Landeskrankenhaus Klagenfurt

Sankt Pölten, Austria

Landeskrankenhaus Klagenfurt

Sankt Pölten, Austria
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Seebacher V.,Medical University of Vienna | Polterauer S.,Medical University of Vienna | Grimm C.,Medical University of Vienna | Husslein H.,Landeskrankenhaus Klagenfurt | And 4 more authors.
British Journal of Cancer | Year: 2010

Background: To analyse the correlation between pre-treatment plasma fibrinogen levels and clinical-pathological parameters in patients with endometrial cancer and to assess the value of plasma fibrinogen as a prognostic parameter. Methods: Within a retrospective multi-centre study, the records of 436 patients with endometrial cancer were reviewed and pre-treatment plasma fibrinogen levels were correlated with clinical-pathological parameters and patients survival.Results: The mean (s.d.) pre-treatment plasma fibrinogen level was 388.9 (102.4) mg per 100 ml. Higher plasma fibrinogen levels were associated with advanced tumour stage (FIGO I vs II vs III and IV, P=0.002), unfavourable histological subtype (endometrioid vs non-endometrioid histology, P0.03), and higher patients age (≤67 years vs >67 years, P=0.04), but not with higher histological grade (G1 vs G2 vs G3, P=0.2). In a multivariate analysis, tumour stage (P=0.001 and P<0.001), histological grade (P=0.009 and P=0.002), patients age (P=0.001 and P=0.001), and pre-treatment plasma fibrinogen levels (P=0.04 and P=0.02) were associated with disease-free and overall survival, respectively.Conclusion: Plasma fibrinogen levels can be used as an independent prognostic parameter for the disease-free and overall survival of patients with endometrial cancer. © 2010 Cancer Research UK All rights reserved.

PubMed | Allgemeines Krankenhaus Linz, Innsbruck Medical University, Paracelsus Medical University, Landeskrankenhaus Klagenfurt and 4 more.
Type: Journal Article | Journal: Journal of the International AIDS Society | Year: 2014

While antiretroviral therapy (ART) has increased the survival of HIV patients and turned HIV infection into a chronic condition, treatment modifications and poor adherence might limit this therapeutic success.Patients from the Austrian HIV Cohort Study, who started their first ART after Rilpivirine became available in February 2011, were analyzed for factors associated with treatment modification which could be either a change of drugs or a stop of the regimen. A drug was considered as stopped when the regimen was interrupted for more than eight days. Drugs of particular interest were Darunavir (DRV), Atazanavir (ATV), Raltegravir (RAL), Rilpivirine (RPV) and Efavirenz (EFV). RPV and EFV were analyzed only when taken as single tablet regimen. Other drugs were summarized as other. Proportional hazards regression methods were used to identify predictors of discontinuation and Kaplan-Meier estimates were used to calculate probabilities of discontinuation. Patients who died were censored at the date of death.965 patients started ART, 282 with DRV, 161 with ATV, 96 with RAL, 108 with RPV and 118 with EFV. Median time for taking initial ART is 11.6 months. 322 (33.4%) patients modified their initial ART. The overall probability of modification at one year was 28.7%, at two years 40.0% and at three years 49.8%. In a multivariable proportional hazards regression analysis, AIDS diagnosis at baseline and injecting drug use (IDU) of men compared with men who have sex with men (MSM) have a higher risk of switch/stop. Compared with DRV, RPV showed a much lower and ATV and particularly other a higher risk for discontinuation (Table 1).Rates of modification and interruption were still high in recent years, particularly in the first year of ART. The decreased rate of modification found in patients treated with Rilpivirine may be attributed to selection of patients according to guidelines.

