Krebs als Kriegsfolge

Ohne ZusammenfassungNach einem militärärztlichen Vortrag am 28. V. 1943.     

Glykierungsprodukte als Gerinnungsaktivatoren

A procoagulant state often exists in patients with diabetes mellitus, extensively increasing the risk of myocardial infarction in connection with functional and anatomical abnormalities of blood vessels. Patients with diabetes mellitus are therefore grouped in the same risk group as those who have survived myocardial infarction. Diabetes mellitus is characterized by hyperglycaemia which facilitates the formation of advanced glycation endproducts (AGEs) and precursors such as methylglyoxal (MG) in blood. In addition, there are other exogenous sources of AGEs, such as cigarette smoke and foods fried at high heat. AGEs have a crucial role in the pathogenesis of diabetes complications. Diabetes mellitus is associated with hyperactivity of platelets and leukocytes, as well as with increased interaction between these cell types, which could result in a procoagulant state.     

Tabakrauchen als Suchterkrankung

In approximately every second smoker, regular tobacco smoking causes a dependence syndrome with severe physical and mental after-effects, ranging from the development of drug tolerance and symptoms of withdrawal to continuing loss of control and psychosocial problems. Nicotine dependence is a clinically defined psychiatric disorder with high prevalence and above-average duration. Compared to other drugs, tobacco has a very high dependence potential. The total biopsychosocial risk potential of tobacco is rated as above-average compared to other legal and illicit drugs. Complex neurobiological and reinforcement mechanisms form the basis of nicotine dependence, making it difficult to quit and implying a possible lifelong risk of relapse. Consequently, addicted smokers have serious problems in controlling their abuse behaviour and in remaining abstinent after quitting. They therefore usually need professional help, including anti-craving medications. A variety of evidence-based smoking cessation therapies with satisfactory success rates are now available.     

Sport als Therapie

Over the last 2 decades the clinical application of physical exercise as a therapeutic strategy has developed from rehabilitation to prevention and treatment of cardiovascular diseases. This shift in clinical application was accompanied by a more systematic research approach of the involved mechanisms and the objective clinical assessment of sport interventions using prospective randomized clinical trials. This ongoing process established physical exercise as an evidence-based and guideline-oriented treatment option.In stable coronary artery disease (CAD), exercise therapy has long been used for rehabilitation purposes following an acute myocardial infarction. A recent meta-analysis revealed a significant 27% reduction of total mortality among training patients. Four mechanisms are considered important mediators of the reduced cardiac event rate: improvement of endothelial function, reduced progression of coronary lesions, reduced thrombogenic risk, and improved collateralization. The therapeutic benefit of regular physical exercise has also been confirmed in direct comparison with an interventional strategy: a 12-month exercise therapy in stable CAD patients was associated with a higher event-free survival as compared to conventional percutaneous coronary intervention.In stable chronic heart failure (CHF), physical activity was traditionally discouraged-with negative consequences for the patients: exercise intolerance worsened, the progression of disease-related muscular atrophy accelerated. A carefully designed exercise program at 50-70% of the maximal oxygen uptake was effective in improving exercise capacity by 12-32%. In a recent meta-analysis, exercise therapy reduced the relative risk of CHF mortality by 35% and CHF-related hospitalizations by 28%. Considering the growing body of evidence in favor of sport as a therapy, training interventions should be considered additional/alternative therapeutic strategies as compared with established pharmacological/interventional options.     

Hochaltrigkeit als Akzeptanzproblem

The demographic trend towards an ageing society implies increasing numbers of persons well advanced in years. According to a performance-oriented sociocultural frame of reference, the societal acceptance of this group in terms of personal esteem and social integration is no longer self-evident. Based upon generalizing prejudices, disregarding the individual progress of ageing, elderly persons are often perceived as an unproductive burden. By means of detailed theses, problem areas are presented and analysed, linked to a reduction of “useful” social performance and to patterns of reaction against the loss of personal and social acceptance. Potentials for the advancement of a self-determined life practice, aiming at maintaining largely the competence for meaningful personal action, are discussed. A “humanization of well advanced old age” is advocated, combining as long as possible competence for independent living with social integration through active citizenship.     

Diabetes als Schlaganfallrisikofaktor

From an epidemiological perspective diabetes and stroke are important clinical conditions necessitating an interdisciplinary approach in diagnosis and treatment. Generally, diabetes elevates the risk of stroke two- to four-fold. If additional risk factors are present, the risk increases exponentially. In diabetics the pattern of stroke is different with less intracerebral hemorrhages and more macro- and microangiopathic strokes. Importantly 20–30% of first-ever stroke patients reveal an impaired glucose tolerance or even hitherto unknown diabetes. Pathophysiologically, insulin resistance is of central importance, being frequently associated with hypertension, hyperglycemia and hyperinsulinemia. Endothelial dysfunction already occurs in this prediabetic stage, followed by vascular inflammation associated with elevated thrombosis and reduced fibrinolysis. If these conditions persist, intravascular pathology characterized by atherosclerosis of the large and small vessels develops, culminating in stroke. Interrupting this pathway early in order to prevent primarily diabetes-associated stroke represents an important challenge.     

