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
Bacterial contamination of solutions for parenteral administration for single- and multiple-dose vials after multiple use in the hospital.
Outbreaks traced to bacterial contamination of multiple-dose vials are reported in the literature. During a four-month period, multi-dose vials (MDVs), single-dose vials (SDVs), and vials containing self-prepared admixtures were collected from various wards to analyse sterility of their contents. We examined 68 commercially available MDVs containing sodium chloride 0.9% or heparin with added preservative and 17 single dose vials (SDVs) containing aqua ad injectionem or sodium chloride 0.9% and 11 vials with admixtures (ADX) of heparin and sodium chloride 0.9%, both without preservative. ⋯ On average, the volume of the samples was 80% of the original volume. A proportion of 4% of vials was not sterile. A training programme for health care workers in aseptic techniques and for validation of the preparation of solutions for parenteral use should be installed.
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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.