Epidemiology and economic burden of fragility fractures in Austria.

Fragility fractures are a frequent and costly event. In Austria, 92,835 fragility fractures occurred in patients aged ≥ 50 years in 2018, accruing direct costs of > 157 million €. Due to demographic aging, the number of fragility fractures and their associated costs are expected to increase even further. INTRODUCTION: Fragility fractures are frequently associated with long hospital stays, loss of independence, and increased need for care in the elderly, with consequences often leading to premature death. The aim of this study was to estimate the number of fragility fractures and associated healthcare costs in Austria in 2018. METHODS: The number of in-patient cases with relevant ICD-10 diagnoses in all Austrian public hospitals was derived from discharge documentation of diagnoses and procedures covering all public hospitals in Austria. Fractures resulting from falls from standing height in patients aged ≥ 50 years were used as a proxy for fragility fractures, and the number of in-patient and out-patient cases was estimated. The direct costs of these cases were calculated using the average cost of the corresponding in-patient hospital stay and the average cost for the out-patient stay. RESULTS: The present study estimated the number of fragility fractures (pelvis, thoracic and lumbar vertebra, hip, humerus, rib, forearm, and tibia) for 2018 at 92,835 or just over half of all fractures in patients aged ≥ 50 years, corresponding to a prevalence of 2,600 per 100,000 inhabitants of this age group. A constant increase in the proportion of fragility fractures among all fractures was observed with increasing age in both men and women. These fractures amounted to direct costs of > 157 million €. CONCLUSION: Fragility fractures are a frequent and costly event in Austria. Due to the aging of the population, the number of fragility fractures and their associated costs is expected to increase even further.

[Diagnosis and therapy of post-traumatic hemobilia]. / Príspevek k diagnostice a lécbe poúrazové hemobilie.

The submitted case-history deals with a successfully diagnosed and treated case of post-traumatic hemobilia in a 13-year-old girl. Hemobilia was manifested clinically by the typical Sandblom triad of symptoms. It was due to a pseudoaneurysm of the peripheral arteriole of the hepatic artery diagnosed by selective liver angiography. In treatment selective intraarterial embolization of the supplying artery proved useful.

Selective intraarterial chemotherapy of tumors in the lingual artery territory by a new approach.

Selective intraarterial neoadjuvant chemotherapy of carcinoma in the region of the lingual artery was performed in 23 patients (bilaterally in 4 patients). The superficial temporal artery (STA) was surgically exposed and a preshaped infusion catheter was inserted. The catheter tip was maneuvered through the STA into the lingual artery under fluoroscopic guidance. Two combinations of cytostatic agents were then continually infused through the catheter for 5-9 days. Treatment response was observed in 16 patients, 9 of whom showed a complete response. The combination of cisplatin and 5-fluorouracil was found most effective. The catheter became dislocated six times among 27 catheterizations and in each instance the position could be corrected. No major complications were encountered. We conclude that selective infusion technique is safer than previously reported semiselective infusions techniques.

[Tumor microembolization in the lungs--a cause of marked dyspnea, syncope, hemolytic syndrome and disorders of hemocoagulation]. / Nádorová mikroembolizace do plic--prícina výrazné dusnosti, synkop, hemolytického syndromu a poruchy hemokoagulace.

The authors describe the course of the disease in a 28-year-old woman who suffered two years following surgery of breast cancer from rapidly deteriorating dyspnoea, syncopes and laboratory manifestations of global respiratory insufficiency. The finding on auscultation of the lungs was normal, pulmonary angiography did not reveal signs of serious pulmonary embolization. The patient died after ten days in hospital despite comprehensive therapy and artificial ventilation. Necropsy revealed multiple microembolizations of tumourous cells into the pulmonary vessels as the main causes of the disease. Concurrently infiltration of the bone marrow by tumourous cells was revealed. The course of the disease was complicated by impaired haemocoagulation as a result of microangiopathic haemolytic anaemia and disseminated intravascular coagulation during the passage of erythrocytes through the pathologically altered pulmonary capillaries and impaired liver function.

[The role of the exercise test in patients with ischemic heart disease in estimating the risk of sudden death]. / Prínos pracovního testu u nemocných s ischemickou chorobou srdecní k odhadu rizika náhlé smrti.

