1,721,009 research outputs found
B-Vitamine in der Geriatrie – was bestimmen, was ersetzen?
No full textZusammenfassung Ein Vitamin-B1-Mangel kann sich als Wernicke-Enzephalopathie oder als Beriberi manifestieren. Geriatrische Patienten mit den Diagnosen Demenz oder Delir haben niedrigere Vitamin-B1-Spiegel als solche ohne diese Diagnosen. Ebenso zeigen sich bei geriatrischen Patienten mit höherem Vitamin-B1-Spiegel bessere Ergebnisse in der Funktionalität (Barthel-Index) bei Entlassung. Vitamin B6 ist an über 100 Reaktionen als Koenzym beteiligt und ein Mangel kann daher mit vielen Symptomen einhergehen. Klinische Manifestationen des Vitamin-B12-Mangels reichen von frühen neuropsychiatrischen bis zu hämatologischen Symptomen, wobei die makrozytäre Anämie als später Indikator eines Vitamin-B12-Mangels gilt. Neurologische Symptome treten sehr häufig schon vor oder ohne hämatologische Manifestationen auf. Die Bestimmung des Vitamin-B1-Spiegels im Blut ist wenig aussagekräftig. Die Wernicke-Enzephalopathie ist eine klinische Diagnose. Zur Diagnose eines Vitamin-B6-Mangels wird die Bestimmung von Pyridoxin (Pyridoxal-5′-Phosphat) im Plasma empfohlen. Ein erniedrigter Holo-TC-Spiegel im Serum gilt als frühester Marker eines Vitamin-B12-Mangels. Eine kombinierte Bestimmung von Vitamin B12, Holo-TC, MMA und Homozystein scheint die diagnostische Zuverlässigkeit bei Vitamin-B12-Mangel zu erhöhen. Für Empfehlungen zur Substitutionstherapie bei allen B-Vitaminen liegen kaum bzw. keine evidenzbasierten Daten vor. Durch die Substitution von 0,8 mg Folsäure, 0,5 mg Vitamin B12 und 20 mg Vitamin B6 konnte in einer randomisierten kontrollierten Studie bei Patienten mit einer leichten kognitiven Störung eine Verlangsamung der Hirnatrophie bewirkt werden
Frequency of dementia syndromes with a potentially treatable cause in geriatric in-patients: analysis of a 1-year interval
No full textIn addition to neurodegenerative and vascular causes of dementia, in the differential diagnosis potentially reversible conditions of dementia also must be assessed. Routine laboratory parameters and neuroimaging, which are recommended for the differential diagnosis of suspected dementia by the German S3 Guideline "Dementia", were retrospectively studied in 166 geriatric patients with suspected dementia. Delirium was diagnosed in six patients (3.6 %). These six patients were excluded from the study. Of the 160 remaining patients, there were 99 (59.6 %) with an already known dementia. In this subgroup of patients, we found a potentially treatable cause of dementia in 18.2 %. In the remaining 61 patients (36.8 %), the newly diagnosed dementia syndrome was established according to ICD-10 criteria. Potentially reversible causes of the dementia syndrome were found in 19 of these patients (31.1 %). The most common cause was depressive pseudodementia in eight patients followed by vitamin B-12 deficiency in six patients. A significant amount of our patients showed laboratory or imaging changes suggestive of potentially reversible causes of the dementia syndrome upon admission. The results of our study indicate the importance of careful differential diagnosis of dementia based on the recommendations of guidelines. Although therapy of these potential causes is not always accompanied by a full recovery, the identification and therapy of treatable causes of cognitive deficits are possible even for general practitioners, who often are the primary contact persons of affected individuals.Robert Bosch Foundation; Sparkasse Gottinge
Foramen magnum meningioma: long-term follow up without neurosurgery—A case report
No full textAbstract Background Foramen magnum meningiomas can cause lower cranial nerve deficits or brain stem symptoms. When they become symptomatic or when growth is documented, surgical resection is indicated. Case presentation In a white German 79-year-old woman, a small dorsal foramen magnum meningioma was detected by cerebral magnetic resonance imaging. After 7 years, cerebral magnetic resonance imaging showed considerable tumor growth (an increase in diameters from 15 × 16 × 20 mm to 28 × 30 × 37 mm), brain stem compression, and obstructive hydrocephalus. The clinical symptoms were however mild. The patient refused surgery. After a follow-up of over 18 months, she is still able to walk and live relatively independently. Conclusions In the case of a slowly growing presumed benign intracranial tumor, deferral of surgery may be a justifiable option in old age, when symptoms are mild and social factors present an obstacle to immediate surgery. Since a spontaneous reduction in the growth rate is often observed in large intracranial meningiomas, some patients can survive with moderate deficits and a high quality of life in spite of substantial compression of the brain stem
Antibiotic susceptibility of Gram-negative bacteria in cerebrospinal fluid compared with Mueller-Hinton broth and artificial cerebrospinal fluid
No full texthttp://dx.doi.org/10.13039/100019147 Universitätsmedizin Göttingenhttp://dx.doi.org/10.13039/501100014058 Gesellschaft für Geneti
Absence of Streptococcus pneumoniae in pharyngeal swabs of geriatric inpatients
No full textColonization of the pharynx by Streptococcus pneumoniae was studied in 185 in-hospital geriatric patients (median age 81 years) from 29 March 2011 to 22 June 2011. Swabs were plated on blood agar plates. Colonies with a morphology suggesting S. pneumoniae were further analyzed. Surprisingly, pneumococci were not found in any of the samples. Pneumococci chronically colonizing the pharynx of elderly people may be much rarer than previously thought and probably are not the source of pneumococcal pneumonia in old age.European Commission [CAREPNEUMO] [223111]; Sparkasse Gottinge
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