Evidenzbasierte Therapie des Raynaud-Syndroms

Raynaud's syndrome has a prevalence of 3-5% in the general population. Despite its high frequency, the majority of available therapies have not been validated in randomized controlled trials. Effective therapies with a high level of evidence include the calcium channel blocker nifedipine. As analyzed by meta-analyses, nifedipine showed improvement of the peripheral circulation, as well as reduction of both the intensity and frequency of attacks in patients with primary and secondary Raynaud's syndrome as compared to placebo. Similar results in a metaanalysis were obtained for intravenous infusions of iloprost in patients with secondary Raynaud's phenomenon associated with systemic sclerosis. In addition, intravenous infusions of iloprost improved healing of fingertip ulcers in patients with systemic sclerosis. Therapies with significant effects in single randomized controlled trials include angiotensin II-receptor type 1 antagonists (losartan), the calcium channel blockers felodipine und amlodipine, serotonin-reuptake-inhibitors (fluoxetine) und phosphodiesterase-V-inhibitors (sildenafil, vardenafil). However, the results for these promising substances have to be confirmed in long-term trials with larger patient numbers.     

Herzgruppen in Deutschland—Status quo und Perspektiven

Currently, more than 6,600 heart groups (AHGs) have been established in Germany, in which more than 110,000 patients are physically active. Following cardiac rehabilitation (CR) after an acute event, in the AHG patients aim to meet the set rehabilitation goals in groups of about 15-20 patients, instructed by a competent exercise therapist and attended by a physician. While physical activity has been the dominant aspect thus far, psychosocial and educative elements are now more strongly integrated to stabilize secondary prevention. According to the German rehabilitation law, the patient is legally entitled to participate in AHGs. The insurance companies pay 6.00 Euros for 90 therapeutic units at 60-90 min each. Thereafter, the patient should be encouraged to continue participation at his/her own cost. The opportunity to participate in AHG is not yet sufficiently responded to by the patients. According to different studies, only 13-40% of all patients attend an AHG after phase II CR. In future, special emphasis has to be placed on the recruitment of more patients into AHGs, especially those groups which are known to be underrepresented (e. g., women, old patients, patients with low socioeconomic status). Furthermore, AHGs have to be established for patients with special needs, e. g., heart failure patients or young grown-ups with congenital heart diseases. Until now, the efficiency of AHG participation has not been sufficiently investigated. In a case-control study analyzing the long-term results of AHG participation, an improvement in physical performance as well as a reduction of cardiovascular morbidity (54%) and medical costs (approximately 47%) were observed. In future, more high-class investigations on this field are needed.     

Standardtherapie der Aortenklappenstenose

This paper gives an overview of the indications for surgical therapy of aortic valve stenosis. The current surgical management and the results of aortic valve replacement are outlined. The presented results of aortic valve replacement especially in elderly and high-risk patients compare favorably with other published data in respect to perioperative morbidity and mortality.All newly developed procedures for the treatment of aortic stenosis therefore will have to prove their superiority in future.     

Herz und Sport

Ohne Zusammenfassung     

Vorsorge- und Rehabilitationsmaßnahmen für Kinder und Jugendliche

As the result of new legislation introduced in 2007 children in Germany enjoy the same rights to prophylaxis and in-patient rehabilitation services as adults. The aim of pediatric rehabilitation is to prevent children from losing their ability to function or participate or to recover lost functions, activities and participation. The best interests of the child are the main consideration. Both preventative and rehabilitative measures may be employed for specific indications, usually following established guidelines. In pediatric rehabilitation, the parents of children under the age of 12 years may also be involved in the medical treatment and health education as “co-therapists”. In contrast, -child treatment programmes focus more on the parents. Based on requirements laid down by the insurer, the main emphasis of these latter programmes is on prevention, psychosocial aspects and parent-child interaction, which is integrated into the treatment plan. Every pediatrician should therefore know the differences between parent-child treatment programmes and approaches directed primarily at the child, in order to help the patients choose the appropriate rehabilitative therapy.     

Umweltinduzierte frühe Prägung von Asthma und Epigenetik

The term “early programming” describes the mechanisms by which specific environmental exposures during critical periods of early development have a long-term impact on a child’s disease risks in later life. Moreover, this effect is passed on across generations even after discontinuation of the exposure. Understanding these mechanisms offers the potential of targeted therapeutic reprogramming in order to prevent asthma. Programming of diseases is caused by epigenetic mechanisms. These are heritable gene modifications that leave the DNA sequence untouched but can nonetheless be transferred to the next generation. The influence of prenatal exposures during pregnancy, such as nutrition, immune stimulatory substances or tobacco smoke on a child’s risk for asthma has been highlighted in epidemiologic studies. Only recently, it was shown for the first time that exposure to nutrients or exhaust fumes in utero leads to epigenetic changes and is directly associated with asthma risk in children. This risk was transmitted across two generations. The potential of this new insight into epigenetically mediated early programming of asthma offers novel opportunities for the development of pre-symptomatic preventive strategies.     

Akrofaziale Dysostose Typ Nager

Acrofacial dysostosis type Nager in neonates is associated with high morbidity and mortality as a result of respiratory problems. Tracheotomy should be considered in order to stabilize the respiratory situation promptly. Primary mandibular distraction osteogenesis is not able to guarantee sufficient stabilization of the respiratory situation given the small bone structures; this approach should be reserved for older and larger patients.     

Interdisciplinary European Guidelines for Surgery for Severe (Morbid) Obesity

Foreword In 2005, for the first time, an expert panel named “The Bariatric Scientific Collaborative Group” (BSCG), was appointed through a joint effort of the major European Scientific Societies which are active in the field of obesity management. Societies that constituted this panel were: International Federation for the Surgery of Obesity – European Chapter (IFSO-EC), European Association for the Study of Obesity (EASO), European Childhood Obesity Group (ECOG) and the International Obesity Task Force (IOTF) which was represented during the completion process by its representatives. The BSCG was composed of officers representing the respective Scientific Societies (including four acting Presidents, two past Presidents, one Honorary President, and three Executive Directors). The panel was also balanced by the presence of many other opinion leaders in the field of obesity. The BSCG composition allowed coverage of the key disciplines in comprehensive obesity management, as well as being reflective of European geographic and ethnic diversity. This joint BSCG Expert Panel has convened several meetings which were entirely focused on guideline creation during the past 2 years. There was a specific effort to develop and concur on clinical guidelines which reflect current knowledge, expertise and evidence- based data on treatment of morbid obesity.     

Folgen der okkulten Insuffizienzfraktur des Os sacrum

Low back pain disorders of the elderly can potentially be caused by sacral insufficiency fractures due to osteoporosis, radiation necrosis or seldom malignant processes. In our institution an increasing numbers of patients suffering from osteoporotic sacral insufficiency fractures could recently be observed. In a case report study clinical symptoms, diagnostic procedures as well as therapeutic options are discussed.