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In Osterreich sind rund 744.000 Erwerbstatige Schichtarbeiter. Da der Mensch eine tageszyklische Spezies ist, lost die Schichtarbeit Storungen der zirkadianen Rhythmik aus. Ziel der Studie ist es, den Zusammenhang zwischen Schichtarbeit, Ubergewicht und Hypogonadismus aufzuzeigen. Im Rahmen eines Mannergesundheitstages wurden bei Mitarbeitern des osterreichischen Bundesministeriums fur Inneres Serumtestosteron, PSA und, mittels bioelektrischer Impedanzanalyse, die Korperzusammensetzung bestimmt. Die Teilnehmer mussten in einem Fragebogen angeben, ob sie Schichtdienst leisten und ob sie an Schlafstorungen („shift work sleep disorder“), leiden. Ein Testosteronmangel wurde mit einem Wert 25 definiert. Bei 36 Mannern konnten die Daten ausgewertet werden, 12 davon leisteten Schichtdienst. Bei unserer Studie mit alteren Teilnehmern hatten fast 60 % der Probanden mit Schichtdienst verminderte T‑Spiegel (Testosteronspiegel) mit einem um ~25 % niedrigeren Gesamt‑T. Personen mit Schlafstorungen hatten deutlich niedrigere T‑Werte. Die Parameter fur die Korperzusammensetzung, wie Korpergewicht, BMI und Fettanteil, zeigten bei der Gruppe der Schichtarbeiter hohere Werte. Bei ~30 % fand sich ein erhohter PSA-Wert. Diese Ergebnisse spiegeln wider, dass Schichtarbeit mit einem deutlich hoheren PSA assoziiert ist. Das Prostatakarzinomrisiko steigt um ~2,8 %/5 Jahre, und im Schnitt haben Schichtarbeiter ein relatives Risiko von ~1,2 (95 %-KI: 1,1–1,5). Schichtarbeit ist ein Risikofaktor fur Adipositas, Hypogonadismus und Prostatakarzinom. Ein Grosteil der Beschaftigten toleriert allerdings Schichtarbeit ohne Probleme, wobei Schlafstorungen ursachlich zu einer verminderten Toleranz und niedrigeren Testosteronspiegel fuhren konnen.

Burnout and work-related stress symptoms of anxiety disorder and depression cause prolonged work absenteeism and early retirement. Hence, reliable identification of patients under risk and monitoring of treatment success is highly warranted. We aimed to evaluate stress-specific biomarkers in a population-based, “real-world” cohort (burnouts: n = 40, healthy controls: n = 26), recruited at a preventive care ward, at baseline and after a four-month follow up, during which patients received medical and psychological treatment. At baseline, significantly higher levels of salivary cortisol were observed in the burnout group compared to the control group. This was even more pronounced in midday- (p

Bite wounds are among the commonest types of trauma to which man is the subject. They account for 5 % of the total traumatic wounds evaluated in the emergency department (ED) and approximately 1 % of all the ED visits. Early estimation of infection risk, adequate antibiotic therapy and if indicated surgical treatment are the cornerstones of successful cure of bite wounds. A total of 5248 consecutive trauma patients were collected prospectively and analysed retrospectively over a period of 15 years in this study at a level I trauma centre, Department of Trauma Surgery, Medical University of Vienna, Austria. The mean age was 33.8 years (range 0–97), 2620 (49.9 %) were male and 2628 (50.1 %) were female individuals. In our study population, a total of 2530 dog bites (48.2 %), 930 cat bites (17.8 %), 357 other animal bites (6.8 %), 426 human bites (8.1 %) and 1005 human self-bites (19.2 %) have been observed. A total of 995 wounds (19.0 %) have been infected. Surgery was done in 132 wounds (2.5 %). We could show a six times higher infection rate of cat bites compared to dog bites. Human bites showed a total infection rate of 8.2 %. Observed infection rate of puncture wounds and wounds greater than 3 cm was 1.5 times higher than for all other wounds in the present study. Total infection rates within 24 h to antibiotic administration was 29.3 %, compared to 65.0 %

The purpose of this study was to determine whether different forms of stabilization for open femur fractures can be performed without influencing outcome, in particular infection and delayed unions/nonunions. Although the traditional management of these injuries is external fixation, a trend toward definitive stabilization techniques has evolved in the current literature. All open fractures of the femur shaft and the distal femur presenting to our urban Level I trauma center during a 10 year period were reviewed. A total of 40 patients (41 fractures) were initially treated at the above institution within 6 h of injury. All patients underwent emergent wound irrigation, debridement, and antibiothic theraphy. The method of fracture immobilization was left to the discretion of the attending trauma surgent. Study population consited of 12 (29 %) GI, 10 (25 %) GII, and 19 (46 %) GIII fractures. Initially, fracture management was performed with external fixation (EF) 19 (43.2 %), intramedullary nailing (IM) 18 (38.6 %), plating (PL) 3 (6.8 %), screw fixation (SF) 1 (2.3 %) and without treatment 4 (9.1 %). In all, 3 (6.8 %) fractures were complicated by infection, 7 (15.9 %) had implant failure, and 5 (11.4 %) developed delayed union. Using external fixation in acute fracture treatment for open femur fractures is a safe and effective surgical technique. Based on our results, external fixation might be superior to intramedullary nailing or plating when evaluating outcome parameters and complications.

