Wiener klinische Wochenschrift
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Anemia is a frequent finding in patients treated in ICUs and results in a high number of red blood cell transfusions. Many patients are already admitted to ICUs with subnormal hemoglobin values. Surgery, frequent phlebotomies and overt bleeding episodes are obvious reasons for continuous blood loss during the ICU stay. ⋯ However, the optimal transfusion trigger in relation to patient comorbidity requires further investigation. Rigorous strategies of blood conservation may help to avoid transfusions. Red blood cell substitutes and recombinant erythropoietin are promising treatment options that are currently under investigation.
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Wien. Klin. Wochenschr. · Jan 2001
Review Comparative Study[Botulinum toxin treatment of hip adductor spasticity in multiple sclerosis].
Spasticity results in a resistance to passive movement and decrease of passive mobility of the involved joints and is defined as a state of hypertonicity with exaggeration of tendon reflexes mediated by a loss of inhibitory control of upper motor neurons. In patients with severe stages of multiple sclerosis (MS) spasticity of the lower limbs often leeds to a spastic pattern with hip adduction resulting in decreased range-of-motion (ROM), increased pain, spasms, and functional disability (disturbed gait and sitting position) as well as difficulties with perineal hygiene. Local botulinum toxin type A (Btx-A) injections in spastic muscles offer a new treatment approach for managing spasticity and associated problems. ⋯ A maximum dose of 1500 units Dysport (400 units Botox) per treatment session and 250 units Dysport (50 units Botox) per injection site is recommended. See table for dose-range of Dysport, and Botox in the treatment of adult patients with hip-adductor spasticity. For evaluation of treatment effects in hip adductor spasticity clinical examination with specific scales and measurements (see Appendix) at baseline, 4 and 12 weeks following BtxA injection is recommended:--Global rating of severity (0-4; patient's self assessment and physician's rating) --Global rating of response (-4 - +4; patient's self assessment and physician's rating)--Visual Analogue Scale (patient's self assessment of pain)--Active and passive ROM (manual goniometer)--Distance between the medial femur condyles in thigh extension (distance in cm)--Modified Ashworth scale (0-4)--Ten meter walking time (seconds)--Functional Ambulation Categories (0-5)--Score of perineal hygiene (0-5).
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Wien. Klin. Wochenschr. · Jan 2001
Review Comparative Study[Botulinum toxin type A treatment of upper limb spasticity].
In recent years, local injections with Botulinum toxin type A (BtxA) have become the treatment of choice for dystonia. However, several studies have demonstrated its efficacy and safety in the treatment of focal spasticity as well. These studies have shown efficacy and safety in upper limb spasticity treatment at a total dose between 500 and 1500 units of Dysport per injection session. ⋯ In addition to functional improvement, BtxA treatment may also be considered for the following reasons: treatment of spasticity associated pain or painful muscle spasms, improved hygiene, facilitation of care, prevention of skin breakdown, and improved positioning of the upper limb. The definition of a realistic treatment goal, in agreement with the patient, as well as adjunctive physiotherapy are prerequisites for a successful BtxA treatment. Dose recommendations are given in Table 1.
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Wien. Klin. Wochenschr. · Jan 2001
Review Comparative Study[Treatment of focal dystonia with botulinum toxin A].
Local injections with Botulinum toxin A (BtxA) are safe and effective in the treatment of focal dystonia. In cervical dystonia and blepharospasm, BtxA injections have become the treatment of choice. However, good results have also been reported with oromandibular dystonia, spasmodic dysphonia and writer's cramp. ⋯ In up to 5% of patients with dystonia, the development of neutralising antibodies is reported following repetitive injections with BtxA. Patients with antibodies had a shorter interval between injections, more "boosters", a higher dose per 3-month interval, and a higher total dose injected. In case of neutralizing antibodies against the A toxin, the treatment with Botulinum toxin B (Neurobloc) is a possible alternative.
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Wien. Klin. Wochenschr. · Dec 2000
Review Comparative Study[Atypical neuroleptics: new approaches to drug therapy of schizophrenic disorders].
The introduction of conventional antipsychotics revolutionized the management of psychotic disorders in the 1950s. The use of these agents has been marked by several shortcomings, including their association with severe motor disturbances and their limited efficacy in treating the negative and cognitive symptoms of schizophrenia. Patients noncompliance has largely been the result of subjectively distressing extrapyramidal motor side-effects (EPMS). ⋯ The implications of EPMS reduction touch several domains of pathology in schizophrenia such as short- and long-term movement disorders, noncompliance, relapse rate, negative symptoms and cognitive dysfunction. Novel antipsychotics may represent the second pharmacological revolution in the treatment of psychotic disorders. There is, however, still a need for a critical evaluation of the risk-benefit-ratio of differing atypical agents.