Fajkovic H.,Landesklinikum St. Poelten |
Klatte T.,Medical University of Vienna |
Nagele U.,Landeskrankenhaus Hall in Tirol |
Dunzinger M.,Landeskrankenhaus Vocklabruck |
And 3 more authors.
World Journal of Urology | Year: 2013
Introduction: Through evolution in technology, endoscopic treatment has gained popularity for the treatment of upper tract urothelial carcinoma (ENDO-UTUC). Methods: A total of 20 patients with ENDO-UTUC were compared to 178 treated by radical nephroureterectomy (RNU) for a pTa-1 UTUC, and a systematic review was performed. Results: Mean age for ENDO-UTUC was 71. 9 ± 16. 0 years, and tumor features were favorable (90 % papillary, 14 low grade, 11 pTa). All ENDO-UTUC were performed ureteroscopically. Mean follow-up was 20. 4 ± 30 months. The 5-year overall survival (OS) rate was 45 %. Local (LR) and bladder recurrence (BR) was 25 and 15 %. Time to definitive treatment was longer, ASA higher, LR rates higher, OS lower for ENDO-UTUC (all p < 0. 001), but no difference was recorded for BR (p = 0. 056) and cancer-specific survival (CSS) (p = 0. 364). Postoperative kidney function (KF) was better in the ENDO-UTUC (p = 0. 048), though preoperative KF showed no difference. The maximal level of evidence was 3b, patients were highly selected, numbers of patients were low, and ASA scores high. OS was rather low and CSS high. LR rate was high (61 %) and BR rate moderate (39 %) for ureteroscopic and 36 and 28 %, respectively, for percutaneous approach. Conclusions: LR for ENDO-UTUC is high. In high-grade UTUC, oncological outcome is worse. RNU is associated with a significant loss of KF, but LR is rare. ENDO-UTUC is reserved for selected cases if elective. In imperative cases, it has to be balanced between KF, morbidity of the procedure, risk of operation and tumor control. ENDO-UTUC is not necessarily underused in Austria, because of lack in evidence, but 41 % of all RNU were performed in pTa/pTis/pT1 lesions. © 2012 Springer-Verlag.
Stadlbauer A.,MR Physics Group |
Stadlbauer A.,Friedrich - Alexander - University, Erlangen - Nuremberg |
Salomonowitz E.,MR Physics Group |
Brenneis C.,Landesklinikum St. Poelten |
And 4 more authors.
European Radiology | Year: 2012
Objectives To investigate the detectability of CSF flow alterations in the ventricular system of patients with hydrocephalus using time-resolved 3D MR velocity mapping. Methods MR velocity mapping was performed in 21 consecutive hydrocephalus patients and 21 age-matched volunteers using a 3D phase-contrast (PC) sequence. Velocity vectors and particle path lines were calculated for visualisation of flow dynamics. CSF flow was classified as "hypomotile flow" if it showed attenuated dynamics and as "hypermotile flow" if it showed increased dynamics compared with volunteers. Diagnostic efficacy was compared with routine 2D cine PC-MRI. Results Seven patients showed hypomotile CSF flow: six had non-communicating hydrocephalus due to aqueductal stenosis. One showed oscillating flow between the lateral ventricles after craniotomy for intra- cranial haemorrhage. Seven patients showed normal flow: six had hydrocephalus ex vacuo due to brain atrophy. One patient who underwent ventriculostomy 10 years ago showed a flow path through the opening. Seven patients showed hypermotile flow: three had normal pressure hydrocephalus, three had dementia, and in one the diagnosis remained unclear. The diagnostic efficacy of velocity mapping was significantly higher except for that of aqueductal stenosis. Conclusions Our approach may be useful for diagnosis, therapy planning, and follow-up of different kinds of hydrocephalus. © European Society of Radiology 2011.
Fajkovic H.,New York Medical College |
Halpern J.A.,New York Medical College |
Cha E.K.,New York Medical College |
Bahadori A.,New York Medical College |
And 6 more authors.