PubMed | Allgemeines Krankenhaus Linz, Innsbruck Medical University, Paracelsus Medical University, Landeskrankenhaus Klagenfurt and 4 more.
Type: Journal Article | Journal: Journal of the International AIDS Society | Year: 2014

For some patients, it remains a challenge to achieve complete virological suppression which is the goal of antiretroviral therapy (ART). Identifying factors associated with low-level viraemia (LLV) and virological failure (VF) under ART might help to optimize management of these patients.We investigated patients from the Austrian HIV Cohort Study receiving unmodified ART for >6 months with two nucleoside reverse-transcriptase inhibitors (NRTIs) with either a non-nucleoside reverse-transcriptase inhibitor (NNRTI) or a boosted protease inhibitor (PI) or an integrase inhibitor (INSTI) between 1 July 2012 and 1 July 2013 with at least one viral load (VL) measurement below the limit of detection (BLD) or below level of quantification (BLQ) in their treatment history. VF was defined as HIV-RNA levels 200 copies/mL and all other quantifiable measurements were classified as LLV. Factors associated with LLV and VF compared to BLD and BLQ were identified by using logistic regression models.Of the 2,276 patients analyzed, 1,972 (86.6%) were BLD or BLQ, 222 (9.8%) showed LLV and 82 (3.6%) had VF. A higher risk for LLV and VF was found in patients with ART interruptions and in patients with boosted PI therapy. The risk for LLV and VF was lower in patients from a centre which uses Abbott RealTime HIV-1 assay compared to the other centres measuring VL by the Roche Cobas AmpliPrep/Cobas TaqMan 2.0. A higher risk for LLV but not for VF was found in patients with a higher VL before ART and shorter ART duration. A higher risk for VF but not for LLV was found in patients of younger age, originating from a high prevalence country, with a lower CD4 count and in male injecting drug users.This study of well-defined patients on stable ART over a period of more than six months gives insights into the different factors associated with LLV and VF. In patients with VF, factors associated with adherence play a prominent role, whereas in patients with LLV, the biology of viral replication comes additionally into effect. Despite its observational design, it has implications for patient management and forms the basis for future outcome studies.

Breschan C.,Landeskrankenhaus Klagenfurt | Platzer M.,Landeskrankenhaus Klagenfurt | Jost R.,Krankenhaus Spittal Drau | Stettner H.,Klagenfurt University | And 3 more authors.
British Journal of Anaesthesia | Year: 2011

Background. During ultrasound (US)-guided cannulation of the subclavian vein (SCV) via an infraclavicular route, the view of the needle behind the clavicle may be obscured. This study describes the US-guided supraclavicular cannulation of the brachiocephalic vein (BCV). Methods. The 25 mm broadband linear array US probe was placed in the supraclavicular region to obtain a longitudinal view of the BCV beginning at the junction of the internal jugular vein and SCV. Using the in-plane technique, the needle was directed under US guidance into the BCV. Results. Forty-two cannulations in 35 patients (aged 26 months-8 yr, weight range 0.9621 kg) were included. Central venous catheter placement was successful in all children. In 31 patients (73.8), the BCV was successfully punctured on the first attempt, in six patients (14.2) after two attempts, and in five patients (11.9) after three attempts. Significantly more puncture attempts were needed in the smaller weight and younger children, whereas the time course of the study had no significant impact on the success rate. Conclusions. This US-guided method offers a new possibility for central venous line placement in small children. It provides good needle guidance without any disturbing US shadow caused by bony structures. © 2011 The Author Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.

Husslein H.,Landeskrankenhaus Klagenfurt | Worda C.,Medical University of Vienna | Leipold H.,Landeskrankenhaus Klagenfurt | Szalay S.,Landeskrankenhaus Klagenfurt
Geburtshilfe und Frauenheilkunde | Year: 2012

Purpose: To evaluate whether ultrasound accuracy of estimated fetal weight (EFW) differs in women with diet controlled gestational diabetes mellitus (GDM) compared to nondiabetic pregnant women. Material and Methods: We included 363 patients, 121 patients with diet controlled GDM and 242 patients with a normal oral glucose tolerance test (oGTT). Each case of diet controlled GDM was matched with 2 unaffected controls. All patients were screened/diagnosed for GDM by means of an oGTT. Both groups received ultrasound examination including fetal biometry, using Hadlocks Formula, within 7 days to delivery. After birth, gestational age, birthweight and Apgar scores were collected from each newborn. Results: There was a good correlation between EFW and birth weight (coefficient = 0.747, p < 0.001 by Pearson correlation, even after adjustment for glucose status). Regression analyses, including noGDM/GDM, maternal age, maternal body mass index, birth weight and time interval between ultrasound and delivery revealed that only fetal birth weight significantly influences weight difference between ultrasound EFW and actual birth weight at term. Conclusion: Our data suggests that ultrasound accuracy of EFW using Hadlocks Formula at term does not differ in women with diet controlled GDM compared to women with normal glucose tolerance.

