Feldkirch, Austria
Feldkirch, Austria

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Ruedl G.,University of Innsbruck | Kopp M.,University of Innsbruck | Burtscher M.,University of Innsbruck | Bauer R.,KFV Kuratorium fur Verkehrssicherheit | Benedetto K.,Landeskrankenhaus Feldkirch
Sportverletzung-Sportschaden | Year: 2013

Background: Annually, in Austria more than 10 million people participate in winter sport activities such as alpine skiing, snowboarding, cross country skiing and ski touring. About 80 - 90 % of all accidents are caused by a fall without other people involved and about 10 % are caused by collisions between people. Methods: In the winter season 2011/2012, skiers and snowboarders injured due to a fall or a collision on a ski slope have been interviewed about potential intrinsic and extrinsic risk factors in the Austrian province Vorarlberg. Results: In total, 1741 people injured by a self-inflicted fall and 137 people injured due to a collision have been interviewed. People injured due to a collision showed more often a head injury (15 vs. 8 %) and more often a concussion (15 vs. 6 %). Furthermore, people injured due to a collision were significantly older (41 vs. 33 years) and showed a higher proportion of skiers (86 vs. 79 %) as well as of higher skilled people (83 vs. 74 %) compared to those injured by a self-inflicted fall. Collisions between sport participants incurred significantly more often on slope intersections (11 vs. 4 %), when more people were on ski slopes (30 vs. 12 %) and when the sun was shining (85 vs. 69 %). Conclusion: According to the results of this study, preventive recommendations to reduce the risk of a collision include an adaptation of the individual skiing or snowboarding behaviour and the actual speed on skill level, weather conditions and number of other skiers and snowboarders on ski slopes. In addition, influences of adaptive visual information and supervision systems at slope intersections and in relation to weather and traffic conditions should be evaluated. © Georg Thieme Verlag KG Stuttgart · New York.


Gitt A.K.,University of Heidelberg | Drexel H.,Landeskrankenhaus Feldkirch | Feely J.,St James's Hospital | Ferrieres J.,Toulouse University Hospital Center | And 11 more authors.
European Journal of Preventive Cardiology | Year: 2012

Background: The prevalence of persistent lipid abnormalities in patients receiving statins in primary and secondary care is needed to formulate recommendations for future treatment. Studies associating cardiovascular risk factors with lipid target goal achievement are lacking.Design: A cross-sectional, observational study that assessed the prevalence of persistent dyslipidemia in patients treated with statins and analyzed predictors of lipid target achievement.Methods: Serum lipid values of 22,063 statin-treated patients were studied in the context of their cardiovascular risk factors, and the potency and composition of their lipid-lowering treatment. European Society of Cardiology recommendations were used to classify patient risk, and to define LDL-cholesterol goal and normal levels for HDL-cholesterol and triglycerides.Results: Overall, 48.2% of patients did not achieve the therapeutic goal for LDL-cholesterol, either as a single lipid anomaly or associated with low HDL-cholesterol, elevated triglycerides, or both. Lack of goal achievement was more prevalent among low-risk patients (55.8%) than high-risk patients (46.8%). Serum LDL-cholesterol levels were lower in high-risk patients. Predictors associated with LDL-cholesterol goal achievement were higher statin dose (odds ratio (OR): 0.35), specialist treatment (OR: 0.74), or combined lipid-lowering therapy (OR: 0.80).Conclusions: Nearly half of statin-treated patients missed their therapeutic LDL-cholesterol goal, highlighting a gap between recommendations and clinical practice. Better achievement of LDL-cholesterol therapeutic goal was found among patients at high cardiovascular risk, those on high statin doses or using combination therapy, and patients managed by specialists. Results suggest that residual dyslipidemia in statin-treated patients at low cardiovascular risk may be reduced by increasing statin dose. © The European Society of Cardiology 2011 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.


Lamm W.,Medical University of Vienna | Willenbacher W.,University of Innsbruck | Lang A.,Landeskrankenhaus Feldkirch | Zojer N.,Wilhelminenspital Vienna | And 5 more authors.
Annals of Hematology | Year: 2011

Bortezomib-dexamethasone (Btz/Dex) is an active regimen in patients with multiple myeloma and has been used in few patients with amyloidosis. Here, we report a retrospective evaluation of the efficacy and toxicity of Btz/Dex in 26 patients with AL amyloidosis (AL). Eighteen patients (69%) received Btz/Dex as first-line treatment. Organs most frequently involved were kidneys (100%) and heart (35%); five patients (19%) had less than two organs involved. The overall response rate was 54% (14 of 26 patients), with eight patients (31%) achieving a hematologic complete remission (CR). All patients who reached a CR received Btz/Dex as first-line therapy. Median time to response was 7.5 weeks. Improvement in organ function was noticed in three patients (12%). Median progression-free survival (PFS) and overall survival (OS) was 5.0 and 18.7 months, respectively; in CR patients, however, median PFS and OS have not yet been reached. Toxicities were manageable, with hematological side effects being most common. No grade 3/4 neuropathy was observed. Our results confirm the activity of bortezomib/dexamethasone in patients with AL amyloidosis and suggest that patients achieving a CR have a marked benefit for survival. © 2010 Springer-Verlag.


