ABSTRACT
The 2015 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension are also valid for Germany. The guidelines contain detailed recommendations for the targeted treatment of pulmonary arterial hypertension (PAH). However, the practical implementation of the European Guidelines in Germany requires the consideration of several country-specific issues and already existing novel data. This requires a detailed commentary to the guidelines, and in some aspects an update already appears necessary. In June 2016, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany. This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, a number of working groups was initiated, one of which was specifically dedicated to the management of decompensated right heart failure, intensive care management and perioperative management in patients with pulmonary hypertension. This article summarizes the results and recommendations of the working group on decompensated right heart failure, intensive care and perioperative management in patients with pulmonary hypertension.
Subject(s)
Cardiology/standards , Hypertension, Pulmonary/surgery , Monitoring, Intraoperative/standards , Practice Guidelines as Topic , Pulmonary Medicine/standards , Ventricular Dysfunction, Right/prevention & control , Germany , Humans , Hypertension, Pulmonary/complications , Hypertension, Pulmonary/diagnosis , Ventricular Dysfunction, Right/diagnosis , Ventricular Dysfunction, Right/etiologyABSTRACT
This is a report of a 70-year-old patient with spontaneous pain of the dorsum area of the left foot. A few days later there was a sudden onset of foot drop. First, an idiopathic peroneal palsy was assessed but an MRI showed a cystic tumour near the fibular head. These findings resulted in the patient attending our clinic for surgical treatment. During the operation we found an intraneural ganglion of the deep peroneal nerve and the common peroneal nerve. There was no connection with the superior tibiofibular joint. The ganglion was therefore removed. Two months after the operation the patient reported an improvement of the pain but no improvement of movement of the foot. An intraneural ganglion of the peroneal nerve derives from the superior tibiofibular joint. Given access to the articular branch, the cyst typically spreads out proximally from the deep peroneal nerve to the common peroneal nerve and to the point of the sciatic nerve. The clinical symptoms are correlated with the extent of cyst propagation. Recommended therapy would include the ligation of the aricular branch, or synovectomy, or resection of the superior tibiofibular joint and decompression of the cyst.
Subject(s)
Ganglion Cysts/diagnosis , Ganglion Cysts/surgery , Peroneal Neuropathies/diagnosis , Peroneal Neuropathies/surgery , Aged , Humans , Male , Treatment OutcomeABSTRACT
Of a total of 182 papillary neoplasms, 25 lesions (average size, 3.1 cm) were classified on cytologic and histologic grounds as being encapsulated carcinomas. In eight of these tumors (32.2%) cervical lymph node metastasis and/or intraglandular lymphatic spread was observed. It was not possible to separate on histologic grounds those that did metastasize from those that did not. The excellent prognosis for the encapsulated variant of papillary thyroid carcinoma was confirmed by a long follow-up period in which no evidence of recurrences or further metastasis was registered as compared with the time of initial diagnosis, whatever the mode of therapy. On the basis of these findings, the encapsulated papillary carcinoma can be regarded as an early or slowly growing form of the papillary thyroid carcinoma.
Subject(s)
Carcinoma, Papillary/pathology , Thyroid Neoplasms/pathology , Adult , Aged , Female , Humans , Lymphatic Metastasis , Male , Middle Aged , NeckSubject(s)
Ascites/therapy , Peritoneovenous Shunt/methods , Vascular Surgical Procedures/methods , Diet, Sodium-Restricted , Equipment Failure , Furosemide/therapeutic use , Hemorrhage/etiology , Humans , Life Expectancy , Peritoneovenous Shunt/adverse effects , Pleural Effusion/etiology , Pulmonary Edema/etiology , Spironolactone/therapeutic useABSTRACT
In a follow-up study of 112 patients who had subtotal thyroidectomy because of Graves' disease and nodular goitre with hyperthyroidism, 81% were euthyroid, 10,7% developed hypothyroidism and 8% had persistent or recurrent hyperthyroidism. 12,5% of the euthyroid patients had goitre; 10 of these patients had cold thyroid nodules. The assessment of the dignity of the cold nodules and guidelines for the therapeutic procedure are stressed. The importance of considering clinical findings on one hand and thyroid function tests on the other hand in the choice of effective treatment - prophylaxis against euthyroid goitre, substitution with hormones, iodine-131 therapy, antithyroid drugs or reoperation - is outlined.
Subject(s)
Goiter, Nodular/surgery , Graves Disease/surgery , Hyperthyroidism/surgery , Postoperative Care/methods , Thyroidectomy , Follow-Up Studies , Humans , Postoperative Complications/blood , Recurrence , Thyroid Hormones/bloodABSTRACT
Various diseases can symptomatically resemble appendicitis. It has been proved that luminal obstruction is the most frequent cause of inflammation of the appendix. There are various causes of obstruction, such as scars, foreign bodies, tumors, granulomas, and dysfunction of coecocolon. Every appendix should therefore be histologically examined. The operative indication for appendectomy should not only include the time factor, but also anamnesis, complaints, and clinical presentation. It is inconsiderate to perform appendectomy as a prophylaxis against appendicitis. Finally, it is surprising that there have been almost no experimental studies on pathogenesis of appendicitis.
Subject(s)
Appendix , Acute Disease , Appendicitis/surgery , Appendix/surgery , Chronic Disease , Crohn Disease/surgery , Granuloma/surgery , Humans , Intestinal Diseases/classification , Intestinal Diseases/surgeryABSTRACT
For over a decade, therapeutic results in cases of macrocarcinoma have remained almost constant. The absolute 5-year survival rate is 10-15%. However, in cases of early detection, the 5-year survival rate is over 90%. Systematic screening to detect the cancers early has resulted. The practical results is the systematic observation of high-risk groups. The therapy of choice for macrocarcinoma and cancer that is detected early is subtotal resection. Resection of the cardia should be replaced by gastrectomy, which should also be performed only when defined diagnostic criteria are met.
Subject(s)
Stomach Neoplasms/surgery , Gastrectomy/methods , Humans , Lymphatic Metastasis , Neoplasm Metastasis , Prognosis , Stomach Neoplasms/diagnosisABSTRACT
The increasing number of toxic cirrhoses of the liver and their concomitant diseases demands differentiation in the choice of surgical technique in acute hemorrhage. The characteristics of the habitually orthostatic human circulation give some indications on the formation of varices. Experience offers new approaches to the prevention of reflux in the esophagus. Diagnostic and therapeutic procedures in the different types of bleeding in the acute hemorrhage of portal hypertension and intrahepatic block are discussed.
