Zystektomie im Alter

Bladder cancer is a carcinoma of the elderly population. The highest incidence of bladder cancer is between the ages of 70 and 80 years old. Radical cystectomy remains the gold standard for muscle invasive bladder cancer treatment. In this article different aspects of radical cystectomy in elderly patients are reviewed. The Pubmed-MEDLINE database was searched using the following keywords: radical, cystectomy, elderly and age.     

Prinzipien des perioperativen Gerinnungsmanagements

The coagulation system is a complex network of interacting proteins and cells with extensive sensitivity, amplification and control pathways. The system represents a delicate balance between procoagulant and anticoagulant as well as profibrinolytic and antifibrinolytic activities. Clinically relevant phenotypes, e.g. bleeding and thrombosis, occur immediately when this balance is no longer in equilibrium. A correct understanding of the complex coagulation pathophysiology in the perioperative setting is essential for an effective treatment. In a bleeding patient, patient’s history, clinical findings, routine and advanced laboratory coagulation testing as well as point-of-care coagulation monitoring help to reliably and readily identify the underlying coagulation disorder. Modern coagulation management is proactive, individualized, balanced and follows clearly defined algorithms. Coagulopathic bleeding can be successfully controlled with specific interventions in the coagulation system.     

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.