World Journal of Urology | Year: 2011
Introduction: While patient gender is an important factor in the clinical decision-making for the management of bladder cancer, there are minimal evidence-based recommendations to guide health care professionals. Recent epidemiologic and translational research has shed some light on the complex relationship between gender and bladder cancer. Our aim was to review the literature on the effect of gender on bladder cancer incidence, biology, mortality, and treatment. Methods: Using MEDLINE, we performed a search of the literature between January 1975 and April 2011. Results: Although men are nearly 3-4 times more likely to develop bladder cancer than women, women present with more advanced disease and have worse survival. Recently, a number of population-based and multicenter collaborative studies have shown that female gender is associated with a significantly higher rate of cancer-specific recurrence and mortality after radical cystectomy. The disparity between genders is proposed to be the result of a differences exposure to carcinogens (i. e., tobacco and chemicals) as well as reflective of genetic, anatomic, hormonal, societal, and environmental factors. Explanations for the differential behavior of bladder cancer between genders include sex steroids and their receptors as well as inferior quality of care for women (inpatient length of stay, referral patterns, and surgical outcomes). Conclusions: It is imperative that health care practitioners and researchers from disparate disciplines collectively focus efforts to appropriately develop gender-specific evidence-based guidelines for bladder cancer patients. We must strive to develop multidisciplinary collaborative efforts to provide tailored gender-specific care for bladder cancer patients. © 2011 Springer-Verlag.
Kopec G.,John Paul II Hospital |
Moertl D.,Landesklinikum St Poelten |
Jankowski P.,Jagiellonian University |
Tyrka A.,John Paul II Hospital |
And 2 more authors.
Canadian Journal of Cardiology | Year: 2013
Background: Idiopathic pulmonary artery (PA) hypertension (IPAH) is associated with severe PA remodelling. Although the resulting increase in pulse wave velocity (PWV) might be of major pathophysiological relevance, little is known about PA-PWV in IPAH. The aim of this study was to characterize PA-PWV and its predictors in patients with IPAH. Methods: We studied 26 consecutive patients with incident IPAH aged 55.0 (45.0-66.0) years (62% female) and 10 control subjects without pulmonary hypertension. PA-PWV was measured invasively; PA wall thickness and diameter were assessed using intravascular and transthoracic ultrasonography. Results: PA-PWV was higher in IPAH than in control subjects (10.0 [7.5-14.0] m/s vs 3.5 [1.9-4.0] m/s; P < 0.001) as was also PA diameter and PA wall thickness. In IPAH patients, in univariate analysis PA-PWV was greater in men than in women and in patients with body mass index (BMI) < 25 kg/m2 than with BMI ≥ 25 kg/m2 and correlated positively with symptomatic disease duration, mean PA pressure, pulmonary vascular resistance, creatinine level, and negatively with low-density lipoprotein (LDL) cholesterol and triglyceride level but not with PA diameter or PA wall thickness. In multiple regression analysis mean PA pressure, LDL cholesterol level and BMI < 25 kg/m2 were the main predictors of PA-PWV in IPAH patients (R2 = 77%; P < 0.001). Conclusions: PA-PWV is increased in IPAH patients. High PA pressure, low LDL cholesterol level, and BMI < 25 kg/m2 explain most of its variability in this group. © 2013 Canadian Cardiovascular Society.
Beltrame A.M.,Centro Clinico |
Todt I.,Charité - Medical University of Berlin |
Sprinzl G.,Landesklinikum St Poelten |
Profant M.,Slovak Medical University |
Schwab B.,Leibniz University of Hanover
Annals of Otology, Rhinology and Laryngology | Year: 2014
Objective: This study aimed to review current knowledge regarding implantation of the Vibrant Soundbridge floating mass transducer (FMT) at the round window (round window vibroplasty) as well as to form a consensus on steps for a reliable, stable surgical procedure. Data Sources: Review of the literature and experimental observations by the authors. Conclusion: Round window (RW) vibroplasty has been established as a reliable procedure that produces good and stable results for patients with conductive or mixed hearing loss. The experience gained over the past few years of the authors' more than 200 implantations has led to consensus on several key points: (1) a wide and bloodless access to the middle ear with facial nerve monitoring, (2) the careful and correct identification and exposure of the round window membrane, (3) a good setup for efficient energy transition of the FMT, namely, perpendicular placement of the FMT with no contact to bone and the placement of cartilage behind the FMT to create a preloaded "spring" function, and (4) 4 points of FMT fixation: a rim of the round window bony overhang left intact both anterior and posterior to the FMT, conductor link stabilization, and cartilage behind the FMT. In addition, the FMT should be covered with soft tissue. © 2014 The Author(s).
