Landesklinikum St. Polten

Sankt Pölten, Austria

Landesklinikum St. Polten

Sankt Pölten, Austria
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Hirschl M.M.,Landesklinikum St. Polten | Mayr H.,Landesklinikum St. Polten | Erhart F.,Landesklinikum Mostviertel Amstetten | Brunner W.,Landesklinikum Mostviertel Melk | And 3 more authors.
American Journal of Emergency Medicine | Year: 2012

Objectives: Patients with acute myocardial infarction are at high risk of dying within the first hours after onset of coronary ischemia. Therefore, pharmacological intervention should be started in the prehospital setting. This study investigates the effect of the prehospital administration of bivalirudin on short-term morbidity and mortality compared to heparin plus abciximab in patients with ST-segment-elevation myocardial infarction (STEMI). Methods: One hundred ninety-eight patients with STEMI treated with bivalirudin in the prehospital setting were prospectively collected. Coronary angiography was performed to identify the infarct-related artery. In case of a percutaneous coronary intervention, bivalirudin was given according to the guidelines. The historic control group consisted of 171 consecutive patients from the same myocardial infarction network treated with unfractioned heparin and abciximab administration before the admission to the emergency department of the percutaneous coronary intervention center. The primary outcome parameter was the incidence of major adverse cardiac events (recurrent myocardial infarction, stroke, death, target vessel revascularization for ischemia) within 30 days after the primary event. Results: The overall rate of major adverse cardiac events was significantly lower in the bivalirudin group compared to the abciximab group (7.6% vs 14.6%; P =.04). The number of major bleedings was significantly higher in the abciximab group compared to the bivalirudin group (11.8% vs 3.8%; P =.03). Conclusions: The use of bivalirudin in the prehospital setting leads to a reduced rate of major cardiovascular events compared to a standard treatment with abciximab plus heparin. Bivalirudin is a reasonable choice of treatment in the prehospital setting for patients with STEMI. © 2012 Elsevier Inc. All rights reserved.

Fischer G.,Johannes Gutenberg University Mainz | Stadie A.,Johannes Gutenberg University Mainz | Reisch R.,University of Zürich | Hopf N.J.,Katharinenhospital | And 7 more authors.
Neurosurgery | Year: 2011

BACKGROUND: Improvements in preoperative imaging and intraoperative visualization have led to a refinement in surgical techniques. OBJECTIVE: Report of a 20-year experience with application of the keyhole technique as a contribution to the ongoing debate on the impact of limited craniotomies in aneurysm surgery. METHODS: Over a 20-year period, 1000 consecutive patients with 1297 aneurysms were surgically treated in 1062 operations: 651 in the acute stage after SAH and 411 with unruptured aneurysms. The outcome was assessed with the modified Rankin scale and approach-related complications. RESULTS: The majority of the cases were treated by 4 different keyhole approaches: The supraorbital approach was used in 793 patients for 989 aneurysms, the subtemporal in 48 patients for 50 aneurysms, the interhemispheric in 46 patients for 51 aneurysms, and the retromastoidal in 55 patients for 55 aneurysms. In 120 patients, the classic pterional approach was applied to treat 152 aneurysms. The results of unruptured aneurysms were good (modified Rankin scale ≤ 2) in 96.52%. The complication rates of the keyhole approaches were less than in the pterional group, although the difference did not reach statistical significance. CONCLUSION: The overall outcome, rate of retreatment, and approach-related complications with keyhole approaches for the management of ruptured and unruptured aneurysms are comparable to recently published conventional surgical aneurysm series. In addition to the common benefits of limited-exposure approaches, this series demonstrates appropriate safety and applicability of the keyhole technique in aneurysm surgery. Copyright © 2011 by the Congress of Neurological Surgeons.

Friedrich K.M.,Medical University of Vienna | Mamisch T.C.,University of Bern | Plank C.,Medical University of Vienna | Langs G.,Medical University of Vienna | And 4 more authors.
European Journal of Radiology | Year: 2010

