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.     

Gesundheits?konomische Aspekte und finanzielle Probleme in der Pr?natalmedizin und Geburtshilfe

The diagnosis-related groups (DRG) system of financing healthcare in Germany will lead to disparities in patient care and medical services rendered in prenatal and obstetric medicine. The high costs related to the treatment of high-risk pregnancies in the level I clinics indicate that there are significant shortcomings in cost reimbursement and currently these issues are inadequately addressed by the DRG system. The high costs arise from the more specialized care provided by level I centers, which treat patients with more complicated conditions and require longer hours of hospital staff. The lack of a distinction between the requirements of different intrauterine treatment options in prenatal medicine leads to underfunding such that, for example, the material costs of some interventions are not covered by the DRG pricing and reimbursement system. Resulting from the financial deficits in the level I centers and facilities of specialized medicine is a major deterioration of their organization and staffing, which has significant implications on the training and continued education of young doctors. This system, which to the present time has been an inadequate means of covering the costs of hospital outpatient and inpatient services, raises concerns of insufficient incentives for the training and continued education of young physicians. This may result in a decrease in quality of care in the field of obstetric and prenatal medicine.