Lindner G.,Medical University of Vienna |
Funk G.-C.,Otto Wagner Spital |
Lassnigg A.,Medical University of Vienna |
Mouhieddine M.,Medical University of Vienna |
And 3 more authors.
Intensive Care Medicine | Year: 2010
Purpose: Hypernatremia is common in the medical Intensive Care Unit (ICU) and has been described as an independent risk factor for mortality. Hypernatremia has not yet been studied in a collection of ICU patients after cardiothoracic surgery. Therefore, we wanted to determine the incidence of hypernatremia in a surgical ICU and its association with outcomes of critically ill surgical patients. Methods: In this retrospective cohort study performed at a surgical ICU of a university hospital in Vienna, patients were admitted to the ICU after major cardiothoracic surgery between May 1999 and October 2007. Data on serum sodium in the ICU, ICU mortality, hospital mortality, and length of ICU stay were collected prospectively. Results: 2,699 patients underwent surgery during the study period, and 2,314 patients were included in the study. Two hundred twenty-one (10%) patients acquired hypernatremia during their ICU stay. Median onset of hypernatremia was on day 4 (2-7). Patients with ICU-acquired hypernatremia had a higher ICU mortality (19%) compared to patients without hypernatremia (8%; p < 0.01). Length of ICU stay was increased in patients with hypernatremia (17 vs. 3 days; p < 0.01). In a multivariate Cox regression, ICU-acquired hypernatremia was an independent risk factor for ICU mortality within 28 days. Conclusions: Hypernatremia is a common event early in the course of critical illness after major cardiothoracic surgery and is independently associated with ICU mortality within 28 days. Future research should focus on the impact of hypernatremia on physiological functions as well as adequate and safe treatment of the electrolyte disorder. © 2010 jointly held by Springer and ESICM.
Beinhardt S.,Medical University of Vienna |
Aberle J.H.,Medical University of Vienna |
Strasser M.,Paracelsus Medical University |
Duliclakovic E.,Wilhelminenspital |
And 15 more authors.
Gastroenterology | Year: 2012
Single nucleotide polymorphisms (SNPs) in IL28B and serum levels of interferon γ inducible protein 10 (IP-10) predict outcomes of antiviral therapy in patients with chronic hepatitis C. We associated IL28B SNPs rs12979860 and rs8099917, along with serum levels of IP-10, with outcomes of patients with acute hepatitis C (AHC). We studied 120 patients with AHC (64 male; 37 ± 16 years old) and 96 healthy individuals (controls). The IL28B SNPs rs12979860 and rs8099917 were detected using real-time polymerase chain reaction; serum concentrations of IP-10 were measured by enzyme-linked immunosorbent assays of 62 patients with AHC. Hepatitis C virus was cleared spontaneously from 59 patients (49.2%). The IL28B rs12979860 C/C genotype was more frequent among patients with AHC than controls (62.5% vs 39.6%; P <.001) and among patients with spontaneous clearance than those without (74.6% vs 51.7%; P =.02) (positive predictive value, 60.3%). Patients with IL28B rs12979860 C/C more frequently developed jaundice (53.2% vs 27.6%; P =.022) than carriers of the T allele. The median level of IP-10 was lower among patients with AHC and spontaneous clearance (764  pg/mL) than those without spontaneous clearance (1481  pg/mL; P =.006). Based on receiver operating characteristic analysis, 540 pg/mL IP-10 was set as the cutoff for patients most likely to have spontaneous clearance (positive predictive value, 71.4%; negative predictive value, 65.9%). Including data on IP-10 levels increased the ability of the IL28B rs12979860 C/C to identify patients most likely to have spontaneous clearance (83% of those who had an IP-10 level <540 pg/mL and 32% who had an IP-10 level >540 pg/mL) (P <.01). The combination of serum level of IP-10 and SNPs in IL28B can identify patients with AHC who are most likely to undergo spontaneous clearance and those in need of early antiviral therapy. © 2012 AGA Institute.
