Kurt Lenz | Medical University of Vienna (original) (raw)
Papers by Kurt Lenz
Patienten mit einem Guillain-Barre-Syndrom werden ublicherweise wegen drohender bzw. schon besteh... more Patienten mit einem Guillain-Barre-Syndrom werden ublicherweise wegen drohender bzw. schon bestehender Ateminsuffizienz an Intensivstationen aufgenommen. Die intensivmedizinischen Probleme, die sich bei diesen Patienten stellen, konnen jedoch weit uber die heute als etabliertes intensivmedizinisches Behandlungsverfahren geltende Plasmapherese (in Form der Membranplasmaseparation) bzw. die Respiratortherapie hinausreichen. In der vorliegenden Ubersicht sollen die uber die Diagnostik und spezifische neurologische Therapiemasnahmen hinausgehenden intensivmedizinischen Probleme bei Patienten mit Guillain-Barre-Syndrom besprochen werden [1, 2].
The American Journal of Clinical Nutrition, 1994
The elimination of intravenously infused amino acids was evaluated in six patients with acute ren... more The elimination of intravenously infused amino acids was evaluated in six patients with acute renal failure (ARF), 6 with conservatively treated chronic renal failure (CRF), 6 subjects receiving regular hemodialysis treatment (RDT), and 5 healthy control subjects. In ARF, CRF, and RDT groups, whole-body clearance (Cltot) of the 10 amino acids was elevated (113.5 +/- 1.5; 94.2 +/- 1.5 and 127.6 +/- 12.4, respectively, vs 85.2 +/- 4.8 mL.kg-1.min-1 in control subjects, P < 0.001). In ARF, Cltot of histidine, lysine, and methionine was higher and Cltot of phenylalanine and valine was lower as compared with control subjects. In CRF, Cltot of tryptophan and histidine was elevated and Cltot of phenylalanine was reduced; in RDT, Cltot of histidine, methionine, tryptophan, lysine, isoleucine, and leucine was raised. In all groups the relative clearance (% of total clearance) of phenylalanine and valine was reduced, and relative clearance of histidine and tryptophan was elevated. We conclude that in renal failure the elimination of amino acids from the intravascular space is profoundly altered and that the pattern of metabolic aberrations is similar in ARF, CRF, and RDT groups.
Intensivmedizinisches Seminar, 1995
Die Zufuhr von Blut- und Plasmaprodukten, insbesondere im Rahmen der Intensiv- und Transplantatio... more Die Zufuhr von Blut- und Plasmaprodukten, insbesondere im Rahmen der Intensiv- und Transplantationsmedizin, ist ein integraler Bestandteil der optimalen Patientenbetreuung. Allerdings kann diese Form der Therapie mit Komplikationen verbunden sein, wobei ein Anstieg der Komplikationsrate mit der Menge an transfundierten Plasmaprodukten zu erwarten ist [1–5].
11th Annual meeting of the EBMT, 1985
10 adult patients and 9 children with SAA underwent allogeneic (17) or syngeneic (2) BMT. The med... more 10 adult patients and 9 children with SAA underwent allogeneic (17) or syngeneic (2) BMT. The median age was 17 years (range 4–37),all patients were pretransfused with a median of 7 units of red blood cells (range:2–50),15 of 19 patients had received platelet support with a median of 8 single donor platelet transfusions (range 1–29) The median duration of disease was 12 weeks (3–150).9 cases were classified as idiopathic,5 had a history of hepatitis,2 were previously exposed to Chloramphenicol and 2 cases were due to Novaminsulfone and Phenylbutazone,respectively.l patient had Fanconi-anemia.17 of 19 patients were pretreated with low-dose steroids,5 patients were also pretreated with androgens,without any success. Prior to BMT,16 patients had suffered from febrile episodes,all patients had experienced minor or major bleeding complications.
