Deutsche medizinische Wochenschrift
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Right ventricular failure may result from an newly developed disease (e.g. as a consequence of acute respiratory distress syndrome [ARDS] or of severe pulmonary embolism) or of already present pulmonary hypertension (PHT). There is as yet no generally recognized definition of acute or chronic right ventricular failure. The particular clinical picture and the associated hemodynamics determine this condition. ⋯ The central goal in the treatment of right heart failure as part of PHT is to lower pulmonary vascular resistance and thus decrease right ventricular afterload. However, it is very difficult to break the vicious circle involved in the acute right heart syndrome, it must be the primary aim of treatment to recognize as early as possible any worsening of PHT and prevent acute right heart failure. Lung transplantation or surgical atrioseptostomy may represent possible ultimate therapeutic options for patients with PHT.
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Abnormal liver function tests occur in 3 - 5% of pregnancies for different reasons. Apart from pre-existing liver diseases liver diseases occurring during pregnancy, such as gall stones or viral hepatitis, most liver dysfunctions in pregnancy are caused by one of the five pregnancy-related liver diseases. The five known pregnancy-related liver diseases can be classified in two main categories depending on their association with or without preeclampsia. ⋯ However, many life-threatening maternal complications like liver hematoma or rupture and abruptio placentae can occur. Acute fatty liver of pregnancy is also a severe illness occuring mostly in the third trimester; microvesicular fat deposition in the liver can cause liver failure with coagulopathy and encephalopathy. Only the immediate delivery of the fetus can save mother and child.
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Dtsch. Med. Wochenschr. · Oct 2008
Comparative Study[Emergency medical care of terminally ill patients].
3 % of all emergency calls in Germany are related to terminally ill cancer patients. It was the aim of this investigation to prospectively include over a lenghty period all emergency calls from cancer patients in the final stage of their disease, to elucidate the specific features of these calls and to compare them with calls of other reasons. ⋯ Our data demonstrate that the care of cancer patients in the final stage of their disease is an important factor in emergency medicine. For this reason special knowledge of problems arising in relation to end of life care is essential.
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Dtsch. Med. Wochenschr. · Oct 2008
Comparative Study[Amanita poisoning--comparison of silibinin with a combination of silibinin and penicillin].
Current treatment of amatoxin poisoning includes the administration of silibinin and penicillin in combination or silibinin alone. The aim of this study was to compare both therapeutic regimes. ⋯ A lower death and transplantation rate was observed in the silibinin treatment group than in group treated with silibinin combined with penicillin. However, this difference was not statistically significant. The high risk ratio relating to the time-dependent effect of silibinin suggests its efficaciousness in the treatment of amatoxin poisoning. The latency period was assessed as an independent prognostic factor.
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Dtsch. Med. Wochenschr. · Oct 2008
Case Reports[Severe myocardial infarction due to late and very late stent thrombosis after coronary artery stenting with drug-eluting stents].
Two men, 59 and 65 years old, both with coronary heart disease, were admitted to hospital with acute ST-segment elevation myocardial infarction. They both had undergone coronary artery stenting with drug-eluting stents 9 months and 3 years before, respectively. After stent implantation combined antiplatelet therapy with acetylsalicylic acid and clopidogrel had been administered for 6 and 18 months, respectively. Clopidogrel had been stopped 10 weeks ago in patient 1 and 18 months ago in patient 2. ⋯ Myocardial infarction is common in patients with a history of coronary artery disease. Especially after coronary artery stenting with drug-eluting stents, severe myocardial infarction due to stent thrombosis may occur late after stent implantation and be independent of changes in antiplatelet therapy. These patients and physicians should therefore be fully aware of this risk and of the crucial importance of antiplatelet therapy after coronary artery stenting.