European journal of medical research
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Acute liver failure represents one of the most challenging conditions in intensive care treatment. In most cases there is no causal medical therapy available for survive making the intensive care treatment as the most important management tool, as bridge to transplant or still the recovery of the liver. These patients frequently develop multi-organ failure, placing them at risk of hemodynamic disorder, cerebral edema, coagulopathy and various renal and metabolic complications.
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Comparative Study
The effect of examination stress conditions on the cortisol content of saliva - a study of students from clinical semesters.
Psychological stress factors can lead to changes in the immune system, the nervous system, and to psychosomatic diseases, besides releasing typical stress metabolites. This study on hand was to record the reliability of stress self assessment of students in various stress periods, and to be compared with the cortisol value of the saliva. ⋯ The results cover a significant correlation of particular stress factors to changes in cortisol values. It is important for dental therapy to use stress reducing measures, or reduce them as much as possible in order to avoid factors that pre-operatively can affect the patient in a stressful way.
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Pulmonary embolism is a frequently observed clinical symptom. Its mortality rate is ca. 10 % und occurs mainly in the acute phasis. Immobilization, surgery, old age, malignancies, hormonal factors as well as inherited or acquired thrombophilia are important risk factors. ⋯ The risk of pulmonary embolism could be lowered by 50 % through prophylaxis with unfractioned or low-molecular-weight heparin. The therapy of pulmonary embolism stratifies the clinical grade and reaches from ambulant therapy with low-molecular-weight heparin to thrombolysis or embolectomy in massive pulmonary embolism. Long-term anticoagulation, usually with vitamin-K-antagonists, should be applied according to the individual risk profile of the patient.
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Review Comparative Study
Low-molecular-weight heparin (LMWH) in the treatment of thrombosis.
Thromboembolic complications are a common and costly medical problem, associated with significant morbidity and mortality, especially in postoperative patients. There have been reports of death due to thromboembolic complications even after short procedures, e.g. arthroscopy. Low-molecular-weight heparins (LMWHs) (e.g., certoparin, dalteparin, enoxaparin, nadroparin, reviparin, tinzaparin) have been tested for treatment of deep vein thrombosis in comparison to unfractionated heparin (UFH) in many patients being effective and safe alternative for treatment of deep vein thrombosis (DVT) and venous thromboembolism (VTE). ⋯ In summary, LMWHs have an established role in the treatment of DVT and pulmonary embolism (PE), on an in- and outpatient basis and could realize substantial savings. Most studies were performed with dalteparin, enoxaparin and nadroparin. There is evidence that LMWHs may help to prolong survival in cancer patients and to avoid complications of the acute coronary syndrome.
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The unique pathophysiology of end-stage liver disease (ESLD) has important implications on critical care treatment after liver transplantation. To determine hemodynamic parameters and responses, each patient must be carefully evaluated for the individual clinical appearance of cirrhosis and portal hypertension. ⋯ The improved understanding of the pathophysiology of ESLD has resulted in novel treatments and approaches to the problems that emerge as patients get critically ill or undergo orthotopic liver transplantation (OLT). These issues become much more relevant with increased adult-to-adult living donor liver transplantation, where the scheduled operation allows a precise preoperative management in an Intensive Care Unit (ICU).