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The Refeeding Syndrome (RFS) is a serious complication in patients receiving nutrition support after a period of severe malnutrition. We frequently recognize and diagnose the RFS due to increased awareness. Thus, we observe that many physicians do not know the RFS and that it is rarely diagnosed. The aim of the study was to determine whether physicians in Germany know the RFS. A questionnaire with a case vignette about an older person who developed the RFS after initiation of nutritional therapy was submitted to German physicians and fifth year medical students, who were participants of educational lectures. Of the 281 participants who answered the respective question, 40 participants (14%) correctly diagnosed the RFS of the case vignette and 21 participants (8%) gave nearly correct answers. Indeed, the majority of the participants did not diagnose the RFS. Although the RFS may lead to fatal complications, it is unknown to the majority of the queried physicians. Therefore, there is a call to implement the RFS in respective curricula and increase systematic education on this topic.

Objectives Objective of this study was to analyse the association between impairment of Barthel Index items and hematologic parameters in geriatric inpatients. Methods Patient recruitment of the “GeriPravalenz2013” study has been described before. Inclusion criteria: in-patient aged > = 70 years; exclusion criteria: actual cancer disease or cancer associated treatment. Anemia was defined according to WHO criteria. Physical impairment was assessed by Barthel Index (BI). Association between all 10 items of the BI and hematologic parameters was statistically evaluated. Results Anemia prevalence was 55.1% (319/579) with BI impairment in 96.2% patients. T-test revealed significant lower BI in anemic patients (47.9 vs 54.3; p = 0.004). Binary logistic regression revealed that growing age, reduced MCV, reduced iron levels and reduced Hb levels were associated with increased impairment of several items of the Barthel-Index. Interestingly, increased levels of albumin and folic acid (FA) were associated with increased impairment of BI items. Conclusion Anemia and lower levels of anemia related parameters showed a negative impact on ADL and physical performance based on BI items. An impaired total BI should result in an analysis of BI subitems, particularly if anemia related laboratory parameters are deviant. Reasons for the negative impact of elevated FA and albumin levels on BI remain speculative.

For the diagnosis, prevention and therapy of malnutrition, it is important to estimate the energy and fluid requirements of an individual patient. To our knowledge, it is unknown how accurately medical doctors can estimate the energy and fluid requirements of patients in a clinical routine situation. Hence, we conducted the following survey. A written face-to-face survey about the energy and fluid requirements of and tube feeding and fluid recommendations for a typical patient was performed with 179 medical doctors. An estimation error of >15% was defined as relevant. The results revealed substantial variations in estimating the energy and fluid needs of the patient. A total of 25% of the participants underestimated the energy requirements, and 47% of the participants underestimated the fluid requirements. In addition, 68% of the participants recommended a daily dose of tube feeding that was

