Wiener klinische Wochenschrift
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Although the phrase "no suicide without depression" may not be quite correct in this extreme wording, it must be stressed that the connection between depression and suicide is close and that the contribution of depression towards suicide is very large. The task of the examining physician is twofold. In the first place he has to judge from the phenomenological-psychopathological point of view to which extent the patient shows signs of the so-called "pre-suicidal syndrome", consisting of multi-dimensional narrowing in, inhibited and self-directed aggression, and increasing suicidal fantasies. ⋯ Endogenous depression, senile depression and neurotic depression have to be taken into consideration and the extent of the risk of suicide depends, not least, on the type of depression. As to therapy, neurotic depression requires psychotherapy, senile depression calls for socio-therapeutic measures and endogenous depression necessitates the administration of antidepressives. In all cases, however, the foundation for successful therapy rests on the achievement of a harmonious and genuine doctor-patient relationship.
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Wien. Klin. Wochenschr. · Jan 1985
Case Reports[1st case of AIDS in Salzburg. Important diagnostic hint by determination of neopterin].
This case report describes the first case of AIDS in Salzburg. The patient belonged to the male homosexual risk group. ⋯ The diagnosis of AIDS was corroborated by highly elevated urinary neopterin levels. Despite treatment with antibiotics the patient died within 5 weeks due to cardiorespiratory insufficiency.
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Wien. Klin. Wochenschr. · Nov 1984
Randomized Controlled Trial Clinical Trial[Effect of nootropic drugs on normal and disturbed sleep of the elderly: controlled studies with pyridoxilate and street noise].
The effect of the nootropic drug, piridoxilate on normal and on exogenously (by traffic noise) disturbed sleep and awakening quality was investigated in a double-blind placebo-controlled study. 10 elderly subjects with a mean age of 62 years spent 13 nights in the sleep laboratory: 2 adaptation nights, 1 baseline night, 3 drug nights (placebo, 300 and 600 mg piridoxilate), as well as 2 drug nights with nocturnal traffic noise (placebo and 600 mg piridoxilate) and the subsequent wash-out nights. Polysomnographic recordings (including EEG, EMG and EOG) were carried out between 10:30 p.m. and 6.00 a.m. Traffic noise was pre-recorded at a busy Viennese street and presented continuously by a loudspeaker with a sound pressure level at the ear of between 68 and 83 dB (A) [mean 75.6 dB (A)]. ⋯ Nocturnal traffic noise produced a decrease in total sleep time and sleep efficiency, an increase in wakefulness and drowsiness (stage 1), as well as a decrease in REM and deep sleep stages, the last-mentioned being of statistical significance. Subjectively, the elderly subjects reported a deterioration in sleep quality due to traffic noise, an increase in middle and late insomnia, as well as a deterioration in awakening quality (dizziness, tiredness, headaches). Piridoxilate did not ameliorate these sleep disturbances.(ABSTRACT TRUNCATED AT 250 WORDS)
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Wien. Klin. Wochenschr. · Apr 1984
Review[Pathophysiology and therapy of diabetic ketoacidosis and of non-ketoacidotic hyperosmolar diabetic coma].
Metabolic derangements in diabetic coma are the sequelae of insulin deficiency. These defects are aggravated by the actions of insulin counteracting ("diabetogenic") hormones and hypertonic dehydration, which both impair insulin action. Conversely, it has been shown that hypo-osmolar rehydration of a hyperosmolar, severely hyperglycaemic diabetic patient reduces insulin resistance and restores biological responsiveness of previously dehydrated insulin-dependent tissues towards insulin. ⋯ This approach probably avoids a too rapid fall in plasma osmolarity, minimizes the risk of cerebral oedema and hypokalaemia, and improves survival. The development of severe diabetic ketoacidosis or of hyperosmolar non-ketotic diabetic coma should be prevented by advice to patients on the importance of metabolic monitoring, which can be done by proper self-monitoring of blood glucose. In addition, information should be provided on the detrimental metabolic effects of both dehydration and stress.
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Wien. Klin. Wochenschr. · Jan 1984
The development and rationale of pressure-controlled intermittent coronary sinus occlusion--a new approach to protect ischemic myocardium.
The early concept of global retroperfusion and arterialisation of the coronary sinus was discarded because of unacceptable damage to the myocardium, although many authors provided evidence on the improvement of cardiac function during ischemia. Furthermore, the exact mechanism of coronary sinus retroperfusion remained poorly understood. The lack of a strong physiological basis for retroperfusion as well as the development of coronary bypass grafting lessened interest in this revascularisation technique. ⋯ This report explains the proposed nature of action of enhanced washout of myocardial edema induced by P-ICSO. Moreover, beneficial effects of P-ICSO observed during canine studies are summarized. It is concluded that this new simple retroperfusion technique has the clinical potential to serve as interim support to protect deprived myocardium until definite reperfusion is available.