Deutsche medizinische Wochenschrift
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Heart surgery has been performed in an increasing number of elderly patients in the recent years. Currently about 20 % of all patients in cardiac surgery are older than 75 years, however their number is increasing constantly. ⋯ Surgical pathways in the therapy of coronary artery disease or valve disease are described. Furthermore, age related morbidity and mortality and related surgical options to improve the outcome are discussed.
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Haemoptysis and haemoptoe mainly differ in the amount of expectorated blood. Causes of haemoptysis are diverse and include bronchitis, bronchiectasis, carcinoma, tuberculosis and other infectious pulmonary disease. Haemoptysis almost exclusively involves bronchial arteries, rarely vessels of the pulmonary-artery circuit. ⋯ Chest X-ray is an integral part in each evaluation, as is bronchoscopy. Fiberoptic bronchoscopy is easily performed, although rigid bronchoscopy considerably extends the armamentarium of diagnostic and therapeutic measures. (Pulmangio-) chest CT scan as well as echocardiography and angiographic procedures provide extended diagnostic and therapeutic options. Surgery may be required in severe bleeding complications or during stable disease as a diagnostic approach.
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Dtsch. Med. Wochenschr. · Jan 2005
Review Comparative Study[Primary prevention of cardiovascular disease].
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Sepsis is one of the most frequent infectious problems at Intensive Care Units, and sepsis is associated with significant mortality. The latter could not be markedly reduced in the last years, despite a number of advances in the field of volume substitution, catecholamines, and endocrinologic therapy. The reason might be that important steps towards overcoming of sepsis are the surgical resection of infectious foci and an adequate antibiotic treatment. ⋯ Since no major progress in the development of new antibiotics can be expected for the next years, sepsis treatment must be focused on prevention of infection, and on an optimised application of current antibiotic substances. The key factors are a broad and high dose initial treatment, a de-escalation strategy according to the clinical course, and -with exceptions- a limitation of treatment to 7 to 10 days. Rotation of antibiotics should be performed, if problems with resistances exist or no specialist for infectious diseases is available on the Intensive Care Unit.