Deutsche medizinische Wochenschrift
-
Dtsch. Med. Wochenschr. · Mar 2015
[Do we use the wrong target value for the supportive therapy of sepsis?].
Sepsis is a generalized, usually infectious disease with a complex dsyregulated immune response and capillary leak. The leakage leads to a severe drop of blood pressure with hypoperfusion and sympathetic counterregulation. The lung is frequently involved either as a source of the inflammation or by emergence of an ARDS, both resulting into severe hypoxemia. ⋯ It is not surprising, that there are no plausible data in the literature which have shown a positive effect for the target value PaO2 or SaO2. Studies are urgent needed to compare CaO2 as a target value to the standards in the current guidelines. Additional animal experiments should be done to get information on the critical range of CaO2, in order to translate these results into treatment strategies for intensive care unit patients with severe hypoxemia.
-
A chest tube is used to drain the contents of the pleural space to reconstitute the physiologic pressures within the pleural space and to allow the lungs to fully expand. Indications for chest tube placement include pneumothorax, hemothorax, pleural effusion, pleural empyema, and major thoracic surgery. ⋯ Applying the step-by-step technique presented, placement of a chest tube is a quick and safe procedure. Complications - frequently occurring when the tube is inserted with a steel trocar - include hemothorax, dislocation, lung lacerations, and injury to organs in the thoracic or abdominal cavity."
-
Dtsch. Med. Wochenschr. · Mar 2015
Review[Tropheryma whipplei: pathogen of Whipple's disease and more].
Within the last years the understanding of infection with Tropheryma whipplei was significantly enhanced by improvement of molecular biology, microbiology and immunology. The following entities of infection or carriage, respectively, with T. whipplei must be differentiated: besides in the context of classical Whipple's disease (CWD), the rare chronic infection with T. whipplei (estimated incidence: 1 : 1,000,000), T. whipplei can be detected more frequently in stool specimens of children with acute gastroenteritis or asymptomatic carriers, or as a cause of isolated endocarditis. However, infection with T. whipplei only rarely results in CWD. ⋯ Successful treatment can be achieved in most of the cases by antimicrobial therapy and first prospective treatment trials are published. However, neuronal CWD still can be progressive lethal and an immune reconstitution inflammatory syndrome (IRIS) might complicate the course of treatment and in worst case end fatal. Thus, because of the complexity of the disease a specialised reference centre should be consulted for diagnosis and treatment of CWD.
-
Dtsch. Med. Wochenschr. · Mar 2015
Review Comparative Study[Lipid lowering by rosuvastatin: how do statins differ?].
-
Dtsch. Med. Wochenschr. · Mar 2015
[Treatment of chronic heart failure: what's not (yet) in the guidelines].
2012 Scientific meeting of the European Society of Cardiology (ESC), the current Guidelines on Acute and Chronic Heart Failure were introduced whose preparation had started 18 months earlier. These guidelines integrate scientific evidence of the years 2011 and 2012, leaving several questions open due to gaps in knowledge. ⋯ Based on recent studies, we will address some of these questions and discuss potential impact of their results on current clinical practice. A further official update of the ESC heart failure guidelines is expected for early 2016, which will then show if today's assessment holds true.