Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Apr 2008
Review[Heart failure in chronic obstructive pulmonary disease (COPD)].
Chronic obstructive pulmonary disease (COPD) has significant extrapulmonary effects, among others, on cardiovascular disease. Heart failure can frequently be found in patients with COPD. Etiology of heart failure in COPD is only poorly understood but may be related to the high frequency of ischemic heart disease in this population. Furthermore, recent data suggest that diastolic left ventricular dysfunction may have a role for heart failure in COPD.
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Dtsch. Med. Wochenschr. · Apr 2008
Case Reports[Bilateral fractures of the humerus after hypoglycemic seizure].
An 87 year-old woman with insulin dependent diabetes was referred to our hospital because she had sustained a generalized tonic-clonic seizure. Initial blood sugar concentration before hospital admission was 1.1 mmol/l. ⋯ The presentation of simultaneous bilateral fractures of the humerus is a rare but severe and almost pathognomonic complications of generalized tonic-clonic seizures, for example in the context of marked hypoglycemia. Appropriate monitoring and treatment of blood sugar levels in diabetics must be emphasized.
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Dtsch. Med. Wochenschr. · Apr 2008
[Electrocardiographic changes in patients presenting with an acute coronary syndrome: "apical ballooning" versus anterior myocardial infarction].
Transient left ventricular (LV) apical ballooning (AB) is characterized by chest pain, electrocardiographic (ECG) changes and LV apical akinesia mimicking anterior myocardial infarction (AMI) in the absence of coronary artery disease. This study aimed to assess if the ECG could reliably differentiate between these two syndromes with a similar clinical presentation. ⋯ ECG findings in AB patients are significantly different from those in AMI patients. At initial presentation, the extent of ST-segment elevation and the number of abnormal Q waves are greater in AMI. During follow-up, no Q wave, a longer QTc interval and a greater extent of T-wave inversion are typical findings in AB patients.
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Dtsch. Med. Wochenschr. · Apr 2008
Review[Complications after lung transplantation. Part 1: Intensive medical and pneumologic complications].
Primary graft dysfunction and/or phrenic nerve lesion are common complications in the early phase after lung transplantation. Respiratory insufficiency is the most common reason for admission to the intensive care unit for patients after lung transplantation. Pulmonary complications in the post transplant management are acute allograft rejection (50% in the first year), infections, endobronchial bleeding, necrosis and fibrinous bronchitis. Chronic graft dysfunction (bronchiolitis obliterans syndrome) and infections are major obstacles to long-term survival.
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Central sleep apnea (CSA) is characterized by a lack of drive to inspire for at least 10 sec. In the CSA-syndrome accompanying arousals and desaturations of the arterial blood cause sleep disturbances and sympathetic nerve activations which lead to excessive daytime sleepiness and increase the risk for cardiovascular morbidity. There are six manifestations of CSA: a rare primary or idiopathic form, often in hypocapnic patients with an increased hypercapnic ventilatory drive; Cheyne-Stokes respiration, characterised by periodic CSA and a crescendo/decrescendo breathing pattern, often in patients with severe cardiac or neurological diseases; high altitude-induced periodic breathing (above 4000 m), CSA due to medical or neurological conditions; CSA due to drug or substance use; and primary sleep apnea of infancy. Besides the consequent treatment of the underlying medical conditions therapeutic options include the use of drugs, e. g. acetacolamide or oxygen, as well as non-invasive ventilation, e. g. continuous positive airway pressure (CPAP) or adaptive servo-ventilation.