Tauern Hospital Zell am See

Background and Objectives: We aimed to assess the outcomes of upfront Optilume drug-coated balloon (DCB) dilation in patients after failed treatment for complex recurrent urethral stricture disease. All patients presented with acute urinary retention and were treated with DCB dilation regardless of stricture site and length. Materials and Methods: We retrospectively evaluated patients with acute urinary retention and known complex recurrent urethral strictures. Patients presented at the urology emergency room of our tertiary centre with an inability to void or a post-void residual (PVR) volume exceeding 400 mL between August 2021 and February 2024. Urethrography and/or endoscopic imaging confirmed the diagnosis. Patients with urinary tract infection/sepsis and those with neurological disease were excluded. Urethral dilation to 20 Fr was performed, followed by DCB dilation (30 Fr, 10 bar, 10 min). The primary endpoints were anatomical success (≥14 Fr by cystoscopy/calibration) at 12 months and freedom from repeat interventions. Results: Thirty-one consecutive male patients were evaluated, with twenty-six patients followed for ≥12 months (mean age 65 ± 16.8 years). The stricture sites included seven bulbopenile, seven bulbomembranous, seven anastomotic, three bladder neck, one penile, and one panurethral stricture. The median number of prior urethral/surgical interventions was 2 [IQR: 1-3] (range: 1-31). The median stricture length was 3 [IQR: 2-4] cm (range: 1-8). At 12 months, 65.4% (17/26) of subjects voided satisfactorily and were free of recurrence and reoperation. Conclusions: Timely DCB dilation may offer a viable treatment option for patients with complex recurrent urethral strictures and urinary retention, particularly those who are unable or unwilling to undergo surgical reconstruction and prefer to avoid indwelling catheters.

Purpose of ReviewTo define international clinical pharmacist contributions to managing sepsis in critically unwell patients and explore variation.Recent FindingsClinical pharmacists improve clinical outcomes and cost efficiencies. They provide pharmaceutical advice on selection, administration, plus monitoring of antimicrobials and supportive therapies. Logistical activities reduce drug administration times. Guideline production, patient/clinician education, prescribing error identification, plus therapeutic optimisation activities are also reported.SummaryA survey incorporating semi-structured interviews identified further antimicrobial stewardship, prescribing and digital contributions to optimise sepsis management. However, disparities associated with multidisciplinary team integration and intensive care unit service provision were found. Variability was attributed to multifaceted physical, social, financial, training and education themes. Findings empower collaborations between pharmacists and stakeholders to identify and overcome contribution barriers. Strategies to mitigate barriers and enhance sepsis contributions were envisaged by reported aspirations. These emphasised the importance of professional advocacy, interprofessional education and impactful implementation research.

For future buildings (nZEBs according to EPBD) efficient and cost-effective heating systems with a high share of renewable energy ar0e1 r1equired. Heat pumps (HP) are considered as one of the key technologies in the building sector. However, in particular in high-density housing areas, source exploitation is strongly limited. Accordingly, the market in Austria does not currently provide real alternatives to apartment gas or electric boilers. Split type HPs with low power can be made compact and cost effective and thus offer new possibilities. However, split type HPs represent a real alternative only if the acceptance for them can be improved by means of improved modularity, design, architectural attractive integration in the building envelope and reduced sound emissions. The goal of the Austrian FFG research project FitNeS is the development and optimization of modular split HPs with compact and silent façade-integrated outdoor units. The outstanding features of the concept are a modular design with a high degree of prefabrication and representing a visually and architectonically attractive, economic and sustainable solution for both new constructions and renovations. Different concepts of façade-integrated outdoor units will be developed and evaluated with regard to design, façade construction, accessibility (for maintenance), building physics, efficiency, etc. on the basis of the technical and non-technical boundary conditions.

Hiatal hernias are currently classified into type I–IV hernias (◘ Fig. 38.1). In type I hernias, also called sliding hernias, the gastroesophageal junction is situated above the diaphragm. They are the most common type of hiatal hernia with 80–85% of all hiatal hernias. Type II–IV hernias are less common and characterized by a paraesophageal involvement. Especially type II hernias are rare and characterized as pure paraesophageal hernias. Type III hernias are a combination of type I and type II hernias, the gastroesophageal junction, and the fundus herniate through the diaphragm. If an intra-abdominal organ other than the stomach herniates, a type IV hernia is present. Surgical treatment in type I hiatal hernia is only indicated for concomitant gastroesophageal reflux disease. Hiatal hernias with paraesophageal involvement should be operated if they are symptomatic because of the risk of progression and the risk for complications such as incarceration. The aim of the surgical therapy is the constant reposition of the hernia sac content and the repair of the hiatus. Hiatal hernia repair can either be performed transabdominally or by transthoracic access with an open or minimally invasive approach. The laparoscopic approach is associated with reduced perioperative morbidity and shorter hospital stay while showing equal symptomatic outcome compared to the open abdominal and the transthoracic approach. The minimally invasive abdominal access is thus the preferred approach for most hiatal hernias. Besides the access, the dissection of the hernia sac, the type of cruroplasty, the use of mesh augmentation, and the addition of a fundoplication are factors that have to be considered for an ideal hiatal hernia repair. The chapter gives an evidence-based overview on the mentioned technical considerations, and recommendations are made according to the SAGES Guidelines and the latest literature (◘ Tables 38.1 and 38.2).

The widespread use of meshes for hiatal hernia repair has emerged in the era of laparoscopic surgery, although sporadic cases of mesh augmentation of traumatic diaphragmatic rupture have been reported. The indications for biologic meshes in diaphragmatic repair are ill defined. This systematic review aims to investigate the available evidence on the role of biologic meshes in diaphragmatic rupture and hiatal hernia repair. Limited data from sporadic case reports and case series have demonstrated that repair of traumatic diaphragmatic rupture with biologic mesh is safe technique in both the acute or chronic setting. High level evidence demonstrates short-term benefits of biologic mesh augmentation in hiatal hernia repair over primary repair, although adequate long-term data are not currently available. Long-term follow-up data suggest no benefit of hiatal hernia repair using porcine small intestine submucosa over suture repair. The effectiveness of different biologic mesh materials on hernia recurrence requires further investigation.

Background:Comparative data of endoscopic full-thickness-gastroplication with well-established surgical therapies are scarce. This prospective randomized controlled study comparatively evaluates the effectiveness of endoscopic plication and laparoscopic antireflux surgery (LARS) one year after the procedures.