Pseudostenokardie-Symptomkomplexe bei hämodynamischer Diagnostik bei Herzischämie

The purpose of this study was to determine the frequency of pseudocoronary syndromes in persons undergoing cardiac diagnostic tests because of suspected ischaemic heart disease. The study involved 384 subjects, 114 women and 270 men aged 21–75 years, who had been referred for precise cardiac diagnosis with a tentative preliminary diagnosis of ischaemic heart disease. In each subject an exercise stress test was performed, as was an ECG both at rest and during exercise and a coronary angiogram. Subjective sensations (e.g. pain in the chest, dyspnoea) experienced during the tests were also taken into account. Of the 384 patients suffering from pain in the chest area, ischaemic heart disease was excluded in 180 cases. In this subgroup the target HR (submaximal HR) was achieved during the stress test without any significant alterations in the ECG trace (raising or lowering of the ST segment). The subsequent coronary angiography definitively excluded any cardiogenic origin of the pain in the chest.     

Blutdruck bei Phosphat-Steroid-Kardiopathie

Research in Experimental Medicine - Nach der Beschreibung der Phosphat-Steroid-Kardiopathie (Ph.SK) werden auf Grund von an Ratten vorgenommenen Untersuchungen die möglichen Zusammenhänge...     

Schmerzbehandlung bei Karzinompatienten

Freedom from cancer pain is one of the four priorities of the WHO Cancer Control Programme. Every day 3.5 million people are suffering from cancer pain, and most do not receive adequate relief. A lack of training in cancer pain management at most nursing and medical schools is the principal reason for this, coupled with limited availability of oral strong opioids in many countries. Education is the key to progress in cancer pain management. Health workers must appreciate that: 1. Attention must be paid to all aspects of suffering -physical, psychological, social and spiritual. 2. In advanced cancer, most patients with pain have multiple pain. 3. Pain experienced in carcinoma is not always caused by the tumour. 4. There is more to pain management than the use of analgesics. 5. In the case of opioid-responsive pains, analgesics should be administered by mouth according to a regular time-schedule and with dose increments. 6. Adjuvant medication is generally necessary. 7. Opioid-resistant pains require other forms of treatment. 8. Pain is the physiological antagonist to the central depressant effects of opioids. 9. Opioid tolerance is not a problem in practice. 10. Psychological dependence does not occur in patients receiving opioids for pain relief. 11. Patients receiving analgesics must be carefully monitored. 12. Teamwork is necessary for good results.     

Buprenorphineinsatz bei Kindern

There is a paucity of relevant pediatric data on buprenorphine, especially with respect to the long-term application in children suffering chronic pain or to pediatric pharmacokinetic as well as pharmacodynamic data after repeated sublingual or long-term transdermal administration. Compared to adults, after single-dose buprenorphine, children seem to exhibit a larger clearance related to body weight and a longer duration of action. If combined with other opioids or sedatives or if the metabolite norbuprenorphine cumulates, it is difficult to estimate the risk of respiratory depression. Clear-cut evidence is missing that in children there is a ceiling of buprenorphine-induced respiratory depression. Due to its various application routes, long duration of action, and metabolism largely independent of renal function buprenorphine is of special clinical interest in pediatrics, especially for postoperative pain and cancer pain control. There is no reason to expect effects fundamentally different from those in adults.     

