Fortschritte der Medizin
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Fortschritte der Medizin · Jun 1998
Review[Cardiac arrhythmias in sleep apnea. Increased cardiovascular risk caused by nocturnal arrhythmia?].
In sleep-disordered breathing (SDB), the greatest clinical relevance attaches to obstructive sleep apnea on account of its high prevalence and its concomitance with diseases of the cardiovascular system. The high mortality rate of untreated patients is believed to be due to the consequences of these latter diseases. Thus, for example, in addition to systemic arterial hypertension, elevated rates of such disorders as pulmonary hypertension, right heart insufficiency, coronary heart disease, myocardial infarction and stroke are also found. ⋯ Till the mid-eighties the prevalence of bradycardic arrhythmias was reported to be more than 30%. However, the importance of cardiac arrhythmias has been overestimated, as is supported in particular by current studies on large non-selected samples showing a much lower prevalence of apnea-related arrhythmias. In the differential diagnosis, however, consideration must be given to SDB in patients with nocturnal arrhythmias and heart rate variations.
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The large majority of patients being managed in palliative medicine are suffering from incurable, far advanced and progressive cancer. An overall treatment strategy not only includes the treatment of physical symptoms but also integrates the psychological, social and spiritual problems of the patients and his/her relatives. The most stressful physical symptom is pain, which may be so severe as to be intolerable. ⋯ The opioid of choice is oral morphine. The value of oral oxycodone and hydromorphone has not yet been fully established, and it remains to be seen what role they will play in the future. These two substances are expected to become available in Germany in 1998.
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Iron deficiency anemia is a common symptom of chronic occult gastrointestinal bleeding. There are numerous potential sources of gastrointestinal hemorrhage, most of which can be detected with the aid of endoscopy of the upper and lower digestive tract. Diagnostic procedures for the small bowel are less sensitive and usually more invasive. On the basis of the relevance of information they provide, the various diagnostic procedures and their indication in the diagnosis of iron deficiency anemia are critically reviewed, and a systematic diagnostic strategy developed.
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Fortschritte der Medizin · Dec 1996
Review[Coma in myxedema--a rare complication of hypothyroidism. Possible iatrogenic factors should be taken into account].
Myxedema coma is the most severe form of hypothyroidism and is characterized by extreme hypothermia, bradycardia, central hypoventilation and hypoxia. Common causes are intercurrent diseases, interruption of thyroid hormone treatment, or an overdose of sleeping pills or sedatives. ⋯ Consideration must also be given to an extra-thyroidal influence on the hormone levels. Intensive care treatment involving intravenous high-dose L-thyroxine and the reversal of hypoxia improve the prognosis of the serious disease.
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Anticholinergic delirium is a common side effect of various psychotropic drugs. The correct diagnosis is often delayed. The anticholinergic potential of many psychotropic agents is not known; it may become more manifest as a result of combination and cumulation effects. When the correct diagnosis has been established, a dose reduction or discontinuation of the drug involved may prove effective treatment.