Versicherungsrechtliche Medizin. Gewerbepathologie. (Gewerbliche Vergiftungen)

International Journal of Legal Medicine -     

Atmung und Säure-Basengleichgewicht in der Schwangerschaft

Zusammenfassung Die alveolare Kohlensäurespannung wurde bei 2 Vpn. über die ganze Schwangerschaft verfolgt und bei einer dritten im Beginn der Schwanger schaft.Bei einer der untersuchten Vp. wurden gleichzeitig Erregbarkeitskurven über die ganze Dauer aufgestellt, bei einer anderen die Alkalireserve und das p_H aus dem arteriellen Blut bestimmt.1. Die alveolare CO₂-Spannung ist in der lutealen Phase des Menstruationszyklus bereits erniedrigt, bei Eintritt einer Gravidität sinkt sie langsam weiter als Folge einer Ventilationssteigerung. Der Verlauf der Kurve legt nahe, daß es sich in erster Linie um eine Progesteronwirkung handeln könne.2. Die Erregbarkeit für Kohlensäure nimmt wenigstens bis zum 6. Lunarmonat zu. Der Apnoepunkt wird in Richtung zu niedrigeren Kohlensäurespannungen verschoben.3. Das arterielle p_H wird bei absinkender Alkalireserve zunächst konstant gehalten. Nach der Entbindung geht p_H vorübergehend unter den Ausgangswert.4. Zur Erklärung der Ventilationssteigerung in der Gravidität wird eine die Atmung steigernde Wirkung des Progesteron angenommen, die bereits am Anfang der Gravidität durch eine infolge erhöhten Stoffwechsels vermehrte Säurebildung unterstützt wird, während am Ende der Schwangerschaft aueh vom Fetus in das Blut der Mutter einströmende Säuren beteiligt sind.Mit 6 Textabbildungen.     

Complex regional pain syndrome and dysautonomia in a 14‐year‐old girl responsive to therapeutic plasma exchange

Reflex sympathetic dystrophy, also known as complex regional pain syndrome (CRPS), has recently been shown to be associated with autoantibodies against β2‐adrenergic and muscarinic M2 receptors. In addition to pain and sudomotor/vasomotor symptoms, dysautonomia is also observed in a subset of CRPS patients. Despite its severity, there are few effective therapies for CRPS described to date. We report a case of a 14‐year‐old girl with CRPS of her right leg and dysautonomia (gastroparesis, postural tachycardia) refractory to multiple therapies, successfully treated with therapeutic plasma exchange (TPE) with albumin replacement. The patient, who has serum anti β2‐adrenergic and muscarinic M2 receptor autoantibodies in addition to nicotinic acetylcholine receptor ganglionic autoantibodies, underwent an initial course of five TPEs over a 2‐week period. She demonstrated a clinical response to TPE as manifested by a rapid improvement in her fatigue and gastroparesis, with a gradual yet significant improvement in her leg pain and sudomotor/vasomotor flares. Following the loading procedures, the patient was treated with rituximab. She continues to require periodic TPE to maintain a remission, with additional immunosuppression being considered long term. Although further studies are needed, TPE (in combination with immunosuppression) may be an appropriate therapy for CRPS patients with detectable autoantibodies, as it is for better characterized diseases with autoantibodies against neuronal surface receptors such as myasthenia gravis or Lambert Eaton myasthenic syndrome. J. Clin. Apheresis 31:368–374, 2016. © 2015 Wiley Periodicals, Inc.     

Disability,coping and quality of life in individuals with muscular dystrophy: a prospective study over five years

Purpose : The present study investigates progressive muscular dystrophy over a five year period. The purpose is twofold: to describe changes over time and to investigate relations between disability, coping and quality of life. Method : The study group comprised 45 adults (16 men and 29 women), with an average age of 44 years. All were assessed in 1991 and 1996, with the following instruments: the ADL staircase, the Self-report ADL, the Mental Adjustment to Cancer scale, the Sickness Impact Profile and the Psychosocial well-being questionnaire (Kaasa). Results : Increasing disability was accompanied by an increase in dependence on others and a significant deterioration of health-related quality of life and with regard to 'Satisfaction'. The predominant type of coping was 'Fighting spirit', whilst 'Fatalism' showed the greatest decline over time. 'Ambulation' and the ADL staircase correlated with 'Physical index' on the SIP. Correlations between disability, coping and quality of life were moderate. The results can serve as a basis for planning and evaluation of recurring rehabilitation for persons with MD.     

Disability and quality of life in individuals with postpolio syndrome

Purpose : The purpose of the study is to investigate disability and quality of life in individuals with the characteristic symptoms of postpolio syndrome. Method : Disability is assessed by means of the self-report activities of daily living instrument, and quality of life by means of Kaasa's questionnaire and the quality of life profile. Results : The 39 subjects have on average lived with polio sequelae for 52 years. Their main difficulties are with moving, lifting and carrying. This means restricted mobility, sedentary activities and a need to prioritize. Half of them feel that polio has lessened their possibilities in life, and a quarter have still not accepted the limitations polio has involved. Nevertheless the majority report a high level of psychosocial well-being, and almost a quarter say that living with polio has meant personal development and strength. We found a significant correlation between on the one hand disability with regard to ambulation, arm strength and finger strength on the self-report ADL, and on the other hand the number of negative problems on the quality of life profile (0.33-0.45). Conclusion : The latter instrument needs further testing before its validity can be determined with certainty.     

Low and High Field Magnetic Resonance for in Vivo Analysis of Seeds

Low field NMR has been successfully used for the evaluation of seed composition and quality, but largely only in crop species. We show here that 1.5T NMR provides a reliable means for analysing the seed lipid fraction present in a wide range of species, where both the seed size and lipid concentration differed by >10 fold. Little use of high field NMR has been made in seed research to date, even though it potentially offers many opportunities for studying seed development, metabolism and storage. Here we demonstrate how 17.5T and 20T NMR can be applied to image seed structure, and analyse lipid and metabolite distribution. We suggest that further technical developments in NMR/MRI will facilitate significant advances in our understanding of seed biology.     

Golimumab improves socio economic and health economic parameters in patients with rheumatoid arthritis,psoriatic arthritis,and ankylosing spondylitis

Abstract

Background

Golimumab (GLM) has shown its efficacy and safety in various clinical trials. We aimed to assess the effect of GLM on socio economic and health economic parameters in daily clinical practice.     

War Experiences and General Health Among People in Bosnia‐Herzegovina and Kosovo

War experiences may have an extensive impact on the health status of the exposed populations. This population‐based study aimed to examine the relationship between war experiences and self‐reported general health in representative sample surveys from Bosnia‐Herzegovina (n = 3,313) and Kosovo (n = 1,000). Data were collected with face‐to‐face interviews fielded in the winter of 2003–2004. Logistic regression analysis was used to compute unadjusted and adjusted odds ratios (ORs). The adjusted effects of the extensiveness of war experiences on poor health were positive in both countries, but they were statistically significant only for Bosnia‐Herzegovina: OR = 1.04, 95% CI [1.00, 1.08] for Bosnia‐Herzegovina and OR = 1.03, 95% CI [0.98, 1.09] for Kosovo. The strongest observed effect was found for Kosovo only: The extensiveness of war experiences was relatively strongly related to longstanding health problems, OR = 1.09, 95% CI [1.03, 1.15]. We found that war experiences may contribute to increased poorer health in the exposed populations; however, the effects 4–9 years after the war ended were modest. Hence, war experiences seemed to be more strongly related to war‐related distress and posttraumatic stress disorder than to self‐reported general health.