Fahrunsicherheit durch Drogen und Medikamente

Zusammenfassung Medikamente – insbesondere solche mit zentralnervöser Wirkung – können einerseits die Fahrsicherheit einschränken, andererseits kann durch eine Arzneimitteltherapie eine krankheitsbedingt eingeschränkte Fahrsicherheit gebessert bzw. eine Fahreignung wiederhergestellt werden. Für die verschiedenen verkehrsmedizinisch bedeutsamen Arzneimittelgruppen werden im Folgenden die relevanten Leistungseinbußen dargestellt. Die dem Arzt im Zusammenhang mit einer Arzneimitteltherapie obliegenden umfangreichen Beratungs- und Hinweispflichten für seinen Patienten werden ebenfalls vorgestellt.     

A review of 43 cases of tetanus neonatorum.

Forty-three patients with neonatal tetanus admitted to the Infectious Diseases Ward of the Istanbul University Faculty of Medicine Children's Hospital at Capa from 1982-1989 are presented. Thirty-two (74.4%) of the subjects were boys. The overall mortality was found to be 60 percent and the mean incubation period 6.1 +/- 20 days. The mean period between onset of symptoms and hospital admission was 1.7 days. Thirty-nine (90.7%) of the 43 patients were unhygienic home deliveries and only two cases were delivered with a midwife in attendance. None of the mothers of the children in our series had been immunized with tetanus toxoid. The incidence of neonatal tetanus in Turkey is on the decline, but a fraction of the population, the so-called urban poor, is still at high risk for preventable diseases. Every contact an unvaccinated person has with a health care professional should be viewed as an opportunity for tetanus immunization.     

Clinical utility of dorsal sural nerve conduction studies in healthy and diabetic children.

OBJECTIVE: Monitoring of the dorsal sural sensory nerve action potential (SNAP) is a sensitive method for detection of peripheral neuropathies. We tried to determine the normal dorsal sural nerve conduction values of the childhood population and assessed the clinical utility of this method in diabetic children who have no clinical sign of peripheral neuropathy. METHODS: In the study, 36 healthy and 27 diabetic children were included. In all subjects peripheral motor and sensory nerve studies were performed on the upper and lower limbs including dorsal sural nerve conduction studies. RESULTS: The dorsal sural SNAP mean amplitude was 8.24+/-3.08 microV, mean latency was 2.47+/-0.48 ms, mean sensory conduction velocity was 41.63+/-5.43 m/s in healthy children. Dorsal sural SNAPs were absent bilaterally in one diabetic patient. In the other 26 diabetic patients, the mean dorsal sural nerve distal latency was longer (2.93+/-0.63 ms, P = 0.004), mean SCV was slower than in healthy subjects (36.68+/-7.66 m/s, P = 0.005). However, dorsal sural nerve amplitude was not different between the groups. A dorsal sural nerve latency of more than 2.9 ms had a sensitivity of 50% and a specificity of 75%. A dorsal sural nerve velocity of less than 36 m/s had a sensitivity of 54% and a specificity of 92%. CONCLUSIONS: We designated the reference values of the dorsal sural nerve in healthy children. In addition, our findings suggest that dorsal sural nerve conduction studies may have value to determine neuropathy in the early stages in children with diabetes. SIGNIFICANCE: The dorsal sural nerve conduction studies in diabetic children may have value to determine the neuropathy in its early stages.     

Orofaziale Regulationstherapie nach Castillo Morales

The goal of Castillo-Morales’ orofacial therapy is to improve the coordination of oral motor functions in cooperation with other body systems. The processes involved in sucking, biting, chewing and swallowing are stimulated by specific techniques of sensory stimulation such as touching, stroking, stretching, exerting pressure or the vibration of mimic and tongue-bone musculature, as well as massage of the gums and palate or the application of technical apparatus. Sufficient head and posture control is fundamental and must be the first goal. Successful therapy, especially for ICP-children, has been documented in progress reports and case studies. As yet, however, there is no evidence of specific effects on eating and speech functions. Therefore, the therapy can be recommended only in order to achieve specific goals and for a limited time, being aware of the risk of overstimulation.     

Ruptur der langen Bizepssehne und operative Therapiestrategien

Zusammenfassung Die Ruptur der langen Bizepssehne beruht auf ihrer anatomischen Disposition und, bedingt durch die biomechanische Belastung, zu 90% auf degenerativen Veränderungen. In der Regel finden sich begleitende Verschleißschäden anderer Strukturen des Schultergelenks wie der Rotatorenmanschette. Es wird ein Überblick über die Häufigkeit und den Entstehungsmechanismus von Rupturen der langen Bizepssehne sowie gängige operative Behandlungskonzepte gegeben. Die Rolle und das anatomisch-funktionelle Prinzip der Sehne des Caput longum im komplexen dynamischen System des Schultergelenks werden erläutert. Eingang finden die klinische Symptomatik, Beschreibungen sowie Wertungen apparativer diagnostischer Verfahren. Der Stand derzeit etablierter Operationstechniken wird unter Darstellung von Vor- und Nachteilen beleuchtet und diskutiert. Des Weiteren werden die selbst favorisierte Methode und die gesammelten Erfahrungen dargestellt.