Der Urologe. Ausg. A
-
Sepsis is the third most common cause of death in Germany. Every fourth patient with sepsis has urosepsis. Even if substantial therapeutic progress has been made, sepsis remains a severe condition with high morbidity and mortality that requires rapid interdisciplinary measures. Besides life-threatening complications, acral necrosis as presented here can occur as a result of disseminated intravascular coagulation and severe microcirculatory disorders.
-
Der Urologe. Ausg. A · Jun 2014
[Rivaroxaban, dabigatran and apixaban: new anticoagulants in operative urology].
The periprocedural management of patients receiving long-term oral anticoagulant therapy is a common but complex clinical problem. It is well established that maintaining oral anticoagulation is associated with an increased risk of bleeding in the periprocedural period while discontinuing anticoagulant therapy postoperatively leads to an elevated risk for thromboembolic events, especially in high risk patients. Nowadays there is growing evidence to maintain antiplatelet therapy with acetylsalicylic acid (ASS, Aspirin®) perioperatively in a setting of secondary prophylaxis. ⋯ Critical consideration is necessary regarding potential pitfalls, such as impaired renal function, insufficient possibility of laboratory monitoring and lack of antidotes in cases of postoperative hemorrhage. Although periprocedural protocols for the use of NOACs are emerging, robust clinical data are still scarce. This article provides a practical, clinician-focused approach to periprocedural management of NOACs.
-
Modern medicine is a highly complex service industry in which individual care providers are linked in a complicated network. The complexity and interlinkedness is associated with risks concerning patient safety. ⋯ Standard operating procedures (SOPs), crew resource management (CRM), as well as operational risk evaluation (ORE) are historically developed and trusted parts of a comprehensive and systemic safety program. If medicine wants to follow this quantum leap towards increased patient safety, it must intensively evaluate the results of other high-reliability industries and seek step-by-step implementation after a critical assessment.
-
Der Urologe. Ausg. A · Apr 2014
Review[Alpha emitter radium-223 dichloride: new therapy in castration-resistant prostate cancer with symptomatic bone metastases].
Radium-223 dichloride (Ra-223) is an alpha emitter with low toxicity for the treatment of patients with castrations-resistant prostate cancer (CRPC) and symptomatic bone metastases showing a 30% reduction in the risk of death, as compared to placebo. Because of the favorable physical and chemical characteristics, Ra-223 can be handled easily in daily practice based on interdisciplinary co-operation between urology and nuclear medicine. Ra-223 has been approved under the product name Xofigo® by the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA).
-
Der Urologe. Ausg. A · Jan 2014
Case Reports[Vena cava cement embolism after percutaneous kyphoplasty. Interventional radiological recovery in metastasized urothelial cancer].
For patients suffering from vertebral metastases vertebroplasty and kyphoplasty offer two relatively new treatment options for the stabilization of vertebral compression fractures. This can help to reduce the fracture-associated symptoms and can improve the quality of life. Cement extravasation is a specific complication of this therapy. This article reports a case of multiple cement paravasations in the paravertebral veins, the vena cava inferior and peripheral segmental and subsegmental pumonary arteries after kyphoplasty of an extensive pathological vertebral body fracture in a 64-year-old man suffering from metastatic urothelial cancer.