Wiener medizinische Wochenschrift
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Wien Med Wochenschr · Jan 2007
Review[Invasive candidiasis in the critically ill, patient non-neutropenic].
Invasive candidiasis can occur in immunosuppressed patients as well as in critically ill, non-immunocompromised patients and is associated with high mortality (20-40 %). Intestinal Candida colonisation is an important source for invasive candidiasis. ⋯ Among patients with invasive candidiasis, antifungal treatment should be started without delay. Antifungal prophylaxis is currently not recommended in critically ill, non-immunocompromised patients.
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Invasive fungal infections (IFI) are a major cause of morbidity and mortality in cancer patients receiving myelotoxic chemotherapy. Established risk factors are previous fungal infection, neutropenia exceeding 10 days, older age, active cancer, corticosteroid therapy, administration of broad spectrum antibiotics, allogeneic HSCT, central venous catheter and organ dysfunction. The strategies to manage IFI comprise chemoprophylaxis, preemptive, empirical and directed antifungal therapy. ⋯ Liposomal amphotericin B is a good alternative candidate and caspofungin is reserved for salvage treatment. Invasive candidiasis should be treated with caspofungin or one of the lipid based amphotericin B formulations. Since non-albicans species are increasingly observed, the use of fluconazole is reserved for "stable", non-neutropenic patients.
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Wien Med Wochenschr · Jan 2007
[Surgical treatment of knee joint osteoarthritis in the middle-aged patient].
Several treatment options for the osteoarthritis of the knee in middle-aged patients to preserve the joint are available. Arthroscopic debridement is still a valuable treatment when detailed indications are considered. Microfracture procedure showed good and excellent results primarily at a follow-up of 2 years. ⋯ Up till now, there was no significant difference in outcomes comparing ACI and mosaicplasty or microfracture. Basic for successful surgical cartilage repair is a stable joint with a normal limb. An eventual additional osteotomy of the knee should be considered based on a standing, three-joint radiograph in every patient.
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Fibromyalgia is a common chronic pain syndrome affecting particularly middle aged women. The symptomatology is characterized by diffuse widespread myofascial pain and tenderness on palpation at multiple "tender points". Additional symptoms are various vegetative and functional disorders, nonrestorative sleep, depression and anxiety. ⋯ Medication and physical therapies only accomplish some temporary symptomatic relief (30-50%). Psychosomatic rehabilitation should not focus on reduction of pain, but rather on physical reconditioning and development of an active coping style. In this context psychological interventions, education and psychotherapy are essential.