[Chest trouble and hemiparesis. A paradoxical emergency?]. / Kasuistik interaktiv: Thoraxschmerzen und Hemiparese. Ein paradoxer Notfall?

The case of a young female patient with progressive chest trouble and dyspnea is reported. After development of a massive cerebral infarction, thrombolysis and afterwards decompressive craniectomy had to be performed. A patent foramen ovale (PFO) could be detected by transesophageal contrast-echocardiography accountable for a paradox embolism in existence with a deep vein thrombosis. The patient survived this situation but sustained persistent hemiparesis.

[Case report: severe thrombocytopenia]. / Kasuistik interaktiv--Schwere Thrombozytopenie.

In this case report, we describe the course of a chronic hemodialysis patient who has been treated for 7 days with linezolid for pneumonia caused by a methicillin-resistant staphylococcus aureus and who developed severe thrombocytopenia which was reversible after having stopped the treatment. Since there is an increasing evidence that linezolid induces severe thrombocytopenia, especially in patients requiring hemodialysis, indication for treatment with linezolid should be made with caution and monitoring of blood count in short-term intervals should be performed in critically ill patients. Linezolid is a representative of a new antibiotic class, i.e. an oxazolidinone, which inhibits the bacterial protein synthesis at the ribosom. Such agents do not have any relation to common anti-infectives and act nearly exclusively against Gram-positive bacteria and mycobacteria. In clinical practice, linezolid is most widely used for treatment of Gram-positive infections, mainly caused by methicillin-resistant Staphylococcus aureus (MRSA). The major adverse effects of linezolid are diarrhoea, nausea, and headache. Furthermore, abnormalities in blood count, i.e. leukocytopenia, thrombocytopenia and anaemia, have been reported.

[Anaesthesia for patients with phaeochromocytoma - specifics, potential complications and drug strategies]. / Anästhesie bei Phäochromozytom--Besonderheiten, mögliche Komplikationen und medikamentöse Strategien.

Perioperative management of patients with phaeochromocytoma requires detailed knowledge on the pathophysiology and potential complications. Intraoperatively, hypertensive crisis and tachyarrhythmias may occur resulting from massive catecholamine release. Thus, preoperative treatment with the alpha-antagonist phenoxybenzamine is obligatory. In contrast, sodium nitroprusside is the substance of choice for intraoperative control of blood pressure. alpha-blocking agents may be used in phaeochromocytoma but only under sufficient alpha-blockade. Removal of a malignant tumour of the adrenal gland may induce massive haemorrhage, and thus anaesthetic management has to be modified.

[Anaesthesia for patients with adrenal gland diseases]. / Anästhesie bei Erkrankungen der Nebennierenrinde--Effizientes Risikomanagement von der Prämedikation bis zum Aufwachraum.

Perioperative management of patients with adrenal gland diseases requires detailed information on the individual endocrine status and the potential complications. Typical signs of primary hyperaldosteronism (Conn's syndrome) comprise arterial hypertension, hypokalaemia and metabolic alkalosis. In such cases preoperative treatment with spironolactone is highly recommended. In patients with hypercortisolism (Cushing's syndrome) the following concomitant disorders must be considered particularly: arterial hypertension, osteoporosis, vulnerable skin, diabetes mellitus, and increased risk for infection and thromboembolism. In all patients with proven or suspected adrenocortical insufficiency (i.e. Addison's disease, after removal of a cortisol producing tumour or as the result of long-term therapy with glucocorticoids) consequent perioperative supplementation of hydrocortisone is mandatory. In patients with phaeochromcytoma hypertensive crisis and tachyarrhythmias may occur intraoperatively resulting from massive catecholamine release. Thus, preoperative treatment with the beta-antagonist phenoxybenzamine is obligatory. In contrast, nitroprusside is the substance of choice for intraoperative control of blood pressure. beta-blocking agents may be used in phaeochromocytoma but only under sufficient beta-blockade. Removal of a malignant tumour of the adrenal gland may induce massive haemorrhage, and thus anaesthetic management has to be modified.