Medizinische Klinik最新文献

Systemic mastocytosis comprises disorders characterized by an accumulation of genetically altered mast cells in all organs and tissues due to an increased proliferation rate and reduced apoptosis of those pathologic mast cells. Release of their mediators can effectively influence organ function and can lead to systemic effects without inducing traces in routinely used laboratory parameters or imaging methods. In most cases, little invasive investigations allow diagnosing the disease and, hence, an appropriate therapy consisting of a basic medication with antihistamine and mast cell membrane-stabilizing compounds that should be supplemented, if required, by a medication adapted to individual symptoms, can be initiated. Because of the probably high prevalence of the disorder, systemic mastocytosis should be considered as a differential diagnosis in particular in the case of chronic gastrointestinal complaints such as abdominal pain/discomfort possibly associated with diarrhea, at an early stage.

In an appeal concerning accusations of defamation, the England and Wales Court of Appeal Decisions determined that evidence-based statements are to be judged as opinions and not statements of fact. Since the authors consider it probable that this legal judgment will exert influence on physicians' decisions about the provision of health care services, they have compiled the implications of the judgment and discuss its consequences. The own analyses and considerations lead to the conclusion that confidence-based medicine follows evidence-based medicine. This extension is necessary because evidence-based medicine has not been able to generate the required trust. Therefore, it will be demanded to underpin the existing concept with additional data. These data will be necessary because it is no longer sufficient to convince scientists with data which are obtained under ideal conditions, but to convince critical members of society with additional data which have been obtained under everyday conditions.

Background and purpose: Sudden cardiac arrest appears in 1-5 patients/ 1,000 clinical admissions. In spite of different research approaches, the prognosis after in-hospital resuscitation has not significantly improved in the last 40 years. This account presents the experiences with a hospital-wide emergency plan using the concept of defibrillation by first responders.

Methods: In 2003, a hospital-wide emergency plan was implemented. The concept comprised the setup of 15 "defibrillator points", training of the entire hospital personnel as first responder, and the introduction of an emergency team. Over the following 3 years, the concept was optimized. In a period from May 2006 to April 2008, the data of all patients who received an in-hospital resuscitation were collected.

Results: Within 24 months, a total of 41 resuscitations were conducted. Out of these, 24 patients (58%) were under intensive monitoring when the event occurred. Initially, 15 patients (36%) showed ventricular fibrillation, 15 (36%) a pulseless electrical activity, and eleven (27%) an asystoly. A total of twelve patients (29%) left hospital alive. About half of them (42%) experienced ventricular fibrillation and were under observation at the time of event.

Conclusion: The data collected since the implementation of the hospital- wide emergency plan in 2003 reflect the daily clinical routine. The results show that there is a better outcome especially in patients with ventricular fibrillation when receiving first-responder defibrillation.

Emotional stress facilitates the occurrence of cardiac arrhythmias including sudden cardiac death. The prevalence of anxiety and depression is increased in cardiac patients as compared to the normal population. The risk of cardiovascular mortality is enhanced in patients suffering from depression. Comorbid anxiety disorders worsen the course of cardiac arrhythmias. Disturbance of neurocardiac regulation with predominance of the sympathetic tone is hypothesized to be causative for this. The emotional reaction to cardiac arrhythmias is differing to a large extent between individuals. Emotional stress may result from coping with treatment of cardiac arrhythmias. Emotional stress and cardiac arrhythmias may influence each other in the sense of a vicious circle. Somatoform cardiac arrhythmias are predominantly of psychogenic origin. Instrumental measures and frequent contacts between physicians and patients may facilitate disease chronification. The present review is dealing with the multifaceted relationships between cardiac arrhythmias and emotional stress. The underlying mechanisms and corresponding treatment modalities are discussed.

Case report: The authors report on a 51-year-old patient with transient pareses, myalgias, and a massive creatine kinase elevation which had led to an intensive neurological work-up by the general practitioner. Despite refractory hypertension, primary aldosteronism was not excluded. At the authors' clinic, the patient was diagnosed to have Conn's syndrome. Laparoscopic adrenalectomy revealed a big adenoma of the left adrenal gland.

Conclusion: Transient pareses, myalgias, and creatine kinase elevation can indicate primary aldosteronism among hypertensive patients. If clinically suspected, the aldosterone-renin ratio should be determined.

This review introduces new therapeutic options in the treatment of chronic idiopathic constipation and irritable bowel syndrome with constipation. Therefore, prucalopride and lubiprostone are discussed including their mechanisms and side effects. In addition, other substances that are currently under evaluation such as renzapride and linaclotide are described, since recent results showed a significant effect in patients with constipation. Thus, after the withdrawal of tegaserod due to cardiac side effects, new potent drugs are now available for the treatment of constipation.

Hashimoto's thyroiditis is a common autoimmune thyroid disease with preference of female gender. The chronic thyroiditis is characterized by autoantibodies against thyroid peroxidase and thyroglobulin. With manifestation, there is often a subclinical hypothyroidism that finally progresses to a persistent hypothyroidism with typical clinical symptoms and the need of hormonal substitution in succession of the lymphocytic infiltration of the thyroid. The ultrasound of the thyroid shows a hypoechogenic and inhomogeneous parenchyma. Autoimmune thyroiditis is frequently associated with autoimmune disease of other organs, such as vitiligo, Addison's disease, diabetes mellitus type 1, often in the sense of polyglandular syndrome 2.