Gruber I.,Landesklinikum St. Poelten |
Klein M.,Landesklinikum St. Poelten
Journal of the Turkish German Gynecology Association | Year: 2011
The last three decades have seen considerable progress in the development of culture media for ART and infertility treatment. Basic research on the metabolism of mammalian preimplantation embryos demonstrated the specific needs in the evolving stage of the embryo growing in vitro. Two different philosophies led to two different culture strategies for human preimplantation embryos: the 'back-to-nature' or sequential culture principle, and 'let-the-embryo-choose' or one-step culture principle. Both systems are commercially available and the discussion between the different groups of scientists is ongoing. As a matter of fact, all ART culture media currently used are not optimal for the growing human preimplantation embryo. However, further research is needed to reduce stress to the human preimplantation embryo and determine how many embryos from a treatment cycle are capable of producing a live birth.
Steiner S.,Medical University of Vienna |
Steiner S.,University of Ottawa |
Moertl D.,Landesklinikum St. Poelten |
Chen L.,University of Ottawa |
And 2 more authors.
Thrombosis and Haemostasis | Year: 2012
Since novel antiplatelet treatments (prasugrel, ticagrelor, high-dose clopidogrel) have been predominantly tested against standard-dose clopidogrel, data on direct comparisons between these therapies are scarce. We therefore indirectly compared their efficacy and safety in patients undergoing percutaneous coronary intervention. Electronic databases were searched systematically to identify head-to-head randomised controlled trials (RCTs). Network meta-analysis was performed using generalised linear mixed models with adjustment for length of follow-up. Findings were corroborated by mixed treatment comparison through Bayesian methods. Fourteen RCTs were identified and included in the analysis (high- vs. standard-dose clopidogrel: 9 trials, prasugrel vs. high-dose clopidogrel: 2 trials, prasugrel vs. standard-dose clopidogrel: 2 trials, ticagrelor vs. standard-dose clopidogrel: 1 trial). No significant differences were found for efficacy outcomes except for stent thrombosis favouring prasugrel (vs. ticagrelor: odds ratio [OR] 0.63, 95% confidence interval [CI]: 0.42, 0.94; vs. high-dose clopidogrel: OR 0.70, 95%CI: 0.48, 1.01). Prasugrel exhibited a similar bleeding risk as high-dose clopidogrel, but more major (OR 1.43, 95%CI 1.07, 1.90) and major or minor bleeding (OR 1.36, 95%CI 1.09, 1.69) compared to ticagrelor. Ticagrelor was also associated with less major or minor bleeding compared to high-dose clopidogrel (OR 0.81, 95%CI 0.69, 0.96). No differences were seen for non CABG-related major bleeding between the three strategies. Results were corroborated in a subgroup analysis comprising only patients with acute coronary syndromes. In the absence of head-to-head clinical trials, network meta-analysis suggests potentially relevant differences in efficacy and bleeding risk among novel antiplatelet treatments and may thereby advance understanding of their differential therapeutic properties. © Schattauer 2012.
Friedricha K.M.,Medical University of Vienna |
Fruhwald-Pallamara J.,Medical University of Vienna |
Stadlbauerb A.,Landesklinikum St. Poelten |
Salemc G.,Landesklinikum St. Poelten |
Salomonowitzb E.,Landesklinikum St. Poelten
European Journal of Radiology | Year: 2010
Objective: To assess the long-term outcome of selective thrombolysis in patients with hypothenarhammer syndrome by 3.0-T magnetic resonance (MR) angiography. Materials and methods: Seven patients (6 men, 1 woman; mean age, 58.6±14.4 years) were investigated. Long-term follow-up examinations (9-11 years post-interventional) were based on 3.0-T MR angiography. Pre- versus post-thrombolysis images and post-thrombolysis versus long-term follow-up images were compared with respect to arterial diameter. Additionally, changes in patients' symptoms were assessed. Results: The long-term follow-up examination showed worse contrast filling of the ulnar digits compared to the immediately post-interventional angiographic images only in one patient (14.3%), whereas worse contrast filling of the deep palmar arch or the ulnar artery was registered in three patients (42.9%). Three of seven patients (42.9%) reported worse symptoms, two patients (28.6%) stable symptoms at the longterm follow-up MR angiography. In two patients (28.6%) the change of symptoms could not be observed due to missing post-interventional clinical data. Conclusions: At the long-term follow-up, clinically, mild progression was found rather often, whereas with respect to imaging findings progression at the ulnar digits was rare. We assume that collateral vessels might play a major role in the post-interventional follow-up. In many instances the patients' symptoms are not in line with the angiographic findings. © 2009 Elsevier Ireland Ltd.