Intensive Care Medicine, 2015
More than 20 years ago we reported an analysis of a case series of elderly critically ill patient... more More than 20 years ago we reported an analysis of a case series of elderly critically ill patients with acute kidney injury (AKI)-then termed acute renal failure. At that time, AKI was regarded as a &amp;amp;amp;amp;amp;amp;amp;quot;simple&amp;amp;amp;amp;amp;amp;amp;quot; complication, but has since undergone a fundamental change and actually has become one of the central syndromes in the critically ill patient. We have analyzed elderly patients above 65 years of age with an AKI defined as serum creatinine above 3 mg/dl corresponding to modern KDIGO stage 3, most of them requiring renal replacement therapy (RRT). Using an extremely complete data set the diagnosis differentiated the underlying disease entity, the dominant cause of AKI, acute and chronic risk factors (comorbidities). Special aspects such as severity of disease, early AKI at admission versus late AKI, early versus later start of RRT, AKI not treated by RRT in spite of indication for RRT, various measures of short-term and long-term prognosis, renal outcome, patients dying with resolved AKI, and causes of death were evaluated. Crude mortality was 61 % which corresponds to modern studies with gross variation among the different subgroups. Age per se was not a determinant of survival either within the group of elderly patients or as compared to younger age groups. Despite an increase in mean age and disease severity during the observation period prognosis improved. A total of 17 % of patients developed a chronic kidney disease. Long-term survival as compared to the general population was low. A look back at the last two decades illustrates a remarkable evolution or rather metamorphosis of a syndrome. AKI has evolved as a central syndrome in intensive care patients, a systemic disease process associated with multiple systemic sequels and extra-renal organ injury and exerting a pronounced effect on the course of disease and short- and long-term prognosis not only of the patient but also of the kidney. Moreover, the &amp;amp;amp;amp;amp;amp;amp;quot;non-renal-naïve&amp;amp;amp;amp;amp;amp;amp;quot; elderly patient with multiple comorbidities has become the most frequent ICU patient in industrialized nations.
Pädiatrie und Pädologie, 1981
Data of the Poison Information Center in Vienna and analysis of the literature indicate: 1) Accid... more Data of the Poison Information Center in Vienna and analysis of the literature indicate: 1) Accidental ingestion of corrosives by children occurs frequently, but rarely causes dangerous complications or sequelae (edema of the larynx, perforation and stricture formation in the esophagus or stomach). This is in contrast to attempted suicides by adults. 2) The first and most important step after the accident is the intake of copious amounts of water. The dangers of neutralizing acid or lye are discussed. 3) Only symptoms and signs, not kind or pH of the caustic agent afford a reliable guide for deciding whether or not the child needs further observation and treatment. This paper deals with first aid measures only, not with further treatment (e.g. shock treatment, prophylaxis of stricture formation etc.).
Intensivmedizinisches Seminar, 1991
Seit dem Jahre 1982 wird an der Intensivstation der I. Medizinischen Universitatsklinik eine EDV-... more Seit dem Jahre 1982 wird an der Intensivstation der I. Medizinischen Universitatsklinik eine EDV-masige Verarbeitung bakteriologischer Befunde durchgefuhrt [1].
Intensivmedizinisches Seminar, 1991
Wahrend eines Krankenhausaufenthaltes erwerben zirka 10% der Patienten eine Infektion. Diese Infe... more Wahrend eines Krankenhausaufenthaltes erwerben zirka 10% der Patienten eine Infektion. Diese Infektionsrate ist auf Intensivstation mit 14% noch deutlicher ausgepragt [5]. Das Auftreten ist abhangig von der Funktionstuchtigkeit des Abwehrsystems des Patienten und von den hygienischen Bedingungen unter denen der Patient untersucht und behandelt wird. Bei Schwerstkranken ist zusatzlich die Art und Anzahl invasiver diagnostischer und therapeutischer Masnahmen fur die Entstehung von Infektionen von Bedeutung.
Wiener Medizinische Wochenschrift, Oct 31, 1982
Therapeutic methods for treating poisoned men are based on the principles of intensive care thera... more Therapeutic methods for treating poisoned men are based on the principles of intensive care therapy. The elimination of toxins depends on the circulatory circumstances; an enhancement of poison elimination can be achieved in providing a normal circulation. In the treatment of most cases of poisoning gastric and gut lavage will be sufficient. An extracorporeal toxin elimination with hemodialysis or hemoperfusion will be reserved for special cases, because of increased technical and personal expense and a higher complication rate, compared to other methods of treatment in poisoning. Forced diuresis is a simple method, but the efficacy is reduced to a small number of substances. Also reduced to certain toxins is the method of elimination with hyperventilation.
