Pathologie odontogener Kieferhöhlenerkrankungen

The differential diagnosis of odontogenic lesions of the maxillary sinus may cause significant problems; however an adequate therapy is based on the correct histopathological diagnosis determining whether the surgical treatment consists of a simple minimally invasive procedure or a complex resection with safety margins and perhaps also lymph node dissection. Only an integrated approach considering all clinical, radiological and histopathological information can allow for an adequate treatment of an individual case. This overview discusses the most relevant entities which can be differentiated by histopathological criteria with respect to their clinical impact.     

Odontogene Kieferhöhlenerkrankungen

Odontogenic diseases of the maxillary sinus belong to the typical spectrum of diseases in oral and maxillofacial surgery. Sinusitis of odontogenic source accounts for about one tenth of cases of all maxillary sinusitis. Other odontogenic sinus diseases include cysts and tumors of odontogenic origin. Diagnosis usually requires a thorough dental and clinical examination of the patient including appropriate radiographs. The most common causes of odontogenic sinusitis include dental abscesses and periodontal diseases that had perforated the Schneidarian membrane, irritation and secondary infection caused by intra-antral foreign bodies, and sinus perforations during tooth extraction. In most cases surgical and dental treatment of the odontogenic pathological conditions combined with medical therapy is indicated.     

Bildgebende Verfahren bei Kieferhöhlenerkrankungen

Nowadays, with a wide availability of modern tomographic imaging procedures, diagnostic imaging of diseases concerning the maxillary sinuses has undergone a change. Ultrasonography is hardly used anymore and conventional radiography with panoramic radiography and x-ray imaging in occipitomental view has lost some of its significance in favor of cross-sectional modalities, such as computed tomography (CT), digital volume tomography (DVT) and magnetic resonance imaging (MRI). The aim to illustrate the anatomy as well as pathological findings in the initial examination, free of superposition and with a high validity, can only be attained by sectional imaging. For this reason conventional radiographic modalities are nowadays often no longer used. Both panoramic tomography and classical x-ray imaging of the paranasal sinuses are, however, still justified for follow-up examinations. With regard to patient radiation exposure, cone beam computed tomography and computed tomography are comparable when using low-dose protocols and both modalities are suitable to solve questions located in the high contrast range. Magnetic resonance imaging remains the method of choice when imaging and differentiating soft tissues.     

Die Kieferhöhle und die laterale Nasenwand

Modern concepts in the therapy of odontogenic maxillary sinusitis take the function of the paranasal sinuses into account. Besides the knowledge of pathological conditions within the maxillary sinus, a profound knowledge of the anatomy, especially of the ostiomeatal complex and the physiology of the maxillary sinus is essential. Anatomical variations in the area of the natural ostium and impairments of mucociliary clearance promote the development of maxillary sinusitis.     

Medikamentöse Therapie der Belastungsinkontinenz

Zusammenfassung Harnspeicherung und Miktion sind komplexe physiologische Funktionen und erfordern eine Koordination von allen 3 efferenten Bereichen des Nervensystems (Parasympathikus, Sympathikus, somatisches Nervensystem). Der N. pudendus setzt sich sowohl aus efferenten als auch afferenten Fasern zusammen; erstere haben ihren Ursprung im Nucleus Onuf. Eine Vielzahl von Studien hat 5-HT- und NE-Systeme mit der Steuerung des unteren Harntraktes in Verbindung gebracht.Bisherige Kenntnisse über die Steuerung des unteren Harntrakts beim Menschen wurden überwiegend durch tierexperimentelle Studien erworben. Duloxetin, ein kombinierter Serotonin-/Noradrenalin-Wiederaufnahmehemmer, bietet hier einen neuen therapeutischen Ansatz zur medikamentösen Behandlung der Belastungsinkontinenz. Duloxetin scheint am präsynaptischen Neuron im Nucleus Onuf zu wirken. Eine Phase-II- und 3 Phase-III-Studien zeigten eine signifikante und klinisch relevante Reduktion der Harninkontinenzepisodenfrequenz und Lebensqualität der behandelten Patientinnen im Vergleich zu Placebo. Als häufigste Nebenwirkung wurde Übelkeit genannt.     