Wilhelma I.R.,Friedrich - Alexander - University, Erlangen - Nuremberg | Tzabazisa A.,Friedrich - Alexander - University, Erlangen - Nuremberg | Likarb R.,Landeskrankenhaus Klagenfurt | Sittla R.,Friedrich - Alexander - University, Erlangen - Nuremberg | Griessingera N.,Friedrich - Alexander - University, Erlangen - Nuremberg
European Journal of Anaesthesiology | Year: 2010

Background and objective The 5% lidocaine medicated plaster is a topical treatment for peripheral neuropathic pain symptoms (e.g. burning, shooting and stabbing pain) and is registered for the treatment of postherpetic neuralgia. This study examined the efficacy and tolerability of long-term treatment with the 5% lidocaine medicated plaster in patients with localized neuropathic pain conditions. Methods Twenty patients with localized neuropathic pain [postoperative neuropathic pain (n=14); complex regional pain syndrome (n=2); and postherpetic neuralgia (n=4)], who had been successfully treated with 5% lidocaine medicated plaster, were followed up by telephone interview after 3 and 5 years. Questions were related to the efficacy, development of tolerance, tolerability, wear time and comfort of the plaster. Results At 3 years, 10 out of 20 (50%) initial responders were still using the plasters with no decline in analgesic efficacy. After 5 years, eight of the original 20 responders (40%) maintained treatment and continued to experience effective pain relief. The 12 responders who discontinued treatment did so because they no longer required analgesic therapy (n=4); their health insurer refused to fund treatment (n=2); they were lost to follow-up (n=1); or had © 2010 European Society of Anaesthesiology.

Seebacher V.,Medical University of Vienna | Polterauer S.,Medical University of Vienna | Grimm C.,Medical University of Vienna | Rahhal J.,Medical University of Vienna | And 7 more authors.
British Journal of Cancer | Year: 2012

Background: Gamma-glutamyltransferase (GTT), a known marker for apoptotic balance, seems to promote tumour progression, invasion and drug resistance. Recently, high GGT serum levels were shown to be associated with impaired prognosis in patients with cervical cancer. The aim of this study was to investigate the value of pre-therapeutic serum GGT levels as prognostic parameter in patients with endometrial cancer. Methods: Within the present multi-centre trial, clinical-pathological parameters and pre-therapeutic serum GGT levels were evaluated in 874 consecutive patients with endometrial cancer. Patients were stratified in GGT risk groups, and univariate and multivariable survival analyses were performed.Results:Mean pre-therapeutic serum GGT level was 30.8 (41.5) U l -1. Elevated and highly elevated serum GGT levels (P<0.03 and P<0.005), tumour stage (P<0.001 and P<0.001), grade (P<0.001 and P<0.02) and age (P<0.001 and P<0.001) were independently associated with progression-free survival in univariate and multivariable survival analyses. Pre-therapeutic GGT was not associated with advanced tumour stage (P<0.6), higher histological grade (P<0.6) or unfavourable histological subtype (P<0.3). Conclusion: Pre-therapeutic serum GGT is a novel and independent prognostic parameter for progression-free survival of patients with endometrial cancer. Stratifying patients into prognostic subgroups could be used for patient counselling and individualised treatment planning. © 2012 Cancer Research UK All rights reserved.

