[Internal medical emergencies in the pregnant patient : Peripartum sepsis, metabolic derailment, endocrinological emergencies and pulmonary edema]. / Internistische Notfälle bei der schwangeren Patientin : Peripartale Sepsis, Stoffwechselentgleisungen, endokrinologische Notfälle und Lungenödem.

Peripartum emergencies that require intensive medical care represent a major challenge for the interdisciplinary treatment team. Due to physiological changes in pregnant women symptoms can be masked and the initiation of treatment is delayed. Peripartum sepsis has a relatively high incidence. The anti-infective treatment depends on the spectrum of pathogens to be expected. Endocrinological emergencies are rare but can be fulminant and fatal. The development of ketoacidosis is favored by decreased bicarbonate buffer and placental hormones. In the case of thyrotoxicosis, propylthiouracil and thiamazole are available for treatment depending on the stage of gestation. Sheehan's syndrome is an infarction of the anterior lobe of the pituitary gland during a hemorrhage. Due to the loss of production of vital hormones, this can be fatal. The development of pulmonary edema is just as acute. This is favored by physiological changes during pregnancy. The differentiation between hypertensive and hypotensive pulmonary edema is important for the causal treatment.

[Vascular emergencies in pregnant patients : Peripartum hemorrhage, thromboembolic events and hypertensive diseases in pregnancy]. / Vaskuläre Notfälle bei der schwangeren Patientin : Peripartale Hämorrhagie, thrombembolische Ereignisse und hypertensive Schwangerschaftserkrankungen.

In developed countries, peripartum hemorrhage, thromboembolic events and hypertensive pregnancy disorders are the most frequent complications in pregnancy. They pose a significant challenge for the interdisciplinary team of gynecology and anesthesiology. Untreated, these pregnancy-related complications result in a fulminant course. Close consultation between the specialist departments and knowledge of the area of responsibility are essential. In the case of acute bleeding the anesthesiologist is responsible for maintaining adequate circulatory conditions and management of hemostasis. Thromboembolic events require immediate anticoagulation and focused diagnostics. Thereby, both the fetal and the maternal risks must be weighed up. The hypertensive diseases in pregnancy have a very high risk of complications. In addition to symptomatic treatment in the intensive care unit, the optimal time of delivery must be determined by an interdisciplinary consensus. This is the only causal treatment option possible.

[Internal medical emergencies in the pregnant patient : Peripartum sepsis, metabolic derailment, endocrinological emergencies and pulmonary edema]. / Internistische Notfälle bei der schwangeren Patientin : Peripartale Sepsis, Stoffwechselentgleisungen, endokrinologische Notfälle und Lungenödem.

Peripartum emergencies that require intensive medical care represent a major challenge for the interdisciplinary treatment team. Due to physiological changes in pregnant women symptoms can be masked and the initiation of treatment is delayed. Peripartum sepsis has a relatively high incidence. The anti-infective treatment depends on the spectrum of pathogens to be expected. Endocrinological emergencies are rare but can be fulminant and fatal. The development of ketoacidosis is favored by decreased bicarbonate buffer and placental hormones. In the case of thyrotoxicosis, propylthiouracil and thiamazole are available for treatment depending on the stage of gestation. Sheehan's syndrome is an infarction of the anterior lobe of the pituitary gland during a hemorrhage. Due to the loss of production of vital hormones, this can be fatal. The development of pulmonary edema is just as acute. This is favored by physiological changes during pregnancy. The differentiation between hypertensive and hypotensive pulmonary edema is important for the causal treatment.

[Dexmedetomidine in the treatment of acute alcohol withdrawal delirium]. / Dexmedetomidin in der Therapie des akuten Alkoholentzugsdelirs.

Alcohol withdrawal syndrome has a high clinical prevalence. Severe cases must be treated in an intensive care unit and are associated with a high mortality rate, depending on patient comorbidities. Clinical requirements include sedation, control of vegetative symptoms, treatment of hallucinations and, when necessary, anticonvulsive therapy. Currently, there is no single substance that fulfills these requirements. National and international guidelines recommend a combination of various substances. The central α2-adrenergic receptor agonist clonidine is used as a therapeutic adjuvant. In consideration of its pharmacological characteristics, dexmedetomidine is assumed to be more advantageous compared to clondine. Case studies with dexmedetomidine in alcohol withdrawal syndrome show the safety of its application and a benzodiazepine-sparing effect. Its incorporation in escalating intensive care therapy of severe cases could be appropriate.