Irlenbusch U.,Marienstift Arnstadt |
Blatter G.,Rosenberg Clinic |
Gebhardt K.,Marienstift Arnstadt |
Pap G.,Park Clinic |
Zenz P.,Otto Wagner Spital
International Orthopaedics | Year: 2011
This prospective study aimed to analyse the effect of a newly developed double-eccentric adjustable stemmed prosthesis on reconstruction of the osseous anatomy, range of motion, strength and pain relief. A total of 91 consecutive hemiprostheses were evaluated preoperatively and three, six, 12, 24 and 48 months postoperatively (mean±SD 46.2 ± 10.9 months) by the American Shoulder and Elbow Surgeons (ASES) and Constant scores as well as radiological assessment. Clinical evaluations showed an increase in Constant score from 21.9 to 64.8 points and in ASES score from 24.9 to 77.9 points after two years. The results depend mainly on the underlying pathology. The best results were observed for primary osteoarthritis and avascular necrosis of the humeral head. All heads were eccentrically positioned. Specific stem-related complications were not observed. Because of the eccentric positioning of all heads it is reasonable to use adjustable shaft prostheses. The clinical results are comparable to data in the literature. Additional study provided a better or comparable clinical outcome and a low revision rate, when compared with other modern adjustable implants in the literature. © 2010 Springer-Verlag.
Radke S.,RWTH Aachen |
Pfersmann V.,Otto Wagner Spital |
Derntl B.,RWTH Aachen |
Derntl B.,Jülich Research Center
European Archives of Psychiatry and Clinical Neuroscience | Year: 2015
Impairments in emotion recognition and psychosocial functioning are a robust phenomenon in schizophrenia and may affect motivational behavior, particularly during socio-emotional interactions. To characterize potential deficits and their interplay, we assessed social motivation covering various facets, such as implicit and explicit approach-avoidance tendencies to facial expressions, in 27 patients with schizophrenia (SZP) and 27 matched healthy controls (HC). Moreover, emotion recognition abilities as well as self-reported behavioral activation and inhibition were evaluated. Compared to HC, SZP exhibited less pronounced approach-avoidance ratings to happy and angry expressions along with prolonged reactions during automatic approach-avoidance. Although deficits in emotion recognition were replicated, these were not associated with alterations in social motivation. Together with additional connections between psychopathology and several approach-avoidance processes, these results identify motivational impairments in SZP and suggest a complex relationship between different aspects of social motivation. In the context of specialized interventions aimed at improving social cognitive abilities in SZP, the link between such dynamic measures, motivational profiles and functional outcomes warrants further investigations, which can provide important leverage points for treatment. Crucially, our findings present first insights into the assessment and identification of target features of social motivation. © 2015, Springer-Verlag Berlin Heidelberg.
Sachs G.,Medical University of Vienna |
Moser E.,Medical University of Vienna |
Katschnig H.,Ludwig Boltzmann Research Institute |
Gur R.C.,University of Pennsylvania |
And 2 more authors.
Psychiatry Research - Neuroimaging | Year: 2012
Functional magnetic resonance (fMRI) imaging was used to measure amygdala activation in an emotional valence discrimination task in clinically stable patients with schizophrenia treated with atypical antipsychotics and healthy controls. No difference was detected between patients with schizophrenia and controls. © 2012 Elsevier Ireland Ltd.
Stollberger C.,Krankenanstalt Rudolfstiftung |
Sporn R.,Krankenanstalt Rudolfstiftung |
Skala K.,Otto Wagner Spital |
Schneider B.,Sana Kliniken Lubeck GmbH |
Finsterer J.,Krankenanstalt Rudolfstiftung
International Journal of Legal Medicine | Year: 2010
Takotsubo cardiomyopathy is characterized by transient left ventricular dysfunction, electrocardiographic changes, and minimal release of myocardial enzymes that mimic acute myocardial infarction in patients without coronary artery disease. Takotsubo cardiomyopathy is frequently triggered by emotional or physical stress and occurs primarily in post-menopausal women. The pathomechanism of Takotsubo cardiomyopathy is, so far, unknown. Stress-induced amnesia is probably induced by perturbation of the hippocampal function. Assault-induced Takotsubo cardiomyopathy associated with amnesia has not been reported so far. In a 77-year-old Caucasian female, hospitalized because of confusion, anterograde amnesia, and hypertension after she had been assaulted by a female who sneaked up to her when she was unlocking the door of her apartment, Takotsubo cardiomyopathy was diagnosed based on clinical findings, electrocardiography, echocardiography, and coronary angiography. Follow-up after 8 weeks showed a regression of electrocardiographic and echocardiographic abnormalities; the amnesia for the assault, however, remained unchanged. This case shows that Takotsubo cardiomyopathy may be triggered by emotional stress induced during an assault. Assaultinduced stress may not only induce Takotsubo cardiomyopathy but also amnesia for some of the events that occurred during the act. © The Author(s) 2010.
