Prävention ernährungsabhängiger Erkrankungen

Faced with the obesity epidemic there is need for therapy as well as public health strategies for health promotion and obesity prevention. Both strategies add to each other, none should be done in isolation. Obesity is not only an individual problem. It is also a problem of our society. We are now an overweight society, which is on the way to a fat society. There is urgent need for a national public health strategy for population wide prevention of overweight and obesity. Health authorities as well as politicians are asked to support public health strategies creating a supportive environment for making healthy choices the easier choices.     

Gynäkologische Notfälle

Zum Thema Gyn?kologische Notf?lle stellen sicherlich nur einen kleinen Teil der Erkrankungen dar, die vom Hausarzt behandelt werden müssen. Meist wird sich die Patientin direkt an ihren Gyn?kologen oder die n?chstgelegene gyn?kologische Klinik wenden. Der Hausarzt wird meist dann konsultiert, wenn die Beschwerdesymptomatik einen Hausbesuch erforderlich macht. In der Mehrzahl müssen gyn?kologische Notf?lle in der Klinik weiter diagnostiziert und auch therapiert werden. Dennoch ist es sicher erforderlich, dass auch der Hausarzt die wichtigsten Ursachen verschiedener akut einsetzender Beschwerden kennt, um die entsprechenden Notfallma?nahmen ergreifen zu k?nnen und auch über die Dringlichkeit der Klinikeinweisung sowie über die Anforderungen an die anzufahrende Klinik entscheiden zu k?nnen.     

Atorvastatin zur Primärprävention kardiovaskulärer Ereignisse

Ohne Zusammenfassung     

Serum-Glutaminsäure-Oxalessigsäure-Transaminase-, Aldolase-Aktivität und Kreislauf

Zusammenfassung An Hand vergleichender Untersuchungen zwischen dem Verhalten der Fermentaktivitäten (SGOT und Aldolase) und den Kreislaufgrößen bei 26 Patienten mit Myokardinfarkten, 11 Patienten mit Angina pectoris, 10 Patienten mit apoplektischen Insulten, 10 Patienten mit intestinalen Blutungen und 6 Patienten mit Lungenembolien konnte eine quantitative Korrelation nicht festgestellt werden. Sowohl Blutmengenreduktion und Ausbildung eines Schocksyndroms, wie auch die Entwicklung einer Herzinsuffizienz mit Vergrößerung der aktiven Blutmenge (Plusdekompensation nachWollheim) verliefen ohne quantitative Beziehung zu den Aktivitätsschwankungen. Andererseits fand sich die differentialdiagnostische Bedeutung der Fermentuntersuchungen besonders zur Unterscheidung von Myokardinfarkten, schweren Angina-pectoris-Anfällen ohne Myokardnekrosen und Lungenembolien erneut bestätigt. Außerdem konnte eine gewisse Parallelität zwischen den Fermentaktivitätserhöhungen und den elektrokardiographischen Veränderungen beim Infarkt beobachtet werden.Mit 3 Abbildungen in 6 Einzeldarstellungen     

Conversation with Klaus Mäkelä

In this occasional series we record the views and personal experiences of people who have specially contributed to the evolution of ideas in the Journal's field of interest. Klaus Mäkelä is a Finnish sociologist who has exerted a wide international influence in thinking on alcohol research and policy analysis.     

Primärprävention von Herz-Kreislauf-Erkrankungen

Preventive medicine has not been adequately established in our health care system. Despite growing in-sight into the causes underlying arteriosclerotic cardiovascular disease, half of the population dies and even more suffer from it. Generally the correction of risk factors is regarded as causal therapy. Modification of the lipid and carbohydrate metabolism or the blood pressure are certainly effective, however, intervention trials have also demonstrated the limitations. Mostly an unhealthy lifestyle underlies these risk factors so that correction of the lifestyle is the causal therapy in the true sense. That is the principle basis for primary prevention, while pharmacotherapy can only be an adjunct. Inadequate nutrition, physical inactivity and smoking are considered the true major risk factors in our society. Changes in nutrition in favor of plant products, some physical activity and refraining from smoking can serve an effective contribution to health. In the future not only medical, but also economic requirements will increasingly force us to establish prevention on the basis of lifestyle changes as a mainstay of medicine.     

Weiterbildung älterer Arbeitskräfte angesichts einer veränderten Weiterbildungsorganisation

In the following contribution the under-proportional participation rate of older workers in vocational training is analyzed. Regarding the changes concerning the organization of vocational training to more job-integrated, self-directed and computer-based learning the consequences for training opportunities, motivation to learn and performance possibilities as well as institutional basic conditions to optimize the participation of elderly workers in further training are discussed.     

Primäre ziliäre Dyskinesie

Primary ciliary dyskinesia (PCD) is a rare autosomal recessive disorder with defective structure or function of normally motile cilia, leading to chronic upper and lower respiratory tract infections, fertility problems and organ site abnormalities. The PCD is a genetically heterogeneous condition entailing a broad range of different disease variants. Diagnosing these different PCD phenotypes requires a combined approach using complementary methods for detection of defects of ciliary function, ultrastructure and composition as well as low nasal nitric oxide values and biallelic genetic mutations. To date, mutations in 31 different genes have been linked to PCD permitting a genetic diagnosis in approximately 60?% of cases. Due to the lack of adequate trials evidence-based knowledge on the epidemiology, disease course and management of PCD is currently lacking. An international PCD registry has been developed to overcome these limitations (www.pcdregistry.eu) and is currently recruiting patients. Current treatment regimens have to rely on expert opinions and on experience gained from other respiratory diseases. The management of PCD includes surveillance of pulmonary function, culturing upper and lower airway secretions and diagnostic imaging. Daily airway clearance techniques as well as prompt antibiotic treatment of infections are the cornerstones of PCD treatment regimens.     