Autoimmunerkrankungen sind eine klinisch heterogene Gruppe von Erkrankungen, die den Hausarzt oft vor differentialdiagnostische Herausforderungen stellen. Mit Ausnahme der rheumatoiden Arthritis, die mit einer Pravalenz von ca. 1 % der Bevolkerung zu den haufigen Autoimmunerkrankungen zahlt, sind systemische Autoimmunerkrankungen in der allgemeinmedizinischen Praxis so selten, dass der niedergelassene Arzt fur Allgemeinmedizin meist wenig Erfahrung mit den einzelnen Krankheitsbildern hat. Bei entsprechender klinischer Symptomatik und mit gezielten Fragestellungen konnen bestimmte Autoantikorper die Verdachtsdiagnose stutzen. Die osterreichische Gruppe der Europaischen Autoimmun Standardisierungsinitiative (EASI, European Autoimmunity Standardisation Initiative) hat es sich zum Ziel gesetzt, im vorliegenden und 2009 publizierten Leitfaden, dem Allgemeinmediziner einen Wegweiser durch den Dschungel der Biomarker fur Autoimmunerkrankungen zu bieten.

Accurate assessment of injury severity is critical for decision making related to the prevention, triage, and treatment of several injured patients. Early estimation of mortality risk of critically injured patients is mandatory for adequate therapeutic strategies. Current risk stratification relies on clinical diagnosis and scoring systems. In our study, we hypothesized whether a simple laboratory test, the CK/CK-MB ratio, could help improving risk prediction in severely traumatized patients.In a 9-year period, 328 nonselected trauma patients were included in our retrospective study at a Level I Trauma Center up to September 2002. Data for this study were obtained from our computerized trauma database, established in September 1992.In our study population, we could show a negative correlation between Injury Severity Score (ISS) and leukocytes. A positive correlation was detected for liver enzymes and CK-MB. The correlation between ISS and Na(+) was significant. No correlation between ISS, K(+), and Hb/Ht could be observed. Exitus was associated with ISS, alteration in thrombocytes, CK, CK-MB, CRP, Crea, and Na(+).In our study population, CK-MB levels showed a significant correlation with overall surveillance in polytraumatized patients. In our opinion, this might suggest that CK-MB levels could be taken as an indirect predictor for survival. Our findings need to be proven in further prospective clinical trials.

Elevated coagulation factor VIII activity has been associated with increased risk for both venous and arterial thrombosis. The current study evaluated the influence of Factor VIII levels and interactions with gender on all cause mortality in a large Austrian cohort.During 1991 and 2003, 11203 individuals, first ever request for laboratory analyses of FVIII: C, ageor =18 years, were included in this study. The median observation period was 5 years covering a total of 46000 person-years. The death rate was 17.1%.Compared to individuals within the reference category (FVIII: C94%) hazard ratios gradually increased from 1.4 (95% CI: 1.1-1.8) in the 152-170% category (5th decile) to finally 4.4 (95% CI: 3.5-5.5) in the313% category (highest decile, all p0.05). The association between FVIII: C levels and mortality remained essentially unchanged when considering non-cancer mortality, all cause vascular mortality or mortality due to ischemic heart disease. Compared to males females with elevated FVIII: C had a worse outcome resulting in higher hazard ratios reaching 6.8 (95% CI: 4.6-9.9) within the highest decile compared to males (HR: 3.4 (95% CI: 2.6-4.5)).In our large patient cohort we might be able to demonstrate for the first time that FVIII: C plasma activity is strongly associated with all cause mortality. Additionally, FVIII: C appears to interact with gender. Especially in women FVIII: C might help identifying high-risk cohorts, which might benefit from individualized prevention strategies.

Elevated plasma cell membrane glycoprotein 1 (PC-1) expression and the frequent PC-1 K121Q polymorphism have recently been associated with insulin resistance. Since insulin resistance represents an important risk factor for atherosclerotic vascular disease and myocardial infarction, we investigated the involvement of the PC-1 K121Q polymorphism in the development of myocardial infarction. We analyzed two independent series of cardiovascular patients at a defined end-point of atherosclerotic vascular disease (those having suffered myocardial infarction) for the PC-1 K121Q mutation by a newly developed mutagenic separated PCR assay. In both patient groups the presence of the Q allele was significantly associated with younger age at the time of first myocardial infarction, suggesting a more rapid progression of endothelial dysfunction. In a multivariate analysis carriers of the 121Q allele from Vienna and from Central Germany exhibited a 2.6- and a 4.2-increased odds, respectively, for suffering myocardial infarction within the first tertile of age (

Detection of chimerism by PCR analysis of short tandem repeats (STR) in blood samples of patients who received allogeneic bone marrow transplantation (BMT) has proved to be an important method for early detection of relapse. The prerequisite for this type of analysis is knowledge of donor and recipient pretransplantation genotypes. In some cases, recipient cells from time points prior to BMT are not available and the pretransplant fingerprint cannot be determined. As BM recipients only alter their genotype in blood cells, we attempted to identify patient's pretransplantation genotypes after transplantation in mouthwash samples that contain easily accessible epithelial cells. Of 17 patients who had undergone BMT between one week and 45 months prior to analysis, DNA was isolated from mouthwash cell pellets or from epithelial cells obtained from mouthwashes. PCR analysis of STR loci in the von Willebrand and the tyrosine hydroxylase genes were performed. Even though the mouthwash cell pellets contained about 75% epithelial cells (presumably of recipient origin) and only about 25% leukocytes (presumably of donor origin), three of five patients showed donor genotype and only two patients exhibited chimeric DNA patterns, when cellular DNA was obtained by boiling of mouthwash cell pellets. Following phenol/chloroform extraction, eight of 10 DNA samples exhibited a chimeric pattern, while two of 10 DNAs showed only donor genotype. Of three patients, epithelial cells were attached to magnetic beads prior to DNA isolation. Even this DNA contained donor and recipient material. From our results it appears that blood cells serve as preferential DNA source in mouthwash samples and cannot be removed by epithelial cell separation.