Hospital Rudolfstiftung

Vienna, Austria

Hospital Rudolfstiftung

Vienna, Austria
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Dorler J.,Innsbruck Medical University | Edlinger M.,Innsbruck Medical University | Alber H.F.,Innsbruck Medical University | Altenberger J.,Paracelsus Medical University | And 8 more authors.
European Heart Journal | Year: 2011

Aims Pre-treatment with clopidogrel results in a reduction of ischaemic events in non-ST-elevation acute coronary syndromes. Data on upstream clopidogrel in the setting of primary percutaneous coronary intervention (PCI) are limited. The aim of this study was to investigate whether clopidogrel loading before arrival at the PCI centre may result in an improved outcome of primary PCI for ST-elevation myocardial infarction (STEMI). Methods and results In a multicentre registry of acute PCI, 5955 patients undergoing primary PCI in Austria between January 2005 and December 2009 were prospectively enrolled. The patients consisted of two groups, a clopidogrel pre-treatment group (n = 1635 patients) receiving clopidogrel before arrival at the PCI centre and a peri-interventional clopidogrel group (n = 4320 patients) receiving clopidogrel at a later stage. Multiple logistic regression analysis including major confounding factors stratified by the participating centres was applied to investigate the effect of pre-treatment with clopidogrel on the in-hospital mortality. Additionally, two subgroups, with or without the use of GP IIb/IIIa antagonist therapy in the catheterization laboratory, were analysed. On univariate analysis, clopidogrel pre-treatment was associated with a reduced in-hospital mortality (3.4 vs. 6.1, P< 0.01) after primary PCI. On multivariate analysis, clopidogrel pre-treatment remained an independent predictor of in-hospital mortality [odds ratio (OR) 0.60, 95 confidence interval (CI) 0.350.99; P = 0.048], especially in patients receiving additional GP IIb/IIIa antagonist therapy in the catheterization laboratory (OR 0.40, 95 CI 0.190.83; P = 0.01). Conclusion Clopidogrel pre-treatment before arrival at the PCI centre is associated with reduced mortality in a real world setting of primary PCI. These results strongly support the recommendation of clopidogrel treatment 'as soon as possible' in patients with STEMI undergoing pimary PCI. © 2011 The Author.

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 [1132470] pg/mL) than those without spontaneous clearance (1481 [1414412] 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.

Bodner K.,Hospital Rudolfstiftung | Bodner K.,United Arab Emirates University | Bodner-Adler B.,Al Ain Hospital | Grunberger W.,Hospital Rudolfstiftung
Archives of Gynecology and Obstetrics | Year: 2011

Objective: Aim of the study was to evaluate Evra use in adolescents and compare the outcome with adult users. Methods: A total of 80 adolescents and 178 adults were followed-up at 1-, 3-, and 6-month interval with their compliance, satisfaction, cycle control, and adverse events being assessed. Results: Compliance rate was generally higher among adult users (p < 0.05). Partial and complete patch detachment were both significantly higher among adolescents (p < 0.05). Self-reported side effects did not differ between both groups and declined over the time. Overall satisfaction was high among most subjects. Compared with previous contraception, most subjects reported better satisfaction with Evra (p < 0.05). Conclusion: This investigation observed an overall positive impression of Evra with good compliance among adolescent and adult users. This might be an effect of the convenience of the weekly dosing schedule. Compliance is of utmost importance in teenagers as this age group is at highest risk of unintended pregnancy. © 2010 Springer-Verlag.

Bodner K.,Hospital Rudolfstiftung | Bodner K.,United Arab Emirates University | Wierrani F.,Hospital Rudolfstiftung | Grunberger W.,Hospital Rudolfstiftung | Bodner-Adler B.,Al Ain Hospital
Archives of Gynecology and Obstetrics | Year: 2011

Objective: The aim of the study was to compare the maternal and neonatal morbidity associated with elective cesarean sections with planned vaginal delivery. Methods: A total of 178 women with elective cesarean section were compared with the next parity- and age-matched women presenting in spontaneous labor. Our analysis was restricted to a sample of low-risk obstetrical women. Maternal and neonatal outcomes were the main outcome variables of interest. Maternal morbidity outcome variables included wound infection, trauma, puerperal febrile morbidity and significant blood loss (>500 ml). Neonatal outcomes were captured by Apgar scores, cord pH as well as the occurrence of neonatal infections. Results: A significantly higher rate of puerperal febrile morbidity (n = 46 vs. 14, p = 0.0001) and wound infections (n = 16 vs. 2, p = 0.0001) could be detected in the elective cesarean section group. Additionally, a significant blood loss > 500 ml was more than twice as frequent in the cesarean section group (n = 22 vs. 10, p = 0.03) with non-significant lower postpartum hemoglobin levels being observed (10.4 vs. 11.2 g/dL, p > 0.05). A significant increase for the use of iron supplementation (n = 146 vs. 122, p = 0.002), analgesics (n = 168 vs. 60, p = 0.0001) and antibiotics (n = 48 vs. 18, p = 0.0001) could be found in the puerperal period and hospital admission was prolonged in elective cesarean section (6.8 vs. 3.5 days, p = 0.0001). Additionally, problems in breastfeeding occurred more frequently in this group (n = 18 vs. 4, p = 0.002). Neonatal complications were generally low in both the groups with no significant differences being observed (p > 0.05). Conclusion: The increased maternal morbidity in elective cesarean section included puerperal febrile morbidity, wound infections as well as breastfeeding problems in the postpartum period. Women should be sufficiently counseled regarding the increased risk of these complications. © 2010 Springer-Verlag.

