Acta medica Austriaca最新文献

Latent subclinical hypothyroidism represents a particular problem in treatment for sterility, and can only be diagnosed after the results of a TRH test have been obtained (delta TSH > 15 microE/ml). Bearing these results in mind and by the administration of thyroid gland hormones or combinations of gonadotropins or clomifen, pregnancy rates in women with anovulatory sterility can be improved.

Gamma-hydroxybutyric acid is a gamma-aminobutyric acid analogue which can be found in the human brain and is believed to be a neurotransmitter in the central nervous system. In animal experiments as well as in humans gamma-hydroxybutyric acid has been shown to alleviate the symptoms of the alcohol withdrawal syndrome. 299 patients, who were admitted to hospital for reasons primarily unrelated to their alcohol dependence, were treated with gamma-hydroxybutyric acid when symptoms of the alcohol withdrawal syndrome occurred. Gamma-hydroxybutyric acid was usually given at a daily dose of 50 mg/kg in 3 divided doses, the clinical course of the patients was followed for 7 days or until discharge from hospital. Patients were 214 men and 82 women aged 18-87 years. The reasons for admission to hospital were frequently internal diseases, neurological/psychiatric problems, trauma or surgery. At the start of gamma-hydroxybutyric acid treatment, tremor was present in 81% of patients, sweating in 76% and unrest in 92%. Symptoms occurred 1-72 hours after admission. The efficacy of gamma-hydroxybutyric acid to ameliorate or suppress the symptoms of the alcohol withdrawal syndrome was judged to be excellent in 57%, good in 34%, fair in 18%, insufficient in 3% of patients. Drug tolerance was judged to be excellent in 79%, good in 17%, fair in 2% and poor only in 1% of patients. Adverse events were rare and mild. It is concluded that gamma-hydroxybutyric acid is an attractive alternative to tranquilizers in the management of the alcohol withdrawal syndrome in hospital.

Frequent reports of gender differences in cardiology prompted us to study the cardiological situation in Tyrol, Austria, from 1995 to 2000. Mortality statistics for heart deaths 1995: women 1008 (53.5%), men 875 (46.5%); 2000: women 1104 (58.2%), men 792 (41.8%). Coronary heart deaths 1995: women 572 (50.0%), men 571 (50.0%); 2000: women 634 (54.4%), men 531 (45.6%). Angiograms 1995: women 332 (33.9%), men 646 (66.1%); 2000: women 688 (32.5%), men 1429 (67.5%). Bypass surgery 1995: women 54 (33.0%), men 156 (67.0%); 2000: women 42 (27.5%), men 157 (72.5%). Heart deaths 1995-2000: women +9.5%, men -9.5%; coronary heart deaths 1995-2000: women +10.8%, men -7.0%. By (welcome) contrast, coronary angiograms 1995-2000: women +107.2%, men +121.2%. Bypass operations 1995-2000: women -22.2%, men +0.6%. Life expectancy 1995-2000: women +0.6%, men +0.6%. Patient age at heart death 1995-2000: women +1.8%, men +2.5%. In aggregate, we see that for decades more women than men have died a heart death, but that cardiac mortalities remain a typically "male bastion" with persistent gender differences in access to clinical cardiology. The worsening trend for women begs for awareness programs and corresponding preventive measures.

The purpose of this investigation was to evaluate the changes in blood pressure and the pulse rate of hypertensive patients having dental extraction under a local anesthetic containing a vasopressor. The study included 64 patients (42 female and 22 male), 38 to 78 years of age. Twenty-six of the patients were normotensive, 38 were hypertensive patients. The hypertensive patients were identified as those patients who had histories of medically diagnosed high blood pressure and baseline recordings of blood pressures higher than 140/90 mm Hg. Articain HCl with 0.012 mg epinephrine hydrochloride, was used as the local anesthetic for all patients and one tooth was extracted from each patient. Blood pressure and pulse rate measurements were recorded immediately prior to anesthesia, just before extraction and 5 minutes after extraction. The data were analyzed by a two-way ANOVA with repeated measures. Analysis of the data indicated no statistically significant changes in the systolic and diastolic blood pressures and pulse rate for all interval measurements in both normotensive and hypertensive patients (P > 0.05). In this study, it was determined that there were no significant changes in the blood pressures and the pulse rate of hypertensive patients during surgical procedure, and one cartridge local anesthetic with articain HCl containing 0.012 mg pinephrine may be used safely in hypertensive patients with blood pressure equal or smaller than 154/99 mm Hg.

