Therapeutische Umschau. Revue thérapeutique
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Disorders due to spinal cord compression or ischemic spinal cord lesions represent the most relevant nontraumatic spinal cord injuries causing acute para- and tetraplegia. In acute spinal cord compression early diagnosis is most reasonable to indicate early operative intervention with decompression to prevent progressive neurological deficits. ⋯ In chronic spinal cord compression operations are aimed to prevent the development or progression of neurological deficits, as the outcome of rehabilitation is very much dependent to the neurogenic damage. In ischemic spinal cord lesion therapy is restricted to prevent further cadiovascular complications which additionally induce spinal cord dysfunction.
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This overview discusses pathogenesis, clinical presentation, prognostic implications and therapy of central sleep apnea with special reference to Cheyne-Stokes-Respiration or periodic breathing. In contrast to obstructive sleep apnea due to upper airway collapse during sleep, central sleep apnea (CSA) is mainly due to an instability of the breathing control system. Causes of central sleep apnea include alveolar hypoventilation disorders, heart failure, neurologic and autonomic disorders and idiopathic forms of CSA. ⋯ Treatment options for central sleep apnea are oxygen supplementation, medical therapy (i.e. acetazolamide) and CPAP. For patients with central sleep apnoea associated with alveolar hypoventilation nasal ventilation is treatment of choice. Newer nasal ventilation techniques (BiPAP, AutoSetCS) are under investigation for heart failure patients with Cheyne-Stokes-Respiration.
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The treatment of congestive heart failure focuses on three steps: 1. Elimination of the precipitating cause or mechanism, and/or treatment of the underlying disease respectively. 2. Treatment of the failing heart syndrome itself. ⋯ Here amiodarone is the drug of choice today if beta blockers do not suffice. Prophylactic anticoagulation is indicated in all cases NYHA III and IV, with large hearts already in II. Future developments may include new inotropes, the ANP-system, and cytokines, as well as gene therapy for correction of myocardial phenotype change.
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Neurological manifestations are frequent in patients with AIDS. Many neurological disorders have disappeared with the advent of highly active antiretroviral combination therapies. We can speculate that some of these disorders may reappear in patients under antiretroviral therapy, possibly with different clinical manifestations and at a different stage during HIV-infection. ⋯ The analysis of the cerebrospinal fluid by polymerase chain reaction is now a well established diagnostic method for investigating the most common CNS-infections in AIDS-patients. Neuroimaging (by MRI or CT-scan) is an additional, useful investigation. Cerebral toxoplasmosis, cryptococcosis, PML, encephalitis due to herpes-viruses and neurosyphilis are discussed.
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Hypertension in pregnancy is defined by a systolic blood pressure > or = 140 mm Hg and a diastolic blood pressure of > or = 90 mm Hg or by a rise in blood pressure of systolic > or = 30 mm Hg and diastolic > or = 15 mm Hg. High blood pressures are found in 5-10% of all pregnancies. The outcome of pregnancy is influenced by the fact whether there occurs a proteinuria in addition to hypertension. ⋯ The prophylactic use of low-dose heparin, which has lead to a significant decreased incidence of preeclampsia in retrospective analysis, is now the object of a randomized, controlled trial in our hospital. All women who suffered from a preeclampsia should have a check-up after 3-6 months. Preexisting pathologies are found in up to 40% of patients, mostly in multiparae, i.e. chronic hypertension, nephropathy, endocrine pathologies, anomalies of blood coagulation and antiphospolipid-syndrome.