Fragestellung: Altere Menschen haben ein erhohtes Risiko fur Mangelernahrung und sind haufig von Mangelernahrung betroffen. Dabei besteht oft Unklarheit daruber, welche Masnahmen in bestimmten Situationen fur die Betroffenen von Nutzen sind. Ziel der vorliegenden Leitlinie ist es, evidenzbasierte Empfehlungen zur klinischen Ernahrung alterer Menschen zu geben, um Mangelernahrung so weit wie moglich zu vermeiden bzw. zu behandeln. Material und Methodik: Die bestehenden Leitlinien der deutschen und europaischen ernahrungsmedizinischen Fachgesellschaften (DGEM, ESPEN) zur enteralen und parenteralen Ernahrung wurden zusammengefuhrt und in Einklang mit den Richtlinien der AWMF und des AZQ aktualisiert und erweitert. Ergebnisse: Die Leitlinie beinhaltet 60 konsentierte Empfehlungen zur Ernahrungsversorgung alterer Menschen hinsichtlich grundlegender Prinzipien klinischer Ernahrung, relevanter Indikationen (allgemeine Indikation, Mangelernahrung und Risiko fur Mangelernahrung, Gebrechlichkeit, Dysphagie, Huftfrakturen, Depression, Demenz, Dekubitus, Delir) sowie spezifischer Struktur- und Prozessanforderungen fur die Ernahrungsversorgung in geriatrischen Institutionen. Generell sollen Ernahrungsmasnahmen bei alteren Menschen mit einem Risiko fur Mangelernahrung oder mit Mangelernahrung ergriffen werden, um eine adaquate Zufuhr von Energie und Nahrstoffen zu ermoglichen und die gravierenden Folgen von Mangelernahrung zu vermeiden. Dabei kann die orale Ernahrung durch ursachenorientierte, pflegerische und diatetische Masnahmen gefordert werden. Enterale bzw. parenterale Ernahrung sollten initiiert werden, wenn die orale bzw. enterale Nahrungsaufnahme unzureichend oder unmoglich und die Verlaufsprognose insgesamt positiv ist (nicht in terminalen Krankheitsstadien). Schlussfolgerung: Unabhangig von der Indikation muss die Entscheidung fur oder gegen bestimmte Masnahmen immer individuell unter sorgfaltiger Nutzen-Risiko-Abwagung, Berucksichtigung des (mutmaslichen) Patientenwillens und der Prognose getroffen werden. Es wird empfohlen, Ernahrungsmasnahmen nicht erst bei schwerer Mangelernahrung zu beginnen, sondern fruhzeitig, sobald Hinweise auf Ernahrungsrisiken vorliegen.

Anemia and malnutrition are risk factors for frailty in older people but data from multicenter studies among German geriatric inpatients are lacking. This analysis evaluated data from the multicenter study “GerAnaemie2013” commissioned by the German Geriatric Society. The study involved an analysis of the 579 geriatric inpatients recruited in the context of the German multicenter study “GeriAnaemie2013”. Study parameters: Barthel index (BI), handgrip strength, nutritional data (e.g. loss of appetite, loss of weight and decreased food intake). Inclusion criteria: in-patient age ≥70 years, exclusion criteria: current cancer disease or cancer-associated treatment. Anemia was defined according to the World Health Organization (WHO) criteria. The mean age of patients was 81.9 years, overall prevalence of anemia 55.1 %, mean hemoglobin (Hb) level 11.9 g/dl, average BI 50.8 points and 30.3 % of all patients were at risk of malnutrition. While univariate analysis revealed a significantly lower BI in anemic patients, this association was no longer seen in multivariate analysis. Regression analysis revealed that a drug intake of > 5 drugs/day doubles the chance of suffering from anemia with an adjusted odds ratio (OR) of 2.17 (confidence interval (CI) 1.28–3.68, p = 0.004) as well as a serum albumin level below 3.5 g/dl with an adjusted OR of 2.11 (range 1.40–3.19, p < 0.001). Polymedication and low serum albumin were independent risk factors for anemia in geriatric patients, probably reflecting disease severity.

Durchgefuhrt wurde eine retrospektive Evaluation der diagnostischen Wertigkeit der cCT-Perfusion in der Diagnostik dementer Patienten im Vergleich zum Mini-Mental-State-Test (MMSE). Datensatze von 55 Patienten wurden untersucht. Bei allen Patienten wurden eine native, eine KM-gestutzte und eine Perfusions-CT des Neurokraniums angefertigt. Die klinische Erhebung des Demenzgrades erfolgte mit dem MMSE. In den Datensatzen der cCT-Perfusion wurden 24 ROI markiert. Anschliesend wurden Blutvolumen (BV), Blutfluss (BF) und mittlere Transitzeit (MTZ) berechnet und intra- und interhemisphariell sowie mit dem Demenzgrad verglichen. Mit steigendem Demenzgrad zeigten sich eine signifikante Abnahme des BV in der Okzipital- sowie in der Temporalregion. Der BF verringerte sich signifikant im Frontallappen, in der Basalganglien- und der Okzipitalregion. Gleichzeitig konnte eine signifikante Zunahme der MTZ in der Basalganglienregion gemessen werden. Die Gruppe mit Alzheimer-Demenz zeigte eine signifikante Abnahme des BF im Vergleich zur Gruppe der normalen Kandidaten in der Frontal-, Basalganglien-, Okzipital- und Temporalregion. Es war eine Verminderung der zerebralen Durchblutung mit fortschreitender Demenz zu beobachten. Die kostengunstige und nahezu ubiquitar verfugbare cCT-Perfusion liefert Informationen uber regionale zerebrale Perfusionsunterschiede, die eine Graduierung der Demenz erlauben und bei der Differenzierung der Demenzarten hilfreich sein konnen.

