Empfehlungen der European Stroke Initiative für Diagnose und Behandlung spontaner intrazerebraler Blutungen

Zusammenfassung Dieser Artikel stellt eine Übersetzung der im Jahr 2006 herausgegebenen Empfehlungen zur Behandlung von Patienten mit spontaner intrazerebraler Blutung der Europäischen Schlaganfallinitiative (EUSI) für das Europäische Schlaganfall-Council (ESC), die Europäische Neurologische Gesellschaft (ENS) und die Europäische Förderation Neurologischer Gesellschaften (EFNS) dar.Diese EUSI-Empfehlungen werden von dem European Stroke Council (ESC), der European Neurological Society (ENS) und der European Federation of Neurological Societies (EFNS) unterstützt.     

Antiretrovirale Therapieregime

The availability and use of effective antiretroviral combination therapies has dramatically decreased the morbidity and mortality of HIV infection. Almost complete suppression of viral replication by antiretroviral therapy prevents disease progression and development of resistance, as well as leading to both regression of HIV-associated symptoms and clinically relevant immune reconstitution. More than 20 antiretroviral substances in four classes have been approved. As a result of the broad therapeutic options, HIV infection can be better treated. Although a high number of combinations can be conceived, only a small number is actually applicable. The decisions to start, monitor and change therapy have become even more difficult. The indication for treatment, the selection of the most suitable therapy for an individual, the counseling of the patient, and the monitoring of the success of treatment demand a high level of knowledge and experience. Virologic failures of modern antiretroviral therapy regimens are rare in adherent patients.     

Verletzungen der Handwurzel

A fall onto the hand can be followed by ligament ruptures, bone fractures or dislocated fractures of the carpus. The diagnosis is based on history, clinical evaluation, and X-ray examination in two perpendicular planes, followed if necessary by CT scan or MRI scan. Lesions of the scapholunate ligaments cannot be definitely excluded except by arthroscopy. As well as fractures of the carpometacarpal joints, fractures involving the ring structure of the carpus or ligament ruptures between carpal bones are frequently observed, and these lead to significantly impaired biomechanics. The prognosis is poor. The discontinuity of the ring must be repaired by means of osteosynthesis and/or suturing ligaments, with the carpal bones held in place by temporary arthrodesis using K-wires. Dislocation in this region requires rapid realignment, as untreated perilunate dislocation or dislocation of the lunate bone will lead to serious secondary damage, which can only be treated by salvage operations involving loss of function. Inappropriate treatment of an injury to the heel of the hand can lead to carpal collapse.     

Spezifische Immuntherapie

Ohne Zusammenfassung     

Thoraxtrauma

Chest injuries can be sustained in isolation or in association with multiple injuries. Life-threatening complications may ensue because organs that are vital to survival of the organism are situated within the thoracic cavity. These complications include airway obstruction, tension pneumothorax, wide open pneumothorax, flail chest, cardiac tamponade and massive hemothorax. The mortality of patients hospitalized with chest injury can be as high as 10%. Clinical examination and awareness of the possibility of other injuries (high level of suspicion) are essential, and standard chest X-ray, ultrasound and thoracic computed tomography may also be needed for the diagnosis. The first part of this serial paper on the management of chest injuries focuses on anatomical aspects, pathophysiology and symptoms, but mainly on the indications for the standard diagnostic procedures and further high-tech examinations.     

Multiple Lidkantentumore

Ohne Zusammenfassung     

Rehabilitative Maßnahmen bei Patienten mit Pankreaskarzinom

Rehabilitative and palliative measures in the follow-up care of pancreatic cancer patients will remain the dominant medical focus as long as potentially curative measures (recurrence prophylaxis, early detection and therapy of recurrence) have failed to show a significant survival benefit. Rehabilitative measures are possible for patients undergoing potentially curative as well as palliative treatment. Their aim is to alleviate the negative effects of the cancer and its therapy, not only physically, but also psychologically, socially and vocationally. The spectrum of possible somatic handicaps ranges from metabolic disorders, malnutrition and under-nutrition, as well as gastrointestinal symptoms to pain. Assistance in coping with illness, alleviating fears and depression and strengthening compliance are the main areas which are dealt with in psycho-oncology. Assessment of vocational fitness and the capacity to work depends on tumor location, whether R0 or R1 resection has taken place, the extent of pancreas resection, accompanying illnesses, whether or not adjuvant therapy has been given, and the physical condition of the patient