Med Klin
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Review Comparative Study
[Current status of lung transplantation: patients, indications, techniques and outcome].
Lung transplantation has evolved to a standard treatment modality for patients suffering from end-stage lung diseases. ⋯ This article reviews the current strategies in the treatment of lung transplant recipients, surgical techniques, limitations of and outcome after lung transplantation.
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Case Reports
[Recurrent epistaxis in a patient with aortic valve stenosis: a variant of Heyde syndrome?].
The Heyde syndrome describes the coincidence of aortic valve stenosis and intestinal bleeding. The pathophysiologic link between both entities has remained unclear so far. In several studies the intestinal bleedings have been attributed to angiodysplasia. Cessations of the intestinal bleedings following replacement of the aortic valve have been described by numerous reports. ⋯ This case report suggests that aortic valve stenoses may be associated with extraintestinal bleedings as well.
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Case Reports
[Metformin-associated lactic acidosis with acute renal failure in type 2 diabetes mellitus].
An 83-year-old patient was admitted to our hospital because of gastrointestinal symptoms, mental confusion and dysarthria. The patient suffered from type 2 diabetes mellitus and was taking metformin. A mild renal insufficiency was known. On admission, we found impaired consciousness, Kussmaul breathing, a body temperature of 32.1 degrees C, and hemodynamic instability. Laboratory testing revealed lactic acidosis (pH 6.71, base excess--30, standard bicarbonate 4.0 mmol/l, lactate 24.4 mmol/l) and acute renal failure with a creatinine of 10.6 mg/dl and blood urea nitrogen of 134 mg/dl. Electrolytes were not altered; the blood glucose was elevated (147 mg/dl). According to history, physical examination, and laboratory testing the diagnosis metformin-induced lactic acidosis with acute renal failure was made. This diagnosis was confirmed by an elevated level of metformin. As soon as possible a bicarbonate hemodialysis was initiated. After 8 hours of hemodialysis the acid-base metabolism was almost balanced and the vigilance of the patient normalized. No further sessions of hemodialysis were needed and insulin therapy was started. ⋯ Metformin-induced lactic acidosis is a common side effect in patients with renal insufficiency. For an early diagnosis, clinical symptoms of intoxication should be well known by physicians and patients. First-line therapy for correction of lactic acidosis and effective elimination of metformin is bicarbonate hemodialysis. Sodium bicarbonate infusions are not able to correct the acid-base metabolism sufficiently. For prevention the renal function should be monitored closely and metaformin therapy should be stopped, if a deterioration of renal function is observed.
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To date, the problem of infectious risks in the domestic environment has not been focused as intensively as that in the clinical environment. Due to increasing costs in health care, there are considerations to intensify outpatient treatment models, e.g., for hematology-oncology patients, enhancing the importance of this problem. ⋯ The scope of these recommendations is to support the attending physician when advising the immunocompromised patient and to give suggestions for possible control measures to the patient.
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Fever in travellers returning from the tropics may be caused not only by tropical infection but also by travel associated non-specific infections and cosmopolitan infective diseases. ⋯ Plasmodium falciparum infection has to be excluded first because of vital damage. Following malaria (30%) respiratory infections (11%) are common. Fever as a symptom of non-infective disease occurred in 9%. Other diseases (typhus, Dengue fever, tuberculosis) are rare but have to be considered.