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Klagenfurt am Wörthersee, Austria

Goessler A.,Klinikum Klagenfurt Am Woerthersee
European Surgery - Acta Chirurgica Austriaca | Year: 2012

Background: Most infants who are less than one year old experience episodes of gastroesophageal reflux. In infants and children with severe symptoms of pathologic gastroesophageal reflux like difficult oral nutrition, failure to thrive and/or recurrent respiratory infections, pathologic gastroesophageal reflux has to be investigated. Methods: This article gives an overview of history, epidemiology and pathophysiology of gastroesophageal reflux and reviews changes in the different diagnostic and therapeutic approaches during the past decades with a focus on the clinical impact of pathologic reflux in infants and children. Results: Approximately 60% of children become free of reflux-related symptoms within the first two years of life with positioning therapy. If not treated, the remainder symptoms can be present until the fourth year of life, with approximately 5% having continuing problems of reflux and developing severe pathologies. In pediatric patients, the golden standard of reflux investigation is multichannel intraluminal impedance pH monitoring combined with sonography. Preoperatively, upper gastrointestinal contrast studies should be performed to identify anatomical changes. Due to the high potential of maturation of the LES, surgery is seldom needed within the first year of life. Still, in severe cases medical therapy or surgical correction is required both in infants and children. Conclusions: Diagnostics must be adapted to the needs of young infants and children and should involve as little stress as possible. When medical treatment is of limited success, laparoscopic fundoplication is the standard treatment for GERD in infants and children. © Springer-Verlag 2012. Source

Husslein H.,Klinikum Klagenfurt Am Woerthersee | Moswitzer B.,Klinikum Klagenfurt Am Woerthersee | Leipold H.,Klinikum Klagenfurt Am Woerthersee | Moertl M.,Klinikum Klagenfurt Am Woerthersee | Worda C.,Medical University of Vienna
Journal of Perinatal Medicine | Year: 2012

Objective: The objective of this study was to assess whether low placental weight is associated with higher risk of emergency delivery (cesarean section and vacuum-assisted delivery). Methods: This was a retrospective cohort study, including 657 normally developed term pregnancies. A strict methodology was used to provide reliable and reproducible placental weight measurement. Fetal heart rate patterns were analyzed according to the guidelines of the Royal College of Obstetricians and Gynecologists. Linear and logistic multiple regression analyses were used to assess risk factors for emergency delivery. Results: Nulliparity, placental weight <10th percentile, and delivery after 40 weeks of gestation remain significantly associated with higher risk of emergency delivery for non-reassuring fetal status in the multivariable model [odds ratio (OR) 5.13, 95% confidence interval (CI) 2.85-9.22, P < 0.001; OR 2.46, 95% CI 1.49-4.06, P < 0.001; OR 2.23, 95% CI 1.26-4.51, P = 0.01, respectively]. In the group of women who had an emergency delivery, 17.3% had a placental weight <10th percentile, which was significantly different to the group of women who delivered normally (9.4%, P≤0.04). If only emergency cesarean sections were analyzed, the percentage of women with placental weight <10th percentile was 37.5% in the cesarean section group compared to 9.8% in women who delivered normally (P≤0.001). Conclusion: This study suggests that, in clinically normally developed term pregnancies, placental weight <10th percentile is associated with an increased risk for emergency delivery during labor. These results warrant further prospective studies for potential use in clinical practice. Copyright © by Walter de Gruyter · Berlin · Boston. Source

Husslein H.,Klinikum Klagenfurt Am Woerthersee | Husslein H.,Medical University of Vienna | Gutschi M.,Klinikum Klagenfurt Am Woerthersee | Leipold H.,Klinikum Klagenfurt Am Woerthersee | And 3 more authors.
PLoS ONE | Year: 2014

Introduction: To investigate the effect of subcutaneous fat suture closure versus non-closure at cesarean section (CS) on long-term cosmetic outcome. Material and Methods: Women undergoing planned or unplanned CS were randomized to either subcutaneous fat suture closure or non-closure using a 1:1 allocation algorithm. Participants and outcome assessors were blinded to group allocation. Scar evaluation was performed after two and six months. Primary outcome measures were Patient and Observer Scar Assessment Scale (POSAS) summary scores six months after surgery. Secondary outcome measures were Vancouver Scar Scale (VSS) summary scores, retraction of the scar below the level of the surrounding skin, duration of surgery, and development of hematoma, seroma, surgical site infection (SSI) or wound disruption. Data were analyzed according to the intention to treat principle. Results: A total of 116 women were randomized and 91 participants, 47 in the closure and 44 in the non-closure group, completed the trial and were analyzed. There were no differences in patient morphometrics or surgery indications between groups. At two and six months no significant differences were found with respect to POSAS or VSS scores between groups. After two months significantly more women in the non-closure group described their scar as being retracted below the level of the skin (36% vs. 15%, p=0.02) whereas no difference was observed at six months. There were significantly more hematomas in the non-closure (25%) compared to the closure group (4%) (p=0.005). There was no difference in duration of surgery, SSI, seroma formation or wound disruption between groups. Conclusions: Suture closure of the subcutaneous fat at CS does not affect longterm cosmetic outcome. (Level I evidence). © 2014 Husslein et al. Source

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