Pr?natale Herzdiagnostik mittels zwei- und dreidimensionaler Fetalechokardiographie

Zusammenfassung. Einleitung: Die pränatale Beurteilung fetaler Herz- und Gefäßstrukturen mittels zwei- und dreidimensionalen Ultraschalls eröffnet neue Ansätze sowohl für die Diagnosesensitivität als auch die Therapieplanung. Herzfehlbildungen sind neben Harnwegsanomalien die häufigsten angeborenen Fehlbildungen und werden mit einer Neugeboreneninzidenz von 0,5-1,0% angegeben. Methodik: Derzeit ist die vorgeburtliche dreidimensionale Echokardiographie auf zwei verschiedene Arten möglich: 1. durch die Real-Time-3-D-Echokardiographie, die als zukunftsträchtig gilt, aber gegenwärtig noch einige technisch bedingte Limitationen aufweist; 2. durch die dreidimensionale Rekonstruktion einer Vielzahl von synchron zum fetalen Herzrhythmus aufgenommenen zweidimensionalen Schnittbildern. Schlussfolgerung: Die diagnostische Aussagekraft der 3-Dechokardiographie ist zum jetzigen Zeitpunkt insbesondere durch die störanfällige Herzrhythmussteuerung der Bildaufnahme sowie fetale Bewegungsartefakte limitiert. Zukünftige Verbesserungen werden eine technisch schnellere Bilddatenaufnahme und -rekonstruktion erlauben, um so den derzeit noch recht umständlichen Einsatz dieser Bildgebungstechnologie auch außerhalb von pränatalen Experimentalstudien zu ermöglichen. Abstract. Introduction: With increasing experience of obstetric sonographers, a higher proportion of cardiac malformations is found antenatally. However, undiagnosed fetal cardiac defects still result in a significant pre- and postnatal morbidity and mortality. The purpose of two- and three-dimensional echocardiographic imaging in the fetus is to provide clear representations of the underlying cardiac and vascular anatomy. Studies on pre- and postnatal echocardiography have shown these techniques to provide an adequate form of image display for comprehensive assessment of most cases with congenital heart disease. Methods: To date, two different methods are used for threedimensional echocardiography in the fetus. The technique currently employed at numerous institutions derives from a complex assembly of sequentially acquired and reconstructed two-dimensional images and is analogous to the 3-D technology assessed in studies on neonates, children, and adults. Although an electromagnetic location device is used to register transducer position during data acquisition, this technique has important limitations due to fetal movement artifacts and difficulties in cardiac gating. This often results in inadequate image quality when compared with 2-D echocardiography. Recent progress in the design and fabrication of higher-frequency real-time volumetric transducers has greatly improved 3-D echocardiographic imaging resolution and allows more immediate three-dimensional "on-line" analysis of cardiac anatomy. Conclusions: Advantages of 3-D fetal echocardiography include the ability to slice the acquired 3-D volume data into an infinite number of two-dimensional cross sections, and the ability to reconstruct unique three-dimensional views not seen with two-dimensional imaging. However, considering the current limitations and the time needed for 3-D image processing, its practical clinical relevance in the antenatal situation is not yet clear.     

Kardiovaskuläre Prävention und Rehabilitation

The distinction between primary and secondary prevention has been abandoned in favor of cardiovascular prevention, mandating individual risk assessment. First, the individual cardiovascular risk of a person is determined by index diseases like myocardial infarction, peripheral arterial disease or other, or, if absent, by a score consisting of a number of conventional risk factors. According to current guidelines, cardiovascular prevention is indicated, as soon as the risk for fatal cardiovascular disease is > or = 5 %, equivalent to a risk for a major cardiovascular event of > or = 20 %. Non-pharmaceutical approaches are: refraining from smoking, mediterranean diet with fatty fish, physical activity and normal body weight. Blood pressure and diabetes mellitus are optimized. In addition, the following agents are used: platelet inhibitors, beta-blockers, ACE-inhibitors, statins and omega-3 fatty acids. A number of structural problems add to individual factors impeding optimal implementation of cardiovascular prevention in Germany.     

