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Graz, Austria

Kloimstein H.,The Interdisciplinary Center | Likar R.,Hospital Elisabethinen | Kern M.,General Hospital Mittersill | Neuhold J.,General Hospital Mittersill | And 11 more authors.

Objectives The goal of this study was to evaluate the long-term efficacy and safety of peripheral nerve field stimulation (PNFS) for chronic low back pain (cLBP). Materials and Methods In this prospective, multicenter observational study, 118 patients were admitted to 11 centers throughout Austria and Switzerland. After a screening visit, all patients underwent a trial stimulation period of at least seven days before implantation of the permanent system. Leads were placed in the subcutaneous tissues of the lower back directly in the region of greatest pain. One hundred five patients were implanted with a permanent stimulating system. Patients' evaluation of pain and functional levels were completed before implantation and one, three, and six months after implantation. Adverse events, medication usage, and coverage of the painful area and predictive value of transcutaneous electrical nerve stimulation (TENS) were monitored. Results All pain and quality-of-life measures showed statistically significant improvement during the treatment period. These included the average pain visual analog scale, the Oswestry Disability Questionnaire, the Becks Depression Inventory, and the Short Form-12 item Health survey. Additionally, medication usage with opioids, nonsteroidal anti-inflammatory drugs, and anti-convulsants showed a highly significant reduction. Complications requiring surgical intervention were reported in 9.6% of the patients. The degree of coverage of painful areas seems to be an important criterion for efficacy of PNFS, whereas TENS is presumably no predictor. Conclusions This prospective, multicenter study confirms that PNFS is an effective therapy for the management of cLBP. Significant improvements in many aspects of the pain condition were measured, and complications were minimal. © 2013 International Neuromodulation Society. Source

Gangl O.,Hospital Elisabethinen | Froschl U.,Hospital Elisabethinen | Dutta-Fugger B.,Medical University of Vienna | Fugger R.,Hospital Elisabethinen
European Surgery - Acta Chirurgica Austriaca

Background: Pancreatic reresection is an absolute rarity in surgical practice and literature, this induced us to report our experience and present a review of the literature. Methods: Three patients underwent pancreatic reresection at our department. A review of the literature on elective pancreatic reresection was done by a PubMed search. Results: From 2001 to 2008, 189 pancreatic resections due to various indications were performed. In three (1.6%) patients an elective reresection was performed. For 2008, when all reresections were carried out, the percentage of reresection was 7.3% (3=41). Apart from a few single case reports the literature search identified only four small series summarizing the results of 3-15 patients undergoing elective pancreatic reresection. Conclusions: Elective pancreatic reresection is a feasible and safe procedure. Today, recurrence of IPMN and failure of previous surgical therapy in chronic pancreatitis seem to be the most promising indications. © 2010 Springer-Verlag. Source

Beinhardt S.,Medical University of Vienna | Payer B.A.,Medical University of Vienna | Datz C.,Hospital Oberndorf | Strasser M.,Paracelsus Medical University | And 12 more authors.
Journal of Hepatology

Background & Aims IL28B polymorphisms, jaundice, decline in HCV-RNA, IP-10, and gender have been proposed to be indicative of spontaneous clearance of acute hepatitis C virus infection. The aim of this study was to define a score enabling the discrimination of patients with spontaneous clearance of HCV from those with development of viral persistence and need for early antiviral treatment. Methods 136 patients (74 male; 35 ± 15 years) were analyzed. From variables predictive of spontaneous clearance, calculated by univariate analysis, three scores were built. Analogous cut-offs were evaluated by computing area under the receiver operating characteristic curves. Candidate variables and cut-offs were: (I) presence of IL28B C/C (p = 0.027), (II) age (p = 0.031; cut-off: 35 years), (III) peak-bilirubin (p = 0.018; cut-off: 6 mg/dl), (IV) HCV-RNA decline within 4 weeks (p <0.001;cut-off: >2.5 log), (V) serum IP-10 (p = 0.003; cut-off: 546 pg/ml), (VI) presence of CD4(+) Th1 cells (p = 0.024). Each variable was allocated to 0 or 1 point, an HCV-RNA decline of ≥1 log10 but <2.5 log10 to 1 point, a decline of ≥2.5 log10 to 2 points. Three scores were evaluated (Score 1: I-IV; Score 2: I-V; Score 3: I-VI). Results A cut-off of ≥3 points out of 5 in Score 1 (AUROC: 0.82; DeLong 95% CI: 0.76-0.93) predicted spontaneous clearance with a sensitivity of 71% (95% CI: 0.53-0.86) and specificity of 87% (95% CI: 0.73-0.95). PPV and NPV were 79% and 82%. Corresponding findings for Score 2 including IP-10 (AUROC: 0.93; DeLong 95% CI: 0.86-0.93) at a cut-off of ≥4 were: sensitivity 81%, specificity 95% (PPV: 100%; NPV: 77%). A cut-off of ≥5 in Score 3 (AUROC: 0.98; DeLong 95% CI: 0.95-1.0) predicted spontaneous resolution with a sensitivity of 75% and specificity of 100% (PPV: 100%; NPV: 88%). Conclusions The scores enable a reliable discrimination between AHC-patients with high potential for spontaneous clearance from candidates for early therapeutic intervention due to marginal chance of spontaneous resolution. Source

