Dtsch Arztebl Int
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Review Meta Analysis
Acute traumatic coagulopathy in severe injury: incidence, risk stratification, and treatment options.
Clinical observation and research findings show that acute traumatic coagulopathy (ATC) is a major factor that must be addressed in the care of severely injured patients. In this review article, we discuss the incidence and causes of ATC, the potential means of early risk stratification for it, and recommendations for its treatment. ⋯ ATC, a condition associated with increased morbidity and mortality, is seen on admission in one out of four patients with major trauma. The main causes of ATC are tissue damage, hypoperfusion, hemodilution, hypothermia, acidosis, and inflammation. It may be possible to identify patients at risk for ATC early on through the use of rapidly calculable, predictive numerical scales (McLaughlinScore, TASH, and ABC), laboratory tests, and imaging studies (FAST and CT). Acute treatment is focused on the control of bleeding and support of the coagulation system according to the current guidelines. Patients at high risk may benefit from a balanced transfusion strategy. Innovative strategies currently under study include point-of-care-guided treatment and coagulation-factor-concentrate-based treatment.
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In patients over age 60 with acute myeloid leukemia (AML), cure rates are under 10% despite intensive chemotherapy. These patients often have comorbidities, and their treatment must be chosen with care. For those who are not candidates for intensive chemotherapy, one of the available options for palliative treatment should be chosen on the basis of an individual risk-benefit assessment. ⋯ The prognosis of elderly AML patients remains poor despite recent therapeutic advances. The appropriate treatment for each patient can be chosen on the basis of a risk-benefit assessment. Clinical trials evaluating new treatments are urgently needed.
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Despite therapeutic progress, many diseases of the eyes and visual pathways still cause persistent visual deficits that make everyday life more difficult in many ways. Rehabilitation aims to compensate for these limitations by optimizing residual vision. The demand for visual rehabilitation will increase markedly in the near future. ⋯ Suitable rehabilitative measures chosen after the thorough diagnostic evaluation of a visual impairment and analysis of its effects can usually restore reading ability, improve orientation, and thereby enhance the patient's independence and quality of life. As the demand for visual rehabilitation is increasing, steps will need to be taken to make it more widely available. Furthermore, as the scientific basis for visual rehabilitation is currently inadequate in some areas, more research in the field will be needed.
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High-altitude travel, for mountain climbing, trekking, or sightseeing, has become very popular. Therefore, the awareness of its dangers has increased, and many prospective travelers seek medical advice before setting forth on their trip. ⋯ An understanding of the physiology of adaptation to high altitudes and of the pathophysiology and clinical manifestations of high-altitude-related illnesses provides a basis for the proper counseling of prospective travelers, through which life-threatening conditions can be prevented.
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Singultus (hiccup) is common, usually transient, and only rarely indicative of disease. If it persists, it can be highly bothersome, potentially interfering with sleep and leading to depression and physical exhaustion. It is presumed to be due to a disturbance in a reflex arc that includes the brainstem, the phrenic nerve, the vagus nerve, and the sympathetic chain. It can be induced by mechanical irritation (e.g., gastric distention), metabolic or toxic irritation (e.g., alcohol, cigarette smoke), infectious processes, emotional disturbances, and, rarely, neurological diseases. ⋯ This case shows that singultus, though it may seem trivial, deserves to be taken seriously, particularly when it persists and does not respond to medications. Its cause can be discovered in timely fashion by means of a thorough clinical history, physical examination, and ancillary testing.