Deutsche medizinische Wochenschrift
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The foramen ovale which is the fetal connection between the right and left atrium persists in about 30 % of the adult population. In the presence of a persistent foramen ovale (PFO) shunting of blood may occur from the right to the left atrium, and bubbles can reach the systemic circulation during or after the decompression phase of a dive with compressed air. Therefore, divers with PFO may have an increased risk to develop ischemic cerebral lesions and neurologic decompression sickness (DCS). ⋯ Therefore, it remains in the diver's choice to be screened for PFO. Divers with a history of DCS should be monitored for PFO, especially when diving strictly adhered to decompression tables. Divers with PFO who refuse to stop diving after DCS should be advised to adhere to very save dive profiles.
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Dtsch. Med. Wochenschr. · Jan 2004
[Can we afford the costs of progress in intensive care medicine? A plea for a candid debate].
Intensive care medicine is one of the most fast growing segments in medicine. New substances that may improve therapy of the critically ill dramatically have entered the market. Improvements include therapy of methicilline-resistant Staphylococcus aureus (MRSA) infections (linezolid), severe heart failure (calcium sensitizer levosimendan), intractable bleeding (recombinant factor VIIa) and severe sepsis (recombinant activated protein C (aPC)). ⋯ The elderly population will increase dramatically in the next years. Looking at this development, it is not only the question whether we can afford intensive care medicine, but the question has to be enlarged whether we can afford the new developments of intensive care medicine. All responsible persons (intensivists, pharmaceutical companies, politicians) are urged to define solutions in the near future.