Ergebnisse der operativen Revaskularisation beim Diabetespatienten mit arterieller Verschlusskrankheit

Objective

Our aim was to determine which factors influence short- and long-term results following peripheral bypass surgery in diabetic (D) and non-diabetic (ND) patients.

Methods

Retrospective analysis of 721 patients who received either crural or pedal bypass from1/1996 to 12/2005 was carried out. The cohort was made up as follows: diabetic patients (D) 482 (68%), dialysis-dependent patients with chronic kidney disease (KD) 96 (14%), and patients with peripheral artery occlusive disease (PAOD) stage III/IV 644 (89%).

Results

Perioperative patency rates and mortality: patency rate total cohort (C) 85.4%/D 87.3%, major amputation C 7%/D 6.5%, mortality C 5%/D 5.2%. Follow-up according to Kaplan-Meier analysis: Secondary 5-year patency rates: D 43.6%/ND 44.4% n.s. 5-year limb salvage rates: D 69.2%/ND 70.6% n.s. 5-year survival rates: D 47.7%/ND 58.8%, p<0,001; KD 19.5%/non-KD 56.1%, p<0,001; KD and D 16.9%; PAOD II 74%/PAOD III/IV 48.4%, p<0,01; PAOD III/IV and D 46.9%.

Conclusion

There were no differences in 30-day mortality, cumulative bypass patency and limb salvage rates between diabetic and non-diabetic patients. However, diabetes, dialysis-dependent chronic kidney disease and peripheral artery disease type III/IV alone or in combination reduced cumulative survival rates after bypass procedures.     

Akutes Leberversagen aus der Sicht des Internisten und des Chirurgen

Acute liver failure is defined as the sudden loss of liver function without preexisting liver disease. In addition to virus hepatitis infections, drug toxicity is the cause of acute liver failure. In the industrial nations drug toxicity is the main cause. In Germany there is also an etiological change from acute viral hepatitis to drug-induced liver failure. The prognosis for acute liver failure is still poor. Decisive for the course is the clinical diagnosis of the findings of the treating physician. Due to improved diagnostic and intensive care treatment it is nowadays possible to recognize and stabilize affected patients in order to prepare them for transplantation. Orthotopic transplantation is currently the only treatment option which has been shown to improve the survival and prognosis in these patients.     

Bildgebung der Riesenzellarteriitis

This article summarizes the examination technique, typical findings, interpretation and limitations of ultrasound diagnosis in patients with giant cell arteritis. Colour-coded sonography of the temporal artery has gained increasing attention. If experienced ultrasound examiners are available, diagnosis of giant cell arteritis in patients with a typical clinical constellation can be made based solely on sonographic findings, in particular by a hypoechogenic halo. The hitherto probably under-diagnosed large vessel variant of giant cell arteritis shows characteristic findings with a simple and quick ultrasound examination of the proximal arm arteries. High resolution MRI has been shown to be a promising technique for non-invasive imaging of giant cell arteritis. Mural inflammatory changes of the superficial temporal arteries can be depicted and the cranial involvement pattern can be readily assessed and in combination with MR angiography extracranial involvement can be determined within the same investigation. Aortitis is a feared complication of giant cell arteritis but can be detected and inflammatory stenoses of the aortic branch vessels can also be revealed. In the hands of an experienced operator ultrasonography can be regarded as the non-invasive imaging modality of first choice whereas MRI is more expensive and may not be as widely available. However, its imaging acquisition is standardized and is more observer-independent. Reading of the images is a routine task for a vascular radiologist and larger areas of the vasculature can be simultaneously assessed.     

Repressive coping in geriatric patients' reports - impact on fear of falling

We investigated the influence of repressive coping, depression, cognition, education and age on geriatric patients' reports on health-related status in 80 geriatric patients with a history of injurious falls. For patient reports, subjective statements on activity avoidance, perception of terminal decline, falls, and fear of falling were assessed. Co-morbidity and number of medications were documented based on patient charts. Repressive coping was significantly associated with underreporting in geriatric patients in all items documented and predicted most variables of patients' reports. Because of underreporting significant health problems geriatric patients with repressive coping may therefore be at risk for inadequate medical treatment.     

多囊卵巢综合征患者使用屈螺酮与心血管事件相关性分析

本研究探讨多囊卵巢综合征（PCOS）患者使用含屈螺酮的口服避孕药（OC）发生心血管事件的风险。28例PCOS（Rotterdam标准）患者,根据体重指数分成两组,其中16例体瘦者（A组）和12例体胖者（组B）,年龄在18—35岁,未使用激素治疗时间均在6个月以上。给予一种OC药治疗。观察治疗前与治疗6个月后来普汀、同型半胱氨酸、内皮素-1的水平和肱动脉血流介导的血管舒张等指标的变化。     

CPAP-Therapie als additive/adjuvante Herzinsuffizienztherapie?

Chronic heart failure with its age-dependent prevalence and incidence is one of the most frequent diseases. Due to high mortality and morbidity there is the necessity of early diagnosis and therapeutic measures being as causal as possible. The medical graded therapy is based on the combination of ACE-inhibitors/AT1-blockers, beta-blockers, diuretics and digitalis. Cardiac resynchronization therapy represents a novel option of treatment for only 25% of patients. Nevertheless the prognosis of patients with chronic heart failure with conventional medical therapy is remaining poor. Additional improvement in the treatment of patient with chronic heart failure remains a priority medical task. The results of this case report argues for CPAP as further adjunctive treatment option in patients with chronic heart failure.     

Moderne pharmakologische Aspekte der Therapie des Aldosteronismus

The prevalence of primary hyperaldosteronism is 5-10% of all hypertensive patients, and clearly above the estimated prevalence in the past. In nearly 30% of patients with therapy resistant hypertension, primary hyperaldosteronism is detected if they are investigated thoroughly. This will result in 1.5 to 2.5 million people in Germany suffering from primary hyperaldosteronism. Besides efficient diagnostic procedures, an effective treatment is of increasing importance. The aldosterone-producing adenoma (Conn's syndrome) is primarily cured by operation, in most cases performed endoscopically. Bilateral hyperplasia, which is found in two-thirds of primary hyperaldosteronism, is treated primarily by mineralocorticoid receptor antagonist: 12.5-50 mg/day spironolactone (in case of anti-androgenic side-effects alternatively by 50-100 mg/day eplerenone). If the blood pressure can not be lowered by this first-line treatment, an additional treatment with potassium-sparing diuretics, calcium-antagonists, ACE-inhibitors or angiotensin-2-antagonists is necessary. The start of medication should be closely monitored by serum electrolyte and creatinine controls.     

DNA-Chips in der Diagnostik hämatologischer Neoplasien

In hematological malignancies, gene expression profiling using DNA-microarrays led to the discovery of novel lymphoma and leukemia subgroups. The heterogeneous entity of diffuse large B-cell lymphoma could be subdivided into the germinal center B-cell-like and the activated B-cell-like subtype which differ in pathogenesis and clinical behavior. In leukemia, existing entities defined by morphological, cytogenetic, molecular and immunophenotypic criteria were confirmed on the global gene expression level; in addition, new important molecular subgroups could be identified. In retrospective clinical lymphoma and leukemia studies, robust gene expression signatures were discovered that predict the clinical course at the time of diagnosis. Given the huge potential of the DNA-microarray technology, application in the routine diagnostic setting appears possible.