Wiener Klinische Wochenschrift最新文献

Background: The COVID-19 pandemic has led to significant health challenges, with some individuals developing long COVID characterized by persistent symptoms such as fatigue, dyspnea and cognitive difficulties lasting weeks or months after infection. This condition predominantly affects women and may involve prolonged inflammation and autonomic nervous system dysfunction. Current treatments focus on symptom relief and vagus nerve stimulation (VNS) is being investigated for its potential therapeutic benefits.

Methods: This pilot study was a prospective, blinded, randomized controlled trial involving 36 female long COVID patients aged 18-70 years. Participants were assigned to three groups receiving VNS at frequencies of 10 Hz, 25 Hz, or a control of 2 Hz for 3 months. Outcomes were assessed at baseline, after 4 and 12 weeks.

Results: The study revealed that all VNS treatment groups experienced reduction in symptoms associated with long COVID, particularly in fatigue and dyspnea, after 12 weeks. Participants across all frequencies reported an improvement in health-related quality of life. Heart rate variability remained stable throughout the trial, and no significant changes in morning salivary cortisol levels were seen across groups.

Discussion: Vagus nerve stimulation may offer therapeutic benefits for women with long COVID, particularly in reducing fatigue and dyspnea. The treatment was found to be safe, with no significant side effects reported; however, further research with larger study groups is needed to confirm these findings and examine the long-term effects of VNS on autonomic nervous system function.

We present a rare case of a 9-year-old child with acute accommodative comitant esotropia, a form of acquired strabismus caused by excessive smartphone use. Symptoms commonly include double vision, closing or covering one eye when working at close range and tilting the head or its unnatural position to correct visual abnormalities; however, there are also patients without any symptoms. As part of the differential diagnosis it is necessary to exclude any eye diseases or refractive errors and it is highly recommended to carefully exclude pathologies of the central nervous system and intracranial disorders. In absolute numbers seen so far in real life, acute accommodative comitant esotropia is still a rare phenomenon and the relation to smartphone use might be suspected only after all other etiologies have been excluded. Acute accommodative comitant esotropia is mostly a temporary disorder and corrective glasses are usually sufficient for treatment. The present case demonstrates that forming a completely new type of visual disorder related to modern technologies is possible, even in age groups of children where this is a rare occurrence.

Background: Arthrofibrosis (AF) is a relatively frequent complication after knee surgery, leading to painful limitation of joint mobility. Currently, intense stretching is performed in many patients, without improvements in mobility. A novel concept, established on a cellular, cytokine-based model, advocates to consider the warning function of pain and to terminate forced joint mobilization to disrupt the cycle of arthrofibrosis. Based on these findings, our clinic developed a comprehensive antifibrotic treatment protocol. The aim of this analysis was to evaluate the patients treated so far.

Methods: Patients treated at the Clinic Donaustadt, an academic teaching hospital of the Medical University of Vienna, Austria, according to the clinic's AF protocol, were evaluated by reviewing their records. Patellar mobility, range of motion, tightness, overheat, pain, general mobility, assistive devices, working status and the necessity of additional surgery were assessed at baseline, after 2 months and after 12 months (follow-up).

Results: Four patients were treated according to the AF protocol. After two months, patellar mobility and range of motion clearly increased in three out of four patients. At the follow-up examination, patella mobility further increased, extension was complete, flexion at least 120°, and symptoms such as tightness, overheating, nocturnal pain and pain after activity had disappeared in three out of four patients. None of the patients had analgesics or walking aids and three out of four patients had returned to work. Out of the four patients, three expressed high satisfaction with the AF protocol and reported no limitations in daily life, including recreational activities.

Conclusion: Based on this pilot evaluation, the comprehensive conservative AF program seems to have high potential. Therefore, larger future studies should be conducted to validate this concept.

Neuroendocrine neoplasms (NENs) are a heterogeneous group of tumors with different immunophenotypes, morphological features, clinical presentations, and outcomes. Therefore, the diversity of NENs can easily confuse clinicians and lead to misdiagnosis. This article reports a case of a rectal NEN (r-NEN) growing within a lipoma with ulcerative lesions, which had been mistaken for rectal cancer. Fortunately, an experienced surgeon questioned the initial diagnosis (rectal cancer) after combining the results of a colonoscopic biopsy and the digital anorectal examination, thus enabling the patient to avoid unnecessary surgery. Through the review of this case and relevant literature, we further analyze the growth pattern of NENs and lipomas. Additionally, we hope to enhance clinicians' awareness of a NEN that grew insidiously within a lipoma with surface ulcerative lesions, to make accurate diagnoses and treatments in time.