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  • 1
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  12. Deutscher Kongress für Versorgungsforschung; 20131023-20131025; Berlin; DOCPO2-1-10-191 /20131025/
    Publication Date: 2013-10-26
    Keywords: Dialyse ; Niereninsuffizienz ; Nierenersatztherapie ; Prävalenz ; Versorgung ; ddc: 610
    Language: German
    Type: conferenceObject
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  • 2
    ISSN: 1432-1238
    Keywords: Key words Procalcitonin ; APACHE-II score ; C-reactive protein ; SIRS ; Sepsis ; Severe sepsis ; septic shock
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To determine the value of procalcitonin (PCT) in the early diagnosis (and differentiation) of patients with SIRS, sepsis, severe sepsis, and septic shock in comparison to C-reactive protein (CRP), white blood cell and thrombocyte count, and APACHE-II score (AP-II).¶Design: Prospective cohort study including all consecutive patients admitted to the ICU with the suspected diagnosis of infection over a 7-month period.¶Patients and methods: A total of 185 patients were included: 17 patients with SIRS, 61 with sepsis, 68 with severe sepsis, and 39 patients with septic shock. CRP, cell counts, AP-II and PCT were evaluated on the first day after onset of inflammatory symptoms.¶Results: PCT values were highest in patients with septic shock (12.89 ± 4.39 ng/ml; P 〈 0.05 vs patients with severe sepsis). Patients with severe sepsis had significantly higher PCT levels than patients with sepsis or SIRS (6.91 ± 3.87 ng/ml vs 0.53 ± 2.9 ng/ml; P 〈 0.001, and 0.41 ± 3.04 ng/ml; P 〈 0.001, respectively). AP-II scores did not differ significantly between sepsis, severe sepsis and SIRS (19.26 ± 1.62, 16.09 ± 2.06, and 17.42 ± 1.72 points, respectively), but was significantly higher in patients with septic shock (29.27 ± 1.35, P 〈 0.001 vs patients with severe sepsis). Neither CRP, cell counts, nor the degree of fever showed significant differences between sepsis and severe sepsis, whereas white blood cell count and platelet count differed significantly between severe sepsis and septic shock.¶Conclusions: In contrast to AP-II, PCT appears to be a useful early marker to discriminate between sepsis and severe sepsis.
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  • 3
    ISSN: 1432-1238
    Keywords: Key words Procalcitonin ; Lupus erythematodes ; Antineutrophil cytoplasmatic antibody (ANCA) associated vasculitis ; Systemic infection ; CRP
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To investigate whether serum procalcitonin (PCT) levels could be useful to differentiate between systemic infection and the activity of the underlying disease in autoimmune disease.¶Methods: In 18 patients with systemic lupus erythematodes (SLE) and 35 patients with systemic antineutrophil cytoplasmic antibody-associated vasculitis (AAV) clinical disease activity was assessed by score systems. Infection was defined by clinical and microbiological means. PCT was determined in parallel with concentrations of neopterin, interleukin-6 (IL-6), and C-reactive protein (CRP) in 397 serum samples.¶Results: Only in 3 of the 324 samples taken from patients with autoimmune disease but without concomitant infection, serum PCT levels were above the normal range ( 〉 0.5 ng/ml), whereas neopterin, CRP and IL-6 were elevated in patients with active underlying disease.¶All systemic infections (N = 16 in AAV-patients) were associated with markedly elevated PCT-levels (mean ± SD:1.93 ± 1.19 ng/ml).¶Conclusion: PCT may serve as a useful marker for the detection of systemic bacterial infection in patients with autoimmune disease.
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  • 4
    ISSN: 1433-0385
    Keywords: Key words: Mushroom poisoning ; Liver transplantation ; Fulminant hepatic failure.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Der Verlauf von 12 Patienten mit Knollenblätterpilzvergiftung wurde retrospektiv analysiert, um prognostische Kriterien für die Indikationsstellung zur Lebertransplantation herauszuarbeiten. Acht Patienten erholten sich unter konservativer Therapie, bei 3 Patienten war eine Lebertransplantation erforderlich; ein Patient starb bei Vorliegen schwerer Begleiterkrankungen unter konservativer Therapie. Die transplantierten Patienten wiesen initial einen Quick- und Faktor-V-Wert unter 10 % auf. Die Höhe der Transaminasen, des Serumbilirubins, des Serumkreatinins, eine Verlängerung der PTT sowie eine Azotämie hatten keinen sicheren prognostischen Wert. Für die Indikationsstellung zur Transplantation war der initiale Quick- und Faktor-V-Wert und deren inadäquater Anstieg unter Substitution entscheidend. Die Ausbildung einer Encephalopathie sowie ein progredientes Nierenversagen stellen zusätzliche prognostisch schlechte Parameter dar.
    Abstract: Schlüsselwörter: Knollenblätterpilzvergiftung – Lebertransplantation – fulminantes Leberversagen.