Saal D.,Landeskrankenhaus Feldkirch | Heidegger T.,Spitalregion Rheintal Werdenberg Sarganserland | Nuebling M.,Empirical | Germann R.,Landeskrankenhaus Feldkirch
British Journal of Anaesthesia | Year: 2011

Background. 'Continuity of personal care by anaesthetist', as defined by a single anaesthetist providing preoperative evaluation, performing anaesthesia, and delivering a postoperative visit to the patient, has been shown to be a major factor for patient satisfaction with anaesthesia care. This prospective randomized study investigated whether a single postoperative visit increased the patients perception of 'Continuity of personal care by anaesthetist' and hence satisfaction. Methods. In Group 1, the same anaesthetist who conducted anaesthesia visited the patient on the first postoperative day. In Group 2, a nurse anaesthetist who did not participate in anaesthesia delivery made a postoperative visit to the patient. Patients in Group 3 were not visited. Patients received a previously validated questionnaire after discharge from hospital. Results. The negative patient response created by the perception of not being visited after operation by the attending anaesthetist was 13.5% (95% CI ±6.9), 69.2% (95% CI ±10.3), and 77.1% (95% CI ±9.1) in Groups 1, 2, and 3, respectively, with 1 vs 2 and 1 vs 3 (P<0.001) being significantly different. The negative patient response for 'Continuity of personal care by anaesthetist' was 40.0 (95% CI ±5.3), 48.8% (95% CI ±5.6), and 55.5% (95% CI ±5.3) in Groups 1, 2, and 3, respectively, with 1 vs 3 (P<0.001) being significantly different. Conclusions. Perception of the anaesthetist and satisfaction with 'Continuity of personal care by anaesthetist' were significantly increased by the introduction of a single postoperative visit by the anaesthetist compared with no visit at all. Overall satisfaction with anaesthesia was unchanged. © The Author [2011]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.


Rimbach S.,Kantonsspital Munsterlingen | Holzknecht A.,Landeskrankenhaus Feldkirch | Nemes C.,Institute of Pathology | Offner F.,Institute of Pathology | Craina M.,Polytechnic University of Timişoara
Archives of Gynecology and Obstetrics | Year: 2015

Introduction: Minimal invasive approaches have proven beneficial for patients undergoing myomectomy and hysterectomy, but necessary tissue morcellation carries the risk of cell dissemination in rare cases of inadvertent malignancy. Performing the morcellation process within a contained bag system may prevent spilling and therefore enhance safety of the laparoscopic procedures. Material and methods: The present study describes the development and experimental evaluation of a new bag system in vitro and in vivo in a pig model of laparoscopic supracervical hysterectomies. Results: The main results on n = 8 procedures with in-bag morcellation compared to n = 8 controls without bag indicate reproducible feasibility and protective effect of the new bag, which is the first published to our knowledge that does not require puncturing in a standard multiport laparoscopy setting. Overall surgery time was significantly prolonged in the bag group by 12.86 min (P = 0.0052; 95 % confidence interval 4.64–21.07), but peritoneal washings were negative for muscle cells in all cases with bag use, compared to positive cytology in 5/8 cases without bag (P = 0.0256). Conclusion: Clinical trials will now be necessary to investigate the reproducibility of these encouraging data in human application. © 2015, Springer-Verlag Berlin Heidelberg.


Moschel M.,Landeskrankenhaus Feldkirch | Wohlgenannt D.,Landeskrankenhaus Bregenz
European Surgery - Acta Chirurgica Austriaca | Year: 2015

Background: Epidural anaesthesia is considered as a basic element of enhanced recovery after surgery (ERAS). In regard of the expenditure and the possible complications, the authors established a modified protocol without epidural analgesia. Methods: In this prospective single-centre study, 64 consecutive patients undergoing elective colorectal surgery were treated according to the concept of ERAS, replacing epidural analgesia with infiltration of the incision lines. Results: Adequate pain control was possible in 52 (81 %) patients; 55 (86 %) did not need any antiemetic drugs, 41 (64 %) tolerated solid food on the first postoperative day and 51 (80 %) had first bowel movement until day 2. Discharge was possible on day 4.3, overall complication rate was 19 % and 30-day mortality was 3 %. Conclusions: ERAS in elective colon surgery is feasible using local infiltration of the incision line resulting in comparable outcome in regard of pain control, intestinal paralysis and complications. © 2015, Springer-Verlag Wien.


Fink C.,Sportsclinic Austria | Herbort M.,University of Munster | Abermann E.,Landeskrankenhaus Feldkirch | Hoser C.,Sportsclinic Austria
Arthroscopy Techniques | Year: 2014

The quadriceps tendon (QT) as a graft source for anterior cruciate ligament (ACL) and posterior cruciate ligament reconstruction has recently achieved increased attention. Although many knee surgeons have been using the QT as a graft for ACL revision surgery, it has never gained universal acceptance for primary ACL reconstruction. The QT is a very versatile graft that can be harvested in different widths, thicknesses, and lengths. Conventionally, the QT graft is harvested by an open technique, requiring a 6 to 8 cm longitudinal incision, which often leads to unpleasant scars. We describe a new, minimally invasive, standardized approach in which the QT graft can be harvested through a 2- to 3-cm skin incision and a new option of using the graft without a bone block. © 2014 Arthroscopy Association of North America.


