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Vienna, Austria

Siller-Matula J.M.,Medical University of Vienna | Christ G.,Kaiser Franz Josef Hospital | Lang I.M.,Medical University of Vienna | Delle-Karth G.,Medical University of Vienna | And 2 more authors.
Journal of Thrombosis and Haemostasis | Year: 2010

Background and Aim: The prognostic value of the vasodilator-stimulated phosphoprotein (VASP) phosphorylation assay and multiple electrode aggregometry (MEA) for thrombotic adverse events has been shown in independent studies. As no direct comparison between the two methods has been made so far, we investigated which laboratory approach has a better predictive value for stent thrombosis. Methods: The VASP phosphorylation assay and MEA were performed in 416 patients with coronary artery disease undergoing percutaneous coronary intervention. The rate of stent thrombosis was recorded during a 6-month follow-up. Results: Definite stent thrombosis occurred in three patients (0.7%) and probable stent thrombosis in four (1%). Receiver operating characteristic (ROC) analysis demonstrated that MEA distinguishes between patients with or without subsequent stent thrombosis better than the VASP phosphorylation assay: the area under the ROC curve was higher for MEA (0.92; P = 0.012) than for the VASP phosphorylation assay (0.60; P = 0.55). At equal levels of sensitivity (100%), the specificity was greater for MEA than for the VASP phosphorylation assay (86% vs. 37%). Stent thrombosis occurred in 9% of patients with platelet hyperreactivity in MEA, who were simultaneously clopidogrel non-responders in the VASP phosphorylation assay. Interestingly, clopidogrel non-responders in the VASP phosphorylation assay without platelet hyperreactivity in MEA did not suffer from stent thrombosis. Conclusions: Platelet hyperreactivity in MEA might be a better risk predictor for stent thrombosis than the assessment of the specific clopidogrel effect with the VASP phosphorylation assay. © 2009 International Society on Thrombosis and Haemostasis. Source

Rakusa M.,University of Maribor | Grisold W.,Kaiser Franz Josef Hospital | Sellner J.,TU Munich
European Journal of Neurology | Year: 2011

Background: The Union Européenne des Médecins Spécialistes Section of Neurology (UEMS SEN)/European Board of Neurology (EBN) examination was launched in 2009 to set standards in knowledge and skills for the next generation of European neurologists. Methods: Stimulated by the low participation at the first examination, we conducted a survey amongst 76 junior colleagues to assess awareness, motivation and obstacles regarding this examination. Results: Remarkably, junior neurologists indicated great interest in the examination and motivation to spend additional preparation time (up to 6months) with the aim to catch up with European standards and improve the care of patients. However, there are major issues, which detain our colleagues from taking the examination including the amount of the examination fee, the potential lack of language abilities and the varying usage of the recommended books for preparation. Conclusions: This survey highlights the positive attitude of junior neurologists regarding initiatives to improve clinical skills and knowledge. Moreover, this study delineated several factors, which may be considered in the future to increase participation and substantiate the significance of the examination. © 2010 The Author(s). European Journal of Neurology © 2010 EFNS. Source

Zachenhofer I.,Academic Teaching Hospital Feldkirch | Donat M.,Academic Teaching Hospital Feldkirch | Oberndorfer S.,Kaiser Franz Josef Hospital | Roessler K.,Academic Teaching Hospital Feldkirch
Journal of Neuro-Oncology | Year: 2011

Efficacy and tolerability of levetiracetam (LEV) as perioperative seizure prophylaxis in supratentorial brain tumor patients were retrospectively studied. Between February 2007 and April 2009 in a single institution, 78 patients with primary or secondary supratentorial brain tumors [40 female, 38 male; mean age 57 years, from 27 to 89 years; gliomas in 42 patients (53.8%), brain metastases in 17 (21.8%), meningiomas in 16 (20.5%), 1 primary central nervous system (CNS) lymphoma patient, and 2 patients with radiation necrosis] received between 1,000 mg and 3,000 mg LEV perioperatively. Preoperatively, 30 patients had experienced seizures (38.5%), most commonly glioma patients (47.6%), but also meningioma patients (31.3%) or patients with brain metastases (23.5%). No more seizures occurred in patients receiving 1-3 g LEV preoperatively. Within the first week postoperatively, a single seizure occurred in two patients (2.6%). At the end of the follow-up period (mean 10.5 months, range 0-31 months), 71 of the 78 patients (91%) were seizure free and 21 (26%) patients were not taking antiepileptic drugs. We observed side-effects in five patients (6.4%), including non-tumor-associated progressive somnolence in three patients (1.5 g, 1.5 g, and 2 g LEV daily) and reactive psychosis in two patients (1 and 1.5 g LEV daily), regressing after dose reduction. Perioperative LEV in supratentorial brain tumor patients was well tolerated. Compared with the literature, it resulted in low (2.5%) seizure frequency in the early postoperative period. Additionally, its advantage of lacking cytochrome P450 enzyme induction allowed early initiation of effective postoperative chemotherapy in malignant glioma patients. © 2010 Springer Science+Business Media, LLC. Source

