Wiener medizinische Wochenschrift
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The general approach regarding the treatment of sepsis in patients with oncological or haematological malignancies does not differ significantly from that in immunocompetent individuals, however, there are several specialities. The main causes of severe infections in cancer patients include deranged cellular or humoral immunity due to the underlying disease, severe neutropenia as a consequence of cytostatic regimens, lesions of the mucosal barriers due to adverse effects of antineoplastic agents, and violations of the integument by therapeutic interventions. ⋯ On this account precise and intensive therapy has to be initiated in the early stages of sepsis. In the following, we will not primarily focus on sepsis specific treatment modalities, but merely try to elucidate in more detail the pathomechanisms and special features with regard to infectious complications and specific treatment.
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According to the media the recent physician bribery scandal in Germany draws ever further sets. The public prosecutor determines against hospital physicians and coworkers of a pharmaceutical firm. The suspicion: Physicians were recompensed for using up medicines particularly with pleasure trips. ⋯ Occasional allowances, which are not located in connection to a concrete business, but only promoted the sympathetic consideration of the recipient, are not usually punishable. The punishing frameworks for offensces reach up to three years imprisonment. In addition still the absorption of enriching comes (section 20 StGB).
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Owing to the progress of individual life expectancy, the number of demented people will clearly increase in the next decades. Cognitive impairment refers not only to dementia, but also to mild cognitive impairment (MCI), associated with reduced complex daily activity and decreased quality of live. ⋯ The most frequent aetiologies of dementia syndromes are the Alzheimer's Disease (AD), vascular Dementia (VD), the combination of both and Lewy-Body-Disease. Primarily neuro-psychiatric and internal medical reasons for cognitive decline have also to be taken into account for rational treatment.
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Adequate adrenocortical function is essential to survive critical illness. Most critically ill patients display an elevated plasma Cortisol level, reflecting activation of the pituitary-adrenal axis, which is considered to be a homeostatic adaptation. In the setting of critical illness, the failure of an appropriate neuroendocrine response can lead to the picture of vasopressor-dependent refractory hypotension. ⋯ Several controlled studies have shown that stress doses of hydrocortisone given in patients with septic shock reduce the time to shock reversal and decrease mortality. A multicenter large-scale trial (CORTICUS) is on the way investigating the benefit of stress doses of hydrocortisone on the mortality of septic shock. In this review glucocorticoid physiology and regulation during septic shock and the effects of hydrocortison administration in the course of septic shock are being discussed.
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Wien Med Wochenschr · Jan 2002
[Pathophysiology and therapy of sepsis-associated coagulation disorders].
Sepsis and septic shock are very complex and dynamic clinical syndromes. A systemic response to an infection or other triggers can induce a cascade consisting of toxins--leukocytes--cytokines--mediators of inflammation--endothelial cell dysfunction--activation of blood coagulation--intravascular fibrin deposition--alteration of microcirculation, resulting in a damage of organs. ⋯ D-dimer), similar to an acute-phase reaction and full blown disseminated intravascular coagulation with consumption coagulopathy. This article summarizes these pathophysiological mechanisms, shows available diagnostic tools and differential diagnoses, and discusses therapeutic options for sepsis and multi organ failure.