Wiener Klinische Wochenschrift最新文献

{"title":"Acute liver failure in patients admitted to the intensive care unit-a Viennese retrospective single-center analysis.","authors":"Patrick Haselwanter, Seanna Fairfield, Marlene Riedl-Wewalka, Monika Schmid, Albert Friedrich Stättermayer, Thomas Reiberger, Michael Trauner, Christian Zauner, Mathias Schneeweiss-Gleixner","doi":"10.1007/s00508-025-02539-1","DOIUrl":"https://doi.org/10.1007/s00508-025-02539-1","url":null,"abstract":"<p><strong>Background: </strong>Acute liver failure (ALF) is characterized by a rapid deterioration of liver function and a high mortality without transplantation depending on etiology and onset. Immediate transfer to a dedicated intensive care unit (ICU) and evaluation for high-urgency liver transplantation (HU-LTx) is recommended to maximize chances of survival. Data on ALF epidemiology are limited, particularly for Central Europe.</p><p><strong>Methods: </strong>This retrospective single-center study included all ALF patients admitted to the ICU of the Department of Gastroenterology and Hepatology at the Vienna General Hospital between 2012 and 2024.</p><p><strong>Results: </strong>Overall, 31 patients (median age of 44 [interquartile range, IQR 32-56] years, 20 [65%] female) were included. The primary causes of ALF were viral infections (n = 8; 26%), autoimmune hepatitis (n = 5; 16%), drug-induced liver injury (DILI; n = 3; 10%), and Wilson's disease (n = 4; 13%), while in 8 patients (26%) no cause was identified. Median length of ICU stay was 12 (IQR 4-21) days, with mean sequential organ failure assessment (SOFA) and simplified acute physiology score II (SAPS II) scores of 10.55 ± 4.56 and 40.97 ± 14.84. Overall ICU survival was 61% (n = 19). Non-HU-LTx patients (n = 18) had an ICU survival of 44%. HU-LTx was performed in 13 patients (42%), with 12 patients (92%) surviving 28 days. The 6‑month overall survival of HU-LTx patients was 85%.</p><p><strong>Conclusion: </strong>The diverse causes of ALF in Central Europe include most commonly viral infections, autoimmune hepatitis, and DILI. HU-LTx was required and performed in almost half of patients and was associated with favorable survival rates, underscoring the importance of ICU management and early transfer to liver transplantation centers in the management of ALF.</p>","PeriodicalId":23861,"journal":{"name":"Wiener Klinische Wochenschrift","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Completely ulcerated infantile hemangioma: a diagnostic challenge.","authors":"Elias Marquart, Doris Weiss, Klaudija Batinic, Thomas Wiesner, Johannes Rohrbeck, Tamara Arnoldner, Wolfgang Weninger, Tamar Kinaciyan","doi":"10.1007/s00508-025-02543-5","DOIUrl":"https://doi.org/10.1007/s00508-025-02543-5","url":null,"abstract":"<p><p>The present case report describes a completely ulcerated infantile hemangioma (UIH) in a 5-month-old infant on the left proximolateral thigh initially misdiagnosed as pyoderma gangrenosum, sporotrichosis or atypical mycobacterial infection. Clinical assessment, histological findings, and GLUT‑1 immunohistochemistry confirmed the diagnosis of UIH. Systemic propranolol treatment led to rapid ulcer healing within 3 weeks and complete recovery without relapse after 18 months of treatment. The report emphasizes the diagnostic challenges, effective propranolol treatment and the importance of considering UIH in the differential diagnoses of solitary pediatric ulcers.</p>","PeriodicalId":23861,"journal":{"name":"Wiener Klinische Wochenschrift","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No increase of biopsy rates despite high rates of probable eosinophilic esophagitis in patients with esophageal food impaction.","authors":"Lukas Neumann, Rafael Brader, Lili Kazemi-Shirazi, Michael Trauner, Christian Primas, Karin Wisniowski, Jurij Maurer, Hansjörg Schlager, Jagoda Pokryszka, Clemens Dejaco, Walter Reinisch, Gottfried Novacek, Philipp Schreiner","doi":"10.1007/s00508-025-02542-6","DOIUrl":"https://doi.org/10.1007/s00508-025-02542-6","url":null,"abstract":"<p><strong>Introduction: </strong>Eosinophilic esophagitis (EoE) is one of the main causes of esophageal food impaction (EFI). Since only few endoscopists take biopsies during the emergency endoscopy at EFI presentation, as is recommended by current guidelines, a high number of patients will not have a proper diagnosis after EFI. Hence, we investigated the change of biopsy rates and the etiology of EFI over 11 years.