Prävention hämodialysekatheterassoziierter Infektionen

Catheter-related infections are common, cost-intensive and potentially fatal. Catheter-related bacteremia is the most common infective complication and infections are the second most common cause of death in hemodialysis patients. When possible the placement of a hemodialysis catheter should be avoided. If there are no alternatives including peritoneal dialysis and an anticipated duration of more than 3 weeks, a permanent tunnel catheter should be implanted in the right jugular vein. The most important preventive measures are hygienic hand disinfection and strict aseptic conditions during catheter implantation, dressing changes and handling during dialysis. The implementation of simple hygiene standards through training leads to a clear, sustainable reduction of catheter-related bacteremia and is cost-effective. Technical innovations play a subordinate role and the best evidence has been found for the use of antimicrobial ointments and so-called lock solutions.     

ICD-Therapie zur Sekundärprävention

Patients who survive out-of-hospital cardiac arrest or symptomatic ventricular tachyarrhythmias are at considerable risk of recurrence of these events and ultimately death. The implantation of an implantable cardioverter defibrillator (ICD) in patients with previous sustained ventricular tachyarrhythmias (VT) is considered secondary prevention of sudden cardiac death. The purpose of this review is to summarize the most important trials on secondary prevention with an ICD. The results from a meta-analysis showed a relative-risk reduction of 28% in overall mortality. Compared with amiodarone, an ICD provided maximal benefit for those patients with an ejection fraction between 20% and 35%. The results of the ICD trial demonstrate that there is clear evidence for the effectiveness of an ICD in patients with unstable VT; however, for patients with stable VT the results are less clear. Data on older patients are scant, and whether the survival benefit observed in the middle aged and younger-old also extend to older elderly patients with a more limited life span is less clear. Therefore, as the population becomes older, it is important to evaluate the safety, effectiveness, and the cost effectiveness of ICD implantation in this population. Guidelines are important and helpful to guide clinical decisions, but the indication for an ICD still remains an individual decision after evaluation of the risks and benefits for the individual patient. However, the patient needs to be involved, which emphasizes the importance of dialogue between the patient and physician.     

Parameloblastenleukämie mit Paraproteinämie

Zusammenfassung Es wird über eine Paramyeloblastenleukämie berichtet, die sich aus einer anfänglichen Leukozytose mit Linksverschiebung heraus entwickelte und während des gesamten Verlaufes mit einer Paraproteinämie (M-Gradient im gamma-Bereich) und Hyperproteinämie einherging. Die anfangs vorhandene Vermehrung der Gewebsplasmazellen ließ an ein gleichzeitig bestehendes Plasmozytom denken, dieses konnte jedoch autoptisch nicht bewiesen werden. Auf die Problematik der Paraproteinämie ohne morphologisches Korrelat und die Bedingungen zur kryptogenetischen Paraproteinämie wird eingegangen.

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Summary Report of a case of paramyeloblastic leukaemia which arose after a period of time in which there was leucocytosis with leftward shoft. During the whole course of the disease, there was hyperproteinaemia with paraproteinaemia (M-gradient in the gamma region). In the early stages, there was increase of tissue plasma cells, which aroused a suspicion of concomitant plasmacytoma, but this could not be confirmed at autopsy. The subject of paraproteinaemia without an associated morphological substratum is discussed, as is also that of cryptogenetic paraproteinaemia in general.

     

Antikoagulation zur Sekundärprävention

Zusammenfassung Thromboembolische Ereignisse als Folge intravasaler Thrombusbildung stellen eine klinisch bedeutsame Komplikation kardiovaskulärer Erkrankungen dar. Therapeutisch kommen einerseits Heparine anderseits orale Antikoagulanzien zum klinischen Einsatz. Beide Substanzklassen sind in der Prävention und Behandlung venöser und arterieller thromboembolischen Erkrankungen wirksam. Neuere Wirkstoffe wie z. B. direkte Thrombininhibitoren wurden in den letzten Jahren mit zunehmender Intensität und bei spezifischen kardiologischen Fragestellungen klinisch geprüft, können aber derzeit noch nicht für eine Routineanwendung im klinischen Alltag empfohlen werden. Im Gegensatz zu den Antikoagulanzien werden Thrombozytenaggregationshemmer fast ausschließlich bei arteriellen thromboembolischen Erkrankungen eingesetzt. Die größten klinischen Erfahrungen liegen mit Acetylsalicylsäure vor, doch haben inzwischen neue Thrombozyteninhibitoren, wie Thienopyridine und Glykoprotein IIb/IIIa-Rezeptor-Antagonisten einen hohen Stellenwert in der Behandlung der koronaren Herzkrankheit, letztere v. a. beim akuten Koronarsyndrom. Die individuelle Nutzen-Risiko-Abwägung hat stets das erhöhte Blutungsrisiko unter der Therapie zu berücksichtigen.Ein Erratum zu diesem Beitrag können Sie unter finden.     

Sekundärprävention nach Myokardinfarkt

A significant reduction in cardiovascular mortality has been achieved during the last decade. New techniques and materials for early coronary intervention have contributed significantly to reduce early mortality after myocardial infarction. Secondary prevention determines further progress; it combines evidence-based medical treatment as well as lifestyle modifications. ACE inhibitors, angiotensin receptor blockers, and beta-blocker positively affect elevated blood pressure, left ventricular remodeling, and electrical stability. Statins decrease LDL and increase HDL cholesterol. Acetylsalicylic acid and clopidogrel are indicated for antiplatelet therapy. Lifestyle modifications unite a diet rich in polyunsaturated fatty acids, moderate physical activity, weight reduction, and smoking cessation.