[Post-mortem organ donation]. / Postmortale Organspende.

In Germany approximately 3000 body organs are transplanted annually. In general, all artificially ventilated patients with diagnosed brain death are potential organ donors. All German hospitals are obliged to report potential organ donors and be actively involved in the organ donation process. These matters lie under the jurisdiction of the German transplantation act. An essential prerequisite for organ donation is the diagnosis of brain death according to the guidelines of the German Medical Association. Brain death is associated with complex pathophysiological changes in cardiopulmonary function as well as fluid, electrolyte and metabolic homeostasis. In the case of diagnosed brain death and with permission for organ donation, a precise organ-protective therapy is initiated, essentially focussing on optimal organ perfusion and oxygenation. The quality of organ protection has a direct influence on the outcome of transplantation.

[Attitudes of medical staff potentially participating in the organ donation process towards organ donation and transplantation in Bavaria]. / Einstellung von potenziell am Organspendeprozess beteiligten Ärzten und Pflegekräften in Bayern zu Organspende und Transplantation.

BACKGROUND: Organ donation rates in Germany are lower than in other countries and have declined further after manipulations of the waiting lists in some German transplant centers became public. Attitudes and commitment of medical personnel are crucial for successful organ donation. Therefore, we studied the attitudes of hospital staff towards organ donation and transplantation. METHOD: In 50 Bavarian hospitals, medical professionals working in units relevant to organ donation were asked to respond to an anonymous questionnaire. RESULTS: 2983 questionnaires could be evaluated. The majority of all respondents had a positive attitude towards organ donation; 71 % were willing to donate their organs after brain death and 57 % were willing to accept a transplant in case of organ failure. Rates of positive attitude were lower among nurses than among physicians. 28 % indicated that recent developments had a negative impact on their attitude and of those approximately half evaluated the work of transplant centers negatively. Overall only 23 % considered organ allocation as fair. The majority of nurses and a large proportion of physicians considered themselves as not well informed. CONCLUSION: The current loss of confidence into organ donation and transplantation also affects the attitude of medical personnel. Intensified measures of information and full transparency of all procedures are urgently needed.

[Dexmedetomidine]. / Dexmedetomidin.

Dexmedetomidine is a highly selective α2-receptor agonist with sedative, analgetic and anxiolytic effects. It is chemically related to clonidine and has been an authorized drug in Europe since September 2011. Dexmedetomidine enables a level of sedation in which mechanically ventilated patients may be woken by verbal stimulation (Richmond agitation sedation scale RASS 0--3). In this respect dexmedetomidine achieves the same desired effect as propofol and midazolam; however, in direct comparison to a sedation regime with benzodiazepines, dexmedetomidine reduces the prevalence, duration and severity of delirium in intensive care. Patients sedated by dexmedetomidine can statistically be extubated earlier and an influence on duration of stay in the intensive care unit (ICU) has not been shown. Daily therapy costs are approximately 5 times higher than those of propofol but an objective standpoint in relation to clinical cost efficiency is unattainable.

Aggressive combination treatment for invasive fungal sinusitis in immunocompromised patients.

Invasive sinonasal fungal disease is a potentially fatal complication of chemotherapy-induced immunosuppression and neutropenia. We reviewed the outcomes of seven cancer patients who had been diagnosed with invasive fungal sinusitis; six patients had hematologic malignancies and one had breast cancer. At the time of their sinus diagnosis, all patients had been hospitalized and were receiving combination chemotherapy for their underlying malignancy. Impairment of their immune function was characterized by an absolute neutrophil count of less than 1,000/mm3. Aggressive management of their sinonasal fungal disease consisted of surgical debridement and systemic amphotericin B for all patients, and treatment with granulocyte colony-stimulating factor for two patients. Invasive Aspergillus infection was identified in six patients and invasive Candida albicans infection in one. Although the prognosis for these patients was poor and two patients died of the fungal infection, the aggressive treatment strategy resulted in long-term survival for the remaining five patients.

Good prognosis for psychomotor development in survivors with nonimmune hydrops fetalis.

We examined the psychomotor development of 33 of 61 surviving children, from a series of 107 consecutive live-born cases with nonimmune hydrops fetalis. The majority had a normal outcome. Three had a (simultaneous) serious underlying disease (e.g. fetal herpes infection) and had either severe psychomotor retardation or blindness. Two showed clumsiness and were considered to have minor neurological dysfunction. We conclude that survivors, especially those with transient benign intrauterine conditions, such as lymphatic aetiology have no additional risk to their psychomotor development.