Perkutane mechanische Kreislaufunterstützung

In cases of low cardiac output and chronic cardiac failure despite conventional therapy, mechanical circulatory support may be the only option to ensure adequate organ perfusion and to save the life of the patient. In recent years, several conceptionally different methods of circulatory support have been developed for percutaneous application in interventional cardiology and intensive care. Indications range from elective use in complex cardiac interventions to long-term support as a bridge to recovery. As intra-aortic balloon pump support can no longer be considered for routine use in ischemic cardiogenic shock, micro-axial pumps for extracorporeal membrane oxygenation and extracorporeal life support systems (ECMO/ECLS) gain attractiveness due to a more convincing impact on the hemodynamics. However, an increasing level of support is paralleled by greater invasiveness and complexity of the systems. Due to a lack of larger comparative trials, the benefits and risks of adverse events must be balanced against those of conventional therapy with inotropes and largely on an individual basis. This review summarizes the options for percutaneous circulatory support with special consideration to applications in the catheter laboratory and intensive care units in internal medicine.     

Individuelle Therapieziele bei diabetischer Retinopathie und Makulopathie

Prospective randomized studies show that the prevalence and incidence of diabetic retinal complications can be reduced by consistent and suitable adjustment of blood glucose and blood pressure. However, if diabetic retinopathy or maculopathy develop they must be recognized as early as possible and treated according to the stage enabling inclusion of intravitreal injection of vascular endothelial growth factor (VEGF) inhibitors or corticoids in the therapy concept. After operations for age and/or diabetes-related cataracts, diabetic retinal damage, in particular previously existing damage can deteriorate. Therefore, it is important to perform a timely examination and if necessary to treat as soon as possible. In cases of visual impairment or blindness due to diabetic retinopathy or maculopathy despite all therapeutic efforts, visual rehabilitation using magnifying visual aids or by orientation and mobility training can enhance patient independence and quality of life.     

Stellenwert der Arthroskopie bei Gonarthrose

The relevance of arthroscopic surgery in patients with advanced osteoarthritis of the knee has been discussed controversially in recent years. Even though the idea of joint lavage in order to reduce the inflammatory component of the affected joint has not been proven to provide sufficient long-term effects, there are a variety of copathologies that can efficiently be addressed by arthroscopic surgery. The present article summarizes the indications for arthroscopic surgery in patients with osteoarthritis of the knee joint and discusses the scientific literature available on this controversial topic.     

Kombinierte enterale und parenterale Ern?hrung

Malnutrition is an often underestimated problem in the ICU. Adequate nutritional therapy is able to diminish or reverse the deleterious effects of malnutrition. Traditionally, the enteral route is preferred as a more physiologic approach to clinical nutrition. During prolonged critical illness energy uptake via enteral nutrition is often limited by gastrointestinal intolerance. Supplemental parenteral nutrition may be able to decrease the energy deficit in these patients and be therefore a therapeutic approach to improving the patients?? outcome.     

Update Granulomatose mit Polyangiitis (GPA, Wegener-Granulomatose)

Granulomatosis with polyangitis (GPA, Wegener’s granulomatosis) is characterized by a granulomatous inflammation of the respiratory tract and a necrotizing ANCA-associated small to medium-size vessel vasculitis with a predilection for the lungs (pulmonary capillaritis) and kidneys (necrotizing glomerulonephritis). The disease evolves stage-wise and typically starts as inflammation of the respiratory tract followed by development of systemic vasculitis manifestations. Today, treatment is evidence-based and adapted according to activity and disease stage which has resulted in a significant improvement in long-term outcome. Early mortality during the first year of treatment poses one of the main problems and is a result of infections under immunosuppressive treatment. Furthermore, treatment of refractory disease activity which is often represented by granulomatous manifestations is still a challenge and may result in significant organ damage if not treated successfully.     

H?matologische Erkrankungen in der Schwangerschaft

The management of hematologic disorders in pregnancy presents diagnostic and therapeutic challenges requiring a multidisciplinary approach. Iron deficiency is the most common cause of anemia in pregnancy. Gestational thrombocytopenia is defined by mild, asymptomatic thrombocytopenia and usually requires no therapy. Autoantibody-induced idiopathic thrombocytopenia is treated with steroids and high-dose immunoglobulins in patients with platelet counts below 30,000/??l during pregnancy and below 50,000/??l before delivery. The most common hematologic neoplasias in pregnancy include Hodgkin??s disease, aggressive non-Hodgkin??s lymphomas, and acute leukemias. Cure for the mother depends on consistent intensive chemotherapy. Chemotherapy can be administered during the second and third trimester with reasonable safety, though there is an increased fetal risk. It is important to balance the potential fetal risk against the maternal risk of an untreated neoplasia.