117. Medikamentöse Therapie

Zusammenfassung Versucht man, die Prognose unter konservativer und chirurgischer Therapie abzuschätzen, so ist in folgenden Fällen eine medikamentöse Behandlung vertretbar, wenn hierunter eine Beschwerdefreiheit erzielt wird: ältere Patienten (> 70 Jahre); jüngere Patienten mit guter linksventriculärer Funktion, fehlender ST-Senkung unter Belastung ohne gefährliche ventriculäre Arrhythmien. Wurde eine Coronarangiographie durchgeführt, können Patienten mit 1-Gefäß- sowie 2-Gefäß-Erkrankung ohne RIVA-Beteiligung medikamentös behandelt werden. Eine Coronardilatation wird man heute allerdings in allen geeigneten Fällen versuchen.     

Medikamentöse Therapie der weiblichen Harninkontinenz

Zusammenfassung Die medikamentöse Therapie der weiblichen Harninkontinenz setzt profunde differentialdiagnostische und pharmakologische Kenntnisse voraus und sollte abhängig vom Inkontinenztyp nach sorgfältiger Abwägung von Wirksamkeit und Verträglichkeit des Präparats erfolgen. Dranginkontinente Patientinnen werden mit detrusorrelaxierenden oder desensibilisierenden Substanzen (Antimuscarinika, Östrogene, Alphablocker, Beta-Mimetika, Botulinumtoxin A, Resiniferatoxin, Vinpocetin) behandelt, während belastungsinkontinente Frauen eine pharmakologische Stimulierung des Sphinkter- und Beckenbodenapparats benötigen (Alpha-Mimetika, Östrogene, Duloxetin).Bei einer Überlaufinkontinenz kommt es auf eine Reduktion des Auslasswiderstands (Alphablocker, Baclofen, Botulinumtoxin A intrasphinktär) und/oder eine Kräftigung des geschwächten Detrusors (Parasympathomimetika) an. Die Nykturie und nächtliche Inkontinenz wird durch Regulierung der Diurese mit dem ADH-Analogon Desmopressin bekämpft. Zukünftige Entwicklungen lassen eine weitere Optimierung von Wirksamkeit und Verträglichkeit der medikamentösen Therapie der Harninkontinenz erwarten.     

Medikamentöse Therapie der akuten Herzinsuffizienz

Background

The aim of treating acute heart failure is to reduce pulmonary and/or systemic congestion. Rapid diagnosis and initiation of treatment are important. Triggering causes should be sought as they offer additional specific treatment options.

Method

Research and analysis of the literature.

Results

Because acute heart failure is a heterogeneous syndrome, fine-tuning the treatment strategy according to the clinical profile is warranted. The current guidelines recommend primary treatment with oxygen for oxygenation, possibly supplemented by noninvasive ventilation, intravenous furosemide to reduce preload, and nitrates to reduce preload and afterload.

Conclusions

These measures achieve a substantial improvement of symptoms and clinical signs of heart failure in the majority of patients. Unfortunately, large clinical studies that show the best possible use of currently available drugs in order to also reduce hard clinical endpoints such as mortality and morbidity (rehospitalization) are lacking.     

Medikamentöse Therapie des benignen Prostatasyndroms

The pharmacological treatment of benign prostatic hyperplasia (BPH) is indicated when men suffer from lower urinary tract symptoms (LUTS) but there are no absolute indications for prostate surgery or severe bladder outlet obstruction. Phytotherapy can be used in men with mild to moderate LUTS and alpha-blockers can quickly and effectively decrease the LUTS and symptomatic disease progression. Phosphodiesterase type 5 inhibitors (PDE5-I) are an alternative to alpha-blockers when men experience bothersome side effects from alpha-blockers or erectile dysfunction. If patients predominantly have bladder storage symptoms and a small prostate, muscarinic receptor antagonists are a viable treatment option. The combination of alpha-blocker plus muscarinic receptor antagonist is more efficacious in reducing LUTS than the single drugs alone. The 5 alpha-reductase inhibitors (5ARI) can significantly decrease LUTS and disease progression (e.g. acute urinary retention and need for prostate surgery) in men with larger prostates (>?30–40 ml). The combination of 5ARI plus alpha-blocker can reduce LUTS and disease progression more effectively than drug monotherapy. Combination therapy with PDE5-I (tadalafil) plus 5ARI (finasteride) reduces LUTS more substantially than 5ARI alone and, additionally, PDE5-Is reduce the sexual side effects during 5ARI treatment.     

