Plötzlicher Herztod

Background

Sudden cardiac death (SCD) is the most frequent cause of out-of-hospital death in industrialized societies. In about 80?% of the victims SCD results from complications of underlying coronary heart disease, the remainder being due to a wide variety of inborn or acquired heart diseases.

Method

Analysis of clinical trials.

Results

If circumstances of SCD are analyzed in depth, an astonishing number of commonalities can be stated: about two thirds of cases occur at the home of the patient, two thirds in the presence of eye witnesses (most of them relatives), and the majority of victims has typical prodromal symptoms similar to those known from coronary heart disease. Moreover the characteristic warning symptoms are tolerated over a surprisingly long time. Patients and relatives, however, often do not understand the significance of these warning signs. In addition, bystander resuscitation rates in private surroundings are much lower compared to public places, resulting in worse survival rates.

Conclusion

These findings point out a major potential to fight SCD by information and education of patients and relatives on the impact of prodromal symptoms preceding SCD, the necessity of rapid reaction and to train basic life support.     

Plötzlicher Herz-Kreislauf-Stillstand und Reanimation im Sport

Notfall + Rettungsmedizin - Der plötzliche Herz-Kreislauf-Stillstand im Sport ist ein seltenes, aber manchmal ein besonders eindrückliches Ereignis, wie man anhand der Krankengeschichte...     

Plötzliche Luxation einer zwei Jahre vorher behandelten und geheilten angeborenen Hüftgelenskverrenkung

Ohne Zusammenfassung Mit 4 Abbildungen im Text.     

Shhwerhörigkeit und Hörapparat

Ohne Zusammenfassung     

Antibiotikainduzierte Diarrhö und pseudomembranöse Enterokolitis

The spore-forming anaerobic bacterium Clostridium difficile has become a serious enteropathogen. Oral and parenteral administration of antibiotics can cause ecological disturbances in the normal intestinal microflora. Suppression of the normal microflora may lead to reduced colonization resistance with subsequent overgrowth by pre-existing, naturally resistant microorganisms, such as C. difficile. C. difficile infection shows a range of clinical presentations between an asymptomatic carrier state, light diarrhea without inflammatory changes, and pseudomembranous colitis. C. difficile infection is acquired by the fecal-oral or environmental-oral routes. From March 2000 through March 2001 we assessed 48 cases of nosocomial antibiotic-associated diarrhea (AAD). Of these, 21 were due to C. difficile (CDAD). Cephalosporin was the agent most commonly associated with CDAD. Avoidance of cephalosporins, strict use of "single shot" prophylaxis, isolation of infected, symptomatic patients in single-bed rooms, improved hygiene and complete room disinfection lead to a rapid decrease of CDAD. The etiology, prognosis and prophylaxis are discussed in this paper.     

Mammachirurgie und Körperstraffung

Einführung zum Thema

Mammachirurgie und K?rperstraffung     

Penis- und Harnröhrenmissbildungen

Penile and urethral anomalies are common congenital disorders with some rare variations. For example, the floppy penis is dealt with in only a few publications with a small numbers of cases. Other anomalies have not been published at all, i.e., the ectopic penis. Some anomalies become apparent immediately at birth, others remain undiscovered until adolescence. To date there is no established classification system dealing with urethral and penile anomalies. Also, no established guidelines exist for diagnosing and treating these anomalies. Surgical corrections of penile and urethral anomalies should follow standardized procedures on the one hand, but must respect the individual anatomical situation on the other. Since genital anomalies are frequently part of a syndrome, interdisciplinary approaches are advisable. The following article presents a classification of penile and urethral anomalies. Since posterior urethral valves usually affect the bladder and upper urinary tract, this disorder is not included in this review.     

Kleider und Körperform

Ohne Zusammenfassung     

Kosten- und Erlösanalyse

Background

Financial pressure and economic responsibility for budgets demand that different treatments for the same condition be compared for cost effectiveness. In the sector of vascular medicine a cost comparison of carotid endarterectomy (CEA) and carotid artery stenting (CAS) for carotid stenosis is of particular interest.

Methods

We compared the total internal costs and the staff and material costs incurred for 30 CEAs (7 female patients) and 30 CASs (8 female patients). Symptomatic stenosis of the carotid artery was present in 14 of the30 patients in the CEA group and 26 of the 30 in the CAS group. The average age was 70.2 years in the CEA group and 68.4 years in the CAS group.

Results

On average the total internal cost was EUR 3617,61 for CEA and EUR 4,551,67 for CAS. Total procedural costs were EUR 508,61 for CEA and EUR 2142,67 for CAS; CAS involved EUR 1983,81 for material costs, while CEA involved 276,71 for material costs and EUR 448 for anaesthesia in addition. The most cost-intensive items for CEA were the patch (EUR 118,--), sterilisation (EUR 54,48), and the shunt (EUR 28,05). In the case of CAS the most expensive items were the stent (EUR 800,--), the protection system (EUR 800,--) and the balloon catheter (EUR 118,--). Nonprocedural costs (ward, intermediate care suite, laboratory, X-ray and others) were comparable in both groups (CEA: EUR 2661; CAS EUR 2409).

Conclusions

The increasing importance of economics in medicine makes transparent analyses of cost and effectiveness of different treatment options for the same disease necessary. The data presented may give an insight into the resources consumed by and possible income that could accrue from reconstructive treatments for carotid artery stenosis.     

Körperschwere und Gelenke

Ohne Zusammenfassung     

Hirndruck und Hirnödem

In primary and secondary brain diseases, increasing volumes of the three compartments of brain tissue, cerebrospinal fluid, or blood lead to a critical increase in intracranial pressure (ICP). A rising ICP is associated with typical clinical symptoms; however, during analgosedation it can only be detected by invasive ICP monitoring. Other neuromonitoring procedures are not as effective as ICP monitoring; they reflect the ICP changes and their complications by other metabolic and oxygenation parameters. The most relevant parameter for brain perfusion is cerebral perfusion pressure (CPP), which is calculated as the difference between the middle arterial pressure (MAP) and the ICP. A mixed body of evidence exists for the different ICP-reducing treatment measures, such as hyperventilation, hyperosmolar substances, hypothermia, glucocorticosteroids, CSF drainage, and decompressive surgery.     

Intravenöse Dauertropfinfusion und ihre Störungen

Langenbeck's Archives of Surgery - DieWürzburger Klinik hat mit der intravenösen D.I. sehr gute Erfolge aufzuweisen. Fast 33% der im schwersten postoperativen Kollaps Behandelten...     

Schlaf und Schlafstörungen bei Kindern und Jugendlichen

New study results underline the importance of restorative sleep for somatic, mental and cognitive child development. Pediatric sleep disorders are fundamentally different from those of adults. For this reason sleep research and sleep medicine have become increasingly more important in pediatric and adolescent medicine. The aim of this article is to give an overview of pediatric sleep disorders and possible therapeutic interventions. It particularly focuses on sleep-related breathing disorders which are a challenge for interdisciplinary cooperation for the diagnostics and therapy involving pediatricians, dentists, ear nose and throat specialists, orthodontists and oral surgeons.