Akutes Leberversagen

Acute liver failure is a rare dynamic disease with a high spontaneous mortality. It is defined as acute (<26 weeks) severe liver insufficiency (INR?>1.5) with hepatic encephalopathy in the absence of chronic liver disease. The most important prognostic parameters in acute liver failure are the etiology as well as the stage of hepatic encephalopathy. Multiorgan failure, infections as well as advanced cerebral edema are the most frequent causes of death in patients with acute liver failure. Management of acute liver failure always requires intensive care surveillance with close monitoring. In case of complications an early and aggressive therapy is recommended. This includes a fluid and blood glucose monitoring, tracheal intubation and mannitol in cases of cerebral edema, a substitution of coagulation factors only in case of hemorrhage, early antibiotics for infections, early renal replacement therapy, N-acetyl cysteine for stage I/II hepatic encephalopathy as well as etiology-specific therapeutic measures. Liver transplantation is the last step therapy.     

Ruptur einer zerebralen arterioven?sen Malformation

Arteriovenous malformations are vascular anomalies characterised by the presence of an arteriovenous shunt in the absence of a normally structured capillary bed. The prevalence of manifestations in the brain is given in specialist literature with a high level of variability. Brain hemorrhages resulting from a lesion of a cerebral arteriovenous malformation and leading to sudden unexpected death are relatively seldom in forensic autopsy material. The forensic significance of this syndrome may be illustrated by the example of a 16-year-old female who was found dead in the bathroom of her parents?? home for reasons which were initially unexplained.     

Synthetische Cannabinoide

In recent years a flood of new psychoactive substances offered as “legal highs” appeared on the drugs market worldwide. In some parts of the world amphetamine-type stimulants are predominant but in Germany synthetic cannabinoids represent the bigger problem. The high dynamics which are maintained by the “cat and mouse game” of scheduling substances and the producers circumventing the regulations by adding new, chemically modified substances, poses a great challenge for both forensic science and toxicology.     

Pneumonie und diffus parenchymale Lungenerkrankungen im Lungenultraschall

Approximately 200,000 cases of ambulant pneumonia per year are currently anticipated in Germany. In order to reduce complications and to further minimize lethality a rapid diagnosis as well as efficient and quick therapy are significant factors within the medical treatment and the diagnosis can be achieved promptly with the aid of lung ultrasound. This article illustrates the sonomorphology of pneumonia as well as diffuse parenchymal lung disease and presents recent studies on the topic. Furthermore, lung ultrasound is compared with other diagnostic methods.     

Knöcherne Stressreaktionen des Fußes im Sport

Stress reactions and stress fractures are defined as structural damage to bone caused by repetitive stress or stereotypical loading. The balance between loading and unloading of bone is disrupted in stress reactions and stress fractures through the sport-specific demands and by the exogenous or endogenous risk factors present. In sports orthopedics the localization of stress reactions and stress fractures are subdivided into high risk fractures and low risk fractures. Conventional diagnostic radiology can initially be inconclusive. With symptoms persisting over 2 weeks further diagnostics using magnetic resonance imaging (MRI) should be performed. In the area of the foot stress reactions and stress fractures can often occur bilaterally or multifocally and most commonly affect the second metatarsals followed by the third metatarsals. Fractures of the fifth metatarsal, second metatarsal base, medial malleolus as well as navicular and sesamoid fractures are high risk fractures requiring special clinical and radiological monitoring. Basically, conservative treatment using the 2-phase model is the treatment of choice. In delayed union or severe pain surgical treatment is indicated.