The authors evaluated after 4-year interval the results of coronarographic and spiroergometric examination after a work load on a bicycle ergometer up to the limiting work syndrome in 51 all patients with the aim to reveal "risk factors" of sudden death in CHD patients. The following parameters were recorded: age, duration of treatment number of cigarettes smoked, systolic blood pressure at rest and the daily dose of the most frequently used drugs. After the work load the limiting values of pulse rate, systolic blood pressure, oxygen consumption, blood lactate level and the work ECG were evaluated. In the group of 7 sudden deaths of CHD patients the authors found statistically significant (p less than 0.001) a lower mean limiting value of oxygen consumption/kg and a deeper (p less than 0.0001) mean depression of the S-T segment in the work ECG when compared with 35 CHD patients surviving for 4 years. Both indicators are considered the main "risk factors" for sudden death.

Cyanoacrylates: an ideal agent for intravascular embolotherapy?

From a large number of various embolic agents introduced in interventional radiology in last two decades it seems that an ideal embolic agent for intravascular embolization has not been found yet. The favourable properties of one of these agents - n-butyl 2-cyanoacrylate are presented by authors. It is concluded that the intravascular embolotherapy with n-butyl 2-cyanoacrylate performed in a strict accordance with the technical demands has proved to be efficient in the management of symptomatic arteriovenous malformations, in the percutaneous transhepatic embolization of gastroesophageal varices and in palliative embolization of renal tumors.

Longterm catheterization of the lingual artery for intraarterial cytostatic therapy.

The authors present a technique of longterm lingual artery catheterization for intraarterial regional chemotherapy. The transtemporal approach enables safe introduction through the external carotid artery. Catheterization technique is presented in 16 patients with the diagnosis of carcinoma baseos oris and carcinoma linguae. Both the lingual arteries were infused in four patients with tumors spreading over the midline. The dislocation of the catheter was found seven times of twenty catheterizations. The following catheter repozition was always successful.

[Successful treatment of the superior vena cava syndrome caused by thrombosis and a fibrous septum in a patient with a permanent cardiac pacemaker]. / Uspesne lécený syndrom horní duté zíly zpusobený trombózou a vazivovým septem u nemocného s trvalou kardiostimulací.

A patient with a ten-year permanent implantation of a pacemaker was admitted on account of a clinically serious syndrome of the vena cava superior. The cause of the syndrome was an angiographically confirmed extensive thrombosis and after its dissolution a fibrous septum in the area of the orifice of the vena cava superior into the right atrium. The septum caused by a fibrous strip at the orifice of the vena cava superior into the right atrium was removed by surgical operation during thoracotomy by dilatation of the original opening in the fibrous septum by a Broca dilator and digitally. The authors recommend, based on their own experience and data in the literature, to use fibrinolytic therapy in clinically severe thrombosis in the area of the vena cava superior or the right atrium caused by an electrode--during temporary or permanent pacing--or by a catheter used for parenteral nutrition.

[Atherosclerosis risk factors in patients examined by coronarography. I. Selection and evaluation of risk factors]. / Rizikové faktory aterosklerózy u koronargraficky vysetrených pacientu.I. Výber a hodnocení rizikových faktoru.

The significance of individual risk-factors associated with the ischaemic heart disease is known to be estimated differently in various stages. In this account, still more screening and evaluation of mentioned factors is continuously needed in facing different social, economical, demographical and geographical conditions. The analysis has been made of such risk-factors which are generally precluded as decisive ones (age, sex, blood lipid levels, cigarette smoking, higher blood pressure, obesity, diabetes mellitus). The majority of these factors and their interrelations may be influenced. Of special author's concern were different dependencies between the selective groups of coronarographied patients and the groups defined with mainly clinical symptomatology. Authors suggest that the analysis of proper group may be supportive in order to formulate such a complicated topic and outline the appropriate trends of secondary prevention also in their conditions.

[Atherosclerosis risk factors in patients examined by coronarography. II. Results and evaluation in the group of men]. / Rizikové faktory aterosklerozy u koronarograficky vysetrených pacientu. II. Výsledky a hodnocení souboru muzu.