Diagnostik und Therapie nichtseminomatöser Hodentumoren

Testicular cancer currently shows excellent rates of curing and even in advanced stages of disease about 70% can be achieved. This was possible due to continuously carrying out studies. To reduce long-term toxicity the focus is now put on reduction of treatment. In nonseminomatous germ cell cancer this is discussed especially for stage I disease where different therapeutic strategies can be offered. Concerning advanced disease the aim is a further improvement of treatment results. Polychemotherapy and surgical procedures are equally important in this scenario. Concerning residual tumor resection it should always be considered that the procedure can be extended by adjuvant surgery, e.g. cava resection. Therefore, those resections should only be performed at centers where all possibly needed surgical disciplines are available.     

Nichtmedikamentöse konservative Therapie der Arthrose

There are different options for nonpharmacological therapies in osteoarthritis. An educational program and instruction of the patient are of major importance. There is evidence that manual physical therapy and exercise improve function and reduce pain in osteoarthritic joints. Thermal modalities are employed for short-term pain relief and change the intra-articular temperature. Electrotherapy, ultrasound, balneotherapy, and acupuncture show positive therapeutic effects. Orthotics, braces, and wedged insoles may be beneficial in selected cases. Based on the present findings, further investigations are needed to prove the effectiveness of various methods in physical therapy and nonpharmacological approaches to the management of osteoarthritis.     

Medikamentöse Therapie des fortgeschrittenen Blasenkarzinoms

The perioperative treatment of muscle-invasive bladder cancer has become a standard procedure in recent years. New agents, such as programmed cell death protein 1 (PD1) and PD1-ligand 1 (PD1-L1) inhibitors have opened up the door for immunomodulation therapy of metastasized bladder cancer. This article focuses on data which have changed or have the potential to change the pharmaceutical treatment of advanced bladder cancer with a review of the literature in Medline PubMed and proceedings of major meetings, e.g. the European Association of Urology (EAU), the American Society of Clinical Oncology (ASCO), the ASCO Genitourinary Cancers Symposium (ASCO GU) and the American Urological Association (AUA).     

Die Therapie der osteoporotischen Wirbelkörperfraktur

Background

Fractures of the vertebral body are frequently the primary clinical manifestation of osteoporosis, followed by fractures of the wrist and the proximal thigh. Such fractures can occur with or without appropriate trauma.

Therapy

The therapy of these osteoporotic vertebral body fractures is very important because of the increasing fracture risk associated with multiple vertebral body fractures. For acute treatment of such fractures operative and conservative procedures are available with the aim of each therapy to avoid the consequences due to immobilization. Furthermore, the guideline-conform diagnostics and therapy of the underlying cause of the osteoporosis are of decisive importance.     

Diagnostik und Therapie sexueller Störungen

Zusammenfassung Der Wertewandel im Gefolge der sog. sexuellen Revolution und die damit einhergehende größere Offenheit bezüglich des Themas Sexualität, hohe Verbreitungszahlen sexueller Funktionsstörungen, nicht zuletzt aber die Einführung hoch wirksamer Medikamente zur Behandlung der erektilen Dysfunktion sollten dazu geführt haben, dass Sexualstörungen zunehmend in den Fokus ärztlichen Handelns geraten. Die klinische Praxis zeigt aber, dass Ärztinnen und Ärzte nach wie vor ungenügend auf den fachgerechten Umgang mit diesem Thema vorbereitet sind, und dass die Fokussierung lediglich auf ein Symptom gestörter Sexualität an der Lebenswirklichkeit der Patienten vorbeigehen kann.