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.