    Notes: Summary. The clinical course of 12 patients with mushroom poisoning was evaluated in order to define the parameters considered to be relevant to the indication for liver transplantation. Eight patients recovered under conservative therapy; one patient died due to pre-existing, concomitant cardiopulmonary disease. In three patients transplantations had to be performed because of severe liver failure. On admission, the transplanted patients had a decreased Quick's test score and factor V value (〈 10 %). The peak of liver enzymes, serum bilirubin, serum creatinine, partial thromboplastin time and azotemia were not of any prognostic value. Main indications for liver transplantation were a very low initial Quick's test score and factor V value (both 〈 10 %) and their inadequate response under substitution therapy. The development of encephalopathy and renal failure were further parameters indicating poor prognosis.
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  • 5
    ISSN: 1432-2277
    Keywords: Key words Kidney transplantation ; Ureteral complications ; Pyeloureterostomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Necrosis and stenosis of the ureter are severe complications after kidney transplantation and occur with mean incidence of 2,9–13,4 %. Several surgical techniques like simple nephrostomy or complex urinary tract reconstruction have been applied for repair. In this study, our experience with native pyeloureterostomy (NPUS) using the native ureter is presented. Between March 1978 and June 1996, 2592 kidney transplantations were performed in our institution. In 48 patients (1,9 %), secondary urinary tract reconstruction by NPUS was necessary. These patients were evaluated retrospectively by review of the case notes. At the time of operation the mean age was 45 ± 14 years. Indications for NPUS were distal ureteral stenosis (n = 29), necrosis (n = 17), bleeding (n = 1) or iatrogenic lesion of the ureter (n = 1). The mean time period between transplantation and urinary tract reconstruction was 20 ± 23 days (range: 1–90 days) for necrosis and 404 ± 637 days (range: 14–2385 days) for stenosis. A pyeloureterostomy was technically feasible in all patients using the recipient's ipsilateral ureter. In 40 out of 48 patients the graft developed a normal function postoperatively (follow up: 39 ± 48 months). A graft nephrectomy was necessary only in one patient, because of complete pyelonnecrosis 6 days after NPUS. Two grafts were lost due to acute rejection. Data of five patients were not available 〉 15 years after successful reconstruction. We can conclude that NPUS is a safe and simple rescue technique for the treatment of distal ureteral complications after kidney transplantation. Therefore, this technique should be the therapy of choice when secondary reconstruction by re-ureteroneocystostomy is not possible.
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  • 6
    ISSN: 1433-0385
    Keywords: Key words: Mushroom poisoning ; Liver transplantation ; Fulminant hepatic failure.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Der Verlauf von 12 Patienten mit Knollenblätterpilzvergiftung wurde retrospektiv analysiert, um prognostische Kriterien für die Indikationsstellung zur Lebertransplantation herauszuarbeiten. Acht Patienten erholten sich unter konservativer Therapie, bei 3 Patienten war eine Lebertransplantation erforderlich; ein Patient starb bei Vorliegen schwerer Begleiterkrankungen unter konservativer Therapie. Die transplantierten Patienten wiesen initial einen Quick- und Faktor-V-Wert unter 10 % auf. Die Höhe der Transaminasen, des Serumbilirubins, des Serumkreatinins, eine Verlängerung der PTT sowie eine Azotämie hatten keinen sicheren prognostischen Wert. Für die Indikationsstellung zur Transplantation war der initiale Quick- und Faktor-V-Wert und deren inadäquater Anstieg unter Substitution entscheidend. Die Ausbildung einer Encephalopathie sowie ein progredientes Nierenversagen stellen zusätzliche prognostisch schlechte Parameter dar.
    Abstract: Schlüsselwörter: Knollenblätterpilzvergiftung – Lebertransplantation – fulminantes Leberversagen.
    Notes: Summary. The clinical course of 12 patients with mushroom poisoning was evaluated in order to define the parameters considered to be relevant to the indication for liver transplantation. Eight patients recovered under conservative therapy; one patient died due to pre-existing, concomitant cardiopulmonary disease. In three patients transplantations had to be performed because of severe liver failure. On admission, the transplanted patients had a decreased Quick's test score and factor V value (〈 10 %). The peak of liver enzymes, serum bilirubin, serum creatinine, partial thromboplastin time and azotemia were not of any prognostic value. Main indications for liver transplantation were a very low initial Quick's test score and factor V value (both 〈 10 %) and their inadequate response under substitution therapy. The development of encephalopathy and renal failure were further parameters indicating poor prognosis.
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  • 7
    ISSN: 1433-8726
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Patients with end-stage analgesic nephropathy bear a higher risk for urothelial cancer than do patients with other renal diseases. In a retrospective study in patients with analgesic nephropathy and kidney transplants we analyzed the prevalence and clinical course of de novo urothelial cancer. Diagnosis of analgesic nephropathy was based on the patients' history and clinical data. Only patients under cyclosporine treatment were included. Between 1968 and 1993, 2,371 kidney transplants were performed on 2,072 patients in the Department of Abdominal and Transplant Surgery. The prevalence of analgesic nephropathy was 3.1%. Of 65 patients with analgesic nephropathy and kidney transplants, 10 (15.4%) developed urothelial carcinoma; 10.8%, bladder cancer; and 9.1%, renal pelvic cancer. The mean age at diagnosis was 56.1 years. Urothelial cancer occurred on average at 33.6 months posttransplantation. On average, 6 of 10 patients with urothelial cancer died of the disease at 16.9 months after the diagnosis. All patients with urothelial bladder cancer had a muscle-infiltrating tumor of moderate or high grade. Since urothelial renal pelvic cancer occurred in 9.1% of our patients with analgesic nephropathy and urological screening is insufficient in patients on dialysis, we suggest that prophylactic nephroureterectomy be performed on one side before transplantation and on the contralateral side at 3–6 months after transplantation. An aggressive approach is indicated in patients with urothelial cancer of the bladder.