Beinhardt S.,Medical University of Vienna |
Payer B.A.,Medical University of Vienna |
Datz C.,Hospital Oberndorf |
Strasser M.,Paracelsus Medical University |
And 12 more authors.
Journal of Hepatology | Year: 2013
Background & Aims IL28B polymorphisms, jaundice, decline in HCV-RNA, IP-10, and gender have been proposed to be indicative of spontaneous clearance of acute hepatitis C virus infection. The aim of this study was to define a score enabling the discrimination of patients with spontaneous clearance of HCV from those with development of viral persistence and need for early antiviral treatment. Methods 136 patients (74 male; 35 ± 15 years) were analyzed. From variables predictive of spontaneous clearance, calculated by univariate analysis, three scores were built. Analogous cut-offs were evaluated by computing area under the receiver operating characteristic curves. Candidate variables and cut-offs were: (I) presence of IL28B C/C (p = 0.027), (II) age (p = 0.031; cut-off: 35 years), (III) peak-bilirubin (p = 0.018; cut-off: 6 mg/dl), (IV) HCV-RNA decline within 4 weeks (p <0.001;cut-off: >2.5 log), (V) serum IP-10 (p = 0.003; cut-off: 546 pg/ml), (VI) presence of CD4(+) Th1 cells (p = 0.024). Each variable was allocated to 0 or 1 point, an HCV-RNA decline of ≥1 log10 but <2.5 log10 to 1 point, a decline of ≥2.5 log10 to 2 points. Three scores were evaluated (Score 1: I-IV; Score 2: I-V; Score 3: I-VI). Results A cut-off of ≥3 points out of 5 in Score 1 (AUROC: 0.82; DeLong 95% CI: 0.76-0.93) predicted spontaneous clearance with a sensitivity of 71% (95% CI: 0.53-0.86) and specificity of 87% (95% CI: 0.73-0.95). PPV and NPV were 79% and 82%. Corresponding findings for Score 2 including IP-10 (AUROC: 0.93; DeLong 95% CI: 0.86-0.93) at a cut-off of ≥4 were: sensitivity 81%, specificity 95% (PPV: 100%; NPV: 77%). A cut-off of ≥5 in Score 3 (AUROC: 0.98; DeLong 95% CI: 0.95-1.0) predicted spontaneous resolution with a sensitivity of 75% and specificity of 100% (PPV: 100%; NPV: 88%). Conclusions The scores enable a reliable discrimination between AHC-patients with high potential for spontaneous clearance from candidates for early therapeutic intervention due to marginal chance of spontaneous resolution.
Gschwantler-Kaulich D.,Medical University of Vienna |
Natter C.,Medical University of Vienna |
Steurer S.,University of Hamburg |
Walter I.,University of Veterinary Medicine Vienna |
And 3 more authors.
Cellular Oncology | Year: 2013
Purpose: Ezrin is known to be involved in intercellular interactions, and a shift from membrane-bound to cytoplasmatic protein expression has been associated with malignant potential. This association has primarily been demonstrated in cell lines and, as yet, little is known about the distribution of ezrin in primary benign and malignant breast tissues. We have, therefore, set out to investigate ezrin protein expression in a series of primary breast lesions. Methods: Immunohistochemistry was used to detect ezrin expression in 465 samples of normal breast tissues, benign breast tumours, pre-invasive breast lesions, breast cancer tissues and metastatic lymph nodes, and the protein expression patterns observed were correlated with clinicopathological parameters. Results: Ezrin was detected in the cytoplasm of both benign and malignant breast tissues, but its expression was significantly higher in the malignant tissues (13 % vs 60 %, p < 0.0001; χ 2 test). We also detected a statistically significant higher ezrin expression in pre-invasive lesions compared to benign lesions (15 % vs 44 %, p = 0.04; χ 2 test). We did not find such a difference in ezrin expression between pre-invasive and invasive cancer samples, nor between invasive cancer samples and lymph node metastases. Within the group of invasive cancer samples, we found a significant correlation between ezrin expression and CK14 (rs:0.38, p < 0.007) and Her2 (rs:0.25, p < 0.002) expression. No such correlation was observed between ezrin expression and nodal status, grading, patient's age, hormone receptor status, and Ki67 or p53 expression. Conclusion: Taken together, we found that cytoplasmatic ezrin expression increases from benign to malignant breast tumour development. We hypothesize that the tissue architectural alterations that are associated with aberrant ezrin expression may point at pathophysiological mechanisms that may be instrumental for the design of novel therapies. © 2013 International Society for Cellular Oncology.