There is a clear correlation between the incidence of coronary artery disease and existing cardiovascular risk factors. Therefore, it is a matter of interest if there is an accumulation of risk factors in younger patients with premature coronary artery disease compared to those without. We evaluated 1708 consecutive patients who underwent coronary angiography at our institution between August 2001 to February 2002; 85 symptomatic patients under the age of 46 were included in our analysis. In 46 patients (54.1%)--mean age 41.5 +/- 3.6 years--a coronary artery disease was documented, in 39 patients (45.9%)--mean age 39.9 +/- 5.6 years (n.s.)--normal coronary arteries were shown at angiography. Regarding the cardiovascular risk factors in young patients with coronary artery disease compared to young patients without we found a family history of premature coronary artery disease in 54.5% versus 43.6% (n.s.), hypercholesterolemia in 56.5% versus 53.8% (n.s.), LDL cholesterol of 138 +/- 40 mg/dl versus 123.3 +/- 27 mg/dl (s.), HDL cholesterol of 39 +/- 9 mg/dl versus 45.6 +/- 12.6 mg/dl (s.), serum triglycerides of 194.6 +/- 114.9 mg/dl versus 162.1 +/- 98.4 mg/dl (n.s.), diabetes mellitus in 15.2% versus 10.3% (n.s.), hypertension in 45.7% versus 46.4% (n.s.), body mass index > 24.9 kg/m2 in 67.4% versus 69.2% (n.s.), cigarette smoking in 54.6% versus 56.4% (n.s.). And finally, a minimum of two of those risk factors was found in 93.5% versus 87.2% (n.s.). Due to the high prevalence of cardiovascular risk factors in both groups it is impossible to reliably predict the incidence of coronary artery disease from those risk factors. This has to be considered while deciding about the indication for coronary angiography.

Costs of renal replacement therapy are enormous, of which hospitalisation is a major factor. International and national guidelines recommend early creation of fistulas before the start of the haemodialysis. The aim of this study is to calculate the costs of the initial hospitalisation of all incident patients (n = 79) based on the data of the "leistungsorientierte Krankenhaus-finanzierung", which means the Austrian system of financing hospital care according to interventions and diagnosis-groups in the years 1999 and 2000 at the Landeskrankenhaus Innsbruck. The average costs of the hospitalisation at the start of haemodialysis treatment are not significantly different when comparing haemodialysis patients (n = 69) to peritoneal dialysis patients (n = 10). Patients on haemodialysis were divided into two groups, depending on the presence of a usable AV-fistula at the start of the haemodialysis treatment. Costs for both groups differ significantly; for patients of the shunt-group (n = 28) at 4.437 +/- 567 [symbol: see text] they are less than half as high as costs for unprepared patients (no-shunt-group, n = 41) at 9.704 +/- 783 [symbol: see text]. Diagnosis dependent costs (Tageskostenanteile) are 75% higher for patients without shunt compared to patients of the shunt group (4040 vs. 2300 [symbol: see text]). Patients without shunt are hospitalised significantly longer than patients with shunt (18.85 vs. 12.03 days) and qualify less often for kidney transplantation than patients with shunt (28.9% vs. 61.3%). In summary, the data of the "leistungsorientierte Krankenhausfinanzierung" in combination with clinical data (availability of a useable dialysis access, enrolment in kidney transplantation) gives us reliable information on days of hospitalisation, number of dialysis treatments and costs of hospitalisation upon initiation of renal replacement therapy. Based on these data, the rigorous creation of sufficient AV-fistula prior to the start of haemodialysis in all incident patients can save up to 66.400 [symbol: see text]/year of inpatient costs at the Landeskrankenhaus Innsbruck.

In infertile men thyroid hormone and antibody testing was performed and correlated with the results of semen analyses. Evaluation included semen analyses, physical examination, evaluation of sex steroid hormones, thyroid hormones (bTSH, fT4, fT3) and thyroid antibody testing (TGA, TPO-Ab, TRAK). Furthermore 45 men with normal thyroid function were scheduled for TRH testing. No one was diagnosed as having manifest hypo- or hyperthyroidism. Latent thyroid dysfunction had no effect on semen parameters. Elevated TPO-Ab were significantly correlated with reduction in motility of spermatozoa. The routine assessment of thyroid hormones and antibodies in infertile men is not recommended. Subclinical hypothyroidism as a result of TRH testing is a rare finding in infertile men.

Zusammenfassung: Spezifische Umbauvorgänge im Bereich der Randzone des Infarkts und im Bereich des nicht infarzierten Myokards werden als „Remodeling” bezeichnet. Der Prozeß des ventrikulären Remodelings dauert über Wochen und Monate nach der initialen Myokardschädigung bis ein Gleichgewicht zwischen Wandspannung und Festigkeit der Narbe aus kollagenem Bindegewebe erreicht ist. Der Prozeß des Remodelings nach Myokardinfarkt wird in zwei Phasen eingeteilt, einer frühen Phase innerhalb der ersten 72 Stunden und einer späten Phase jenseits der ersten drei Tage. Eine wesentliche Rolle spielen Hypertrophie und Kollagenabbau. Geschädigte Myozyten sezernieren Zytokine, die einen Trigger für nachfolgende biochemische Abläufe im Rahmen des Remodelings darstellen. Neben Revaskularisationsmaßnahmen zur Wiederherstellung eines offenen Infarktgefäßes spielt der Einsatz pharmakotherapeutischer Strategien, wie ACE-Hemmer und β-Adrenorezeptorenblocker zur Beeinflussung des „Remodelings” in der Therapie nach abgelaufenem Myokardinfarkt eine wesentliche Rolle.