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  • 8
    ISSN: 1435-1420
    Keywords: Key words Hepatorenal syndrome ; diagnosis ; differential diagnosis ; pathophysiology ; treatment ; Schlüsselwörter Hepatorenales Syndrom ; Diagnose ; Differentialdiagnose ; Pathophysiologie ; Therapie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Das hepatorenale Syndrom ist definiert als das Auftreten einer Niereninsuffizienz bei schwerer, fortgeschrittener Lebererkrankung, nach Ausschluß anderer Ursachen einer renalen Funktionsstörung. Die Pathogenese des als funktionell anzusehenden Nierenversagens ist komplex und noch nicht in allen Schritten aufgeklärt. Im Zentrum steht eine periphere arterielle Vasodilatation mit Umverteilung des Blutvolumens, wobei dem Stickoxid als möglicherweise primärem Mediator offensichtlich eine besondere Bedeutung zukommt. Als Folge kommt es durch Veränderungen verschiedener pathophysiologischer Mechanismen (Sympathikus, Renin-Angiotensin-System, Vasopressin, Endothelin, Prostanoide, natriuretische Peptide) zu einer renalen Funktionsstörung, welche durch eine kortikale Vasokonstriktion im Bereich der Nieren charakterisiert ist. Eine supportive Therapie und intensive Kreislaufüberwachung steht im Zentrum der Betreuung dieser Patienten. Die Mortalität ist mit über 90% noch immer sehr hoch. Nierenersatzverfahren sollten bei erwarteter Verbesserung der Leberfunktion (akutes Leberversagen, Lebertransplantation) als kontinuierliche Verfahren eingesetzt werden. Die definitiv erfolgreiche Therapie stellt die orthotope Lebertransplantation dar.
    Notes: Summary The hepatorenal syndrome is defined as the development of renal failure in patients with severe liver disease in the absence of any other identifiable cause of renal functional impairment. The pathogenesis of this obviously functional renal failure is complex and not completely understood. Of importance seems to be a peripheral and systemic vasodilatation with redistribution of blood volume. Nitric oxide seems to play a major role as a possible primary mediator. As a consequence changes in several different pathophysiological mechanisms (sympathetic nervous system, renin-angiotensin system, vasopressin, endothelin, prostanoids, natriuretic peptides) lead to a functional renal impairment which is characterized by renal cortical vasoconstriction. Supportive treatment and intensive monitoring of the cardiovascular circulation is the main goal in the care of these patients. The mortality is still high exceeding 90%. Renal extracorporeal support should be initiated using a continuous method when recovery of liver function is expected (acute liver failure, waiting for liver transplantation). The only effective and permanent treatment is orthotopic liver transplantation.
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  • 9
    ISSN: 1435-1420
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Der Internist 40 (1999), S. 13-21 
    ISSN: 1432-1289
    Keywords: Schlüsselwörter Niereninsuffizienz ; Dialyse ; Hämodialyse ; Peritonealdialyse ; Dialyse ; Niereninsuffizienz ; Dialyse ; Komplikationen ; Cimino-Shunt
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Zum Thema Voraussetzung für eine erfolgreiche langfristige Dialysebehandlung ist ein funktionsfähiger Dialysezugang. Komplikationen im Bereich des Dialysezugangs sind eine Hauptursache der ohnehin hohen Hospitalisationsrate der Dialysepatienten. Für die Hämodialyse ist der sog. Cimino-Shunt (Anastomose zwischen A. radialis und V. cephalica) der derzeit beste Zugang mit der geringsten Stenose- und Thrombosierungsneigung. Erst in zweiter Linie sollten Kunststoff-Gefäßprothesen oder ein Cimino-Shunt am Oberarm angelegt werden. Für die Peritonealdialysebehandlung ist die Implantation eines Katheters erforderlich, der mit der Spitze im Douglasraum liegt und nach einem ca. 10 cm langen Verlauf in den Bauchdecken aus dem Hautniveau tritt. Eine sorgfältige Pflege des Dialysezugangs und eine frühzeitige Erkennung von Komplikationen mittels sonographischer und ggf. auch angiographischer Methoden verlängert die Lebensdauer sowohl des Hämodialyse- wie auch des Peritonealdialysezugangs. Neben diesen diagnostischen Methoden werden in der folgenden Arbeit auch aktuelle therapeutische Möglichkeiten bei Komplikationen im Bereich des Dialysezugangs beschrieben.
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