Husslein H.,Landeskrankenhaus Klagenfurt | Lausegger F.,Landeskrankenhaus Klagenfurt | Leipold H.,Landeskrankenhaus Klagenfurt | Worda C.,Medical University of Vienna
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2012

Objective: To evaluate whether gestational diabetes mellitus (GDM) requiring insulin treatment (White's classification A2) is associated with an alteration of pregnancy-associated plasma protein-A (PAPP-A) serum levels at first-trimester screening between 11 and 14 weeks of gestation. Methods: We collected data (20072010) of all women who developed GDM requiring insulin treatment and completed first-trimester combined screening program including the determination of serum PAPP-A and free β-human chorionic gonadotropin (β-hCG). A total of 288 women were included in this study. Each of the 72 women who developed GDM was matched with three unaffected controls. Results: Women with GDM were significantly older (34.2 ± 5.9 vs. 32.3 ± 5.5 years, P = 0.007) and delivered significantly earlier (38.40 ± 2.25 vs. 39.1 ± 2.2 gestational weeks, P = 0.01). Multiple regression analysis revealed, that PAPP-A and β-hCG were independently associated with each other (P = 0.04) but there was no association between GDM/no GDM and the first-trimester serum markers (P = 0.77). Conclusion: Our data suggest that women who are developing GDM needing insulin treatment do not have altered PAPP-A levels at 1114 weeks. © 2012 Informa UK, Ltd.

Kuessel L.,Vienna University Hospital | Grimm C.,Vienna University Hospital | Knofler M.,Vienna University Hospital | Haslinger P.,Vienna University Hospital | And 5 more authors.
Disease Markers | Year: 2013

Oxytocin is crucially involved in the onset and maintenance of labor. We investigated the association between oxytocin receptor gene polymorphisms and preterm birth. The presence of four common oxytocin receptor gene polymorphisms (rs2254298, rs53576, rs2228485 and rs237911) was evaluated in one hundred women with preterm birth and one hundred healthy women using restriction fragment length polymorphism genotyping. No association was found between the presence of any individual oxytocin receptor gene polymorphism and preterm birth. In haplotype analysis, the haplotype combination of rs2254298 A allele, rs2228485 C allele and rs237911 G allele was found to be significantly associated with an increased risk of preterm birth (OR=3.2 [CI 1.04-9.8], p=0.043). In conclusion our findings suggest that a combination of three oxytocin receptor gene polymorphisms is associated with an increased risk for preterm birth. We propose further studies investigating the role of oxytocin receptor gene polymorphisms and preterm birth. © 2013 IOS Press and the authors. All rights reserved.

Kager I.,Landeskrankenhaus Klagenfurt | Mousa S.A.,Free University of Berlin | Sieper J.,Free University of Berlin | Stein C.,Free University of Berlin | And 3 more authors.
Rheumatology International | Year: 2011

Activation of opioid receptors on peripheral sensory nerve terminals by opioid peptides that are produced and released from immune cells can result in inhibition of inflammatory pain. This study tests the hypothesis that postoperative pain is attenuated endogenously through a local sympathetic neurotransmitter-activated release of opioids in patients undergoing knee surgery. We examined the expression of opioid peptides and adrenergic receptors in cells infiltrating inflamed synovial tissue and we hypothesized that intra-articular (i.a.) administration of the adrenergic receptor antagonist labetalol will increase postoperative analgesic consumption and/or pain intensity in these patients. In a double-blind, randomized manner, 75 patients undergoing therapeutic knee arthroscopy received i.a. placebo (20 ml saline) or labetalol (2.5 or 5 mg in 20 ml saline) at the end of surgery. Postoperative pain intensity was assessed by visual analog and verbal rating scales at rest and on exertion, and by the consumption of morphine via patient-controlled analgesia. Synovial biopsies were taken during the operation for double-immunofluorescence confocal microscopy studies. Alpha1- and beta2-adrenergic receptors were co-expressed in opioid peptide-containing cells. No significant difference was seen in pain scores, but patients receiving 2.5 mg labetalol requested significantly higher amounts of morphine. These findings are consistent with the notion that surgical stress induces sympathetically activated release of endogenous opioids from inflammatory cells and subsequent analgesia via activation of peripheral opioid receptors. © 2010 Springer-Verlag.

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