HINTERGRUND: Gastrointestinale Nebenwirkungen unter NSAR, ASS und Phenprocoumon spielen eine bedeutende Rolle im klinischen Alltag. Im Rahmen der Einführung der COX-2 Inhibitoren sollten relevanten Ursachen für Ulcera und Blutungen im Bereich des oberen Gastrointestinaltraktes dargestellt und die Behandlungsstrategien verschieden ausgerichteter Krankenhäuser im klinischen Alltag verglichen werden. METHODEN: Es wurden stationär gastroduodenoskopierte Patienten einer Rheumaklinik und von Krankenhäusern der Grund- und Regelversorgung unter der Therapie mit NSAR, ASS, Phenprocoumon, Glukokortikoiden und COX-2 Inhibitoren im Rahmen einer offenen, multizentrischen Fallkontrollstudie verglichen. Des Weiteren wurden alle Patienten mit einer oberen gastrointestinalen Blutung oder einem Ulcus im Bereich des oberen Gastrointestinaltraktes in die Studie eingeschlossen. Der Einfluss einer Helicobacter pylori Infektion und einer Magenschutzprophylaxe wurde überprüft. ERGEBNISSE: Die höchsten Ulcusraten traten unter der Kombinationstherapie von NSAR und ASS auf. Patienten mit NSAR oder ASS hatten eine Ulcusrate von 35% bzw. 31%. Die Blutungsrate der Patienten mit ASS lag jedoch um 15% höher. Die COX-2 Inhibitoren zeigten mit einer Ulcusrate von 10% deutlich bessere Ergebnisse. Patienten mit einer Helicobacter pylori Besiedlung hatten eine signifikant erhöhte Ulcusrate (48% zu 34%), zeigten aber keine Unterschiede in der Blutungsrate. Der Anteil der Patienten mit einer Magenschutzprophylaxe betrug nur 17%. Die Blutungsrate der Patienten ohne Magenschutz lag bei 87%. SCHLUSSFOLGERUNGEN: Im klinischen Alltag einer rheumatologischen Fachklinik treten gehäuft Ulcera unter NSAR auf. Unter den COX-2 Inhibitoren zeigte sich eine geringere Ulcusrate. Im Unterschied dazu haben in den Krankenhäusern der Regel -und Grundversorgung die Patienten mit einem Ulcus an erster Stelle eine Therapie mit ASS. Eine konsequent durchgeführte Magenschutzprophylaxe mit Protonenpumpeninhibitoren verhindert das Auftreten von gastrointestinalen Ulcera und Blutungen. / BACKGROUND: Gastrointestinal side effects under NSAR, ASS and Phenprocoumon play an important role in the clinical everyday life. In the context of the introduction of the COX-2 inhibitors relevant causes for ulcera and bleedings within the range of the upper gastrointestinal section should be represented and the treatment strategies of differently aligned hospitals in the clinical everyday life be compared. METHODS: Gastro duodenal syncopated in-patients of a hospital for rheumatic diseases and from state hospitals under the therapy with NSAR, ASS, Phenprocoumon, Glukokortikoiden and COX-2 inhibitors were compared within the context of an open, multi-centric drop control study. All patients with an upper gastrointestinal bleeding or an ulcus were included in the area of the upper gastrointestinal section of the study. The influence of a Helicobacter pylori infection and a stomach protection prophylaxis was examined. RESULTS: The highest ulcus rate arose under the combination therapy of NSAR and ASS. Patients with NSAR or ASS had a ulcus rate of 35% and 31% respectively. The bleeding rate of the patients with ASS was however around 15% higher. The COX-2 inhibitors showed clearly better results with an ulcus rate of 10 percent. Patients with a Helicobacter pylori colonization had a significantly increased ulcus rate (48% to 34%), however they showed no differences in the bleeding rate. The proportion of the patients with a stomach protection prophylaxis amounted to only 17 percent. The bleeding rate of the patients without stomach protection was 87%. CONCLUSIONS: In the clinical everyday life of a rheumatological specialized clinic ulcera under NSAR arise. Under the COX-2 inhibitors a smaller ulcus rate shows itself. In contrast to it, patients with an ulcus receive a therapy with ASS in the state hospitals. A consistently implemented stomach protection prophylaxis with proton pump inhibitors prevented the appearance of gastrointestinal ulcera and bleedings.

Esophageal varices are expanded veins of the submucosa that develop in patients with portal hypertension. They develop as collaterals between the portal vein and the superior vena cava. Varices are seen when the HPVG rises >12mmHG and can lead to a life-threatening bleeding episode. Endoscopic band ligation (EBL) is the treatment of choice of acute variceal bleeding. It is also performed for primary and secondary prophylaxis of bleeding from esophageal varices. After EBL, patients are at risk of postinterventional bleeding. Therefore, patients are often hospitalized until endoscopy proves all applied ligation bands have dropped off. At present, there is no standardized algorithm for surveillance of patients after EBL. Furthermore, risk factors for bleeding complications after EBL are poorly evaluated. The available studies mostly investigated patient collectives .after endoscopic sclerotherapy. The aim of this study was to investigate bleeding behaviour after EBL, to make recommendations for in- and out-patient surveillance after EBL and to analyze independent risk factors for bleeding complications after EBL.

No description available.

Objective The goal of this retrospective study is the evaluation of risk factors for postoperative neurological deficits after petroclival meningioma (PCM) surgery with special focus on standard craniotomies. Materials and methods One-hundred-fifty-eight patients were included in the study, of which 133 patients suffered from primary and 25 from recurrent PCM. All patients were operated on and evaluated concerning age, tumor size, histology, pre- and postoperative cranial nerve (CN) deficits, morbidity, mortality, and surgical complications. Tumor-specific features—e.g., consistency, surface, arachnoid cleavage, and location—were set in a four-grade classification system that was used to evaluate the risk of CN deficits and tumor resectability. Results After primary tumor resection, new CN deficits occurred in 27.3% of patients. Preoperative ataxia improved in 25%, whereas 10% developed new ataxia. Gross total resection (GTR) was achieved in 59.4%. The morbidity rate, including hemiparesis, shunt-dependence, postop-hemorrhage, and tracheostomy was 22.6% and the mortality rate was 2.3%. In recurrent PCM surgery, CN deficits occurred in 16%. GTR could be achieved in three cases. Minor complications occurred in 20%. By applying the proposed new classification system to patients operated via standard craniotomies, the best outcome was observed in type I tumor patients (soft tumor consistency, smooth surface, plane arachnoid cleavage, and unilateral localization) with GTR in 78.7% (p < 0.001) and 11.9% new CN deficits (p = 0.006). Conclusion Standard craniotomies as the retrosigmoid or subtemporal/pterional approaches are often used for the resection of PCMs. Whether these approaches are sufficient for GTR—and avoidance of new neurological deficits—depends mainly on the localization and intrinsic tumor-specific features.

No description available.

No description available.