Скачать или смотреть Charité Clinical Journal Club (German) by Fred Luft - 03.07.2019

The N Engl J Med image of the week concerns a 32-year-old woman who presented to the outpatient clinic with a 2-month history of anal pruritus and bleeding. Her abdominal examination was normal, and rectal examination revealed hemorrhoids. You are shown a rectal superficial-mucosal biopsy specimen. What is the most likely diagnosis? You are offered hemorrhoids, enterobiasis, trichuriasis, strongyloidiasis, and colon cancer. The problem here involves egg recognition. Brain activation in response to spoken motor commands can be detected by electroencephalography (EEG) in clinically unresponsive patients. The prevalence and prognostic importance of a dissociation between commanded motor behavior and brain activation in the first few days after brain injury are not well understood. Investigators studied a prospective, consecutive series of patients in a single intensive care unit who had acute brain injury from a variety of causes and who were unresponsive to spoken commands, including some patients with the ability to localize painful stimuli or to fixate on or track visual stimuli. Machine learning was applied to EEG recordings to detect brain activation in response to commands that patients move their hands. The functional outcome at 12 months was determined with the Glasgow Outcome Scale–Extended (GOS-E; levels range from 1 to 8, with higher levels indicating better outcomes). We learn to appreciate cogntive-motor dissociation. Dexmedetomidine (a clonidine derivative) produces sedation while maintaining a degree of arousability and may reduce the duration of mechanical ventilation and delirium among patients in the intensive care unit (ICU). The use of dexmedetomidine as the sole or primary sedative agent in patients undergoing mechanical ventilation has not been extensively studied. In an open-label, randomized trial, investigators enrolled critically ill adults who had been undergoing ventilation for less than 12 hours in the ICU and were expected to continue to receive ventilatory support for longer than the next calendar day to receive dexmedetomidine as the sole or primary sedative or to receive usual care (propofol, midazolam, or other sedatives). The target range of sedation-scores on the Richmond Agitation and Sedation Scale (which is scored from −5 [unresponsive] to +4 [combative]) was −2 to +1 (lightly sedated to restless)...