Intensivmedizinisches Seminar, 1993
In the year 1991 the Research Departement for Intensive Therapy at the University School of Medic... more In the year 1991 the Research Departement for Intensive Therapy at the University School of Medicine in Vienna installed the Patient Data Management (PDM) system 'ATLANTIS' from 'HUMAN MICROPROCESSING' (hmp), 'HOSPITRONICS', at two Intensive Care Units (cardiothoracic and mixed surgical and general). Since this semigraphical version was used largely successfully, it was replaced by the new full graphical version ATLANTIS-GUI (Graphical User Interface) in March 1993. The first practical experiences of this version are presented. The main characteristics of the system ATLANTIS are the use of network connected standard IBM PCs and the ability of the system to communicate indifferently with any medico-technical device, independently from its manufacturer. The only condition is a standard serial port (RS232) on the device. Therefore within the short time of some weeks the patient monitors, the ventilators, the pulsoxymeters and the perfusion pumps have been successfully connected to the system. One of the most important advantages of a PC system is the fact that it is an open system. For this reason a lot of programs, developed by the users of the system, could be integrated. These are for example programs for transfer of the results of the main laboratory and of the 82 T. Neugebauer et al. local acute laboratory, furthermore a program for 24 hours summary printouts, adapted to the requests of the ward. This open architecture, together with the use ofDESQview, allows the use of other programs that share data with the PDM, for example a program for computerassisted weaning from the ventilator (KBWEAN). A program for communication with the host system of the scientific computer center of the university is under development. With this communication it will be possible to use the data base and of the complete statistical tools of the scientific computer center. Another important advantage of a PC system are the high performance and speed at the local workstation. As the computing and memory capacities and the device communication are distributed in a PC network, the performance at the local workstation is not dependent from the number of workstations. In the full graphical version of ATLANTIS it lasts only for some parts of a second in most cases to open a new window. In the semigraphical version there had been some defects, most of them have been eliminated in the new full graphical version, a lot of details had been improved considerably. In conclusion, the concept of a PDM system, based on PCs in a network and of indifferent communication at the bedside, can be regarded as a practical and approved solution with a potential of multiple uses. In the daily clinical work the presentation of trends of various parameters, simultaneously to the actual monitoring, proved to be a great benefit. It can be expected, that this system, together with the module for care planning and documentation which is now under installation, may allow the change to mainly electronic bedside documentation in the near future.
Zeitschrift für Gastroenterologie, 2003
Wiener klinische Wochenschrift, 2007
Intestinal shunting procedures followed by gastrointestinal bypass surgery have been used as ther... more Intestinal shunting procedures followed by gastrointestinal bypass surgery have been used as therapeutic modalities in the treatment of morbid obesity since the mid 1950s. Enthusiasm reached its peak in the early 1960s with the introduction of the jejunoileal bypass, however began to wane as various complications were identified in the remote postoperative period and later. Finally, the jejunoileal bypass was abandoned in the 1980s. Apart from renal disorders, it frequently resulted in abnormal liver function and liver failure which are attributed to fatty infiltration. We report a 56-year-old woman, who underwent jejunoileal bypass surgery 23 years ago. She was admitted to our ICU because of hepatic encephalopathy IV, caused by upper gastrointestinal bleeding. Beside hepatic encephalopathy there were signs of severe liver failure (INR 2.8, cholesterol 32 mg/dl, ICG PDR 5%). Liver biopsy showed fatty infiltration and cirrhosis. Excluding other causes of liver disease, severe fatty liver disease following jejunoileal bypass surgery was diagnosed. The very late onset of severe liver disease emphasizes the importance of lifelong follow-up of these patients.
Wiener Medizinische Wochenschrift, Jan 13, 2021
Despite the unique nature of ethical issues in a longterm care setting, there is limited help in ... more Despite the unique nature of ethical issues in a longterm care setting, there is limited help in decision making for nursing home personnel. 2015 the Hospizverband of Upper Austria established a clinical ethic committee to help providing a good quality of decision making in nursing home. A consultation could be asked by the managing nurses of the longterm care institution, by the resident or by relatives of the nursing home residents. Since the start of the ethic committee 24 from 137 nursing homes in Upper Austria asked for a consultation. All consultations came from the personnel of the nursing homes. Beside the nursing team and 1-3 members of the ethic committee, in 75% of the consultations the physician was present. The most often discussed ethical issues were hospital admission (25%), conflicts with relatives of the residents, artificial nutrition (including PEG tube insertion and displacement) and use of restraints. The most underlying illness was dementia (50%). 20% of the re...
