Medizinische Universitatsklinik

Freiburg, Germany

Medizinische Universitatsklinik

Freiburg, Germany
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Heart failure is a clinical syndrome characterized by typical symptoms, frequently accompanied by typical signs in association with structural or functional cardiac abnormalities. Heart failure with reduced, preserved and as new entity "midrange " ejection fraction are differentiated. A new diagnostic algorithm based on the clinical probability of the presence of heart failure with non-acute onset is presented. Established medical treatment for heart failure with reduced ejection fraction includes ACE-inhibitors, betablockers and mineralocorticoidreceptor-antagonists complemented by diuretics in case of fluid retention. The angiotensinreceptor-neprilysin-inhibitor Valsartan/Sacubitril represents a new therapeutic option. Device therapy, in particular cardiac resynchronisation therapy (CRT), plays an important role in addition to drug treatment. Indications for defibrillators and cardiac resynchronisation are the responsibility of cardiologists. No evidence-based treatment is available for heart failure with preserved ejection fraction. Diuretics improve symptoms of congestion. Triggering factors as well as cardiac and noncardiac comorbidities need to be investigated and treated. © 2017 Hogrefe.

Kern W.V.,Medizinische Universitatsklinik | De With K.,Medizinische Universitatsklinik
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz | Year: 2012

Rational and prudent antibiotic prescribing strategies are important both for the hospital sector as well as for ambulatory medicine. Prerequisites are the availability of antibiotic use and antibiotic resistance data and of infrastructure and trained personnel needed for implementing and evaluating antibiotic policies. Currently, these requirements are not being met sufficiently in Germany. A major challenge in this country is the lack of adequately trained and experienced personnel. On the other hand there are several projects and initiatives supported in part within the national antibiotic resistance control program which have produced some progress and success. One example is GERMAP, the national antibiotic use and resistance atlas covering both human medicine and the veterinary field. Other examples are the recently improved program for continuous hospital antibiotic use, surveillance and feedback and the Antibiotic Stewardship (ABS) training program with establishment of an ABS expert network. Future perspectives include programs for evaluation of practice guideline adherence and the development and evaluation of quality of care indicators. Intermediate and long-term investment is needed in specialty training and certification of a sufficient number of infectious disease physicians, medical microbiologists and infection control doctors/hospital epidemiologists and hospital pharmacists.

Bohm S.K.,Medizinische Universitatsklinik
Viszeralmedizin: Gastrointestinal Medicine and Surgery | Year: 2015

Background: Diverticulosis is a very common condition. Around 20% of diverticula carriers are believed to suffer from diverticular disease during their lifetime. This makes diverticular disease one of the clinically and economically most significant conditions in gastroenterology. The etiopathogenesis of diverticulosis and diverticular disease is not well understood. Epidemiological studies allowed to define risk factors for the development of diverticulosis and the different disease entities associated with it, in particular diverticulitis, perforation, and diverticular bleeding. Methods: A comprehensive literature search was performed, and the current knowledge about risk factors for diverticulosis and associated conditions reviewed. Results: Non-controllable risk factors like age, sex, and genetics, and controllable risk factors like foods, drinks, and physical activity were identified, as well as comorbidities and drugs which increase or decrease the risk of developing diverticula or of suffering from complications. In naming risk factors, it is of utmost importance to differentiate between diverticulosis and the different disease entities. Conclusion: Risk factors for diverticulosis and diverticular disease may give a clue towards the possible etiopathogenesis of the conditions. More importantly, knowledge of comorbidities and particularly drugs conferring a risk for development of complicated disease is crucial for patient management. © 2015 S. Karger GmbH, Freiburg.