Just U.,University of Vienna | Dimou E.,University of Vienna | Knobler R.,University of Vienna | Klosner G.,University of Vienna | And 4 more authors.
Experimental Dermatology | Year: 2012

Extracorporeal photopheresis (ECP) is an established therapy for transplant rejection, graft-versus-host disease (GvHD) after allogeneic stem cell transplantation, cutaneous T-cell lymphoma and systemic autoimmune disorders such as systemic sclerosis. Knowledge regarding the in vivo behaviour of the cells after reinfusion is very limited. The aim of this prospective study was to investigate the path of 8-MOP-/UVA-exposed radiolabelled cells after ECP treatment and reinfusion. In this prospective single-centre study, peripheral blood mononuclear cells (PBMC) and neutrophils of 10 patients undergoing ECP as part of their regular treatment were labelled separately with 111In-oxine after exposure to 8-MOP/UVA and prior to reinfusion. The fate of the labelled leucocytes was monitored at 10min, 3.5 and 24h following reinfusion with whole-body scintigraphy. Comparison of distribution patterns showed that PBMC and neutrophils have different kinetic patterns after intravenous reinjection. The most prominent difference was immediate retention of PBMC but not of neutrophils in the lungs corresponding to a signal three times more intense. After 24h, more than 80% of both cell populations could be detected in liver and spleen. By means of a novel tool allowing for tracking of 8-MOP-/UVA-exposed leucocytes in ECP, we could show that organ-specific homing of leucocytes after ECP can be visualized in vivo and that migration patterns differ between PBMC and neutrophils. Based on our results, further studies should (i) extend the morphometric studies described here to specific ECP-responsive conditions and (ii) functionally address the interaction of ECP-modified PBMC with pulmonary tissue in experimental models. © 2012 John Wiley & Sons A/S.


PubMed | Landeskrankenhaus Feldkirch and Innsbruck Medical University
Type: | Journal: Seizure | Year: 2016

Corpus callosum (CC) is the largest forebrain commissure. This review focuses on the significance of CC for seizure disorders, the role of CC in seizure spread and the surgical disruption of callosal fibers (callosotomy) for treatment of patients with drug-resistant epilepsy.Personal experience/extensive literature review.Structural CC pathologies comprise developmental abnormalities, callosal involvement in identified disorders, transient imaging findings and microstructural changes. Epilepsies are reported in up to two thirds of patients with complete or partial CC agenesis (AgCC). However, AgCC per se is not indicative for seizure disorders. Moreover, additional malformations of cortical development (MCD) are causal. Microstructural CC abnormalities are detected by advanced imaging techniques, are part of diffuse white matter disturbances and are related to cognitive deficits. The etiological significance remains unexplained. However, they are also found in non-epileptic benign and transient disorders. In drug-resistant epilepsies with violent drops to the floor (drop seizures) callosotomy may be beneficial in seizure reduction. Since the EEG after callosotomy exhibits a single seizure focus in up to 50% of patients, consecutive resective surgical methods might be successful.CC is part of cerebral white matter and anomalies cannot act per se as seizure onset zone. Imaging techniques demonstrate additional lesions in patients with epilepsies. CC is the major pathway for seizure generalization. Therefore, callosotomy is used to prevent generalized drop seizures.


PubMed | Landeskrankenhaus Feldkirch and Innsbruck Medical University
Type: | Journal: International orthopaedics | Year: 2016

The Cobb angle as an objective measure is used to determine the progression of deformity, and is the basis in the planning of conservative and surgical treatment. However, studies have shown that the Cobb angle has two limitations: an inter- and intraobserver variability of the measurement is approximately 3-5 degrees, and high variability regarding the definition of the end vertebra. Scoliosis is a three-dimensional (3D) pathology, and 3D pathologies cannot be completely assessed by two-dimensional (2D) methods, like 2D radiography. The objective of this study was to determine the intraobserver and interobserver reliability of end vertebra definition and Cobb angle measurement using X-rays and 3D computer tomography (CT) reconstructions in scoliotic spines.To assess interoberver variation the Cobb angle and the end vertebra were assessed by five observers in 55 patients using X-rays and 3D CT reconstructions. Definition of end vertebra and measurement of the Cobb angle was repeated two times with a three-week interval. Intraclass correlation coefficients (ICC) were used to determine the interobserver and intraobserver reliabilities. 95% prediction limits were provided for measurement errors.Intraclass correlation coefficient (ICC) showed excellent reliability for both methods. The measured Cobb angle was on average 9.2 degrees larger in the 3D CT group (72.8, range 30-144) than on 2D radiography (63.6, range 24-152).In scoliosis treatment it is very essential to determine the curve magnitude, which is larger in a 3D measurement compared to 2D radiography.

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