Hämoptysen

Hemoptysis is a potentially life-threatening complication of various diseases. The most common causes are infectious and inflammatory processes, followed by neoplasms, pulmonary embolisms, mitral stenoses, coagulopathies, and multiple systemic disorders. Primary examinations include chest X-ray, angio CT, and bronchoscopy. Sometimes, a bronchial artery angiogram is required. The patient is at risk of suffocation because blood and clots can severely obstruct his airways. Thus, the most important measures are supplemental oxygen, positioning the patient with the bleeding side down, bronchoscopic suctioning, and removal of blood and clots. Coagulopathies have to be corrected. Application of vasoactive drugs may help temporarily. In cases of bleeding from central lesions, coagulation with laser or argon plasma coagulator is feasible. Heavy bleeding from the periphery requires a balloon or tube tamponade. Depending on the cause and the severity of the bleeding anti-inflammatory medical treatment, hemostyptic radiation therapy, bronchial artery embolization, or a surgical procedure must follow.     

Rezidivierende Hämoptysen bei einer 29-jährigen Patientin

A 29-year old woman was admitted with recurrent hemoptysis. Due to the combination of hemoptysis, alveolar infiltrates and anemia a diffuse alveolar hemorrhage syndrome was suspected. After exclusion of underlying diseases and due to the typical histology we confirmed the diagnosis of an idiopathic pulmonary hemosiderosis. In consequence of an acute progression of the disease with pulmonary hemorrhage and severe anemia an empiric therapy with corticosteroids and azathioprine was initiated, resulting in a distinct recovery.     

33-jährige Libanesin mit rezidivierenden Hämoptysen und zystischer Raumforderung in der Lunge

A 33 year old woman from Lebanon presented with recurrent hemoptysis, subfebrile temperature, dyspnoe in stress, fatigue, weight loss, and pruritus. Serological tests and results from chest X-ray and computer tomography revealed cystic echinococcosis with pulmonary involvement. After refusal of surgical therapy a medical treatment with albendazole was implemented. Two months after the start of the therapy only a small fibrotic residuum in the lung was seen. A spontaneous healing success seems unlikely because of the duration of the pulmonary cyst and the progressive symptoms before treatment.     

Hämoptysen und akutes Nierenversagen bei einem 29-jährigen Patienten mit chronischer Hepatitis C

A 29-year-old male patient with chronic hepatitis C infection and interferon alpha therapy in his medical history was admitted to the hospital because of the clinical manifestation of a pulmonary renal syndrome. High titers of proteinase-3-ANCA were detected, while an infectious agent was ruled out. After diagnosis of Wegener's granulomatosis the patient received prednisolone and cyclophosphamide pulse therapy and remission developed rapidly. Chronic hepatitis C infection as well as interferon therapy are frequently associated with autoimmune disorders. We assume that the interferon therapy itself has triggered autoimmune processes resulting in Wegener's granulomatosis in our patient. Thus we recommend to search specifically for autoimmune disorders in the past medical history and if necessary to consider a screening for autoantibodies before starting an interferon therapy. An autoimmune disease should also be taken into account if new symptoms develop under an ongoing interferon alpha therapy.     

H?moptysen nach Chemotherapie eines Adenokarzinoms der Lunge mit Pemetrexed

We report on a 68-year-old patient who was diagnosed with adenocarcinoma of the lung with bone metastases and was given four cycles of chemotherapy containing pemetrexed and bevacizumab within the context of a clinical trial. The patient developed severe dyspnea, cough, and hemoptysis 3?weeks after administration of the last cycle of chemotherapy. In the absence of other causative factors, a diagnosis of pemetrexed-induced pneumonitis was made and treatment with high-dose steroids initiated. The symptoms improved remarkably within 10?days.     

Hämodialyseverfahren

This article summarizes the innovations in various areas of hemodialysis (HD) with a focus on membranes, hemodiafiltration (HDF), dialysis temperature, dialysis times and frequencies as well as anticoagulation. In two studies on the application of high cut-off (HCO) membranes in the treatment of plasmocytoma, freedom from dialysis at 3 months was not significantly lower (41%) in the HCO group than in the high-flux group (33%); however, after 6 and 12 months freedom from dialysis was significantly higher for HCO. Cooled dialysate clearly reduced the rate of hypotension during dialysis (70%) in a meta-analysis. The discussion on the benefits of HDF remains controversial. The results from studies on the topic of alternative dialysis times and dialysis frequency are still inconclusive. Standard extracorporeal anticoagulation in intermittent HD treatment is performed in patients with a low risk of bleeding with unfractionated heparin or its derivatives. In patients at high risk of bleeding heparin-coated capillaries and regional citrate anticoagulation are valid alternatives. The direct thrombin inhibitor argatroban is an alternative, adequate and safe anticoagulation treatment for heparin-induced thrombocytopenia (HIT) type II dialysis patients.     

Hämorrhoidalleiden

Approximately 70% of the adult population is affected by haemorrhoids one of the most common diseases in industrial nations. Anal bleeding and minor continence disorders as well as itching, soiling and burning are typical discomforts which are independent of the size of the haemorrhoids. Haemorrhoids presenting as solitary, multiple nodes or as circular prolapses are staged into four grades which are the basis for different therapy options. A differentiation must be made between anoderm prolapse, mariscae, thromboses of the anal veins and segmental mucosal prolapse of the rectum as well as circular external prolapse of the rectum. Therapy options in the early stages are conservative measures, such as regulation of defecation, sclerosis and rubber band ligations. Advanced stages require operative methods, such as segmental excision and stapled haemorrhoidopexy. Other procedures, such as (Doppler-guided) haemorrhoidal artery ligation, rectoanal repair, coagulation techniques or other minimally invasive methods are still in need of scientific proof of comparativeness or even superiority to the established methods.     

Sowjetische Hämatogenetik

Ohne Zusammenfassung