[Management of a Port Catheter-Related Superior Vena Cava Thrombosis in the Setting of Active Crohn's Disease: A Case Report]. / Management einer portassoziierten Vena-cava-superior-Thrombose im Rahmen eines Crohn-Schubes.

History and clinical findings A 56 year-old woman was admitted to our hospital for treatment of a severe exacerbation of Crohn's disease. During the stay a port catheter was implanted, safeguarding nutrition. A few days later the patient developed symptoms of a severe superior vena cava (SVC) syndrome with dyspnea, cyanosis, headaches and swelling of face and upper extremities. Examination A CT scan showed port catheter-associated SVC thrombosis with complete occlusion of the SVC. Diagnosis There was a coexistence of a port catheter-associated SVC thrombosis with complete occlusion of the SVC and a severe exacerbation of Crohn's disease with haematochezia. Therapy and clinical course Local prolonged thrombolysis through the port catheter analogous to the regimen used in the 2012 CaVenT Study was started. Subsequently, symptoms of SVC obstruction as well as thrombus extent improved markedly, with only minor increase in gastrointestinal bleeding. Conclusion Local thrombolysis appears to be a safe and effective therapy for port catheter-associated thrombosis that may be considered in the setting of increased risk of hemorrhage.

Hybrid MCDA Methods to Integrate Multiple Ecosystem Services in Forest Management Planning: A Critical Review.

Multi-criteria decision analysis (MCDA) is a decision aid frequently used in the field of forest management planning. It includes the evaluation of multiple criteria such as the production of timber and non-timber forest products and tangible as well as intangible values of ecosystem services (ES). Hence, it is beneficial compared to those methods that take a purely financial perspective. Accordingly, MCDA methods are increasingly popular in the wide field of sustainability assessment. Hybrid approaches allow aggregating MCDA and, potentially, other decision-making techniques to make use of their individual benefits and leading to a more holistic view of the actual consequences that come with certain decisions. This review is providing a comprehensive overview of hybrid approaches that are used in forest management planning. Today, the scientific world is facing increasing challenges regarding the evaluation of ES and the trade-offs between them, for example between provisioning and regulating services. As the preferences of multiple stakeholders are essential to improve the decision process in multi-purpose forestry, participatory and hybrid approaches turn out to be of particular importance. Accordingly, hybrid methods show great potential for becoming most relevant in future decision making. Based on the review presented here, the development of models for the use in planning processes should focus on participatory modeling and the consideration of uncertainty regarding available information.

Fatal cerebral arterial gas embolism after endoscopic retrograde cholangiopancreatography.

We report the case of a 50-year-old woman undergoing elective endoscopic retrograde cholangiopancreatography, who developed coma and hemiparesis secondary to severe cerebral artery gas embolism. Despite prompt diagnosis and early hyperbaric oxygen therapy (HBO(2)) she developed severe cerebral edema and died within 24 h.