2 Ascites is the most common complication of cirrhosis, and ~60% of patients with compensated cir... more 2 Ascites is the most common complication of cirrhosis, and ~60% of patients with compensated cirrhosis develop ascites within 10 years during the course of their disease A panel of experts was selected by the EASL Governing Board and met several times to discuss and write these guidelines during 2008-9. These guidelines were written according to published studies retrieved from Pubmed. The evidence and recommendations made in these guidelines have been graded according to the GRADE system (Grading of Recommendations Assessment Development and Evaluation). The strength of evidence has been classified into three levels: A, high; B, moderate; and C, low-quality evidence, while that of the recommendation into two: strong and weak UNCOMPLICATED ASCITES EVALUATION OF PATIENTS WITH ASCITES Approximately 75% of patients presenting with ascites in Western Europe or the USA have cirrhosis as the underlying cause. For the remaining patients, ascites is caused by malignancy, heart failure, tub...
Wiener Medizinische Wochenschrift, 2021
ZusammenfassungDie Betreuung pflegebedürftiger alter Menschen in Senioreneinrichtungen und Altenh... more ZusammenfassungDie Betreuung pflegebedürftiger alter Menschen in Senioreneinrichtungen und Altenheimen stellt deren Mitarbeiter in ihrer täglichen Arbeit immer wieder vor ethischen Fragen. Der Hospizverband Oberösterreich hat vor 5 Jahren ein klinisches Ethikkomitee eingerichtet, deren Aufgabe es ist, Mitarbeiter von außerklinischen Langzeiteinrichtungen bei ethischen Problemstellungen zu beraten und Hilfe zur Lösung gemeinsam zu erarbeiten. In dieser Zeit wurden 38 ethische Beratungen durchgeführt.Die Anfragen kamen von 24 der 137 in Oberösterreich derzeit bestehenden Langzeiteinrichtungen. Wobei 9 Einrichtungen mehr als eine Anfrage zu einer Beratung in diesem Zeitraum stellten. Teilnehmer an den Beratungen waren einerseits Mitglieder des Behandlungsteams, wobei bei 30 der 38 Beratungen auch die/der behandelnde Ärztin/Arzt anwesend war. Von Seiten des Ethikteams des Hospizverbandes nahmen in der Regel 2 (1–3) Mitglieder teil, wobei ein Mitglied die Moderation leitete, das weitere ...
![Research paper thumbnail of [The intoxication with cyclizin in infancy and adult age (Experiences of a contamination-information-central office) (author's transl)]](https://attachments.academia-assets.com/84011588/thumbnails/1.jpg)
](Epidemiological, clinical and therapeutic aspects obtained from 38 cases of intoxication with the... more Epidemiological, clinical and therapeutic aspects obtained from 38 cases of intoxication with the antiemetic drug "cyclizine" in children and adults are discussed. The relative frequency of accidentally or purposely performed overdosage shows a decreasing tendency. The introduction of regulations after the prescription of cyclizine compounds, leaving a limited dose available without prescription and the introduction of a safety package to prohibit misuse by children are reported in their relationship with the epidemiologic data. A toxic dose of 5 mg/kg body weight, a minimal lethal dose (MLD) of about 80 mg/kg are evaluated and compared with previous published data. Differences of age in the development of the clinical picture of the cyclizine-intoxication with a disposition for the evolvement of convulsions in children compared to the total lack of convulsions in adults have to be pointed out. The management of overdoses follows general principles of treatment like gastri...
American Journal of Physiology-Endocrinology and Metabolism, 1991
The impact of renal failure on the elimination and hydrolysis of three sources of tyrosine for pa... more The impact of renal failure on the elimination and hydrolysis of three sources of tyrosine for parenteral nutrition, the dipeptides alanyltyrosine (Ala-Tyr), glycyltyrosine (Gly-Tyr), and N-acetyltyrosine (NAc-Tyr) was investigated in eight patients on regular hemodialysis therapy (HD) and seven healthy controls (CON). In CON, whole body clearance (Ctot) of Ala-Tyr (3,169 +/- 198 ml/min) was higher than Gly-Tyr (1,781 +/- 184, P less than 0.001), and both exceeded NAc-Tyr (284 +/- 24, P less than 0.001). In HD, Ctot of Ala-Tyr was not different from CON, but Ctot of Gly-Tyr (858 +/- 73, P less than 0.001) and NAc-Tyr (129 +/- 30, P less than 0.02) was decreased. The rise in plasma levels of constituent amino acids was higher in Ala-Tyr vs. Gly-Tyr (P less than 0.01). In HD, the pattern was similar, although the increase in Tyr was less than in CON. Plasma Tyr did not increase with NAc-Tyr in either group. Urinary loss of peptides was neglible, but 60% of NAc-Tyr infused was excreted...
