Der Internist
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Due to the decreasing partial pressure of oxygen, high altitude sickness can occur at heights over 2,500 m. This can be best avoided by slow adaptation to the altitude (acclimatization). In this way the organism adapts to the chronic hyperventilation and in the further process the oxygen content is normalized by an increase in erythrocytes. ⋯ Stress dyspnea, coughing and rasping breathing noises also occur by the potentially fatal high altitude pulmonary edema. All forms of high altitude sickness can be countered by a rapid descent to a height of at least 500 m. In acute mountain sickness acetazolamide can be administered (2 × 250 mg), for high altitude cerebral edema dexamethasone (3 × 4-8 mg) and for high altitude pulmonary edema nifedipine (initially 10 mg then 20 mg retard).
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Malaria is the most important infectious disease imported by travelers and migrants from tropical and subtropical areas. It is imported quite frequently. It is a life-threatening disease. ⋯ Uncomplicated falciparum malaria should be treated in the hospital with either atovaquone-proguanil or with an artemisinin-based combination preparation. If there is evidence of severe malaria, the patient must be moved to an intensive care unit. The antiparasitic agent of choice is then artesunate.
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The one common factor in solid organ transplantation is the need for lifelong maintenance immunosuppression. Drug regimens after organ transplantation typically comprise a combination of different immunosuppressive drugs. In most cases a triple drug regimen with different mechanisms of action is used. ⋯ In each phase an individual combination of immunosuppressants is set up depending on the risk profile of the individual patient to prevent transplant rejection and organ loss. Based on these considerations, concepts of calcineurin inhibitor or steroid reduction have been established in transplant medicine in recent years. The key role in terms of development of new immunosuppressive strategies is taken by kidney transplantation, the most common solid organ transplantation performed.