Objective: To evaluate the use of diffusion-weighted imaging (DWI) for the assessment of cartilage maturation in patients after matrix-associated autologous chondrocyte transplantation (MACT). Materials and methods: Fifteen patients after MACT were examined by 3.0-T magnetic-resonance-tomography; the examination was up to 13 month after surgery in group 1, and later than 13 month after surgery in group 2. Both groups had a follow-up one-year later. DWI was acquired using a steady-state gradient-echo sequence. Mean values of the diffusion quotients of regions of interest within cartilage repair tissue and of reference regions were assessed. Each region-of-interest was subdivided into a deep, and a superficial area. Results: Mean diffusion quotients of cartilage repair tissues were 1.44 (baseline), and 1.44 (follow-up). Mean diffusion quotients of reference tissues were 1.29 (baseline) and 1.28 (follow-up). At the follow-up diffusion quotients of cartilage repair tissue were significantly higher than those of reference cartilage. In group 1 the diffusion quotients were significantly lower at the follow-up (1.45 versus 1.65); in group 2 no statistically significant differences between follow-up (1.39) and baseline (1.41) were found. Reference cartilages and cartilage repair tissues of group 2 showed a decrease of diffusion quotients from the deep to the superficial area being stable at the follow-up. In group 1 initially a significant increase (1.49 versus 1.78) of the diffusion quotients from deep to superficial area of the cartilage repair tissue was found changing into a decrease (1.65 versus 1.52) at the follow-up. Conclusions: DWI detected changes of diffusion within cartilage repair tissue that may reflect cartilage maturation. Changes in diffusity occurred up to two years after surgery and were stable later. Zonal variations within cartilage could be measured. © 2009 Elsevier Ireland Ltd. All rights reserved.

Marhold F.,Landesklinikum St. Polten | Marhold F.,West Virginia University | Rosen C.L.,West Virginia University
Journal of Neurosurgery | Year: 2010

Cerebral bypass procedures in the posterior circulation are difficult to perform and are considered to be high-risk surgery. Venous grafts, like that formed using the saphenous vein (SV), are simple to obtain without posing a high risk of morbidity. The main disadvantage of these high-flow grafts is the mismatch in vessel diameter between donor and recipient vessels in the posterior circulation. The authors performed a retrospective case study based of data from intraoperative video, patient charts, axial images, and cerebral angiograms. They treated a 66-year-old man who presented with a giant aneurysm of the vertebrobasilar junction and another large aneurysm of the basilar tip. They chose to create a vertebral artery (VA)-superior cerebellar artery anastomosis with a tapered-down SV graft. It was necessary to reengineer the SV graft to include a gentle taper that would allow for this anastomosis. The vein was incised for a distance of 2.5 cm. A triangular section of the vein, 2 mm at the base and 20 mm high, was then excised from the opened end of the SV. The 2.5-cm-long venotomy was then closed with interrupted 9-0 Prolene sutures creating a gentle taper to the vein down to ∼ 2.5 mm in diameter. Thereafter, the authors created a standard end-to-side anastomosis of the VA to the SV with 8-0 Prolene. Postoperatively both VAs were obliterated with coils just proximal to the vertebrobasilar aneurysm. The bypass was patent; after a prolonged stay in the intensive care unit, the patient recovered gradually. This technique of linear venotomy along the distal 2.5 cm of the vein and subsequent tapering down of the diameter diminishes the circumference of the distal end of the graft, facilitating bypass to smaller vessels. This is a novel and feasible technique to eliminate vessel mismatch in cerebral bypass procedures in the difficult accessible vessels of the posterior circulation.

Boheim K.,Landesklinikum St Polten | Mlynski R.,University of Würzburg | Lenarz T.,Medizinische Hochschule Hanover | Schlogel M.,Landesklinikum St Polten | Hagen R.,University of Würzburg
Acta Oto-Laryngologica | Year: 2012

Conclusions: The round window (RW) approach in the use of the Vibrant Soundbridge® (VSB) is a safe and effective treatment of conductive and mixed hearing losses for a period of more than 3 years of device use. Objective: To investigate the long-term safety and efficacy as well as user satisfaction of patients with conductive and mixed hearing losses implanted with the VSB using RW vibroplasty. Methods: Twelve patients with conductive and mixed hearing losses were evaluated after 40 months of daily VSB use. Safety was assessed by evaluating reports of postoperative medical and surgical complications as well as by changes in bone conduction hearing thresholds. Efficacy outcome measures included aided and unaided hearing thresholds, speech recognition in quiet and in noise and subjective benefit questionnaires. Results: The safety results revealed no significant medical complications. One subject experienced sudden hearing loss after 1824 months of device use, but still continues to wear the device to her satisfaction. With regard to efficacy, there were no significant changes from short- to long-term results in aided word understanding, functional gain or speech recognition threshold, suggesting that the outcomes are stable over time. Subjective questionnaires revealed either the same or better results compared with the short-term data. © 2012 Informa Healthcare.

