Deutsche medizinische Wochenschrift
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In circulatory arrest, the first minutes and hours are crucial - rapid and adequate care can significantly increase the chances of survival. A large number of disciplines are involved in the recommendations and guidelines for out-of-hospital resuscitation. ⋯ Both the ambulance service and the accepting hospital are faced with major challenges in this regard. This article will illustrate the most important steps during and after resuscitation and discuss innovations.
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Dtsch. Med. Wochenschr. · Jul 2023
[Elevated liver values caused by nonalcoholic steatohepatitis (NASH)].
Non-alcoholic steatohepatitis (NASH) is the progressive entity of non-alcoholic fatty liver disease (NAFLD) and characterised by increased inflammatory activity, potentially resulting in liver fibrosis and ultimately cirrhosis. NASH activity and hepatic fibrosis are the prognosis determinating risk factors - rational stepwise diagnostic approaches are urgently needed as therapeutic options beyond lifestyle modifications are limited.
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Drug-induced toxic hepatopathies and drug-induced liver injury, DILI, are characterized by a variety of clinical manifestations and therefore represent a significant diagnostic challenge. This article shows how DILI is diagnosed and what therapy options exist. ⋯ These newer substances and corresponding hepatotoxic effects are not yet fully understood. The internationally recognized and online available RUCAM score (Roussel Uclaf Causality Assessment Method) helps to assess the probability of drug-related toxic liver damage.
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Dtsch. Med. Wochenschr. · Jul 2023
[Hereditary Liver Diseases: Wilson's Disease and Hemochromatosis].
Wilson's disease and HFE-hemochromatosis are autosomal-recessively inherited metabolic diseases of the liver. Copper overload in case of Wilson's disease and iron overload in case of hemochromatosis lead to organ damage of the liver and other organs. ⋯ Iron overload in hemochromatosis patients is treated with phlebotomies and copper overload in Wilson's disease patients with either chelating medications (D-penicillamine or trientine) or zinc salts. After introduction of lifelong therapy both diseases typically have a favorable disease course and further development of organ-damage can be prevented, especially with respect to liver-damage.
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Thrombosis and embolism are among the most common causes of death worldwide and, in addition to venous thromboembolism with the two main manifestations of deep venous thrombosis and pulmonary embolism, also include arterial thrombotic disease such as myocardial infarction, stroke and systemic arterial embolism. It is often the interaction of several predisposing factors that leads to the formation of an intravascular thrombus. ⋯ For this purpose, a risk-benefit analysis based on the individual case and regular reassessment are of particular importance. In this article, the pathophysiological concepts of venous and arterial thrombosis and the main therapeutic implications resulting from this are reviewed.