Due to the high prevalence of cardiovascular diseases and the corresponding prescription of cardiac drugs, side effects and interactions may occur in a substantial number of patients. They can be explained by either pharmacokinetic or pharmaco-dynamic drug interactions which may be desired, but may also be life-threatening. Despite the fact that the novel oral anticoagulants are well tolerated, several factors restricting the use of these drugs, such as renal failure, have to be considered. The use of antihypertensive drugs may be limited by concomitant use of drugs that either induce of inhibit enzymatic metabolism, respectively inhibit renal drug, electrolyte, and/or water excretion. In this respect, the interaction between beta-blockers, ACE inhibitors, angiotensin receptor blockers and thiazide diuretics with non-steroidal antiinflammatory drugs is especially important. Muscle disorders are frequent side effects in patients undergoing statin therapy and affect up to 5 % of patients. They may manifest as mild myalgia, but also as life-threatening rhabdomyolysis. © 2015 Verlag Hans Huber, Hogrefe AG, Bern.

Horl W.H.,Medizinische Universitatsklinik
Internist | Year: 2011

Urinary tract infections occur very frequently in the community and in hospitalized patients and are mainly caused by Escherichia (E.) coli. Depending on virulence determinants of uropathogenic microorganisms and host-specific defense mechanisms, urinary tract infections can manifest as cystitis, pyelonephritis (bacterial interstitial nephritis), bacteremia or urosepsis. Uncomplicated urinary tract infections in otherwise healthy women should be treated for 3-7 days depending on the antibiotic therapy chosen, even if spontaneous remission rates of up to 40% have been reported. Antibiotics of the first choice for empirical treatment of uncomplicated urinary tract infection are fluoroquinolones, pivmecillinam and fosfomycin. A huge problem is the increasing antimicrobial resistance of uropathogenic microorganisms. Complicated urinary tract infections associated with anatomical and/or functional abnormalities of the urinary tract and/or comorbidities such as diabetes or immunosuppressive therapy, need longer antibiotic treatment (e.g. 10-14 days) as well as interdisciplinary diagnostic procedures. Treatment of community acquired urosepsis includes cephalosporins of the third generation, piperacillin/tazobactam or ciprofloxacin. For nosocomial urosepsis the combination with an aminoglycoside or a carbapenem is recommended. © 2011 Springer-Verlag.

Hammer H.F.,Medizinische Universitatsklinik
Wiener Medizinische Wochenschrift | Year: 2014

This review focuses on seven aspects of physiology and pathophysiology of the exocrine pancreas that have been intensively discussed and studied within the past few years: (1) the role of neurohormonal mechanisms like melatonin, leptin, or ghrelin in the stimulation of pancreatic enzyme secretion; (2) the initiation processes of acute pancreatitis, like fusion of zymogen granules with lysosomes leading to intracellular activation of trypsinogen by the lysosomal enzyme cathepsin B, or autoactivation of trypsinogen; (3) the role of genes in the pathogenesis of acute pancreatitis; (4) the role of alcohol and constituents of alcoholic beverages in the pathogenesis of acute pancreatitis; (5) the role of pancreatic hypertension, neuropathy, and central mechanisms for the pathogenesis of pain in chronic pancreatitis; (6) the relation between exocrine pancreatic function and diabetes mellitus; and (7) pathophysiology, diagnosis and treatment of pancreatic steatorrhea. © 2014 Springer-Verlag.

Kern W.V.,Medizinische Universitatsklinik
Deutsche Medizinische Wochenschrift | Year: 2011

Recent news in the field of bloodstream infection and sepsis relevant for the practitioner include the recommendation in the newly revised German sepsis guideline to introduce selective intestinal decontamination with non-absorbable antimicrobial substances for the prevention of secondary infections in ventilated patients. This intervention, however, remains controversial because there are indications of unfavourable effects (increased development of resistance), and because the effect size has been rather low. Other news indicate not only that procalcitonin can be reasonably used as an aid to determine the duration of antibiotic treatment in community-acquired respiratory infection and pneumonia. A procalcitonin-based algorithm can also be used in critical care patients to shorten the duration of antibiotic administration without worsening outcomes. Recent data indicate that E. coli and S. aureus continue to be the most frequent pathogens isolated in bloodstream infection. The proportion of E. coli strains producing extended-spectrum beta lactamase (ESBL) is increasing. New epidemiologic evidence shows that infections with this pathogen, resistant to many standard antibiotics, are associated with an increased mortality rate, similar to infections due to methicillin-resistant Staphylococcus aureus (MSRA). The incidence of MRSA bacteraemia in Germany can now be estimated better as it has become a notifiable infection. © Georg Thieme Verlag KG Stuttgart New York.

