Wiener Klinische Wochenschrift最新文献

Objective: The aim of the study was to investigate the performance of endovascular aortic aneurysm repair (EVAR) with suprarenal fixation endografts in wide necks for intact abdominal aortic aneurysms (iAAA).

Methods: Anatomical data of the treated iAAAs, acquired from a thin slice computed tomography angiography (CTA) of the abdomen with 3‑dimentional reconstructions preoperatively and postoperatively, were evaluated. A statistical analysis comparing the anatomical characteristics of the aneurysm neck according to the presence of an endoleak was conducted using the SPSS Statistics package version 29.

Results: Between January 2020 and October 2024, 114 patients (105, 92.1% males, median age 75 years) with iAAAs underwent EVAR, most of them (83) with Endurant II/IIs stent-graft (Medtronic, Santa Rosa, US) and of them 15 had a wide neck (28 mm or more). In a multivariate logistic regression analysis the presence of a wide neck had a statistically significant association with the development of a type Ia endoleak (odds ratio, OR 12.961, p = 0.025). A type Ia endoleak was present in 2 of these patients in the first 30 postoperative days. In these 2 patients the oversizing percentage of the proximal landing zone was significantly lower compared to the patients with a wide neck without type Ia endoleak (median oversizing 11.3%, range 6.6-16% vs. 20%, range 15-25%, p = 0.019). The endoleak was persistent in a follow-up period of 18 months.

Conclusion: The use of EVAR with suprarenal fixation endografts in wide infrarenal necks is safe but in the case of poor oversizing, there is a significant risk for development of a persistent type Ia endoleak.

Primary hyperparathyroidism is a frequent endocrine disorder that affects various organ systems. In this review we present and discuss alterations of bone metabolism in primary hyperparathyroidism. Excessive secretion of parathyroid hormone results in increased bone remodelling with an excess of bone resorption. Consequently, bone mineral density declines, bone quality is compromised and fracture risk increases.Successful surgery for hyperparathyroidism results in a normalization of bone turnover and a decrease of fracture risk. Osteitis fibrosa cystica, a severe bone manifestation of hyperparathyroidism, is observed rarely today.

Introduction: Eosinophilic esophagitis (EoE) is one of the main causes of esophageal food impaction (EFI). Since only few endoscopists take biopsies during the emergency endoscopy at EFI presentation, as is recommended by current guidelines, a high number of patients will not have a proper diagnosis after EFI. Hence, we investigated the change of biopsy rates and the etiology of EFI over 11 years.

Methods: All patients presenting at the emergency department (ED) of a tertiary center with an EFI who underwent esophagogastroduodenoscopy (EGD) between 2013 and 2023 were included. Clinical and endoscopic variables were analyzed retrospectively. We performed a binary logistic regression model to predict biopsy performance.

Results: A total of 180 EFI cases (67% male, median age 57 years) were recorded between 2013 and 2023. Overall, esophageal biopsies were taken only in 18% without any increase over time. In patients ≥ 50 years of age (n = 108), the etiology remained unknown in half of patients (48%), followed by gastroesophageal reflux disease (GERD; 23%) and EoE (18%). However, in patients < 50 years of age, EoE was the main suspected etiology in 69% of cases. Biopsies were obtained in only 18% of all patients with suspected EoE. Age, gender, and the year of EFI were not associated with biopsy performance. However, the probability of biopsy increased by a factor of 4.03 in the presence of suspected EoE by the endoscopist.

Conclusion: Despite an increasing awareness of EoE, the biopsy rate in EFI is rather low. Routine biopsies should be taken to shorten diagnostic delay.

Background: Postoperative care is critical for recovery after gynecological procedures. Yet, the absence of consistent guidelines often leaves patients uncertain, potentially hindering healing. This study aimed to assess behavioral recommendations provided by Austrian gynecologists and hospitals to inform the development of standardised postoperative guidance.

Patients and methodology: Between December 2023 and April 2024, questionnaires were sent to 118 gynecologists and 79 hospitals, covering postoperative advice for hysteroscopy, large loop excision of the transformation zone (LLETZ) conisation, tension-free vaginal tape (TVT), laparoscopy, hysterectomy, and caesarean section. Topics included duration of sick leave, follow-up, bathing, tampon use, sexual activity, sports, and lifting restrictions.

