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Sankt Pölten, Austria

Birner P.,Medical University of Vienna | Schoppmann A.,Medical University of Vienna | Schindl M.,Landesklinikum St. Polten | Dinhof C.,Medical University of Vienna | And 3 more authors.
Journal of Clinical Pathology | Year: 2012

Background: CUL-4 plays a critical role in DNA replication in Caenorhabditis elegans, and interacts with p53 and p21 proteins in cell cycle regulation and response to genomic instability. However, the role of CUL-4 in human carcinomas is widely unknown. Aims: To investigate the expression of CUL-4 protein and its association with p53 and p21, and to determine its prognostic relevance in invasive ovarian carcinoma. Methods: CUL-4, p53 and p21 protein expression was determined retrospectively by immunohistochemistry in 140 specimens of human epithelial ovarian tumours (98 invasive carcinomas and 42 tumours of low malignant potential; LMP). Results: Overexpression of CUL-4 was observed in 41 (41.8%) of carcinoma samples and in 10 (23.8%) LMP tumours. CUL-4 was significantly more often overexpressed in invasive carcinomas compared with LMP tumours (p=0.042, χ 2 test, OR 2.302, 95% CI 1.018 to 5.203). In invasive carcinoma, CUL-4 overexpression was found to be a prognostic factor for overall (p=0.017, Cox regression, HR 2.387, 95% CI 1.17 to 4.869) and disease-free survival (p=0.005, Cox regression, HR 3.5, 95% CI 1.465 to 8.365), respectively. In subgroup analysis, CUL-4 was only of prognostic relevance in carcinomas without p53 expression. Conclusion: These data indicate for the first time that CUL-4 might play a relevant role in the development and progression of ovarian carcinoma, warranting further investigations. Degradation of wild-type p53 might be a key mechanism to explain why CUL-4 leads to more aggressive clinical behaviour. Not only CUL-4 itself, but also its associated proteins might represent targets for novel, selective therapeutic strategies.

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.

Flechl B.,Medical University of Vienna | Ackerl M.,Medical University of Vienna | Sax C.,Medical University of Vienna | Oberndorfer S.,Landesklinikum St. Polten | And 10 more authors.
Journal of Neuro-Oncology | Year: 2013

Glioblastoma multiforme (GBM) still harbors a fatal prognosis. The involvement of the neurocognition and psyche poses unique challenges for care provision by relatives. We lack data about the caregivers' perspective on the end-of-life (EOL) phase of GBM patients to improve counseling and support. In this study we investigated the experiences of 52 caregivers of deceased GBM patients treated in Austria. We used a questionnaire developed by the University Medical Centre of Amsterdam for exploration of the EOL-phase in glioma patients. The caregivers (17 men, 34 women) completed the questionnaire in median three years after the patients' death. 29 % of caregivers reported that they felt incompletely prepared for their tasks, however, those with higher education levels felt significantly better informed. 29 % suffered from financial difficulties, which was associated with burnout (60 %) and reduced quality of life (QOL). The patients' most common symptoms reported by caregivers were fatigue (87 %), reduced consciousness (81 %) and aphasia (77 %). 22 % of patients were bedbound during their last three months increasing to 80 % in the last week of life. The reported QOL of caregivers was very low and did not differ between caregivers of patients, who died at home (40 %) and caregivers of patients, who died in hospital (46 %). The caregiver reported that their QOL was only slightly better than the QOL they attributed to the patients. Furthermore, the high frequency of financial difficulties, burnout symptoms and feelings of insufficient information emphasize the urgent need for support and training dedicated to caregivers. © 2013 Springer Science+Business Media New York.

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.

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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