Brandl N.,Medical University of Vienna |
Zemann A.,Medical University of Vienna |
Kaupe I.,Medical University of Vienna |
Marlovits S.,Vienna University Hospital |
And 3 more authors.
Osteoarthritis and Cartilage | Year: 2010
Objective: Activation of granulocytes causes a considerable rise in the concentration of lactoferrin (Lf) in synovial fluid (SF). We here investigate consequences thereof on signal transduction and the balance between catabolic and anabolic metabolism in chondrocytes. Methods: Signal transduction was analysed in cultured chondrocytes by immunodetection of mitogen activated protein kinases (MAPK) and analysis of Smad2 translocation to the nucleus. Expression levels of matrix metalloproteinases (MMPs) and of aggrecan were measured by reverse-transcription-PCR. The proteolytic activity of MMPs was ascertained by zymography. Expression of the low-density-lipoprotein-receptor-related-protein-1 (LRP-1), a Lf receptor for signalling, was assayed by immunohistochemistry in cartilage and in cultured chondrocytes by immunoblotting. Results: We found LRP-1 expressed in dedifferentiated chondrocytes in culture and in cartilage tissue preferentially on the articular surface where it can encounter Lf within SF. Lf stimulated proliferation of chondrocytes, comparable to transforming growth factor-β1 (TGFβ1) and activated p38 and the extracellular-signal regulated-kinases 1/2 (ERK1/2) within minutes. Surprisingly, Lf induced nuclear Smad2 translocation, a signal pathway ascribed to TGFβ receptor activation. Lf significantly increased the levels of catabolic indicators such as MMP1, MMP2, MMP3 and MMP13 and inhibited aggrecan synthesis. Conclusion: Lf is a robust regulator of chondrocyte metabolism, comparable to TGFβ1. The catabolic influence together with the proliferative stimulus indicates a function as an early phase cytokine, enhancing MMPs, necessary for degradation of damaged tissue and stimulating proliferation of chondrocytes, necessary for reconstruction. © 2009 Osteoarthritis Research Society International.
Moertl D.,Landesklinikum St. Poelten |
Moertl D.,Medical University of Vienna |
Steiner S.,Medical University of Vienna |
Steiner S.,University of Ottawa |
And 2 more authors.
International Journal of Technology Assessment in Health Care | Year: 2013
Objectives: A recent randomized, controlled trial in chronic heart failure patients showed that NT-proBNP-guided, intensive patient management (BMC) on top of multidisciplinary care reduced all-cause mortality and heart failure hospitalizations compared with multidisciplinary care (MC) or usual care (UC). We now performed a cost-utility analysis of these interventions from a payer's perspective. Methods: Costs related to hospitalizations, ambulatory physician and nurse visits, and NT-proBNP testing for the three management strategies were acquired for both Austria (€) and Canada () and combined with the survival and quality of life data from the clinical trial for cost-effectiveness analysis. Data on long-term survival, costs, and quality-adjusted life-years (QALY) were extrapolated for a 20-year time horizon using a Markov model, which simulated the progression of disease through beta-blocker use, hospitalizations, and mortality. Results: BMC was the most cost-effective strategy as it was dominant (cost-saving with improved health outcome) over both MC and UC based on both Austrian and Canadian costs. Incremental cost-effectiveness ratios for MC relative to UC were €3,746 and 5,554 per QALY gained for Austrian and Canadian costs, respectively. The probabilities for BMC being the most cost-effective strategy were 92 percent at a threshold value of Austrian €40,000 and 93 percent at a threshold value of Canadian 50,000. Conclusions: NT-proBNP-guided, intensive HF patient management in addition to multidisciplinary care not only reduces death and hospitalization but also proves to be cost-effective. © Cambridge University Press 2012.