Czejka M.,University of Vienna | Gruenberger B.,Hospital Rudolfstiftung | Kiss A.,University of Vienna | Farkouh A.,University of Vienna | Schueller J.,Hospital Rudolfstiftung
Anticancer Research | Year: 2010

Background: The effect of biweekly cetuximab (CTX) on the pharmacokinetics of CPT-11 and its metabolites was evaluated in this prospective, paired, crossover study. Patients and Methods: Patients with epidermal growth factor receptor-positive advanced colorectal cancer received infusions of CPT-11 (180 mg/m2; FOLFIRI schedule) every second week. CTX (500 mg/m2 for 120 min) was infused on day 2, followed by biweekly infusions (500 mg/m2 for 120 min). Plasma samples were analysed on day 1 of cycle 1 (CPT-11 monotherapy) and on day 1 of cycle 3 or 4 (CPT-11 plus CTX). The endpoint of this study was to evaluate differences in plasma concentrations of CPT-11 and metabolites between cycle 1 and cycle 3 (or 4). Results: Generally, there was little difference in CPT-11 pharmacokinetics when combined with CTX in the 11 enrolled patients. However, a significantly lower area under the concentration-time curve from 0-48 hours was observed for the SN-38 glucuronide metabolite with combination therapy versus monotherapy (by 27%, p<0.05). Conclusion: CTX has no clinically relevant impact on the pharmacokinetics of CPT-11 or its activation into SN-38; however, there may be a delay in detoxification of SN-38 by β-D-glucuronidation.

Czejka M.,University of Vienna | Schueller J.,Hospital Rudolfstiftung | Farkouh A.,University of Vienna | Gruenberger B.,Hospital Rudolfstiftung | Scheithauer W.,Medical University of Vienna
Cancer Chemotherapy and Pharmacology | Year: 2011

Purpose: In view of a potential gain in anticancer activity in advanced colorectal cancer (ACRC), there has been considerable interest in using a higher than the approved standard dose of capecitabine (CCB) combined with oxaliplatin. This pharmacokinetic study was designed to evaluate whether CCB is metabolized at the same extent when administered as a monotherapy in two different dose regimens, comparing standard dose (CCB 1) and intensified dose (CCB 2). Patients and methods: Seven patients suffering from ACRC received subsequently two CCB schedules: In the standard schedule, 1,250 mg/m2 CCB p.o. twice daily for 2 weeks was administered, after a pause of 1 week, a dose-intensified CCB 2 schedule was given: 1,750 mg/m2 CCB p.o. twice daily for 1 week to be followed by 1 week rest. Due to this paired cross over design a direct comparison for each single patient was feasible. Results: In both schedules, mean peak plasma concentrations of CCB occurred at about 50 min, those of metabolites shortly later (range 54-80 min). Peak plasma concentrations were about 10% (CCB, DFCR) and 40% (DFUR) higher in the CCB 2 regimen. According to the higher dose of CCB in the dose-intensified regimen (+40%), the AUClast values increased by 34% (CCB), 20% (DFCR) and 58% (DFUR), respectively. Conclusion: The results indicate that higher doses of CCB are metabolized approximately dose-dependent compared to the standard dose. No indices for a saturation of metabolizing processes or any significant delay of elimination rate was observed. The immediate 5FU precursor DFUR was formed at a 50% higher extent (expressed as AUClast values) than in the standard CCB 1 schedule. From the pharmacokinetic point of view, this increased formation rate suggests clinical importance in regard to metabolic activation of CCB. © 2010 Springer-Verlag.