</p><p><strong>Methods: </strong>All patients presenting at the emergency department (ED) of a tertiary center with an EFI who underwent esophagogastroduodenoscopy (EGD) between 2013 and 2023 were included. Clinical and endoscopic variables were analyzed retrospectively. We performed a binary logistic regression model to predict biopsy performance.</p><p><strong>Results: </strong>A total of 180 EFI cases (67% male, median age 57 years) were recorded between 2013 and 2023. Overall, esophageal biopsies were taken only in 18% without any increase over time. In patients ≥ 50 years of age (n = 108), the etiology remained unknown in half of patients (48%), followed by gastroesophageal reflux disease (GERD; 23%) and EoE (18%). However, in patients < 50 years of age, EoE was the main suspected etiology in 69% of cases. Biopsies were obtained in only 18% of all patients with suspected EoE. Age, gender, and the year of EFI were not associated with biopsy performance. However, the probability of biopsy increased by a factor of 4.03 in the presence of suspected EoE by the endoscopist.</p><p><strong>Conclusion: </strong>Despite an increasing awareness of EoE, the biopsy rate in EFI is rather low. Routine biopsies should be taken to shorten diagnostic delay.</p>","PeriodicalId":23861,"journal":{"name":"Wiener Klinische Wochenschrift","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Structural quality criteria of emergency departments in Vienna.","authors":"Harald Herkner, Alexandra J Lipa, Philip Eisenburger, Wilhelm Behringer, Alexander Spiel, Sonja Mahrer, Moritz Haugk, Rainer Thell, Marie-Kathrin Breyer, Nicole Biber, Edith Doberer, Anna Kreil, Michael Schwameis","doi":"10.1007/s00508-025-02541-7","DOIUrl":"https://doi.org/10.1007/s00508-025-02541-7","url":null,"abstract":"<p><strong>Background: </strong>In 2020, the Austrian Association of Emergency Medicine proposed structural quality criteria for in-hospital emergency care in Austria. However, it has not yet been assessed how these criteria apply to existing emergency departments.</p><p><strong>Methods: </strong>All in-hospital emergency departments across Vienna were surveyed using a structured assessment based on published proposed structural quality criteria. A total of 54 criteria were analysed, each rated on a scale of 3 (comprehensive care), 2 (standard care), 1 (basic care), or 0 (not met).</p><p><strong>Results: </strong>Among 16 hospitals, we identified 10 emergency departments. The scores ranged from 87 points (54%) to 151 points (95%). None of the departments met all structural quality criteria. Overall, across all emergency departments, 69% of the criteria aligned with comprehensive care, 7% with standard care and 3% with basic care, while 21% of the criteria were not met at all.</p><p><strong>Conclusions: </strong>A set of proposed structural quality criteria for emergency departments could be quantitatively assessed. While the published criteria and the observed infrastructure are largely consistent, there is significant potential for improvement in both the definition of the criteria and the criteria per se. The extent to which these structural quality criteria are useful for assessing the classification of tiered care models requires further studies in different regions.</p>","PeriodicalId":23861,"journal":{"name":"Wiener Klinische Wochenschrift","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inadequate pediatric reference ranges impede the diagnosis of X-linked hypophosphatemia and hypophosphatasia in Austria.","authors":"Jojo Steininger, Magdalena Jablonska, Susanne Sagmeister, Gabriel Mindler, Adalbert Raimann","doi":"10.1007/s00508-025-02546-2","DOIUrl":"https://doi.org/10.1007/s00508-025-02546-2","url":null,"abstract":"<p><strong>Background: </strong>Accurate diagnosis of many pediatric disorders relies on age-specific laboratory reference ranges. This is particularly important for rare disorders such as X‑linked hypophosphatemia (XLH) and hypophosphatasia (HPP), which present with decreases in serum phosphate and alkaline phosphatase (ALP), respectively.</p><p><strong>Objective: </strong>This study evaluated the use of pediatric reference ranges among Austrian medical laboratories.</p><p><strong>Methods: </strong>A comprehensive list of all extramural clinical laboratories was compiled. A standardized serum sample with pathological values for a 4-year-old child was dispatched to 26 extramural laboratories. The returned absolute and stated reference values were assessed and analyzed.