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.     

Glenoidersatz bei Omarthrose

In anatomical shoulder arthroplasty glenoid replacement is a critical point. Although total shoulder arthroplasty (TSA) provides better functional and pain results than hemi shoulder arthroplasty (HSA) there is great reluctance to implant a glenoid. For successful glenoid replacement it is necessary to preoperatively evaluate clear indications for glenoid replacement. Planning is a crucial point and has to be done thoroughly. The gold standard is an all polyethylene cemented glenoid. The implantation technique is most important to obtain an excellent and long-term result without complications. Significant key factors are preservation of the subchondral bone and an anatomical reconstruction of the glenoid. It seems that after a period of 10 years the loosening rate of glenoids increases and revisions rates rise. Therefore there is a high demand to develop new implants and a need for improved and convertible glenoids with better modularity and alternative options for fixation.     

Mikrobiologie und Diagnostik nichttuberkul?ser Mykobakterien

In recent years, several new techniques for the diagnostic workup of nontuberculous mycobacteria (NTM) have been introduced into laboratories. The use of nucleic acid amplification techniques for species identification has replaced the conventional biochemical methods. The detection of NTM directly from specimens is difficult because of the low bacterial load in the specimens and no standardized method is available yet. Thus, despite the recent improvements the microscopic and the cultural investigation of the specimens is still the reference standard in the diagnosis of NTM.