Patienten mit einem Guillain-Barre-Syndrom werden ublicherweise wegen drohender bzw. schon besteh... more Patienten mit einem Guillain-Barre-Syndrom werden ublicherweise wegen drohender bzw. schon bestehender Ateminsuffizienz an Intensivstationen aufgenommen. Die intensivmedizinischen Probleme, die sich bei diesen Patienten stellen, konnen jedoch weit uber die heute als etabliertes intensivmedizinisches Behandlungsverfahren geltende Plasmapherese (in Form der Membranplasmaseparation) bzw. die Respiratortherapie hinausreichen. In der vorliegenden Ubersicht sollen die uber die Diagnostik und spezifische neurologische Therapiemasnahmen hinausgehenden intensivmedizinischen Probleme bei Patienten mit Guillain-Barre-Syndrom besprochen werden [1, 2].
The American Journal of Clinical Nutrition, 1994
The elimination of intravenously infused amino acids was evaluated in six patients with acute ren... more The elimination of intravenously infused amino acids was evaluated in six patients with acute renal failure (ARF), 6 with conservatively treated chronic renal failure (CRF), 6 subjects receiving regular hemodialysis treatment (RDT), and 5 healthy control subjects. In ARF, CRF, and RDT groups, whole-body clearance (Cltot) of the 10 amino acids was elevated (113.5 +/- 1.5; 94.2 +/- 1.5 and 127.6 +/- 12.4, respectively, vs 85.2 +/- 4.8 mL.kg-1.min-1 in control subjects, P < 0.001). In ARF, Cltot of histidine, lysine, and methionine was higher and Cltot of phenylalanine and valine was lower as compared with control subjects. In CRF, Cltot of tryptophan and histidine was elevated and Cltot of phenylalanine was reduced; in RDT, Cltot of histidine, methionine, tryptophan, lysine, isoleucine, and leucine was raised. In all groups the relative clearance (% of total clearance) of phenylalanine and valine was reduced, and relative clearance of histidine and tryptophan was elevated. We conclude that in renal failure the elimination of amino acids from the intravascular space is profoundly altered and that the pattern of metabolic aberrations is similar in ARF, CRF, and RDT groups.
Intensivmedizinisches Seminar, 1995
Die Zufuhr von Blut- und Plasmaprodukten, insbesondere im Rahmen der Intensiv- und Transplantatio... more Die Zufuhr von Blut- und Plasmaprodukten, insbesondere im Rahmen der Intensiv- und Transplantationsmedizin, ist ein integraler Bestandteil der optimalen Patientenbetreuung. Allerdings kann diese Form der Therapie mit Komplikationen verbunden sein, wobei ein Anstieg der Komplikationsrate mit der Menge an transfundierten Plasmaprodukten zu erwarten ist [1–5].
11th Annual meeting of the EBMT, 1985
10 adult patients and 9 children with SAA underwent allogeneic (17) or syngeneic (2) BMT. The med... more 10 adult patients and 9 children with SAA underwent allogeneic (17) or syngeneic (2) BMT. The median age was 17 years (range 4–37),all patients were pretransfused with a median of 7 units of red blood cells (range:2–50),15 of 19 patients had received platelet support with a median of 8 single donor platelet transfusions (range 1–29) The median duration of disease was 12 weeks (3–150).9 cases were classified as idiopathic,5 had a history of hepatitis,2 were previously exposed to Chloramphenicol and 2 cases were due to Novaminsulfone and Phenylbutazone,respectively.l patient had Fanconi-anemia.17 of 19 patients were pretreated with low-dose steroids,5 patients were also pretreated with androgens,without any success. Prior to BMT,16 patients had suffered from febrile episodes,all patients had experienced minor or major bleeding complications.