Wimmer I.,Landesklinikum St. Polten | Hartmann T.,Landesklinikum St. Polten | Brustbauer R.,Landesklinikum St. Polten | Minear G.,Landesklinikum St. Polten | Dam K.,Landesklinikum St. Polten
Hormone and Metabolic Research | Year: 2014

Abstract Autoimmune thyroiditis (AIT) is one of the most common autoimmune diseases; genetic as well as environmental factors contribute to its pathogenesis. The thyroid is the organ with the highest selenium content per unit weight. Selenium status appears to have an impact on the development of thyroid pathologies. We investigated a possible difference of selenium serum levels as a marker of nutritional selenium supply between patients with AIT in central Lower Austria and a matched group of healthy persons living in the same region. Selenium serum levels in the patients with AIT were 98.0±15.6μg/l. A significant difference to the matched group of normal persons, whose selenium serum levels were 103.2±12.4μg/l, could not be detected by the t-test (p>0.05). We considered the serum selenium levels to be indicators of selenium supply (by alimentation). A serum level of 120-160μg/l of selenium represents the normal range. According to this, most patients and control persons showed mild to moderate selenium deficiency (80-120μg/l selenium). Although our data present slightly higher selenium levels in normal persons than in patients with AIT, this weak and statistically insignificant trend is not sufficient to support the conclusion of a link between inadequate selenium supply and autoimmune thyroid disease. © Georg Thieme Verlag KG Stuttgart.

Steirer T.,Landesklinikum St. Polten
Handchirurgie Mikrochirurgie Plastische Chirurgie | Year: 2011

After performing a right hemicolectomy due to cancer of the colon on a 67-year-old female patient, we detected an ingrown ring on her right ring finger. This had continuously penetrated the proximal phalanx from the flexor side after a trauma 3 years previously. Clinically, a residual flexion function was maintained. In the imaging the bone was found to be eroded, the digital arteries shifted, but the continuity of the deep flexor tendon was preserved. © Georg Thieme Verlag KG Stuttgart New York.

Hirschl M.M.,Landesklinikum St. Polten | Wollmann C.,Landesklinikum St. Polten | Globits S.,Landesklinikum St. Polten
American Journal of Emergency Medicine | Year: 2011

Objective: Pharmacologic cardioversion of atrial fibrillation (AF) is a reasonable mode of treatment if the arrhythmia is of recent onset. Results concerning the response rates of different drugs, respectively, in daily clinical practice and data with regard to the parameters associated with successful cardioversion are not very prevalent. Methods: Three-hundred seventy-six patients who were admitted to the emergency department with acute AF and a duration of shorter than 48 hours were enrolled into the AF registry. Results: The most effective drugs were flecainide and ibutilide (95% and 76%). Low response rates were observed with amiodarone (36%) and the individual use of digoxin or diltiazem (19% and 18%). Factors associated with a successful cardioversion were a lower blood pressure on admission (P = .002), a shorter time interval between the onset of AF and admission to the ED (P = .003), and adherence to treatment guidelines (P < .0001). Conclusion: The use of flecainide and ibutilide is associated with a much higher rate of cardioversion than other drugs we studied.

Kliegel A.,Landesklinikum St Polten | Gamper G.,Landesklinikum St Polten | Mayr H.,Landesklinikum St Polten
European Journal of Emergency Medicine | Year: 2011

This study was undertaken to evaluate the use of therapeutic hypothermia (TH) after cardiac arrest in Lower Austria. A questionnaire was sent to intensive care units (ICUs) in Lower Austria. Methods of inducing and maintaining hypothermia, the practise of rewarming, concomitant therapies and reasons not to cool were documented. Of the 23 ICUs 10 (43%) used TH. Nine (39%) cooled their patients to 32-34°C and one to 34-35°C. Duration of cooling was 24 h (n=8, 35%), 24-48 h (n=1) or 48 h (n=1). For induction of hypothermia, ICUs used cold infusions (n=5, 22%), surface (n=7, 30%) or endovascular cooling (n=6, 26%). The same methods were used during the maintenance period. Reasons not to cool were insufficient staff resources (n=4, 17%), technical complexity of cooling (n=4, 17%) and too little information (n=3, 13%). In conclusion, TH has been poorly implemented in Lower Austria. The reasons for not using hypothermia could possibly be dispelled by education. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Background: Vitamin K prophylaxis administered to newborns prevents rare but potentially serious and sometimes fatal hemorrhage due to vitamin K deficiency. Recommended vitamin K prophylaxis: For many years in Austria it has been recommended that all newborns should receive vitamin K and the present recommendations update in particular practical issues and questions. For healthy term newborns and orally fed preterm infants vitamin K should be given orally immediately after birth, after 4-6 days and after 4-6 weeks. Preterm infants with a birth weight less than 1,000 g should receive 500 μg vitamin K administered intramuscularly or intravenously after birth, preterm infants with a birth weight between 1,000 and 1,500 g should initially receive 1,000 μg. For both groups it is recommended that afterwards 8-10 μg/kg body weight/day should be administered parenterally. At the age of 4 weeks or prior to discharge all infants should again receive an oral prophylaxis of 2 mg vitamin K. For mothers on medications interfering with vitamin K metabolism (e.g. antiepileptic drugs, oral anticoagulants, antibiotics or antituberculostatics) 20 mg vitamin K is recommended during the final 15-30 days of pregnancy. © 2014 Springer-Verlag Berlin Heidelberg.

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