[EEG observations in closed cerebrocranial trauma].
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Brain Injuries↗
Biomedical subjects
J Reichel
Publications and source records attributed to J Reichel.
Primary pulmonary hypertension.
Primary pulmonary hypertension (PPH) is a condition characterized by sustained elevation of pulmonary artery pressure (PAP) without demonstrable cause. The most common symptom at presentation is dyspnea. Other complaints include fatigue, chest pain, syncope, leg edema, and palpitations. Right heart catheterization is diagnostic, showing a mean PAP >25 mmHg at rest and >30 mmHg during exercise, with a normal pulmonary capillary wedge pressure. In the National Institutes of Health-PPH registry, the median survival period was 2.8 years. Treatment is aimed at lowering PAP, increasing cardiac output, and decreasing in situ thrombosis. Vasodilators have been used with some success in the treatment of PPH. They include prostacyclin, calcium-channel blockers, nitric oxide and adenosine. Anticoagulation has also been advised for the prevention of deep vein thrombosis, pulmonary embolism, and in situ thromboses of the lungs. New drug treatments under investigation include L-arginine, plasma endothelin-I, and bosentan. Use of oxygen, digoxin, and diuretics for symptomatic relief have also been recommended. Patients with severe PPH refractory to medical management should be considered for surgery.
Female↗
Treatment of venous thromboembolism.
Venous thromboembolism (VTE) is a disease entity composed of pulmonary embolism (PE) and deep vein thrombosis (DVT). Anticoagulation, initiated as soon as the diagnosis is suspected, is the treatment of choice. Traditionally, anticoagulation is started with intravenous heparin, and changed to warfarin for long-term treatment. The introduction of unmonitored, subcutaneously administered, low molecular weight heparin has resulted in shorter hospitalizations, reduced the incidence of major bleeding as a complication, and shifted the treatment of VTE for selected patients to the outpatient setting. Thrombolytic therapy has been recommended for patients with life-threatening PE. Technologic advances in catheter embolectomy and fragmentation permit clot resolution in patients in whom thrombolytic therapy is contraindicated. Inferior cava filters can be placed percutaneously in patients at high risk for VTE or those in whom anticoagulation is contraindicated. Because VTE is often clinically silent, prevention of VTE is therefore the most effective means to reduce associated morbidity and mortality. Strategies to prevent VTE have been studied and validated for specific clinical circumstances.
Anticoagulants↗