Der Internist
-
Urinary tract infection (UTI) is the most common infection in hospitalized adults. Nosocomial UTIs are mainly associated with the use of urinary catheters. Thus, the decision for catheterization should be made carefully and catheters removed in time. ⋯ Chinolones, broad-spectrum penicillins and third-generation cephalosporins are the mainstay of therapy. Comorbidities should be considered and potential obstructions of urinary flow removed. Economically important are the normally higher prices of i.v. antibiotics compared to oral use.
-
Management of critically ill patients regularly involves the treatment of water and electrolyte disturbances. Moreover, critical care itself may contribute to volume overload and electrolyte abnormalities. ⋯ The shift of volume and potassium in severe pancreatitis, for example, may lead to a life-threatening situation. In brain-dead patients, successful organ donation is facilitated by careful maintenance of water and electrolyte homeostasis.
-
Chronic obstructive pulmonary disease (COPD) is often associated with comorbidities. Cardiovascular diseases, weight loss, loss of fat free mass combined with muscle dysfunction, osteoporosis and depression are the main comorbidities in COPD. ⋯ Thus, the extrapulmonary manifestations are meaningful parameters of clinical assessment. Systemic inflammation is probably the key to the extrapulmonary signs of COPD.
-
Non-invasive ventilation is a technique to ventilate patients without endotracheal intubation and analgosedation. Pressure tight masks allow the ventilation of patients with severe respiratory or ventilatory insufficiency. ⋯ The typical indications are hypoxaemic respiratory failure in pneumonia or cardiogenic pulmonary edema, and hypercapnic ventilatory insufficiency in severe chronic obstructive pulmonary disease, neuromuscular disorders, or advanced kyphoscoliosis. The physiological background, technical aspects of performing non-invasive ventilation, and typical indications are discussed.
-
Bronchial asthma, with a prevalence in Germany of 5% among adults and 10% among children, remains a frequent disease. Newer cell biological data show a separate regulation of the allergy (interleukin 4, IL-4, pathway) and of the eosinophilic inflammation in asthma (IL-5 pathway). Both conditions require a therapeutic approach. ⋯ New medications are intended to overcome any remaining therapeutic weak points. Antileukotrienes and anti-IgE antibodies can contribute to reducing the necessary corticosteroids. Pharmaceutical agents that intervene in the IL-4 or IL-5 regulation or prevent remodeling are being developed.