Med Klin
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Review Comparative Study
[Obstructive sleep apnea-related cardiovascular disease].
The clinical spectrum of obstructive sleep apnea-(OSA-)related cardiovascular disease (CVD) comprises systemic arterial hypertension (prevalence: 40-60%), pulmonary hypertension (20-30%), coronary artery disease (20-30%), congestive heart failure (5-10%), and stroke (5-10%). During sleep, heart rhythm disorders such as atrioventricular blocks, sinus arrests and atrial fibrillation can be induced by OSA. OSA-related CVD mainly affects those patients with an apnea-hypopnea index > 30/h and, if left untreated, is linked to increased mortality. ⋯ Therapy of OSA by continuous positive airway pressure (CPAP) ventilation exerts cardioprotective effects. It has been shown to rectify the vascular micromilieu, restore endothelium-dependent vasodilation, lower 24-h blood pressure, eliminate nocturnal heart rhythm disorders, and improve left ventricular function. Furthermore, long-term CPAP therapy leads to a reduction in important clinical endpoints such as the rates of myocardial infarction and stroke.
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The idiopathic interstitial pneumonias, especially the idiopathic pulmonary fibrosis (IPF), are life-threatening lung disorders, for which no effective treatment option exists. In view of IPF, the American Thoracic Society (ATS)/European Respiratory Society (ERS) consensus statement recommends a combined therapy with corticosteroids and azathioprine or cyclophosphamide, although data from conclusive clinical trials are yet missing and the recurrent clinical experience is that these drugs do not really help in IPF. ⋯ The agents investigated and their targets are: acetylcysteine (reactive oxygen species [ROS] scavenging), interferon-gamma 1b (modulation of Th1/Th2 balance, direct antifibrotic effects), pirfenidone and GC 1008 (blockade of transforming growth factor-beta), FG 3019 (blockade of connective tissue growth factor), imatinib mesylate (blockade of platelet-derived growth factor), bosentan (blockade of endothelin), zileutin (blockade of leukotrienes), etanercept (blockade of tumor necrosis factor-alpha), heparin (alveolar anticoagulation). Hopefully, these new therapeutic strategies may help to improve prognosis of IPF in the future.
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Initiation of effective cardiopulmonary resuscitation (CPR) at the earliest possible time is the most important determinant of prognosis for patients with prehospital cardiac arrest. Basic life support CPR, defibrillation by emergency medical systems or first responders as well as vasopressor drugs or antiarrhythmics are essential. ⋯ Technique and methods of resuscitation are ranging from CPR to additional drugs. Fast and consequent work is essential. Among the "chain of survival" there is an increased value of first responders.
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Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are the two most serious metabolic complications of diabetes mellitus (DM). These disorders can occur in both type 1 and type 2 DM. DKA is characterized by hyperglycemia, ketone body formation and metabolic acidosis. ⋯ The prognosis of both conditions is substantially worsened in patients > 65 years of age and in the presence of coma and hypotension. Mainstays of therapy are intravenous insulin and fluid replacement as well as the concomitant treatment of the precipitating factors. Improved patient education and implementation of measures such as home glucose and ketone monitoring might decrease the number of hospital admissions due to DKA and HHS, which are, in their majority, preventable).
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Crucial for the management of acute renal failure is the differentiation in a prerenal, renal and postrenal form. Prerenal acute renal failure, i.e., hypovolemia, and postrenal acute renal failure, i.e., urinary obstruction, can be treated specifically, and generally, these forms of acute renal failure resolve quickly. By contrast, for intrinsic acute renal failure with acute tubular necrosis, there is no specific therapy and supportive care is necessary until renal function resumes. ⋯ With the incidence of acute renal failure, the prognosis of intensive care patients deteriorates significantly. Temporary extracorporeal detoxification is often necessary, until eventually, there is a restitution of renal function. The prognosis of acute renal failure in intensive care patients is poor, if there is preexisting renal disease or the cause of the acute renal failure cannot be eliminated.