Grisold W.,Kaiser Franz Josef Hospital | Cavaletti G.,University of Milan Bicocca | Windebank A.J.,Mayo Medical School
Neuro-Oncology | Year: 2012

Peripheral neuropathies induced by chemotherapy (CIPN) are an increasingly frequent problem. Contrary to hematologic adverse effects, which can be treated with hematopoetic growth factors, neither prophylaxis nor specific treatment is available, and only symptomatic treatment can be offered. Neurotoxic drugs are becoming a major dose-limiting factor. The epidemiology is still unclear. Several drug-dependent pathogenetic mechanisms exist. CIPN are predominately sensory, length-dependent neuropathies that develop after a typical cumulative dose. Usually, the appearance of CIPN is dose dependent, although in at least 2 drugs (oxaliplatin and taxanes), immediate toxic effects occur. The most frequent substances causing CIPN are platin compounds, vinka alkaloids, taxanes, and bortezomib and thalidomide. The role of synergistic neurotoxicity caused by previously given chemotherapies and concomitant chemotherapies and the role pre-existent neuropathy on the development of a CIPN is not clear. As the number of long-term cancer survivors increases and a new focus on long-term effects of chemotherapy-induced neuropathies emerge, concepts of rehabilitation need to be implemented to improve the patients' functions and quality of life. © 2012 The Author(s). Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. Source

Kottmel A.,Kaiser Franz Josef Hospital | Ruether-Wolf K.V.,University of Basel | Bitzer J.,University of Basel
Journal of Sexual Medicine | Year: 2014

Introduction: Female sexual problems and dysfunctions have a high prevalence, ranging from 12% to 80%, depending on the definition being used, underlying comorbidities, and age. Despite the high prevalence, there are only scarce data about the approach gynecologists use to address female sexual dysfunction. Aim: The aim of this study is to evaluate the approach of Swiss gynecologists to addressing sexual problems among their outpatients. Methods: After a pilot study including 56 physicians, a modified 19-item self-administered questionnaire was sent to 856 Swiss gynecologists to evaluate their methods of management of patients with sexual issues and their attitudes regarding the integration of sexual health issues into the gynecological consultation. Main Outcome Measures: Besides demographic information, the self-administered questionnaire included questions about addressing sexual health as part of consultation routine, estimated frequency of symptoms, reasons for not addressing sexuality, clinical conditions in which sexuality was addressed, and methods of management of sexual problems. Results: Of the 341 responding gynecologists (39.8% response rate), 40.4% reported having at least brief (at least 1-2 days) of training in sexual medicine, 7.9% of the respondents routinely explored sexual issues with more than 80% of their patients, 28.2% of the respondents offered appointments specifically for sexual issues, and 85% proposed referrals to specialized colleagues. Lack of motivation for therapy on the part of the patient was mentioned as the most common cause for persisting symptoms (63.3%). Dyspareunia was quoted as the most/second most prevalent type of female sexual dysfunction by 77.1% of the respondents. Conclusion: We conclude that among Swiss gynecologists, sexual problems are regarded as an important issue in gynecological outpatient care, but addressing patients' sexuality is not yet part of routine practice. Swiss gynecologists seem to be most likely to consider hormonal changes (although not so much those due to oral contraceptives) to necessitate discussion of sexual health issues, while psychosocial transitions or stress seem to be considered less important. Kottmel A, Ruether-Wolf KV, and Bitzer J. Do gynecologists talk about sexual dysfunction with their patients? J Sex Med 2014;11;2048-2054. © 2014 International Society for Sexual Medicine. Source

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