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Breitenfurt bei Wien, Austria

Volkert D.,Friedrich - Alexander - University, Erlangen - Nuremberg | Chourdakis M.,Aristotle University of Thessaloniki | Faxen-Irving G.,Karolinska Institutet | Fruhwald T.,Krankenhaus Hietzing | And 5 more authors.
Clinical Nutrition | Year: 2015

Background: Older people suffering from dementia are at increased risk of malnutrition due to various nutritional problems, and the question arises which interventions are effective in maintaining adequate nutritional intake and nutritional status in the course of the disease. It is of further interest whether supplementation of energy and/or specific nutrients is able to prevent further cognitive decline or even correct cognitive impairment, and in which situations artificial nutritional support is justified. Objective: It is the purpose of these guidelines to cover these issues with evidence-based recommendations. Methods: The guidelines were developed by an international multidisciplinary working group in accordance with officially accepted standards. The GRADE system was used for assigning strength of evidence. Recommendations were discussed, submitted to Delphi rounds and accepted in an online survey among ESPEN members. Results: 26 recommendations for nutritional care of older persons with dementia are given. In every person with dementia, screening for malnutrition and close monitoring of body weight are recommended. In all stages of the disease, oral nutrition may be supported by provision of adequate, attractive food in a pleasant environment, by adequate nursing support and elimination of potential causes of malnutrition. Supplementation of single nutrients is not recommended unless there is a sign of deficiency. Oral nutritional supplements are recommended to improve nutritional status but not to correct cognitive impairment or prevent cognitive decline. Artificial nutrition is suggested in patients with mild or moderate dementia for a limited period of time to overcome a crisis situation with markedly insufficient oral intake, if low nutritional intake is predominantly caused by a potentially reversible condition, but not in patients with severe dementia or in the terminal phase of life. Conclusion: Nutritional care and support should be an integral part of dementia management. In all stages of the disease, the decision for or against nutritional interventions should be made on an individual basis after carefully balancing expected benefit and potential burden, taking the (assumed) patient will and general prognosis into account. © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.

Dolak W.,Medical University of Vienna | Schreiber F.,Medical University of Graz | Schwaighofer H.,Innsbruck Medical University | Gschwantler M.,Wilhelminenspital | And 11 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2014

Background: Biliary radiofrequency ablation (RFA) using the Habib™ EndoHBP catheter is a new endoscopic palliation therapy for malignant biliary obstruction. The aim of this study was to assess the feasibility and safety of this technique. Methods: In this nationwide retrospective study of prospectively collected clinical data, all patients treated by biliary RFA in Austria between November 2010 and December 2012 were included. Procedure-related complications, adverse events within 30 days post-intervention, stent patency, and mortality rates were investigated. Results: A total of 58 patients (31 male, 27 female, median age 75 years) underwent 84 RFA procedures at 11 Austrian referral centers for biliary endoscopy. The predominant underlying condition was Klatskin tumor (45 of 58 cases). All 84 RFA procedures were feasible without technical problems. A partial liver infarction was induced by RFA in a 49-year-old Klatskin tumor patient. During 30 days after each RFA procedure, five cases of cholangitis, three cases of hemobilia, two cases of cholangiosepsis, and one case each of gallbladder empyema, hepatic coma, and newly diagnosed left bundle branch block occurred. Median stent patency after last electively performed RFA was 170 days (95 % CI 63-277) and was almost significantly different between metal and plastic stenting (218 vs. 115 days; p = 0.051). Median survival was 10.6 months (95 % CI 6.9-14.4) from the time of the first RFA in each patient and 17.9 months (95 % CI 10.3-25.6) from the time of initial diagnosis. Conclusions: Except for one severe interventional complication (hepatic infarct), RFA presented as a technically feasible and safe therapeutic option for the palliative treatment of malignant biliary obstruction. The good results of stent patency and survival in this study should be proven in prospective (controlled) trials to further quantify the efficacy of this promising new technique. © 2013 Springer Science+Business Media.

Promberger R.,Krankenhaus Hietzing | Ott J.,Medical University of Vienna | Chalubinski K.M.,Medical University of Vienna
Gynecologic and Obstetric Investigation | Year: 2016

Conservative management of abnormally invasive, residual trophoblastic disease (AIRTD) is underreported. We aimed at critically reviewing our experience with such conservative management. We conducted a retrospective cohort study that included 24 women. The median completed week of gestation at delivery (20/24, 83.3%)/2nd trimester miscarriage (4/24, 16.7%) was 35 (range 17-41). Two women initially chose a surgical treatment (dilatation and curettage), but AIRTD remained sonographically visible afterward. Five patients developed a fever >38.0C for ≥2 days (5/24, 20.8%). Due to heavy vaginal bleeding, 2 patients then underwent dilatation, diagnostic hysteroscopy, and curettage (2/24, 8.3%). One of these women also had to undergo hysterectomy (1/24, 4.2%). The 23 patients without hysterectomy underwent regular sonographic follow-up examinations. Regression of AIRTD was found after a median of 74 days (range 36-323). In conclusion, our data suggest that a conservative, observational treatment is feasible in AIRTD, with low rates of secondary surgical interventions. The long time intervals until regression require perseverance by these patients. © 2016 S. Karger AG, Basel.

Engelhardt P.F.,Landesklinikum Thermenregion Baden | Morakis N.,Landesklinikum Thermenregion Baden | Daha L.K.,Krankenhaus Hietzing | Esterbauer B.,Urologic | Riedl C.R.,Landesklinikum Thermenregion Baden
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2011

Introduction: and hypothesis While the short-term efficacy of intravesical hyaluronan for bladder pain syndrome/interstitial cystitis (BPS/IC) has been demonstrated, no data exist on the long-term outcome of this therapy. Methods: Seventy BPS/IC patients treated with intravesical hyaluronan therapy from2001 to 2003were asked to rate their present status of bladder symptoms on a visual analog scale. Results: Forty-eight of 70 patients responded after a mean follow-up of 4.9 years. The average initial VAS score of 8.15 had been reduced to 2.71 after therapy and further to 2.14 5 years later. Fifty percent of patients (24/48) reported complete bladder symptom remission at 5 years follow-up without any additional therapy; 41.7% (20/48) with symptom recurrence was improved with hyaluronan maintenance therapy. No improvement was reported by four patients. Conclusions: Besides a high rate of acute symptom remission, intravesical hyaluronan also shows long-term efficacy in a considerable number of BPS/IC patients. © The International Urogynecological Association 2010.

Pirker A.,Medical University of Vienna | Kramer L.,Krankenhaus Hietzing | Voller B.,Medical University of Vienna | Loader B.,Medical University of Vienna | And 2 more authors.
American Journal of Neuroradiology | Year: 2011

PRES is a clinicoradiologic entity, combining seizures, blindness, and coma with MR imaging findings of predominantly vasogenic and occasional cytotoxic edema. In this clinical report, we determined the type of edema by using DWI and FLAIR sequences on MR imaging as well as ADC maps in 28 patients with PRES. The neuradiologic findings were correlated with levels of serum albumin, which is a main contributor to colloid osmotic pressure and vascular integrity. The presence of vasogenic edema was significantly associated with decreased serum albumin levels, which may be a particular risk factor for the development of PRES.

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