Results: Responses were received from 54 gynecologists (46%) and 49 clinics (62%). Clinics tended to recommend more restrictive measures than specialists, particularly for LLETZ, TVT, and laparoscopy, while advice aligned for hysterectomy and caesarean section. Notably, for LLETZ conisation, specialists advised 2-4 weeks of rest, whereas clinics recommended 1-2 weeks (p < 0.05). For hysterectomy and caesarean section, both groups advised 4-6 weeks of recovery, with restrictions on weight lifting, sexual activity, and sports. Variability was also seen in the basis for recommendations: 41% of specialists relied on personal experience, while 41% of clinics cited current evidence.

Conclusion: This study highlights significant heterogeneity in postoperative advice across Austria and underscores the need for evidence-based, standardised guidelines to improve the quality and consistency of care in gynecology.

Objective: To inform treatment decisions in clinical practice, we conducted a meta-analysis to evaluate the efficacy and safety of imatinib in patients with COVID-19.

Methods: A comprehensive systematic search was conducted across multiple electronic databases to identify relevant randomized controlled trials (RCTs) comparing imatinib with placebo in patients with COVID-19. A meta-analysis was performed using Review Manager software version 5.3 and followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Results: The analysis included 4 studies with a total of 717 patients. The risk ratio (RR) for 28-day mortality in the imatinib group compared to the placebo group was 0.79 (95% confidence interval. CI 0.51-1.21; p = 0.28). There were no statistically significant differences in the duration of oxygen supplementation (MD = -0.13, 95% CI -2.57-2.31; p = 0.92) or the number of ventilator-free days (MD = 4.71, 95% CI -6.97-16.38; p = 0.43). Imatinib treatment did not significantly reduce the duration of hospital or intensive care unit (ICU) stay. Additionally, there was no significant difference between imatinib and placebo in the risk of any adverse events (AEs) or serious AEs.

Conclusion: Imatinib did not significantly improve clinical outcomes in patients with COVID-19. Future research should consider subgroup analyses based on the biological heterogeneity of COVID-19-associated acute respiratory distress syndrome (ARDS) or the concurrent use of interleukin 6 (IL-6) receptor inhibitors to identify patient populations that may benefit from imatinib treatment.

Heart failure significantly burdens healthcare systems. eHealth products could alleviate this burden by providing patients with recommendations for intensifying diuretic therapy. As evidence on guiding diuretic therapy is scarce, our goal was to identify clinical parameters that eHealth products can use to support heart failure patients in intensifying their diuretic therapy. A post-hoc analysis of the trial of intensified versus standard medical therapy in elderly patients with congestive heart failure (TIME-CHF), comparing an NT-proBNP-guided management strategy with a symptom-guided strategy in elderly heart failure patients, was conducted. Clinical data were collected during patient evaluations at 1, 3, 6, and 12 months of follow-up. At each visit, any increase or new prescription of diuretic therapy was recorded as the outcome event. Mixed-effects logistic regression analyses were used to estimate odds ratios (OR) with 95% confidence intervals (CI), investigating the relationship between the patient data and the odds of diuretic therapy intensification. In this retrospective analysis, 568 heart failure patients were included. Over a 12-month period, 2013 follow-up visits were conducted, during which diuretics were initiated or increased in 370 visits (18.4%). Higher New York Heart Association (NYHA) classification (OR 2.60, 95%CI 1.94-3.50), presence of edema (OR 2.84, 95%CI 2.15-3.77), paroxysmal nocturnal dyspnea (OR 1.52, 95%CI 1.04-2.21), and orthopnea (OR 1.39, 95%CI 1.04-1.85) were significantly associated with the initiation or increase of diuretics. Dyspnea, edema, paroxysmal nocturnal dyspnea, and orthopnea are associated with the intensification of diuretic treatment in HF patients. These symptoms, which patients can easily report, should be integrated into eHealth devices that offer guidance on managing diuretic therapy.