Deutsche medizinische Wochenschrift
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Angioedema is an oedematous swelling of the mucosa or submucosa of the skin. Acute angioedema represents a clinical emergency when the pharynx or larynx are involved and breathing of the patient is impaired. For rapid and effective treatment it is necessary to differentiate between allergic and non-allergic angioedema. ⋯ Antihistamines, corticosteroids and adrenalin can be used to treat allergic angioedema but are ineffective in acute attacks of non-allergic angioedema. In these events the bradykinin-B2-receptor antagonist icatibant (in HAE, or RAE) or C1-INH concentrate (in HAE, or AAE) are therapeutic options for rapid alleviation of acute angioedema. The following article gives an overview of the diagnostics and treatment in the emergency situation of "acute angioedema", especially if swelling of the head-and-neck region is present.
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The prognosis of cardiogenic shock is still dismal despite advancements in diagnostic and therapeutic options. One of the major problems is the development of multi-organ failure caused by impaired organ perfusion with inadequate microcirculation. The diagnosis of cardiogenic shock is based on clinical signs of hypoperfusion, echocardiography, and hemodynamic parameters. ⋯ The assessment of microcirculation during modifications of the treatment of cardiogenic shock is valuable, e. g. during catecholamine therapy or when using of circulatory assist devices. This article summarizes new findings regarding microcirculation in cardiogenic shock, the use of assist devices, and novel pharmacological treatment. Evaluation of microcirculatory changes with its new insights in the complex pathophysiology of cardiogenic shock has the potential to become part of diagnostic algorithms.
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Dtsch. Med. Wochenschr. · Apr 2010
Review[Atrial fibrillation - Links between principles of pathophysiology and treatment].
Atrial fibrillation is the most common supraventricular arrhythmia in humans, basic and clinical sciences are still developing. This present review aims to inform non-cardiologists respectively non-electrophysiologists about the most important pathophysiological concepts and their influence on therapeutical principles of atrial fibrillation. ⋯ Impact of these pathophysiological concepts is discussed within the context of medicamentous, surgical and interventional therapy. Concomitantly, limitations of these therapies due to pathophysiological considerations are delineated.
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Dtsch. Med. Wochenschr. · Mar 2010
Review[Does phenotyping asthma help to improve differential treatment?].
Asthma is a syndrome characterized by airway inflammation, airway hyperresponsiveness (AHR) and airway obstruction. The diagnosis asthma comprises a very heterogeneous patient population. In recent years different strategies have been developed to classify the patients into different phenotypes. ⋯ Still some phenotypes depend on different pathophysiological mechanisms and can differ profoundly in their clinical course. Also for some of these phenotypes specifical treatpeuthic options are available. Therefore a good definition and classification of asthma phenotypes is important in regard of diagnosis, prognosis and therapy of these patients.