Therapy of Left Ventricular Remodeling After Myocardial Infarction

Summary: Left ventricular remodeling is the process by which ventricular size, shape, and function are regulated by mechanical, neurohormonal, and genetic factors. Remodeling may be physiological and adaptive during normal growth or pathological due to myocardial infarction, cardiomyopathy, hypertension, or valvular heart disease. Postinfarction remodeling has been divided into an early phase within 72 hours and a late phase beyond 72 hours. The early phase involves expansion of the infarct zone, which may result in early ventricular rupture or aneurysm formation. Late remodeling involves the left ventricle globally and is associated with time-dependent dilatation, the distortion of ventricular shape, and mural hypertrophy. Hypertrophy and collagen degradation are adaptive responses during postinfarction remodeling. Myocardial repair is triggered by cytokines released from injured myocytes. Ventricular remodeling is influenced most by infarct artery patency. Once infarct evolution has occurred, pharmacological intervention, like ACE inhibition and β-adrenoreceptor blocking agents, may minimize infarct expansion and ventricular dilatation and improve the long-term prognosis.

Zusammenfassung: Anhand einer computerunterstützten Literatursuche soll die Wirksamkeit von gepulsten und konstanten Magnetfeldern bei verschiedenen Erkrankungen überprüft werden. Die Literatursuche erfolgte unter Zuhilfenahme der Datenbanken Medline und Embase (1966  1998) und von Referenzlisten. Auswahlkriterium: alle klinische Arbeiten mit mindestens einer Kontrollgruppe. 31 Arbeiten erfüllten die Auswahlkriterien. 20 Studien hatten ein doppelblindes, randomisiertes und plazebokontrolliertes Design. Die Studien wurden nach Indikationen geordnet. Magnetfeldtherapie wurde zur Knochenheilung, in der Behandlung von degenerativen und entzündlichen Erkrankungen des Bewegungsapparates, bei Schmerzzuständen, zur Ulkusheilung und Reduk­tion von Spastizität angewendet. Der Effekt der Magnetfeldtherapie scheint bei der Knochenheilung und als Analgetikum der Plazebo-Behandlung überlegen zu sein. In der Behandlung anderer Erkrankungen zeigten sich keine einheitlichen Ergebnisse. Die Therapiezeiten variierten zwischen 15 Minuten und 24 Stunden täglich über einen Zeitraum von drei Wochen bis zu 18 Monaten. Eine Tendenz zu längeren Behandlungszeiten bei positiven Studien fällt auf. Die magnetische Flußdichte betrug 2 bis 100 G (0,2 mT bis 10 mT) mit einer Frequenz zwischen 12 und 100 Hz. Die optimale Dosierung bei der Anwendung der Magnetfeldtherapie ist derzeit nicht bekannt.

Summary: Rationale and objectives. Scintigraphy is routinely used in evaluating thyroid nodules. Functioning nodules are reported to have a low probability of being malignant. Therefore cancer should appear hypofunctioning or “cold” on scintiscan. The aim of the study was to compare the scinitgraphic pattern in different tumor stages of thyroid carcinoma. In addition, sonographic results are evaluated. In 151 patients with thyroid carcinoma ^99mTc-pertechnetate scans were evaluated retrospectively by a visual inspection scoring method (A = no significant uptake to D = nodular uptake superior to normal thyroid tissue). Planar images were taken using a small field thyroid gamma camera. There were 52 patients with pT1 carcinoma (2 × follicular and 50 × papillary). The mean tumor size was 0.56 ± 0.26 cm. The scintigraphic results were A and B in 5.7 % (n = 6), C in 73 % (n = 38), D in 15.6 % (n = 8). Out of 40 patients with pT2 carcinoma, 34 had a papillary, 6 a follicular histology. Mean tumor size was 1.66 ± 0.49 cm. The scintiscan was A in 12.5 % (n = 5), B in 32.5 % (n = 13), C in 42.5 % (n = 17) and D in 12.5 % (n = 5). There were 11 patients with pT3 carcinoma (4 × papillary, 7 × follicular).The mean tumor size was 3.96 ± 0.88 cm in diameter. Scintiscan was A in 72.7 % (n = 8), C in 27.3 % (n = 3). Among 48 patients with pT4 carcinoma (2 × follicular, 1 × nondifferentiated, 45 × papillary), scan was A in 41.6 % (n = 20), B in 14.5 % (n = 7), C in 33.3 % (n = 16) and D in 10.4 % (n = 5). Mean tumor size was 2.16 ± 1.45 cm (7 carcinomas È 1 cm, 23 × 1  2 cm, the remaining > 2 cm). Tumor size plays an important role in routinely used planar scintigraphy. Nodules greater than 2 cm in diameter tend to appear cold but microcarcinomas (È 1 cm) are often indifferent on scan. Therefore, planar ^99mTc-pertechnetate scintigraphy is of little value in evaluating small thyroid nodules. In order to diagnose small thyroid nodules, ultrasonography and ultrasonographically guided FNAB should be recommended as the initial diagnostic steps in clinical routine.