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.     

Polytraumadefinition im G-DRG-System 2006

INTRODUCTION: Severely injured patients represent a relevant financial cost factor in the health system especially for high level trauma centres. The introduction of a"diagnosis-related group" (DRG) system in Germany further revealed the potential negative economic impact of severely injured patients for trauma centres. In recent years several changes of the specific DRG for severely injured patients occurred with the aim of a convenient reimbursement for the trauma patient. MATERIAL AND METHODS: The present study analysed 38 multiply injured patients admitted in the first half of the year 2004. These patients were analysed in terms of the respective DRG that was attributed to the patient on the basis of the definition criteria for 2004 and 2005. In addition for the same patient group the total inpatient treatment costs were calculated according to the algorithm developed by the Working Group on Polytrauma of the German Trauma Society. RESULTS: The analysis revealed three major problems in the reimbursement for severely injured patients according to the German DRG system: (1) In spite of the additional payment for blood compounds on top of the DRG reimbursement in 2005 a mean economic deficit of more than 4000 euro remains for each severely injured patient. (2) In 30% of the analysed trauma patients the combination of the diagnosis and operations did not lead to a specific polytrauma DRG or to an intensive care medicine DRG. (3) In the patients that could not be attributed to a polytrauma DRG, the economic deficit was with an average of more than 9000 euro even higher. This attribution aspect is also currently relevant, since the definition criteria for a polytrauma DRG were not changed in 2006 or 2007. CONCLUSION: We conclude that besides the recent changes in the reimbursement for polytrauma DRGs, which have been at least partly adapted to the real financial burden of these patients, the definition of a severely injured patient in the German DRG system may also need to be revised.     

Panzytopenie und generalisierte Lymphknotenschwellung

A 47-year-old woman was admitted to our emergency room because of anemia and acute tonsillitis. She reported recurrent fever and a sore throat. Clinical examination and CT scans showed general lymph node swelling and liver enlargement. In the course of the disease she developed pancytopenia with neutropenic fever, pleuropneumonia, and deep vein thrombosis. The histological examination of a lymph node showed a reactive, EBV-associated lymphadenitis. The examination of the bone marrow showed an activated marrow. The diagnosis of an active EBV infection was established with 2x10⁶/ml EBV gene copies in the blood. In addition, systemic lupus erythematosus was diagnosed because of the typical autoantibody constellation and clinical findings. The immunohematological examination showed autoantibodies against the three blood cell compartments. Because of the severe pancytopenia as a result of the EBV- and SLE-associated autoantibodies and despite recurrent infections, we initiated immunosuppressive therapy with low-dose corticosteroids. This therapy resulted in normalization of the blood counts. Anitibody levels and the EBV genome levels became negative.