The attherosclerosis risk-factors occurrence is studied in the present paper and compared with that of abnormal coronarogram in 376 male subjects. As an abnormal coronarogram is estimated this with at least one of coronaries having more than 50% of lumen obstructed. The abnormal coronarogram occurred significantly with more frequently in male patients with hyperlipoproteinemia an in smokers (p less than 0.001). In a total of male subjects with positive coronarographic findings, the significantly higher averaged levels of total cholesterol (p less than 0.01) have been stated. Authors detected the levels of total cholesterol higher than 6.72 mmol/l and those of triglycerides higher than 1.80 mmol/l are significantly exerting the influence on the value of coronarographic score. Of particular interest is a fact that no significant relation of abnormal coronarogram to the occurrence of systemic hypertension has been detected as well as to the disorders of glycide metabolism and obesity. However, mathematically significant relation has been determined between the smoking and hyperlipoproteinemia (p less than 0.001). The cigarette smoking was stated to enhance hyperlipoproteinemia as 4 %. Smokers have been found to represent pathologically increased both triglyceride and total cholesterol levels. It is to be said that the group of smokers has values of body mass index (BMI) lower ones than the group of non-smokers. Authors also revealed the disorders of glycide metabolism were related with higher occurrence of hyperlipoproteinemia in men as 1-2%. Although no significantly frequent occurrence of glycide metabolic disorders has been proved in men with abnormal coronarogram, the more detailed analysis showed those with glycide metabolic disorders were significantly higher in coronarographic score (p less than 0.05) in contrast with the group compared, and showed significantly higher occurrence of hemodynamically important stenoses than the controls. The results of the present work are believed to enlarge the knowledge about the relations between the atherosclerotic changes, their clinical manifestations and risk-factors estimated in conditions which are completely different from those of routine epidemiological studies. The necessity of primary prevention is confirmed and possible secondary measures are indicated.

[Atherosclerosis risk factors in patients examined by coronarography. III. Results and evaluation of the group of women]. / Rizikové faktory aterosklerózy u koronarograficky vysetrených pacientu. III. Výsledky a hodnocení souboru zen.

The occurrence of atherosclerosis risk-factors has been studied in comparison with the rate of abnormal coronarogram in 63 female subjects. As an abnormal coronarographic finding the obstruction of more than 50% lumen of at least one of coronaries was estimated. Female subjects with hyperlipoproteinemia (p less than 0.001) and hypertension (p less than 0.05) showed significantly more frequent abnormal coronarographic findings. Coronarographically positive women revealed significantly higher levels of total cholesterol (p less than 0.05). No relationship was detected between the pathological coronarogram and glycide metabolic disorders. Of particular interest is a fact that the disorders of glycide metabolism are conditioning the occurrence of hyperlipoproteinemia in women of our group as far as 15-16% (p less than 0.001), whereas in men only as 1-2 % (p less than 0.05). These results are supporting the opinion of those authors who point on the interaction between the disorders of glycide metabolism and hyperlipidemia estimating disorders of glycide metabolism in women to be more significant risk-factor of coronary atherosclerosis than in men. Our findings are confirming specificity of profile of atherosclerotic risk-factors in women. In accord with them, the importance of hyperlipidemia and hypertension is estimated to be the most significant risk of atherogenesis. The implementation of principles of primary and secondary prevention of ischemic heart disease is carried through the common approaches in both men and women.

[Atherosclerosis risk factors in patients examined by coronarography. IV. Relation of atherosclerosis risk factors and clinical manifestations of ischemic heart disease (myocardial infarct, angina pectoris)]. / Rizikové faktory aterosklerózy u koronarograficky vysetrených pacientu. IV. Vztah rizikových faktoru aterosklerózy a klinických projevu ischemické choroby srdecní [IM, AP].

The total of 376 male and 63 female subjects is concerned. As an abnormal coronarogram, such a finding is estimated where at least one of coronaries showed more than 50% lumen obstruction. The occurrence rates of atherosclerotic risk-factors, angina pectoris and myocardial infarction have been studied with regard to the abnormal coronarograms. A special concern in male group is almost simultaneous occurrence of angina pectoris along with positive coronarogram. The occurrence of both studied factors shows an increase with more age. The percentage of IM occurrence is practically the same in all age groups studied regardless to the value of coronarographic score. However, the male subjects with both clear and suspected IM (especially in the age group up to 40 years) are stated to show higher occurrence of normal coronarographic findings (32 %). This is in agreement with the suggestion that also other factors are involved than the atherosclerotic affection of coronary bed, what demonstrates the complexness of pathophysiological mechanisms of IM genesis.

The development of symptomatology and functional condition in patients with negative or minimal findings on coronary vessels after 5 to 10 years.

The authors compared two groups of men: the group with minimal sclerotic wall changes (n = 18) and the group with a normal coronary angiographic finding (n = 32). All the examinations were repeated after 5 to 10 years (mean 8.4 years). The two groups did not differ in the occurrence of the main IHD risk factors, complaints, kind and amount of principal drugs and working history. No statistically significant differences were found between the groups in the reasons for discontinuing bicycle ergometric test or in the exercise ECG finding. The two groups studied did not differ in the mean values of limiting metabolic and cardiologic parameters (oxygen consumption, lactate, pulse rate, RPP index) either. The conclusion can be made that in the functional and clinical prognosis the group of symptomatic men with minor sclerotic wall changes does not differ practically from individuals with completely normal coronary angiography.