Windhofer C.,Paracelsus Medical University | Papp C.,Paracelsus Medical University | Staudach A.,Paracelsus Medical University | Michlits W.,Hospital Rudolfstiftung
International Journal of Gynecological Cancer | Year: 2012

Introduction: Soft tissue reconstruction after vulvar, vaginal, or anal cancer resection poses a formidable task for reconstructive surgeons because of the functional, locational, and cosmetic importance of this region. Although numerous flaps have been designed for vulvar reconstruction, each has its disadvantages. Methods: The authors introduce the local fasciocutaneous infragluteal (FCI) flap for vulvar and vaginal reconstruction after tumor resection, vaginal scar obliteration, and vulvar ulceration in 15 patients operated on between 1999 and 2007. The FCI flap is supplied by the cutaneous branch of the descending branch of the inferior gluteal artery. The sensory supply of this flap comes from side branches of the posterior cutaneous nerve of the thigh. A total of 17 flaps were performed in 15 patients. Results: Except for one, all flaps survived. One flap necrosis occurred because of false postoperative position with compression and tension to the vascular pedicle. In the remaining patients, we found one local cancer recurrence with necessity of a second flap from the contralateral side. The patients report satisfaction with reconstruction, without one having pain at donor site and recurrent vaginal ulceration. Conclusions: This article discusses the expanding indications of this versatile flap and the operative technique of the local FCI flap for reconstruction of vulvar and partial vaginal defects. It can be raised in different volume and dimension out of possible irradiated area with an inconspicuous scar. Copyright © 2012 by IGCS and ESGO.

Stollberger C.,Hospital Rudolfstiftung | Ulram A.,Hospital Rudolfstiftung | Bastovansky A.,Hospital Rudolfstiftung | Finsterer J.,Hospital Rudolfstiftung
Journal of Geriatric Cardiology | Year: 2015

One disadvantage of direct anticoagulant drug is the lack of an antidote, which may become relevant in patients with traumatic brain injury. A 77-years old man with atrial fibrillation and syncope received dabigatran despite recurrent falls. Due to a ground-level-fall, he suffered from subarachnoidal and intraparenchymal hemorrhages, subdural hematoma and brain edema with a midline shift. Despite osteoclastic trepanation and hematoma-evacuation he remained comatose and died seven days later without regaining consciousness. Most probably, decreased dabigatran clearance due to increased age might have contributed to the fatal course. We suggest withholding anticoagulant therapy in patients with unexplained falls. If anticoagulant therapy is deemed necessary, vitamin-K-antagonists with their potential for laboratory monitoring and reversal of anticoagulant activity should be preferred. © 2015 JGC All rights reserved.

Wick G.,Innsbruck Medical University | Grundtman C.,Innsbruck Medical University | Mayerl C.,Innsbruck Medical University | Wimpissinger T.-F.,Hospital Rudolfstiftung | And 4 more authors.
Annual Review of Immunology | Year: 2013

Fibrosis is the production of excessive amounts of connective tissue, i.e., scar formation, in the course of reactive and reparative processes. Fibrosis develops as a consequence of various underlying diseases and presents a major diagnostically and therapeutically unsolved problem. In this review, we postulate that fibrosis is always a sequela of inflammatory processes and that the many different causes of fibrosis all channel into the same final stereotypical pathways. During the inflammatory phase, both innate and adaptive immune mechanisms are operative. This concept is exemplified by fibrotic diseases that develop as a consequence of tissue damage, primary inflammatory diseases, fibrotic alterations induced by foreign body implants, "spontaneous" fibrosis, and tumor-associated fibrotic changes. © Copyright 2013 by Annual Reviews. All rights reserved.

Sherif C.,Hospital Rudolfstiftung
Journal of visualized experiments : JoVE | Year: 2011

For ruptured human cerebral aneurysms endovascular embolization has become an equivalent alternative to aneurysm clipping.(1) However, large clinical trials have shown disappointing long-term results with unacceptable high rates of aneurysm recanalization and delayed aneurysm rupture.(2) To overcome these problems, animal experimental studies are crucial for the development of better endovascular devices.(3-5) Several animal models in rats, rabbits, canines and swine are available.(6-8) Comparisons of the different animal models showed the superiority of the rabbit model with regard to hemodynamics and comparability of the coagulation system and cost-effectiveness.(9-11) The venous pouch arterial bifurcation model in rabbits is formed by a venous pouch sutured into an artificially created true bifurcation of both common carotid arteries (CCA). The main advantage of this model are true bifurcational hemodynamics.(12) The major drawbacks are the sofar high microsurgical technical demands and high morbidity and mortality rates of up to 50%.(13) These limitations have resulted in less frequent use of this aneurysm model in the recent years. These shortcomings could be overcome with improved surgical procedures and modified peri- and postoperative analgetic management and anticoagulation.(14-16) Our techniques reported in this paper demonstrate this optimized technique for microsurgical creation of arterial bifurcation aneurysms.

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