Intensive Care Medicine, 2015
More than 20 years ago we reported an analysis of a case series of elderly critically ill patient... more More than 20 years ago we reported an analysis of a case series of elderly critically ill patients with acute kidney injury (AKI)-then termed acute renal failure. At that time, AKI was regarded as a &amp;amp;amp;amp;amp;amp;amp;quot;simple&amp;amp;amp;amp;amp;amp;amp;quot; complication, but has since undergone a fundamental change and actually has become one of the central syndromes in the critically ill patient. We have analyzed elderly patients above 65 years of age with an AKI defined as serum creatinine above 3 mg/dl corresponding to modern KDIGO stage 3, most of them requiring renal replacement therapy (RRT). Using an extremely complete data set the diagnosis differentiated the underlying disease entity, the dominant cause of AKI, acute and chronic risk factors (comorbidities). Special aspects such as severity of disease, early AKI at admission versus late AKI, early versus later start of RRT, AKI not treated by RRT in spite of indication for RRT, various measures of short-term and long-term prognosis, renal outcome, patients dying with resolved AKI, and causes of death were evaluated. Crude mortality was 61 % which corresponds to modern studies with gross variation among the different subgroups. Age per se was not a determinant of survival either within the group of elderly patients or as compared to younger age groups. Despite an increase in mean age and disease severity during the observation period prognosis improved. A total of 17 % of patients developed a chronic kidney disease. Long-term survival as compared to the general population was low. A look back at the last two decades illustrates a remarkable evolution or rather metamorphosis of a syndrome. AKI has evolved as a central syndrome in intensive care patients, a systemic disease process associated with multiple systemic sequels and extra-renal organ injury and exerting a pronounced effect on the course of disease and short- and long-term prognosis not only of the patient but also of the kidney. Moreover, the &amp;amp;amp;amp;amp;amp;amp;quot;non-renal-naïve&amp;amp;amp;amp;amp;amp;amp;quot; elderly patient with multiple comorbidities has become the most frequent ICU patient in industrialized nations.
Pädiatrie und Pädologie, 1981
Data of the Poison Information Center in Vienna and analysis of the literature indicate: 1) Accid... more Data of the Poison Information Center in Vienna and analysis of the literature indicate: 1) Accidental ingestion of corrosives by children occurs frequently, but rarely causes dangerous complications or sequelae (edema of the larynx, perforation and stricture formation in the esophagus or stomach). This is in contrast to attempted suicides by adults. 2) The first and most important step after the accident is the intake of copious amounts of water. The dangers of neutralizing acid or lye are discussed. 3) Only symptoms and signs, not kind or pH of the caustic agent afford a reliable guide for deciding whether or not the child needs further observation and treatment. This paper deals with first aid measures only, not with further treatment (e.g. shock treatment, prophylaxis of stricture formation etc.).
Intensivmedizinisches Seminar, 1991
Seit dem Jahre 1982 wird an der Intensivstation der I. Medizinischen Universitatsklinik eine EDV-... more Seit dem Jahre 1982 wird an der Intensivstation der I. Medizinischen Universitatsklinik eine EDV-masige Verarbeitung bakteriologischer Befunde durchgefuhrt [1].
Intensivmedizinisches Seminar, 1991
Wahrend eines Krankenhausaufenthaltes erwerben zirka 10% der Patienten eine Infektion. Diese Infe... more Wahrend eines Krankenhausaufenthaltes erwerben zirka 10% der Patienten eine Infektion. Diese Infektionsrate ist auf Intensivstation mit 14% noch deutlicher ausgepragt [5]. Das Auftreten ist abhangig von der Funktionstuchtigkeit des Abwehrsystems des Patienten und von den hygienischen Bedingungen unter denen der Patient untersucht und behandelt wird. Bei Schwerstkranken ist zusatzlich die Art und Anzahl invasiver diagnostischer und therapeutischer Masnahmen fur die Entstehung von Infektionen von Bedeutung.
Wiener Medizinische Wochenschrift, Oct 31, 1982
Therapeutic methods for treating poisoned men are based on the principles of intensive care thera... more Therapeutic methods for treating poisoned men are based on the principles of intensive care therapy. The elimination of toxins depends on the circulatory circumstances; an enhancement of poison elimination can be achieved in providing a normal circulation. In the treatment of most cases of poisoning gastric and gut lavage will be sufficient. An extracorporeal toxin elimination with hemodialysis or hemoperfusion will be reserved for special cases, because of increased technical and personal expense and a higher complication rate, compared to other methods of treatment in poisoning. Forced diuresis is a simple method, but the efficacy is reduced to a small number of substances. Also reduced to certain toxins is the method of elimination with hyperventilation.
