Der Internist
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The early detection and treatment of diabetic nephropathy (DN) is of crucial importance as patients with diabetes mellitus represent the largest proportion of patients on dialysis, with the highest morbidity and mortality. Currently, the first clinical sign of incipient DN is microalbuminuria, but its precision is not optimal. Many studies now report that proteins and peptides are new biomarkers in urine that primarily depict the pathophysiology of DN and thus allow for improved diagnosis of DN. ⋯ Clinical urinary proteome analysis shows great benefits and is already an appropriate tool for the early detection of incipient DN.
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Central venous port systems are an integral part of chemotherapy. Early recognition and management of arterial malposition are crucial to prevent further complications. ⋯ After administration of the first chemotherapy the patient developed acute bihemispheric cerebral infarction and myocardial ischemia due to arterio-arterial emboli with a toxic encephalopathic component. After systemic lysis and surgical removal of the central venous port system, the patient showed a complete recovery.
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The management of hemodynamic instability in the context of sepsis or septic shock is at the forefront in emergency care as well as in the intensive care unit. Cardiovascular instability has a dramatic impact on the rate of organ complications and mortality from sepsis. ⋯ Crystalloid balanced fluid and catecholamines are the cornerstones of therapy management for septic cardiovascular instability. In this article, the most important points of what, when and how much regarding circulation therapy are presented and critically discussed.
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Sepsis and septic shock are still associated with a high mortality and morbidity. A decisive factor for improvement of the outcome is the prompt initiation of an effective antibiotic treatment. ⋯ Effective empirical treatment comprises purposefully selected broad-spectrum antibiotics and also combination treatment or antimycotics in special situations. De-escalation strategies to narrow down or shorten the treatment are safe and can limit the side effects.