Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Nov 2010
Case Reports[Multimodal approach in coincidence of covered ruptured abdominal aortic aneurysm and aortocaval fistula].
A 71-year-old patient had been referred to our hospital with the diagnosis, made by angio-computed tomography (CTA), of a covered ruptured abdominal aortic aneurysm (AAA) resulting in an aortocaval fistula (ACF). ⋯ The coincidence of AAA and ACF is rare. However, the morbidity and mortality are high and require early diagnosis and immediate treatment.
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Dtsch. Med. Wochenschr. · Nov 2010
Randomized Controlled Trial[Procaine infusion for pain treatment of acute pancreatitis: a randomized, placebo-controlled double-blind trial].
Acute pancreatitis is commonly associated with severe abdominal pain, making early pain relief a primary goal of the treatment. This study was undertaken to assess the efficacy of a continuous intravenous (i.v.) infusion of procaine compared with that of a placebo infusion in providing pain relief in patients with acute pancreatitis. ⋯ These data do not indicate a clinically meaningful analgesic effect of i.v. infusion of procaine (maximal amount. 1.92 g/24h) in patients with acute pancreatitis, but suggested that this infusion actually increased the feeling of bodily discomfort and nausea. We thus conclude that a constant i.v. infusion of procaine should no longer be recommended for pain relief in patients with acute pancreatitis anymore.
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Dtsch. Med. Wochenschr. · Nov 2010
Review[Novel anticoagulants for stroke prevention in atrial fibrillation].
The most frequent cardiac arrhythmia and main cause for cardio-embolic stroke is atrial fibrillation. Prophylaxis for thrombembolic events is performed regarding individual risk of patients with either ASS or vitamin-K-antagonists. ⋯ New oral anticoagulants with different mechanisms of action may be a promising therapeutic option in future. This review addresses the new anticoagulants Apixaban, Rivaroxban and Dabigatranetexilat with the design and as available the results of the corresponding phase-III-trials in atrial fibrillation (ARISTOTLE, ROCKET-AF, RE-LY).
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Acute kidney injury (AKI) is characterized by a sudden breakdown of the incretoric and excretoric functions of the kidneys. In intensive care it is always part of a multiple organ failure (MOF). It has a high incidence in intensive care (5 - 20 %), increasing up to 50 % in patients with septic shock. ⋯ In continuous forms of treatment an exchange amount of 20 ml/kg/h should be reached, as in intermittent hemodialysis a Kt/V lower 4 - 4.5/week should be avoided. According to the survival of the patients there is no evidence that either continuous forms of treatment or intermittent dialysis is superior over the other, comparing always these heterogeneous groups of medical and surgical AKI patients. There seems to be a small group of patients (mortality > 80 %) never included in any prospective randomized trial which can only be treated continuously.
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Therapeutic hypothermia (TH) is very effective for the treatment of acute experimental brain injury. In contrast to other neuroprotective methods or pharmacological agents, TH represents the only clinically proven neuroprotective therapy. TH led to a decreased mortality rate and improved functional outcome in patients with cardiac arrest. ⋯ Other important indications such as ischemic stroke remain to be investigated properly. Recent phase II studies are on the way to test safety and feasibility in the early time window of stroke including thrombolysis. The recent article describes the status and perspectives including open questions for hypothermia in neurological intensive care.