in malignant pleural effusion].
Malignant pleural effusions are a grave consequence of advanced cancer disease. The successful suppression of pleural fluid reaccumulation can make a major contribution to the management and palliative care of patients with disseminated cancer. Many treatment concepts have been reported in the literature. ⋯ Talc was superior to other agents in 6 of 6, Corynebacterium parvum in 3 of 4 and bleomycin or tetracycline only in 3 of 8 studies. Adverse effects were frequently observed with cytostatic agents, but were very rare in the case of talc or fibrin instillation. Comparing the recently published data pleurodesis with talc appears to be the most effective treatment strategy, followed by Corynebacterium parvum, bleomycin and tetracycline.
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Wien. Klin. Wochenschr. · Jan 1996
[Predictive value of score parameters of the Simplified Acute Physiology Score (SAPS)-II for the duration of treatment of intensive care patients].
Length of intensive care therapy and the total length of stay in hospital are important determinants of hospital costs. We therefore analysed the correlation between score parameters of SAPS-II with the time spent in the intensive care unit (ICU), and also in the hospital, for 604 general medical intensive care patients (ICU group) and 510 coronary care patients (CCU group). The mean stay in the ICU was 3.68 days for ICU patients and 2.67 days for CCU patients. ⋯ In ICU patients duration of intensive treatment and hospital stay correlated with age, heart rate, maximum systolic blood pressure, body temperature, BUN, serum bilirubin, and sodium (all signs of systemic inflammatory reaction and organ dysfunction); in CCU patients length of intensive treatment and hospital stay correlated with body temperature, diuresis, BUN, bicarbonate, minimum systolic blood pressure (as signs of organ perfusion). A low Glasgow Coma Score was correlated with prolonged intensive care in all patients. In conclusion, score data, appear a suitable tool to predict the duration of intensive care treatment and length of hospitalization, in addition to outcome, and thus serve as gauge of efficiency.
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Wien. Klin. Wochenschr. · Jan 1996
Review[Glutamine: effects on the immune system, protein balance and intestinal functions].
Glutamine is the most abundant free amino acid of the human body. In catabolic stress situations such as after operations, trauma and during sepsis the enhanced transport of glutamine to splanchnic organs and to blood cells results in an intracellular depletion of glutamine in skeletal muscle. Glutamine is an important metabolic substrate for cells cultivated under in vitro conditions and is a precursor for purines, pyrimidines and phospholipids. ⋯ Moreover, glutamine exerted a trophic effect on the intestinal mucosa, decreased the intestinal permeability and thus may prevent the translocation of bacteria. In conclusion, glutamine is an important metabolic substrate of rapidly proliferating cells, influences the cellular hydration state and has multiple effects on the immune system, on intestinal function and on protein metabolism. In several disease states glutamine may consequently, become an indispensable nutrient, which should be provided exogenously during artificial nutrition.
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Wien. Klin. Wochenschr. · Jan 1996
Comparative Study[Evaluation of a new method for determining glycated hemoglobin with monoclonal antibodies (DCA 2000)].
HPLC (High Performance Liquid Chromatography) is commonly regarded as the reference method for HbAlc measurements. However, HPLC requires a relatively large technical staff, expensive laboratory equipment and is rather time consuming. The mobile DCA 2000 instrument determines HbAlc in only 9 minutes, using only one microliter of capillary blood. ⋯ The maximum deviations were plus 1.6% and minus 1.3% HbAlc. DCA 2000 is easy to handle and gives rapid and reliable information on long-term metabolic control. Hence, it could be very useful for clinical practice and outpatient departments.
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Wien. Klin. Wochenschr. · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialThe management of pneumothorax with the thoracic vent versus conventional intercostal tube drainage.
The thoracic vent is a new minimally invasive device for the treatment of spontaneous and iatrogenic pneumothorax. It consists of a polyurethane catheter connected to a plastic chamber containing a one-way valve. As there is no need to connect the thoracic vent to an underwater seal device, immobilization and hospitalization can be avoided. ⋯ Hence, we have performed a randomized study comparing the treatment of pneumothorax by means of the thoracic vent versus conventional intercostal tube drainage in 30 patients, including some with tension pneumothorax. 17 patients were treated with the thoracic vent, 13 with conventional intercostal tube drainage. We found no significant differences in the rate of reexpansion and rate of complications between the group treated with the thoracic vent and the group treated with intercostal tube drainage, but the patients treated with the thoracic vent needed significantly less analgesics. 70% of the patients treated with the thoracic vent were successfully managed on an outpatient basis. All patients treated with intercostal tube drainage were hospitalised; duration of inpatient-therapy was 8 +/- 6.2 days (mean +/- SD).