Patient Blood Management in der Geburtsvorbereitung,Geburtshilfe und postpartalen Phase

Die Anaesthesiologie - Die Implementierung eines Patient Blood Management (PBM) wird zunehmender Standard in der operativen Medizin. Seit einiger Zeit gilt das Interesse auch den vulnerablen...     

Intravascular (”intimal”) epithelioid angiosarcoma: clinicopathological and immunohistochemical analysis of three cases

Angiosarcomas are rare malignant mesenchymal tumours, characterized morphologically by anastomosing vascular channels lined by atypical and proliferative active endothelial cells. An epithelioid cytomorphology of tumour cells is often seen focally in angiosarcoma, whereas purely epithelioid angiosarcomas are rare. Although angiosarcomas show a vascular differentiation they are almost never confined to pre-existing blood vessels. We describe three cases of intravascular epithelioid angiosarcoma arising in the carotid artery of a 60-year-old man, in the infrarenal part of the abdominal aorta and both renal arteries of a 69-year-old woman, and in the abdominal aorta of a 68-year-old man. In all cases malignant tumour tissue was found incidentally after disobliteration of thrombosed vessels. Histologically, purely epithelioid angiosarcoma composed of solid sheets of epithelioid tumour cells was seen; immunohistochemistry confirmed the endothelial differentiation of neoplastic cells. The reported cases show that angiosarcoma can occasionally arise within a pre-existing vessel. Received: 18 May 1999 / Accepted: 8 June 1999     

The alteration of autonomic function in multiple organ dysfunction syndrome

Autonomic dysfunction is associated with the severity of illness and mortality in patients with multiple organ dysfunction syndrome (MODS) and may contribute significantly to the pathogenesis of this syndrome. Several treatment approaches may possibly restore autonomic function in MODS and thus cause the survival benefit.     

Dreidimensionale Trainingstherapie bei Neuropathia vestibularis

Background

No evidence-based rehabilitation concepts exist regarding mobilization and sports therapy in patients with vestibular neuropathy in Germany. The goal of this longitudinal study was to evaluate a standardized sensorimotor training program with two different training phases.

Methods

Sixty-eight patients with vestibular neuropathy were randomized into treatment and control groups. The patients performed a training program of 30 units of 30 min each (10× Aerostep, 20× Spacecurl) and were investigated concerning postural stability, postural subsystems, and subjective perception with posturography and a standardized questionnaire (Dizziness Handicap Inventory, DHI).

Results

Postural stability (p=0.019) and cerebellar control mechanisms (frequency range F 7–8, p=0.033) could be improved significantly. The questionnaire showed significant changes in the physical subscore (p=0.001). Differentiated analysis of the two training phases showed the greatest impact in the frequency range F 5–6 (d=0.563; somatosensory system) in the Aerostep phase and the greatest benefit in the frequency range F 7–8 (d=0.281) in the Spacecurl phase.

Conclusion

Somatosensory intervention with Aerostep and Spacecurl in vestibular neuropathy could significantly influence postural stability and subjective perception compared to traditional rehabilitation.