Hepatitis als Reisekrankheit

Every year over 50 million people travel from industrialized countries to areas with high prevalence of oral-fecal and sexually transmissible forms of viral hepatitis. The risk of infection with hepatitis A is associated with the standard of living, the length of stay, and the area of destination. Acute hepatitis E is predominantly transmitted in India and other Asian countries. The main risk factors for the acquisition of hepatitis B are sexual promiscuity and unprotected sexual intercourse. This report provides detailed information on the risk of hepatitis in travelers, available vaccination schedules, clinical and laboratory diagnostic features, and necessary therapeutic aspects in cases of ongoing acute viral hepatitis.     

Enzym als Geschwulstvirus

Ohne Zusammenfassung     

Das Endothel als Thromboregulator

The endothelium provides an anti-thrombotic surface which is an absolute requirement for intact circulation. It also has the ability to effectively support coagulation. Insufficient support of thrombus formation can have fatal consequences in the event of severe injury or damage to the vessel wall resulting in loss of the container function of the endothelium. However, thrombus formation needs to be strictly limited and controlled to avoid severe clinical consequences as a result of disturbed blood flow. Newer observations suggest that the endothelium might change from an anti- to a pro-thrombotic state even in the absence of any morphologically detectable lesion. It is assumed that such a change in the endothelium’s properties is caused by an “endothelial dysfunction” or “activation” of the endothelium as a consequence of on-going inflammatory processes, metabolic stress such as hyperglycaemia and hypoxia, cyto- and chemokines. The underlying mechanisms have not yet been elucidated in detail, but there is growing evidence that the formation of reactive oxygen species may trigger the expression of pro-thrombotic activities on the endothelial surface which require particular therapeutic attention.     

Die Gicht als Systemerkrankung

Of all inflammatory rheumatic diseases gout has the highest prevalence. Patients with intermittent acute gout attacks are usually treated by primary care physicians. However, in cases of insufficient long-term control of serum uric acid levels, complications or atypical clinical manifestations may necessitate consultation with a rheumatologist in the further course of the disease. An oligoarticular or polyarticular presentation can give rise to the initial suspicion of rheumatoid or psoriatic arthritis. In these cases a careful clinical work-up supported by laboratory and imaging investigations is necessary and synovial fluid analysis is usually required. As in other rheumatic diseases extra-articular manifestations are of utmost importance for morbidity and mortality. Gout is a complex metabolic and inflammatory disease and besides articular symptoms the renal and cardiovascular effects of hyperuricemia are particularly relevant for the overall prognosis.     

Das Krebsleiden als Allgemeinerkrankung

Ohne ZusammenfassungMit 2 Textabbildungen.     

Moraxella osloensis als Sepsis-Erreger

Summary A case of septicemia caused by Moraxella osloensis is described. A 4-year old girl fell ill with symptoms similar to those described in cases of septicemia caused by Neisseria meningitidis. Two days after the commencement of treatment with penicillins, however, Moraxella osloensis could be isolated from cerebral fluid, which contained only a small number of cells. It is assumed that the delayed recovery of the child was directly related to the diminished susceptibility of this Moraxella strain to penicillins. Since Moraxella strains may be resistant to these antibiotics, it is necessary to distinguish between Moraxella and N. meningitidis by means of laboratory tests. The symptoms elicited by Moraxella are similar to those in septicaemia caused by N. meningitidis, but are considerably milder in character.

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Moraxella osloensis als Sepsis-Erreger

Zusammenfassung Bericht über ein 4jähriges Mädchen, das mit grippalen Erscheinungen erkrankte und schließlich Hautblutungen und Hautnekrosen wie bei Menigokokkensepsis entwickelte. Knapp 48 Stunden nach Beginn der Penicillin-Behandlung wurde M. osloensis aus dem Liquor gezüchtet, der nur eine geringe Zell- und Eiweißvermehrung aufwies. Das langsame Abklingen des insgesamt leichten Krankheitsbildes wird auf die verminderte Penicillin-Empfindlichkeit von M. osloensis zurückgeführt. Wegen der therapeutischen Konsequenzen ist es wichtig, Moraxellen von Neisserien zu unterscheiden. Die durch Moraxellen hervorgerufenen Krankheitsbilder ähneln denen, die durch Neisserien verursacht werden, verlaufen aber meist leichter.