Knochenmarksgranulomatose bei Q-Fieber

Zusammenfassung Hintergrund: Petersdorf und Beeson definierten das Fieber unklarer Genese (FUO) als eine sich über mindestens drei Wochen entwickelnde Krankheit mit einer Rektaltemperatur von über 38,3 °C an mindestens drei Tagen, die auch nach einwöchiger stationärer Abklärung ätiologisch unklar bleibt. Ein Viertel derartiger Fälle wird durch Infektionskrankheiten verursacht, am häufigsten durch versteckte Abszedierungen, Endocarditis lenta und Tuberkulose. Fallbeschreibung: Bei einem 29fährigen Patienten mit seit drei Monaten anhaltendem undulierten Fieber führte erst der Nachweis typischer Fibrinringgranulome in der Knochenmarksbiopsie zur Diagnose eines protrahiert verlaufenden Q-Fiebers. Die Diagnose wurde später serologisch bestätigt. Schlussfolgerung: Die Kasuistik unterstreicht die Bedeutung der Knochenmarksbiopsie in der Abklärung des Fiebers unklarer Genese. Abstract Background: Petersdorf and Beeson defined Fever of Unknown Origin (FUO) as an illness characterized by rectal temperature exceeding 38.3 °C on at least 3 occasions, evolving during at least 3 weeks, with no diagnosis reached after 1 week of in-patient investigation. A quarter of FUO cases is caused by infectious diseases, most often hidden abscesses, subacute endocarditis and tuberculosis. Case Report: In a 29-year-old patient with undulating fever of 3 months duration solely the demonstration of bone marrow fibin ring granulomas led to the diagnosis of protracted Q-fever. The diagnosis later has been proved by elevated Coxiella burnetii antibody titers. Conclusion: The case report underlines the diagnostic value of bone marrow biopsy in the evaluation of fever of unknown origin.     

Schmerztherapie bei Kindern

Ohne Zusammenfassung     

Ellenbogenarthroskopie bei Kindern

Due to the development of arthroscopic instruments in recent years, arthroscopy of the elbow joint has become a beneficial therapeutic option in children. Postoperative care with early functional treatment is the clue to successful treatment of the elbow joint. Usually arthroscopy leads to just a minimum of postoperative swelling and pain so that especially in children the functional care can be guaranteed. Pathologies of the elbow in children which can be accessed by arthroscopy include removal of loose bodies eventually combined with treatment of osteochondrosis as well as septic arthritis and synovectomy. The positive outcome after arthroscopic treatment of post-traumatic limited range of motion seen in our patients over the past 10 years shows another reliable indication. The following report presents a review of indications for arthroscopic treatment in the elbow joint in children.     

Retropatellararthrose bei Arthrofibrose

There is a high incidence of patellofemoral arthritis following arthrofibrosis of the knee. Common reasons are ligament reconstruction during the acute inflammatory period, knee fractures, reflex sympathetic dystrophy, immobilisation and infection. Patellofemoral arthritis following arthrofibrosis is caused by an increased retropatellar pressure due to scar tissue formation in knee and capsule, infrapatellar contraction syndrome, lack of extension and chronic inflammatory reaction. The aim of treatment is to restore nearly normal mobility of the knee and patella. Arthroscopic arthrolysis should be performed when conservative treatment fails. In some cases, lateral, medial and posterior releases are indicated. Full extension of the knee, restored mobility of the patella and a strengthened quadriceps muscle are positive prognostic factors.     

Schmerztherapie bei Sichelzellkrankheit

Die Sichelzellkrankheit geht mit einer Vielzahl von Symptomen und Komplikationen einher. Charakteristisch für eine Sichelzellkrankheit sind akute Schmerzkrisen; häufig treten zudem chronische Schmerzen auf. Da sowohl chronische als auch akute Schmerzen zu einer erheblichen Beeinträchtigung der Lebensqualität führen, besitzt die adäquate Schmerztherapie eine besondere Bedeutung. Bei Schmerzkrisen wird eine Behandlung analog zum Stufenschema der Weltgesundheitsorganisation empfohlen, das für die Therapie von Schmerzen im Rahmen von Tumorerkrankungen entwickelt wurde. Chronische Schmerzen können mit lang wirksamen Opioiden als Basis- und kurz wirksamen Opioiden als Bedarfsmedikation therapiert werden. Sollten sich zusätzlich Hinweise auf eine neuropathische Schmerzkomponente finden, stehen als weitere Therapieoptionen Antikonvulsiva, Antidepressiva und gegebenenfalls Ketamin zur Verfügung.     

Rerupturraten bei Rotatorenmanschettendefekten

Ohne Zusammenfassung