</p><p><strong>Results: </strong>Of 22 responding laboratories, 18.2% used appropriate pediatric reference ranges for serum phosphate and 40.9% for ALP. In total, 54.5 and 36.4% of laboratories identified the sample as normal for serum phosphate or ALP, respectively.</p><p><strong>Conclusion: </strong>Despite accurate absolute value measurements, the majority of laboratories failed to identify the test sample as pathologic. In a real-world setting, the results obtained could lead to significant diagnostic delays and missed diagnoses in pediatric patients. The lack of regulatory requirements for pediatric-specific reference ranges in Austria and most European countries contributes to this problem. The study highlights the need for standardization and mandatory implementation of pediatric reference ranges to improve diagnostic accuracy for rare pediatric disorders across Europe.</p>","PeriodicalId":23861,"journal":{"name":"Wiener Klinische Wochenschrift","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wild-type transthyretin cardiac amyloidosis mimicking hypertrophic obstructive cardiomyopathy : A case report.","authors":"Nikol Kubinova, Tomas Paleček, Marek Mika, Radek Jaksa, Ales Linhart","doi":"10.1007/s00508-025-02540-8","DOIUrl":"https://doi.org/10.1007/s00508-025-02540-8","url":null,"abstract":"<p><strong>Background: </strong>Wild-type transthyretin cardiac amyloidosis (ATTRwt CA) is increasingly recognized as an important cause of heart failure and arrhythmias in older people. There are several clinical, echocardiographic, electrocardiographic (ECG) and laboratory features that increase the suspicion for ATTRwt CA. Presentation and phenotype can, however, be associated with atypical findings making it difficult to make a correct diagnosis. A 65-year-old man was admitted for an acute coronary syndrome. Echocardiography revealed diffuse concentric left ventricular (LV) thickening. Because of a history of bilateral carpal tunnel syndrome and polyneuropathy, the patient underwent dedicated laboratory testing and diphosphonate scintigraphy the results of which were suggestive of transthyretin cardiac amyloidosis. Also, a dynamic LV outflow tract obstruction due to the systolic anterior motion of the anterior mitral valve was noted on echocardiography during the initial investigations. Genetic testing for hypertrophic cardiomyopathy was negative. Seeking a conclusive diagnosis, endomyocardial biopsy was performed. This confirmed the diagnosis of ATTRwt CA.</p><p><strong>Discussion: </strong>The presence of dynamic LV outflow tract obstruction is typically seen in patients with sarcomeric hypertrophic cardiomyopathy. It can be rarely seen also in individuals with cardiac amyloidosis, including ATTR-wt CA. The presence of so-called red flags in patients' history, physical examination, laboratory test, ECG and imaging should raise suspicion for other etiologies of LV wall thickening than hypertrophic cardiomyopathy. Although noninvasive diagnosis of ATTRwt CA is possible in most patients, endomyocardial biopsy remains necessary in cases with diagnostic ambiguity.</p>","PeriodicalId":23861,"journal":{"name":"Wiener Klinische Wochenschrift","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Highlights aus unserem Fortbildungsprogramm.","authors":"","doi":"10.1007/s00508-025-02538-2","DOIUrl":"https://doi.org/10.1007/s00508-025-02538-2","url":null,"abstract":"","PeriodicalId":23861,"journal":{"name":"Wiener Klinische Wochenschrift","volume":"137 9-10","pages":"323"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications of forgotten ureteral stents: stone encrustation and stent embedded in stone.","authors":"Gökhan Tonkaz, Duygu Erkal, Mehmet Tonkaz, Ahmet Yasin Yitik","doi":"10.1007/s00508-025-02513-x","DOIUrl":"10.1007/s00508-025-02513-x","url":null,"abstract":"","PeriodicalId":23861,"journal":{"name":"Wiener Klinische Wochenschrift","volume":" ","pages":"317-318"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A causal relationship between hypothyroidism and rheumatoid arthritis, but not hyperthyroidism: evidence from the mendelian randomization study.","authors":"Mingyi Yang, Yani Su, Ke Xu, Pengfei Wen, Jianbin Guo, Zhi Yang, Lin Liu, Peng Xu","doi":"10.1007/s00508-024-02386-6","DOIUrl":"10.1007/s00508-024-02386-6","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the genetic level causal association among hyperthyroidism, hypothyroidism, and rheumatoid arthritis (RA).