Der Anaesthesist
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Patients undergoing non-cardiac surgical procedures who carry coronary artery stents have to be classified as high risk patients. Perioperative myocardial infarction and severe bleeding are possible. ⋯ The urgency of the surgical procedure, perioperative risk and an antiplatelet regimen have to be discussed with the patient and the surgeon in advance. In the case of cardiac complications, rapid therapy by an interventional cardiologist must be available.
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Review
[Neuronal apoptosis following cerebral ischemia. Basis, physiopathology and treatment strategies].
Neuronal injury following cardiac arrest (global cerebral ischaemia) and stroke (focal cerebral ischaemia) is one of the major causes of the high morbidity and mortality associated with these pathological events. One of the major characteristics of this kind of neuronal injury is delayed neuronal degeneration. An increasing body of evidence indicates that apoptosis (programmed cell death) is involved in this process after global and focal cerebral ischaemia. ⋯ This article reviews the molecular basis of apoptosis and its physiological and pathophysiological relevance. The mechanisms of delayed neuronal death following focal and global cerebral ischaemia are presented with particular emphasis on the role of apoptosis. Based on this, possible future therapeutic interventions are highlighted and discussed.
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Multiple organ failure (MOV) still represents the leading medical and economical problem in the care of the critically ill surgical patient. Although the incidence of MOF has tended to decrease over the last several years reflecting improved surgical and supportive therapy in the ICU, prognosis still remains serious when MOF develops. ⋯ Besides complexity and redundancy of the mediator systems involved, their beneficial local reparative as opposed to detrimental systemic effects may have contributed to the disappointing results of anti-mediator strategies in the treatment of MOF and sepsis. Although treatment of the underlying disease remains the cornerstone of the care of the critically ill patient to prevent MOF, recent results indicating a decreased mortality in severely septic patients receiving activated protein C as a supportive treatment suggest that modulation of the mediator cascades of sepsis and MOF remains a generally promising therapeutic strategy.
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The association between pain and inflammation and certain clinical signs led physicians to suspect a connection between immunological mechanisms and headache syndromes even years ago. This review intends to give an overview of the literature which deals with immunological mechanisms in headache syndromes--with divergent results. Thus, a food allergy as a cause of migraine only seems to be relevant in a few isolated cases. ⋯ Although a systemic vasculitis or auto-antibodies probably do not contribute to cluster headache pathophysiology, reports of an immune activation, especially of T-cells, predominate the literature. Nevertheless, the evidence for an immunogenically triggered cluster attack is still lacking. In summary, only a mutual modulation of the immune and the pain system can be assumed with certainty.