Objective: Transjugular intrahepatic portosystemic shunt (TIPS) placement is an established therapy for portal hypertension that leads to variceal bleeding or refractory ascites. We present experiences of the role of TIPS at a liver transplantation center. Material and Methods: One hundred and ten patients were referred to the Radiological Department for TIPS placement. One of the 110 patients had recurrent cirrhosis after liver transplantation with refractory ascites. Function of the TIPS was controlled with Doppler US at 1 day, 1 week, 4 weeks and 4 months after TIPS placement and subsequently every 3 months. Shunt insufficiency was supposed when the blood flow velocity within the stent tract was under 50 cm/s and was an indication for TIPS revision. Results: TIPS was placed in 101 patients. After TIPS placement, 10 patients underwent liver transplantation. While waiting for the new liver, none of them developed variceal rebleeding, ascites or other complications of portal hypertension. Two of the 101 patients had episodes of rebleeding. The frequency of patients undergoing TIPS revision within the first year after TIPS placement was 67.5%, within the second year 38.0% and within the third year 24.4%. The revisions led to sufficient reduction of the portosystemic pressure gradient. Conclusion: In some liver transplant candidates, TIPS can be useful in minimizing the risk of complications of portal hypertension during the waiting time for a liver transplantation. TIPS can be monitored by Doppler US and revised if occlusion occurs.

A 51 year old woman with a two year history of ulcerative colitis developed a wide spread gastrointestinal non-Hodgkin's lymphoma of low grade malignancy (MALT-lymphoma) involving upper and lower gastrointestinal tract, spleen, and bone marrow. After chemotherapy, clinical symptoms improved and lymphocytic infiltrates disappeared. Thirty nine cases of ulcerative colitis and 22 cases of Crohn's disease complicated by gastrointestinal lymphomas reported in published works are reviewed. In inflammatory bowel diseases any dense lymphocytic infiltrates seen in biopsy specimens obtained from ulcerative colitis or Crohn's disease should be assessed to exclude gastrointestinal lymphoma.

Progressive cerebrovascular atherosclerosis and consecutive stroke are among the most common causes of dementia. However, specific risk factors for vascular dementia are still not known. Human telomeres shorten with each cell division in vitro and with donor age in vivo. In human fibroblasts in vitro, the telomere shortening rate decreased with increasing antioxidative capacity. There was a good intra-individual correlation between the age-corrected telomere lengths in fibroblasts and peripheral blood mononuclear cells. In 186 individuals including 149 geriatric patients (age range, 55-98 yr), leukocyte telomeres in patients with probable or possible vascular dementia were significantly shorter than in three age-matched control groups, namely in cognitively competent patients suffering from cerebrovascular or cardiovascular disease alone, in patients with probable Alzheimer's dementia, and in apparently healthy control subjects. No correlation was found to polymorphisms in the apolipoprotein E and glutathione-S-transferase genes. Telomere length may be an independent predictor for the risk of vascular dementia.

Intrahepatic cholestasis and aplastic anemia after N-propylajmaline. A 43 year old female patient taking oral contraceptives for more than five years received the antiarrhythmic drug N-propylajmaline for treatment of ventricular arrhythmia. After twelve days (totale dosage 510 mg N-propyl-ajmaline) acute severe intrahepatic cholestasis and aplastic anemia developed. The erythropoeisis improved after three weeks of treatment with corticosteroids. However, despite treatment with phenobarbital the jaundice receded very slowly. Even after nine years of follow-up cholestatic enzymes are still significantly elevated although serum bilirubin levels are in the normal range. This case report demonstrates that antiarrhythmic drugs may induce nearly irreversible intrahepatic cholestasis and severe hematological disturbances.