</p><p><strong>Methods: </strong>We utilized the genome-wide association studies (GWAS) summary data for exposure (hyperthyroidism and hypothyroidism) and outcome (RA) from the IEU OpenGWAS database. We used two different sets of data (test cohort and validation cohort) for causal assessment of exposure and outcome. To establish a causal relationship between these conditions, we conducted a two-sample Mendelian randomization (MR) analysis. Subsequently, we evaluated the MR analysis results for heterogeneity, horizontal pleiotropy, and outliers, aiming to assess the validity and reliability of the findings. Moreover, we conducted additional analyses to examine the robustness of the MR results, including a \"Leave one out\" analysis and the MR robust adjusted profile score (MR-RAPS) method, ensuring the robustness and adherence to normal distribution assumptions.</p><p><strong>Results: </strong>The findings from the test cohort indicated that hyperthyroidism did not exhibit a genetic causal association with RA (P = 0.702, odds ratio [OR] 95% confidence interval [CI] = 1.021 [0.918-1.135]). Conversely, hypothyroidism displayed a positive genetic causal relationship with RA (P < 0.001, OR 95% CI = 1.239 [1.140-1.347]). The analysis results of the validation cohort are consistent with those of the test cohort. Notably, our MR analysis results demonstrated no evidence of heterogeneity, horizontal pleiotropy, or outliers. Furthermore, our MR analysis results remained unaffected by any single nucleotide polymorphism (SNP) and exhibited a normal distribution.</p><p><strong>Conclusion: </strong>The results of this study showed that hypothyroidism was positively correlated with RA, while hyperthyroidism was not causally correlated with RA. Hypothyroidism may as a risk factor of RA should be paid attention to in clinical work. Future studies are needed to further confirm this finding.</p>","PeriodicalId":23861,"journal":{"name":"Wiener Klinische Wochenschrift","volume":" ","pages":"279-290"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12081479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141432947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic relationship between rheumatoid arthritis and cardiovascular diseases : A systematic review of Mendelian randomization studies.","authors":"Mathias Ausserwinkler, Sophie Gensluckner, Andreas Voelkerer, Jens Thiel, Hans-Jörg Neumann, Maria Flamm, Christian Datz, Elmar Aigner, Bernhard Wernly","doi":"10.1007/s00508-024-02392-8","DOIUrl":"10.1007/s00508-024-02392-8","url":null,"abstract":"<p><strong>Objective: </strong>Rheumatoid arthritis (RA) is recognized as a chronic autoimmune disorder with systemic inflammation and joint damage. Its potential role as a risk factor for cardiovascular diseases (CVD) is increasingly noted. This review delves into the causal relationship between RA and CVD, with Mendelian randomization (MR) offering a genetic perspective.</p><p><strong>Methods: </strong>An extensive search was conducted in PubMed, Cochrane and Web of Science to identify MR studies addressing the RA-CVD link. Out of 530 studies, 9 met the inclusion criteria, which were rigorously assessed using a critical appraisal checklist. These were further stratified by a sensitivity analysis into categories reflecting the strength of their evidence, from not evaluable to robust.</p><p><strong>Results: </strong>From the nine included studies, eight supported a causal association between RA and an increased risk of CVD, specifically coronary artery disease (CAD) and one did not support a link between RA and heart failure. The results suggest that genetic factors associated with RA may contribute to an elevated risk for CVD. Chronic inflammation, prevalent in RA, emerges as a key mediator in this connection.</p><p><strong>Conclusion: </strong>The systematic review corroborates a genetic causal link between RA and CVD, as evidenced by eight of the nine MR studies reviewed. This suggests a need for integrated cardiovascular risk management in the treatment of RA patients. The findings advocate considering anti-inflammatory treatment that can reduce cardiovascular risk. The overarching evidence signifies a potential direction for new therapeutic strategies aimed at enhancing cardiovascular health in RA patients.</p>","PeriodicalId":23861,"journal":{"name":"Wiener Klinische Wochenschrift","volume":" ","pages":"272-278"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12081514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141767607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}