Wiener medizinische Wochenschrift
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Wien Med Wochenschr · Jan 1999
Review[Clinical value of electroconvulsive therapy in treatment of depression].
The electroconvulsive therapy (ECT), which provokes a generalized epileptic seizure by an electrical stimulus, was first administered in 1938 and performed without anesthesia during thirty years. Nowadays, ECT is carried out using brief anesthesia (preferably methohexital) and skeletal muscle relaxation (succinylcholine) to avoid fearful complications like bone and muscle fractures. ECT is a safe treatment without absolute contraindications; the treatment risk corresponds to the risk of general anesthesia. ⋯ Brief pulse stimulation, unilateral nondominant electrode placement and individual stimulus titration with respect to seizure threshold (EEG monitoring is required!) can minimize cognitive side effects. The apprehension that ECT could cause prolonged amnesia and structural brain damage has not been confirmed by the available scientific data. Modern brain imaging methods could elicit the until now unknown mode of action of ECT.
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The term "decompression illness (DCI)" is a disorder which arises from the presence of ectopic gas bubbles following decompression. Scuba diving poses the risk of two typically clinical syndromes: decompression sickness (DCS) and arterial gas embolism (AGE). DCS results from the formation of gas bubbles in the tissues of the body and in the blood due to rapid reduction of the environmental pressure. ⋯ Although the pathophysiological mechanisms of these two disorders are quite different, both of them lead to the same result: inert gas bubbles that may cause impairment of vital functions due to hypoxia. Recognizing the signs and symptoms of DCI is the first step of the therapy. The emergency treatment contains: basic life support, advanced life support--if necessary, horizontal positioning of the victim, administration of 100% normobaric oxygen via face mask or endotracheal tube, rehydration, rapid transportation to the nearest emergency department/hyperbaric facility for definitive treatment in order to prevent serious neurological sequelae.
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Sea-biological basic knowledge for divers is offered only in special lessons for advanced scuba divers. According to statistics, however, five per cent of the deadly diving accidents are caused by underwater organisms. This number could be reduced to a fraction, by correct behaviour during the dive and after an accident. ⋯ Conidae (cone shells), Tridocna (giant clam), octopoda (octopus), 4. Acanthaster planci (crown of thorns), Echinodea (sea urchins), Holothurioidea (sea cucumber), 5. Selachoidei (shark), Batoidei (Ray), Muraenidae (moray), Plotosidae (barbel eels), Synanciidae (stonefish), Scorpaenidae (scorpionfish), Pterois (lion fish), Sphyraena Spec. (barracuda), Balistidae (triggerfish), Ostracionidae (puffer).
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Wien Med Wochenschr · Jan 1999
Randomized Controlled Trial Multicenter Study Clinical TrialPAT--the Preventive Allergy Treatment Study design and preliminary results.
The Preventive Allergy Treatment Study, the PAT Study, is a European multi-center study. The end-point is to show in what capacity allergen specific subcutaneous immunotherapy can reduce the outcome of asthma in children with allergic rhinoconjunctivitis sensitized to birch and/or timothy pollen. Two hundred and ten children aged from 5 to 13 years were included in the study. ⋯ Preliminary data show that immunotherapy has been effective, it has been safe and statistically significantly less children in the actively treated group had asthmatic symptoms than children in the control group. Data have not been evaluated from all centers at the moment. The study is a prospective follow-up study, the patients' data will be evaluated next time in the year 2002.
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Wien Med Wochenschr · Jan 1999
[When should a patient with severe acute respiratory distress syndrome (ARDS) be transferred to a specialized hospital?].
The mortality rate for the advanced adult respiratory distress syndrome is still high. Nevertheless there are recent publications showing decreasing incidence and an improving survival rate. This is due to early diagnosis as well as differentiated treatment concepts. ⋯ The mortality rate was 22.3% altogether, in the group with the conventional treatment 16.0% and 32.6% in the group with ELA. As there are no generally accepted guidelines for the transfer of patients with ARDS to specialized centres, an indication for such a transfer must be established taking into consideration the individual patient history. Very early contact with the specialized centre of choice is recommended.