Kristen A.V.,Medizinische Universitatsklinik
Versicherungsmedizin / herausgegeben von Verband der Lebensversicherungs-Unternehmen e.V. und Verband der Privaten Krankenversicherung e.V | Year: 2010

Heart transplantation is the most effective treatment option for patients with end-stage heart failure to improve exercise tolerance and quality of life. This increase in quality of life may assume that heart transplant recipients are also able to return to their work. In general, there are no medical reasons to oppose a return to work. Despite enormous advances in medical rehabilitation after heart transplantation, the rate of working people among heart transplant recipients is very low. According to a survey at the Heidelberg Heart Transplant Center, only 37% of the heart transplant recipients return to work. This may be caused by tranplant-related problems as well as factors independent of heart transplantation. Furthermore, the psychological burden due to heart transplantation might hamper professional rehabilitation. Thus, psychotherapeutical support during transplant process appears to be appropriate. As a major issue for a return to work appears to be the patient's will, the voluntary nature of return to work step by step has to be limited. Programmes with close collaboration between physicians, health insurance companies, retirement insurance companies, employers, and especially the patients are necessary to increase the rate of professional rehabilitation and to underscore the health economic justification of heart transplant programmes.

Schumacher Y.O.,Medizinische Universitatsklinik | Pottgiesser T.,Medizinische Universitatsklinik
International Journal of Sports Medicine | Year: 2011

The haematological module of the Athletes Biological Passport (ABP) is used to detect blood doping through the longitudinal variation of blood variables, such as haemoglobin concentration (Hb). Sporting federations have opened disciplinary procedures against athletes based on ABP results. Suspicious athletes try to explain the variations in their blood values with dehydration caused by gastrointestinal (GI) problems. The aim of the present report is to describe haemoglobin concentration, a key variable of the ABP, during acute gastroenteritis in athletes. 5 athletes with severe gastroenteritis were studied in retrospective. Blood test results (Hb, white blood cell count (WBC) and differential, CRP) obtained on hospital admission for GI problems were compared to data obtained from the same athletes in states of good health on previous occasions. During GI problems, athletes displayed marked inflammatory constellations with increased CRP and typical WBC shifts. Hb was not affected and remained mostly unchanged. This is in line with basic physiologic fluid regulation, where plasma volume is kept constant, even under conditions of severe dehydration. It is therefore unlikely that fluid loss associated with gastroenteritis will cause athletes blood data to reach levels of abnormality that will be suspicious of blood doping. © Georg Thieme Verlag KG Stuttgart · New York.

Meier R.,Medizinische Universitatsklinik
Aktuelle Ernahrungsmedizin | Year: 2012

The pathogenesis of the inflammatory bowel diseases (IBD) as Crohns disease (CD) and ulcerative colitis (UC) is still not fully understood. Genetic, nutritional and environmental factors as well as the intestinal microbiota are discussed. Nutritional deficiencies and malnutrition are often seen in IBD; they are more frequent in CD than in UC. Nutritional deficiencies must be treated, because they have a negative effect on the outcome. The aim of nutritional support in IBD patients is to prevent or treat malnutrition and to influence specific inflammatory pathways in the intestine. The nutritional treatment is individual according the underlying problems. Optimizing the diet, oral supplements, enteral and parenteral nutrition are used. In this respect enteral nutrition is more beneficial than parenteral nutrition because of its direct effects on the gut and its associated lymphatic tissue. Polymeric diets are as useful as oligomeric diets and are used first. The use of specific formulae (e.g. different lipids) or specific nutrients may be of value since there is some evidence that these can influence the immune and inflammatory response. Further studies are still needed to clarify this in the future. Pre- and probiotics to modify the disease show considerable promise, particularly in maintaining remission in ulcerative colitis and preventing pouchitis. The involvement of a trained dietician can be highly recommended. © Georg Thieme Verlag KG Stuttgart · New York.

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