Intensivmedizinisches Seminar, 1993
In the year 1991 the Research Departement for Intensive Therapy at the University School of Medic... more In the year 1991 the Research Departement for Intensive Therapy at the University School of Medicine in Vienna installed the Patient Data Management (PDM) system 'ATLANTIS' from 'HUMAN MICROPROCESSING' (hmp), 'HOSPITRONICS', at two Intensive Care Units (cardiothoracic and mixed surgical and general). Since this semigraphical version was used largely successfully, it was replaced by the new full graphical version ATLANTIS-GUI (Graphical User Interface) in March 1993. The first practical experiences of this version are presented. The main characteristics of the system ATLANTIS are the use of network connected standard IBM PCs and the ability of the system to communicate indifferently with any medico-technical device, independently from its manufacturer. The only condition is a standard serial port (RS232) on the device. Therefore within the short time of some weeks the patient monitors, the ventilators, the pulsoxymeters and the perfusion pumps have been successfully connected to the system. One of the most important advantages of a PC system is the fact that it is an open system. For this reason a lot of programs, developed by the users of the system, could be integrated. These are for example programs for transfer of the results of the main laboratory and of the 82 T. Neugebauer et al. local acute laboratory, furthermore a program for 24 hours summary printouts, adapted to the requests of the ward. This open architecture, together with the use ofDESQview, allows the use of other programs that share data with the PDM, for example a program for computerassisted weaning from the ventilator (KBWEAN). A program for communication with the host system of the scientific computer center of the university is under development. With this communication it will be possible to use the data base and of the complete statistical tools of the scientific computer center. Another important advantage of a PC system are the high performance and speed at the local workstation. As the computing and memory capacities and the device communication are distributed in a PC network, the performance at the local workstation is not dependent from the number of workstations. In the full graphical version of ATLANTIS it lasts only for some parts of a second in most cases to open a new window. In the semigraphical version there had been some defects, most of them have been eliminated in the new full graphical version, a lot of details had been improved considerably. In conclusion, the concept of a PDM system, based on PCs in a network and of indifferent communication at the bedside, can be regarded as a practical and approved solution with a potential of multiple uses. In the daily clinical work the presentation of trends of various parameters, simultaneously to the actual monitoring, proved to be a great benefit. It can be expected, that this system, together with the module for care planning and documentation which is now under installation, may allow the change to mainly electronic bedside documentation in the near future.
Zeitschrift für Gastroenterologie, 2003
Wiener klinische Wochenschrift, 2007
Intestinal shunting procedures followed by gastrointestinal bypass surgery have been used as ther... more Intestinal shunting procedures followed by gastrointestinal bypass surgery have been used as therapeutic modalities in the treatment of morbid obesity since the mid 1950s. Enthusiasm reached its peak in the early 1960s with the introduction of the jejunoileal bypass, however began to wane as various complications were identified in the remote postoperative period and later. Finally, the jejunoileal bypass was abandoned in the 1980s. Apart from renal disorders, it frequently resulted in abnormal liver function and liver failure which are attributed to fatty infiltration. We report a 56-year-old woman, who underwent jejunoileal bypass surgery 23 years ago. She was admitted to our ICU because of hepatic encephalopathy IV, caused by upper gastrointestinal bleeding. Beside hepatic encephalopathy there were signs of severe liver failure (INR 2.8, cholesterol 32 mg/dl, ICG PDR 5%). Liver biopsy showed fatty infiltration and cirrhosis. Excluding other causes of liver disease, severe fatty liver disease following jejunoileal bypass surgery was diagnosed. The very late onset of severe liver disease emphasizes the importance of lifelong follow-up of these patients.
Wiener Medizinische Wochenschrift, Jan 13, 2021
Despite the unique nature of ethical issues in a longterm care setting, there is limited help in ... more Despite the unique nature of ethical issues in a longterm care setting, there is limited help in decision making for nursing home personnel. 2015 the Hospizverband of Upper Austria established a clinical ethic committee to help providing a good quality of decision making in nursing home. A consultation could be asked by the managing nurses of the longterm care institution, by the resident or by relatives of the nursing home residents. Since the start of the ethic committee 24 from 137 nursing homes in Upper Austria asked for a consultation. All consultations came from the personnel of the nursing homes. Beside the nursing team and 1-3 members of the ethic committee, in 75% of the consultations the physician was present. The most often discussed ethical issues were hospital admission (25%), conflicts with relatives of the residents, artificial nutrition (including PEG tube insertion and displacement) and use of restraints. The most underlying illness was dementia (50%). 20% of the re...