Diagnostik und Prävention kardiovaskulärer Erkrankungen

Ohne Zusammenfassung     

Acetylsalicylsäure und Prävention kolorektaler Karzinome

Observational and some randomized clinical trials suggest that aspirin protects from occurrence and progression of colorectal neoplasias (adenomas, carcinomas). However, there are still open questions, regarding the benefit/risk ratio (bleedings) as well as dosage and duration of treatment during the probably long-term medication, before stringent recommendations regarding clinical use of aspirin can be made. Specifically, there is currently no generally accepted mode of action or molecular target of aspirin, though a relationship to tumor-associated enhanced PGE₂ levels in the affected mucosa is likely. Regular daily intake of aspirin in antiplatelet doses of 100 mg appears to be sufficient in responding persons. If this is confirmed in prospective randomized trials that are currently underway, this might add to the prophylactic use of aspirin and would suggest a pharmacological relationship to inhibition of COX-1 mediated prostaglandin/thromboxane biosynthesis as a common primary target for both cardiocoronary and antineoplastic prophylaxis. Prophylactic aspirin use might then add to an undoubtedly important healthy lifestyle including appropriate diet.     

Potenziale und Ansätze der Prävention

Zusammenfassung Prävention und Gesundheitsförderung sind lohnenswerte Investitionen in die Zukunftssicherung der sozialen Sicherungssysteme und bieten einen nachhaltigen gesamtgesellschaftlichen und individuellen Nutzen. Die Bundesregierung hat die Stärkung von Prävention und Gesundheitsförderung in ihrer Koalitionsvereinbarung ausdrücklich zur gemeinsamen Strategie ihrer Politik erklärt und will diese Bereiche in Deutschland aufwerten und ausbauen. Das Bundesministerium für Gesundheit und Soziale Sicherung trägt durch verschiedene Maßnahmen und Strategien zur Verbesserung der Rahmenbedingungen für eine nachhaltige Stärkung von Prävention und Gesundheitsförderung bei, u. a. durch die Arbeiten an einem Präventionsgesetz sowie durch die Gründung des Deutschen Forums Prävention und Gesundheitsförderung.     

Acetylsalicylsäure und Prävention kolorektaler Karzinome

Observational and some randomized clinical trials suggest that aspirin protects from occurrence and progression of colorectal neoplasias (adenomas, carcinomas). However, there are still open questions, regarding the benefit/risk ratio (bleedings) as well as dosage and duration of treatment during the probably long-term medication, before stringent recommendations regarding clinical use of aspirin can be made. Specifically, there is currently no generally accepted mode of action or molecular target of aspirin, though a relationship to tumor-associated enhanced PGE₂ levels in the affected mucosa is likely. Regular daily intake of aspirin in antiplatelet doses of 100 mg appears to be sufficient in responding persons. If this is confirmed in prospective randomized trials that are currently underway, this might add to the prophylactic use of aspirin and would suggest a pharmacological relationship to inhibition of COX-1 mediated prostaglandin/thromboxane biosynthesis as a common primary target for both cardiocoronary and antineoplastic prophylaxis. Prophylactic aspirin use might then add to an undoubtedly important healthy lifestyle including appropriate diet.     

Prävalenz und Pathogenese von Aortenklappenkalzifikationen

BACKGROUND: Calcific aortic valve disease is present in more than 25% of patients > 65 years of age and is associated with a 50% increased risk of cardiovascular events. The clinical significance of aortic valve calcification detected incidentally by radiologic examinations, especially on CT scans of the chest, was unknown. Concerning the multifactorial pathogenesis of aortic valve calcification, recent data indicate that, besides other factors, also the regulators of calcification play a key role in the disease process. PURPOSE: This study aims to give an overview of the prevalence and clinical significance of incidentally detected aortic valve calcifications. Moreover, the role calcification inhibitors in the pathogenesis of aortic valve calcification is discussed.     

ICD-Infektionen: Prävention und Therapie

Infections of implantable cardioverter defibrillators (ICD) are severe, potentially life-threatening complications of ICD therapy. In the majority these infections are nosocomial by staphylococci, which become apparent within 0.5 years after implantation. Prophylaxis requires a strictly sterile environment during implantation and perioperative antibiotics. While infection of the ICD pocket is diagnosed clinically, infection of the electrodes must be proven by transesophageal echocardiography and positive blood cultures. Therapeutically, the complete ICD system has to be removed to avoid relapses of infection. Beyond 6 months after implantation, lead extraction might become technically demanding and should be done with a standby of cardiac surgery. Antibiotic treatment has to be started before removal of the system, continued for at least 2 weeks before reimplantation and for another 10 days thereafter. Reimplantation should be done outside the originally infected area.     

