Peri-operative management of an adult patient with type 2N von Willebrand's disease scheduled for coronary artery bypass graft.

We describe a patient with type 2N von Willebrand's disease scheduled for elective coronary artery bypass graft for severe three-vessel coronary artery disease with involvement of the left main stem. He was given a pre-operative bolus of 3000 IU factor VIII/Willebrand factor concentrate (approximately 40 IU.kg(-1)), followed by a continuous infusion of 3 IU.h(-1) (228 IU.h(-1)) before undergoing coronary surgery with full heparinisation and cardiopulmonary bypass. There were no intra-operative bleeding complications and only one unit of packed red blood cells was required postoperatively. Thromboprophylaxis with low-molecular weight heparin and aspirin was given and the infusion of factor VIII/von Willebrand factor concentrate continued for 2 days. As a result of haematological monitoring, heparin therapy was changed from prophylactic to therapeutic on day 5-6 and stopped on day 7.

[Strategies to improve the life situation of minority ethnic elders shown by means of the example of a model project in the Unna district]. / Massnahmen zur Verbesserung der Lebenssituation älterer Migranten/innen dargestellt am Beispiel eines Modellprojektes im Kreis Unna.

In Germany, the topic 'Ethnicity and Age' is a central concomitant of demographic and social change and has become a big challenge for existing structures of community care for elders. In this context, the Kreis Unna implemented a model project, which aimed at informing minority ethnic elders about the German care and welfare system. The project also tried to promote their usage of services and offers for elders in a sustainable way. Within the frame of the project, two information series were held. The first addressed minority ethnic elders and informed them about the German care and welfare system. The second qualified staff in the field of care and work for elders for the special needs of minority ethnic elders. The project was supported and evaluated by the Institute for Gerontology at the University of Dortmund. By viewing the results of the evaluation, it becomes evident that the two information and qualification series proved successful for both groups and, in general, are transferable to other municipalities. However, it also became clear that reducing barriers of access to the German care and welfare system is a very difficult process for both sides. A better usage of institutions and services of community care for elders by minority ethnic elders can only be accomplished by constant measures.

[Rupture of a splenic aneurism in an emergency situation]. / Ruptur eines Milzarterienaneurysmas im Notarztdienst.

We report on a 36 year old patient who collapsed at home and was resuscitated by prehospital medical emergency services. He presented on scene unconscious with severe ST-elevations on the ECG and hardly palpable pulses. His previous medical history included only idiopathic hypertension and his professional background as manager of a company was associated with high stress levels. The prehospital diagnosis was myocardial infarction with cardiogenic shock. A hypovolemic shock was excluded from the differential diagnosis because of the age of the patient, lack of a precipitating trauma and inconsistent symptoms. The patient died after terminating prolonged resuscitation. A post mortem showed as cause of death the rupture of a splenic artery aneurysm. We emphasize that a cardiovascular collapse in a young patient without specific history or trauma still can be caused by hypovolemic shock due to intra-abdominal or -thorac bleeding.

[A comparison of the British and German of community care reaction on ethnic minority senior citizens]. / Die britische und deutsche Antwort der Altenhilfe auf zugewanderte Senioren/innen im Vergleich.

In Germany, 'Ethnicity and Age' is a central topic of demographic and social change and has become an important issue within gerontological/social political discourses and also a large challenge for existing structures of community care for the elderly. So far, on the scientific as well as the practical level, only a few attempts have been made in Germany to take a look at the experience of other countries. Based on the author's thesis, the following essay aims to bridge this gap. Within the broader context of comparing different welfare systems, it analyzes and compares specific experiences in the field of developing and opening up social services for elderly from black and ethnic minority groups in Germany and Great Britain. Focus is placed on the comparison of life situations of black elderly and legal frameworks of community care for elderly.