Der Internist
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While the treatment of varicose veins has remained unchanged over the past 100 years based on the three principles of compression, sclerotherapy, and classic varicose vein surgery, alternative approaches and advancements in treatment have developed in the last 10 years such as foam sclerotherapy, endovenous laser therapy, and radiofrequency obliteration. In contrast to classic varicose vein surgery, prospective, randomized, comparative studies are available with respect to the modern treatment procedures. They clearly show that endovenous thermal techniques are not inferior to the classic operation regarding the perioperative complication rate. ⋯ Especially in cases of recurrent varicose veins from the saphenofemoral or popliteal junction, foam sclerotherapy should be considered as the ideal method. All procedures significantly improve the patients' quality of life and the symptom complaints related to varicose veins. They are not in competition, but rather partially complement each other so that a combination of several approaches is quite judicious.
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Hepatopulmonary syndrome, portopulmonary hypertension and hepatic hydrothorax are typical pulmonary complications in patients with liver cirrhosis. Whereas hepatopulmonary syndrome and portopulmonary hypertension represent pulmonary vascular diseases, the development of hepatic hydrothorax is associated with the presence of ascites and phrenic lesions. ⋯ In severe portopulmonary hypertension specific medical treatment is indicated. In selected patients, beside intravenous prostanoids, oral endothelin receptor antagonists and phosphodiesterase type-5 inhibitors are possible treatment options.
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Deep vein thrombosis and pulmonary embolism (venous thromboembolism) have a prevalence as high as 1-2/1000/year. Timely diagnosis and therapy prevent or reduce the acute life threatening and the long term disabling complications. Due to the variability in its signs and symptoms, venous thromboembolism should frequently be considered as a differential diagnosis. ⋯ Current standard of care for deep vein thrombosis is venous ultrasound of the leg, for pulmonary embolism it is CT pulmonary angiography. Sensitivity and specificity of both methods are high enough to allow for a definitive diagnosis. Diagnostic challenges remain the suspicion of relapsing disease and venous thromboembolism in pregnancy.
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In recent years, a global increase of Clostridium difficile-associated infections (CDI) and the emergence of new hypervirulent strains causing numerous outbreaks was noticed. The appearance of these strains was accompanied by increased morbidity and mortality, affecting patients previously unknown to be at risk for CDI. ⋯ So far, the changing epidemiology of CDI did neither change diagnosis nor therapy of CDI but necessitates a series of preventive measures like the surveillance of CDI and contact precautions while caring for affected patients. If there are complicated or severe cases of CDI, the hypervirulent strains should be suspected and stool culture for isolation of C. difficile should be aimed.