2 Ascites is the most common complication of cirrhosis, and ~60% of patients with compensated cir... more 2 Ascites is the most common complication of cirrhosis, and ~60% of patients with compensated cirrhosis develop ascites within 10 years during the course of their disease A panel of experts was selected by the EASL Governing Board and met several times to discuss and write these guidelines during 2008-9. These guidelines were written according to published studies retrieved from Pubmed. The evidence and recommendations made in these guidelines have been graded according to the GRADE system (Grading of Recommendations Assessment Development and Evaluation). The strength of evidence has been classified into three levels: A, high; B, moderate; and C, low-quality evidence, while that of the recommendation into two: strong and weak UNCOMPLICATED ASCITES EVALUATION OF PATIENTS WITH ASCITES Approximately 75% of patients presenting with ascites in Western Europe or the USA have cirrhosis as the underlying cause. For the remaining patients, ascites is caused by malignancy, heart failure, tub...
Wiener Medizinische Wochenschrift, 2021
ZusammenfassungDie Betreuung pflegebedürftiger alter Menschen in Senioreneinrichtungen und Altenh... more ZusammenfassungDie Betreuung pflegebedürftiger alter Menschen in Senioreneinrichtungen und Altenheimen stellt deren Mitarbeiter in ihrer täglichen Arbeit immer wieder vor ethischen Fragen. Der Hospizverband Oberösterreich hat vor 5 Jahren ein klinisches Ethikkomitee eingerichtet, deren Aufgabe es ist, Mitarbeiter von außerklinischen Langzeiteinrichtungen bei ethischen Problemstellungen zu beraten und Hilfe zur Lösung gemeinsam zu erarbeiten. In dieser Zeit wurden 38 ethische Beratungen durchgeführt.Die Anfragen kamen von 24 der 137 in Oberösterreich derzeit bestehenden Langzeiteinrichtungen. Wobei 9 Einrichtungen mehr als eine Anfrage zu einer Beratung in diesem Zeitraum stellten. Teilnehmer an den Beratungen waren einerseits Mitglieder des Behandlungsteams, wobei bei 30 der 38 Beratungen auch die/der behandelnde Ärztin/Arzt anwesend war. Von Seiten des Ethikteams des Hospizverbandes nahmen in der Regel 2 (1–3) Mitglieder teil, wobei ein Mitglied die Moderation leitete, das weitere ...
Epidemiological, clinical and therapeutic aspects obtained from 38 cases of intoxication with the... more Epidemiological, clinical and therapeutic aspects obtained from 38 cases of intoxication with the antiemetic drug "cyclizine" in children and adults are discussed. The relative frequency of accidentally or purposely performed overdosage shows a decreasing tendency. The introduction of regulations after the prescription of cyclizine compounds, leaving a limited dose available without prescription and the introduction of a safety package to prohibit misuse by children are reported in their relationship with the epidemiologic data. A toxic dose of 5 mg/kg body weight, a minimal lethal dose (MLD) of about 80 mg/kg are evaluated and compared with previous published data. Differences of age in the development of the clinical picture of the cyclizine-intoxication with a disposition for the evolvement of convulsions in children compared to the total lack of convulsions in adults have to be pointed out. The management of overdoses follows general principles of treatment like gastri...
American Journal of Physiology-Endocrinology and Metabolism, 1991
The impact of renal failure on the elimination and hydrolysis of three sources of tyrosine for pa... more The impact of renal failure on the elimination and hydrolysis of three sources of tyrosine for parenteral nutrition, the dipeptides alanyltyrosine (Ala-Tyr), glycyltyrosine (Gly-Tyr), and N-acetyltyrosine (NAc-Tyr) was investigated in eight patients on regular hemodialysis therapy (HD) and seven healthy controls (CON). In CON, whole body clearance (Ctot) of Ala-Tyr (3,169 +/- 198 ml/min) was higher than Gly-Tyr (1,781 +/- 184, P less than 0.001), and both exceeded NAc-Tyr (284 +/- 24, P less than 0.001). In HD, Ctot of Ala-Tyr was not different from CON, but Ctot of Gly-Tyr (858 +/- 73, P less than 0.001) and NAc-Tyr (129 +/- 30, P less than 0.02) was decreased. The rise in plasma levels of constituent amino acids was higher in Ala-Tyr vs. Gly-Tyr (P less than 0.01). In HD, the pattern was similar, although the increase in Tyr was less than in CON. Plasma Tyr did not increase with NAc-Tyr in either group. Urinary loss of peptides was neglible, but 60% of NAc-Tyr infused was excreted...