Der Internist
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Superior vena cava syndrome is a medical condition determined by the mechanisms of extrinsic compression, invasion or thrombosis of the superior vena cava. The most common underlying cause is a malignant process, especially lung cancer and lymphoma. Typical symptoms include progressive dyspnea, head and upper body edema and cyanosis. ⋯ In most patients the initial symptom is progressive back pain with an axial or radicular distribution. MRI should be preferred in the diagnostic work-up, corticosteroids be administered promptly after biopsy. Radiation therapy or surgical treatment should be started as soon as possible.
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Infections in immunosuppressed patients have always to be regarded as emergencies, as they have a high rate of complications and mortality. The most important risk factor is severity and duration of granulocytopenia. Risk scores help to identify patients who, despite their immune deficiency have a low risk of complications. ⋯ Empirical treatment has to be broad to cover possible microorganisms. Especially meningitis, abdominal infections, sepsis and pneumonia can be regarded as infectiological emergencies. Patients with these infections have to be treated with intensive antimicrobial treatment, taking into account the possible causative agents.
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Oncologic patients may suffer from acute central nervous system disorders either related to the disease itself or to its therapy. These disorders may present as a disturbance of consciousness, as mental changes, as focal neurological signs, as epileptic seizures or as a combination of these. Symptoms may be caused by cerebral metastases, hemorrhage, ischemia or infectious complication, by metabolic changes or by treatment sequealae. This article will focus on clinical presentation, diagnostic workup and possible therapy or prophylaxis of these complications.
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Patients with malignancies often experience acute disorders of coagulation. They may manifest as thromboembolism, disseminated intravascular coagulation or a tendency to bleed. ⋯ Some complications typical for patients with malignancies are discussed. Among these are tumor associated thrombophilia, acquired von Willebrand's disease, and thrombocytopenia.