Wiener Klinische Wochenschrift最新文献

Aim/hypothesis: The main aim of the study was to identify point of care available laboratory and clinical predictors of 7‑day mortality in critically ill patients with a hyperglycemic crisis.

Methods: A retrospective study of 990 patients with the first hospitalization due to hyperglycemia was performed. Patients were classified as having diabetic ketoacidosis (DKA) or being in a hyperosmolar hyperglycemic state (HHS) according to the recommendations of the American Diabetes Association (ADA). Patients not fulfilling the ADA criteria for DKA or HHS were summarized in a third group (unclassifiable hyperglycemia, UCH). The primary outcome was 7‑day mortality, potentially relevant factors were analyzed as secondary outcomes.

Results: Overall, the 7‑day mortality was 7.5%, with no significant differences between DKA (7.8%), HHS (14.5%) and UCH (6.1%). Blood lactate levels were significantly higher in nonsurvivors than survivors in all three groups (mean level of 6.3 mmol/l vs. 3.4 mmol/l in DKA, 5.3 mmol/l vs. 3.1 mmol/l in HHS, 5 mmol/l vs. 2.5 mmol/l in UCH). Measured and calculated osmolality were significantly higher in nonsurvivors in the DKA group (measured osmolality 359 mosmol/kg vs. 338 mosmol/kg, calculated osmolality 315 mosmol/kg vs. 305 mosmol/kg) and patients with UCH (354 mosmol/kg vs. 325 mosmol/kg; 315 mosmol/kg vs. 298 mosmol/kg) but not in patients with HHS. Survival analysis for the DKA group showed no significant differences in 7‑day mortality when patients were compared by the ADA criteria of severity (severe, moderate, or mild). Patients with elevated calculated osmolality (> 320 mosmol/kg) and lactate (> 4 mmol/l) had the lowest 7‑day survival rate (66.7%).

Conclusion/interpretation: Our data showed that elevated lactate levels were associated with higher mortality in all types of hyperglycemic crises.

Objective: The aim of this study was to create a patient-centered comic on palliative care with and for patients admitted to a palliative care unit and to examine their experiences of graphic educational material.

Methods: This study employed a qualitative methodology using semi-structured interviews with advanced cancer patients admitted to the palliative care unit of the Medical University of Vienna. The data were analyzed using thematic analysis with the assistance of the MAXQDA software.

Results: In the first phase of the comic creation 6 interviews were conducted and 15 additional interviews in the second phase, all of which examined patients' reactions to the comic. The findings revealed three themes: 1) patients' experiences with and understanding of graphics about palliative care, 2) patients' perceptions of the possibilities for use of the comic and 3) how the visual material facilitated access to the patients' shared imagination and interpretations. The medium generated curiosity, participation, and positive reactions. Patients were inclined to be involved in patient-centered educational material that enabled an entry into conversations and connection, giving access to feelings and associations of patients.

Conclusion: The results of the present study offer insights into mostly positive reactions of patients when presented with a comic about palliative care. The study showed how illustrated educational information led to deepened conversation among the interviewer and the patients, offering insights into their experiences and imagination.

Objective: To identify factors for tumor relapse and poor outcome in patients with meningiomas in the first two decades of life.

Methods: All patients ≤ 21 years of age who underwent resection of a meningioma at the department of neurosurgery, Medical University of Vienna between 1989 and 2022 were included in this retrospective study. Clinical and radiological data were extracted from the medical records. Outcome and tumor relapse were analyzed for tumor location, histological findings and extent of resection.

Results: In this study 18 patients were included, 6 meningiomas were located in the skull base, 5 in the convexity and 7 in other locations including intraventricular and spine (2 patients each), falx, intraparenchymal and optic nerve sheath. Most frequent symptoms were seizures and cranial nerve palsy. In total 56% of the meningiomas were World Health organization (WHO) grade 1, 39% grade 2 and 5% grade 3. Gross total resection was achieved in 67%. The overall relapse rate was 61% and 50% underwent repeat surgery. All patients with convexity meningiomas became seizure free and had a favorable outcome. Relapse and clinical outcome were independent of WHO grade among the whole cohort but the outcome significantly depended on the WHO grade when patients with skull base meningiomas were analyzed as a subgroup. The relapse rate was significantly higher in cases of skull base location (100% vs. 42%, p = 0.038) and after subtotal resection (100% vs. 42%, p = 0.038). Clinical outcome was also significantly worse and the rate of complications was higher in patients with skull base meningiomas.

Conclusion: Patients with convexity meningiomas in the first two decades of life have a good outcome due to high chance of gross total resection. Patients with skull base meningioma are at high risk of relapse and poor outcome, particularly those with WHO grades 2 and 3. Subtotal resection in patients with skull base location is probably the main reason for this difference.

The aim of the study was to readdress basal cell carcinoma (BCC) in the periocular region to prove the efficacy of histologically controlled surgical treatment and to identify high-risk characteristics.Retrospective analysis of 451 microscopically controlled BCC excisions in the periocular region. Tumor location, tumor size, AJCC 7 classification, and histological results were recorded. The same procedure was followed for recurrences.A recurrence rate of 5.0% was observed after the first microscopically controlled excision. Recurrent BCCs show a shift from nodular to sclerosing BCC as the primary histological type as well as a change in primary location from lower eyelid to medial canthus. The frequency of BCC with deep extension increased from 7.3% to 24.7%, and 57.1% after the second and third operations, respectively. The recurrence rate increased to 9.5% and 42.9%, after the second and third operations, respectively.In conclusion, we are facing the same challenges in surgical BCC treatment as 30 years ago. The distribution of periocular BCC location, histologic subtype and recurrence rates mirror the literature und the general consensus. The recurrence rate increases with every operation needed. Sclerosing BCCs with deep extension at the medial canthus bear the greatest risk for recurrence. In such cases, centers of expertise should be consulted and additional treatment options should be considered.

Fecal incontinence (FI) is a common disease with higher incidence rates in the elderly population. Treatment of affected patients remains challenging and ranges from conservative management to surgical techniques. Despite all efforts patients often undergo several therapeutic measurements to achieve reasonable functional improvements.Although sacral neuromodulation still remains a key therapy with success rates up to 80%, a significant number of patients do not respond sufficiently and require further treatment.Several artificial bowel sphincter devices exist, which can lead to better functional control in selected patients. Notably, complications after these surgeries do occur frequently and the need for implant replacement is still considerable high.A novel anal band, developed by Agency for Medical Innovations (A.M.I., Austria) is currently under evaluation. This device, composed of silicone and polyester, is placed around the anus outside the external sphincter muscle complex aiming to improve stool continence via mechanical pressure. Early results of this new operation are eagerly awaited.