Muin D.A.,Medical University of Vienna |
Wolzt M.,Medical University of Vienna |
Marculescu R.,Medical University of Vienna |
Sheikh Rezaei S.,Medical University of Vienna |
And 6 more authors.
Fertility and Sterility | Year: 2015
Objective To assess the effect of on-demand intranasal oxytocin administration on female sexual function and activity. Design Randomized, prospective, double-blind, placebo-controlled, crossover trial with duration of 22 weeks. Setting Academic medical center. Patient(s) Thirty pre-and postmenopausal women with sexual dysfunction. Intervention(s) Over 8 weeks, intranasal oxytocin (32 IU) or placebo self-administered by women within 50 minutes before sexual intercourse; after a washout period of 2 weeks, crossover with patients switched to the alternate group for another 8 weeks. Main Outcome Measure(s) Primary outcome parameter: Female Sexual Function Index (FSFI); secondary outcome parameters: Female Sexual Distress Scale (FSDS), Sexual Quality of Life-Female (SQOL-F), Sexual Interest and Desire Inventory-Female (SIDI-F), and Hamilton depression scale (HDS). Result(s) After oxytocin and placebo, the FSFI score increased by 26% and 31%, SQOL-F score by 144% and 125%, and SIDI-F score by 29% and 23%, respectively (repeated measures analysis of variance between groups). After oxytocin and placebo, the FSDS score decreased by 36% and 45%, respectively (repeated measures analysis of variance between groups). There was no statistically significant treatment, sequence (placebo first/second), or interaction effect. Conclusion(s) Long-term intranasal oxytocin and placebo administration both improved sexual function and symptoms of depression in women over time with no treatment, sequence (placebo first/second), or interaction effect. Clinical Trial Registration Number NCT02229721. © 2015 American Society for Reproductive Medicine.
Weber T.,Sozialmedizinisches Zentrum Ost Donauspital |
Schiebenpflug C.,Sozialmedizinisches Zentrum Ost Donauspital |
Deusch E.,Otto Wagner Spital
F1000Research | Year: 2013
Introduction: Bronchial asthma with respiratory failure is a challenge for the intensivist as mechanical ventilation is often difficult due to bronchoconstriction and air-trapping. We describe a case of severe asthma with respiratory acidosis in a 10-year-old patient unresponsive to multipharmacologic broncholytic therapy. Only the initiation of sevoflurane inhalation resolved severe bronchoconstriction and dynamic hyperinflation, leading to complete recovery. Case presentation: A 10-year-old Caucasian boy was intubated and mechanically ventilated due to an asthmatic attack. Bronchoconstriction and dynamic hyperinflation were severe while multipharmacological broncholytic therapy was unsuccessful. Inhalation with sevoflurane via an anaesthesia machine was the key intervention leading to gradual resolving of severe hypercapnia and respiratory acidosis. Furthermore bilateral pupil dilation occurred during hypercapnia, but no intracranial pathology could be detected. The patient made an uneventful recovery. To our knowledge this is the first case where hypercapnia and respiratory acidosis were so profound and long lasting yet the patient survived without any damage. Conclusions: Inhalational anaesthetics must be considered as an early treatment option in ventilated asthmatic patients with bronchial obstruction unresponsive to conventional therapy even though their administration in intensive care units may be difficult. © 2012 Weber T et al.