Prävention und Nachsorge der Sepsis

The 1st revision of the S2k guideline on the prevention and follow-up care of sepsis, provided by the German Sepsis Society in collaboration with 17 German medical scientific societies and one self-help group provides state-of-the-art information on the effective and appropriate medical care of critically ill patients with severe sepsis or septic shock. The guideline recommendations may not be applied under all circumstances. It rests with the clinician to decide whether a certain recommendation should be adopted or not, taking into consideration the unique set of clinical facts presented in connection with each individual patient as well as the available resources.     

Therapie und Prävention der Hyperthyreose

A decreased serum TSH level can be observed in more than 10% of the German population. Although treatment is not mandatory in each of these cases patients with an unrecognized autonomous thyroid dysfunction have a substantial risk of developing thyrotoxicosis when exposed to large amounts of iodine. Thionamid drugs in combination with potassium perchlorate are given for preventive and therapeutic reasons until definitive thyroidectomy or radioiodine therapy is performed. In younger patients Graves' disease is the main cause of hyperthyroidism. Medical treatment with antithyroid drugs is established to render patients euthyroid. Having decreased the dose as far as possible, drug therapy is continued for 12-18 months to achieve a maximum rate of permanent remission. Ongoing clinical research aims to characterize clinical or laboratory predictors associated with a high risk of relapse after medication is stopped. Selenium supplementation is proposed to be a new therapeutic approach for autoimmune thyroid disease. It is already used quite liberally although data of powerful randomized trials are not available.     

Prähospitalversorgung und Akuttherapie des ischämischen Schlaganfalls

An acute ischemic stroke (AIS) is always a life threatening medical emergency. The possibility and success of applying an effective acute therapy depends mainly on a fast decision-making process within the pre-clinical phase of patient care. Systemic thrombolysis using recombinant tissue plasminogen activator (rtPA) is an effective treatment for AIS, but is restricted to the first 3 h after symptom onset and is most effective the earlier the treatment is applied. Thus, avoiding delays until treatment is the main challenge in the acute care of stroke patients. Time to treatment consists of two distinct segments, each having its own special problems and challenges: the pre-hospital phase and the early in-hospital treatment. However, for optimized stroke care, both parts need to be closely coordinated. In this article, specifics and problems of pre- and in-hospital care of acute stroke patients are discussed.     

Bevölkerungsbezogene und individuelle Prävention

In the German health system up to now prevention takes only a marginal position. To tap the full preventive potential in future population-based and risk group-strategies must be systematically extended, combined with individual strategies in clinical preventive medicine and integrated in health care. This report gives international and national examples for these strategies and shows that such preventive programmes could be effective as well cost-effective.     

Weingenuss und Prävention der koronaren Herzkrankheit

There is a J-shaped correlation between the amount of alcohol consumed per day and overall mortality risk and an inverse correlation between the amount of alcohol consumed per day and cardiovascular mortality. The evidence is stronger for men than for women. The correlations are independent of the type of alcoholic beverage predominantly consumed. Possible mechanisms explaining the cardioprotective, antiatherosclerotic effects of moderate alcohol consumption are inhibition of platelet aggregation, increase in serum high density lipoprotein (HDL) levels and prevention of diabetes mellitus. The two latter mechanisms can also explain a delayed progression of atherosclerosis due to alcohol consumption. The beneficial effects are counteracted by detrimental effects of alcohol on the incidence of cancer diseases, liver cirrhosis, violence and accidents; therefore, alcohol consumption in general cannot be recommended for prevention of cardiovascular diseases.     

Prävention und höheres Lebensalter

Ohne Zusammenfassung     

Über Präcarcinose und pathologische Entdifferenzierung

Ohne Zusammenfassung     

Pathophysiologie und Prävention des Typ-2-Diabetes

Die Diabetologie - In den letzten beiden Jahren wurden neue Erkenntnisse zur Pathophysiologie und Prävention des Typ-2-Diabetes im Rahmen des Diabetes Updates präsentiert, die in...