Wiener medizinische Wochenschrift
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Perforating injury allows the dispersion of environmental fungi and fungal spores together with miniscule foreign bodies into traumatized tissue where they can multiply and cause invasive infection. Acute invasive fungal infection after open fractures is uncommon. ⋯ Injury-related fungal infections of the immuncompromised host may lead to rapid invasion and generalization of the fungal infection. The following review will focus on the fungal infections after perforating injuries and open fractures including the invasive mycoses as a direct consequence of the trauma, post-traumatic fungal infections, tropical fungal infections (mycetoma), invasive fungal infections after near-drowning and nosocomial invasive fungal infections of the critically ill post-traumatic patient admitted to the intensive care unit.
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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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The expectations of total joint replacement are constantly increasing: Freedom of pain and mobility used to be the primary goal, while nowadays it is longevity despite heavy loading and intense sporting activity. A preoperative sportive patient expects to be able to perform his favorite sporting activities like hiking, swimming and cycling, but also the more demanding skiing, tennis and jogging, for example, after surgery. The aim of this article is to illustrate what level of sporting activities can be performed by patients with total joint replacement. Are there differences between the pre- and postoperative levels? What are the risks for, and negative influences on, the prosthesis during intense sporting activity? What is the role of the physician? Finally, recommendations for sporting activities after total hip and knee replacement are given.
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Recent progress has enhanced our understanding of the pathogenesis of cholestatic liver diseases. Mutations in genes encoding for hepatobiliary transport systems can cause hereditary cholestatic syndromes and exposure to cholestatic agents (drugs, hormones, inflammatory cytokines) can lead to reduced expression and function of hepatic uptake and excretory systems in acquired forms of cholestasis. In addition to transporter changes which cause or maintain cholestasis, some alterations in transporter gene expression can be viewed as hepatoprotective mechanisms aimed at reducing intrahepatic accumulation of toxic biliary constituents such as bile acids and bilirubin. ⋯ In addition to transcriptional changes, reduced transporter protein insertion to or increased retrieval from the cell membrane as well as other mechanisms such as altered cell polarity, disruption of cell-to-cell junctions and cytoskeletal changes are involved in the pathogenesis of cholestasis. Understanding the detailed mechanisms regulating expression of transport systems and enzymes is essential for the development of novel therapeutic agents. Such future approaches could specifically target nuclear receptors thus restoring defective transporter expression and supporting hepatic defense mechanisms against toxic bile acids.
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Postoperative radiotherapy is the treatment of choice for high grade gliomas and glioblastomas. The goal of the adjuvant radiotherapy is to improve local control and long term survival. The benefit of re-irradiation for recurrent or progressive glioma is controversial. The therapeutic benefit of any radiotherapy intervention must be balanced by the risk of neurotoxicity and its impact on quality of life.