Rutter K.,Medical University of Vienna | Hofer H.,Medical University of Vienna | Beinhardt S.,Medical University of Vienna | Dulic M.,Wilhelminenspital | And 9 more authors.
Alimentary Pharmacology and Therapeutics

Background The introduction of direct-acting anti-virals has increased sustained virological response (SVR) rates in chronic hepatitis C genotype 1 infection. At present, data on long-term durability of viral eradication after successful triple therapy are lacking. Aim To evaluate the long-term durability of viral eradication in patients treated with triple therapy, including direct-acting anti-virals. Methods Patients who participated in randomised, controlled trials or an extended access programme of treatment with peginterferon-α2a/ribavirin in combination with a direct-acting anti-viral (telaprevir, danoprevir, faldaprevir, simeprevir, mericitabine, balapiravir) were followed after achieving SVR. The median follow-up after the patients was 21 (range: 7-64) months. Results One hundred and three patients with chronic hepatitis C genotype 1 infection [f/m: 34/69; GT-1b: 67 GT-1a: 34, GT-4: 2; mean age: 47.6 years (45.5-49.7; 95% CI)] achieving a SVR triple therapy were followed. Two cases of late relapses (2/103, 1.9%; 95% CI: 0.24-6.8) were observed. One patient was cirrhotic, both carried the genotype 1b and completed the prescribed treatment. The relapses occurred 8 and 12 months after cessation of anti-viral treatment. Cloning sequencing revealed identical sequence in both patients. Resistance analysis revealed no presence of viral resistance. Conclusion Like the SVR after peginterferon-α2/ribavirin combination treatment, HCV eradication after triple therapy remains durable after long-term follow-up. © 2013 John Wiley & Sons Ltd. Source

Ludwig H.,Wilhelminenspital | Rauch E.,Wilhelminenspital | Kuehr T.,Hospital Wels Grieskirchen | Adam Z.,University Hospital | And 8 more authors.

We prospectively evaluated the activity and tolerance of lenalidomide-dexamethasone in 35 patients with acute light chain-induced renal failure. The lenalidomide dose was adapted to the estimated glomerular filtration rate and dexamethasone was given at high dose in cycle one and at low dose thereafter. Four patients died within the first two cycles, and five discontinued therapy leaving 26 patients for the per-protocol analysis. Responses were observed in 24/35 (68.6%) patients of the intent-to-treat population. Complete response was noted in seven patients (20%), very good partial response in three patients (8.6%), partial response in 14 patients (40%), and minimal response in one patient (2.9%). Renal response was observed in 16 (45.7%) patients: five (14.2%) achieved complete, four (11.4%) partial and seven (20%) minor renal responses. Five of 13 patients who were dialysis dependent at baseline became dialysis independent. The median time to myeloma and to renal response was 28 days for both parameters, while the median time to best myeloma and best renal response was 92 and 157 days, respectively. The median estimated glomerular filtration rate increased significantly in patients with partial response or better from 17.1 mL/min at baseline to 39.1 mL/min at best response (P=0.001). The median progression-free and overall survival was 5.5 and 21.8 months, respectively, in the intent-to-treat population and 12.1 and 31.4 months, respectively, in the per-protocol group. Infections, cardiotoxicity, anemia and thrombocytopenia were the most frequent toxicities. In conclusion, the lenalidomide-dexamethasone regimen achieved rapid and substantial myeloma and renal responses. The trial was registered under EUDRACT number 2008-006497-15. © 2015 Ferrata Storti Foundation. Source

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