Nicht-Opioid-Analgetika bei chronischen Schmerzen

Zusammenfassung Zu den Nicht-Opioid-Analgetika rechnet man im allgemeinen die Vertreter dreier Gruppen von Analgetika: die Salicylate, die Pyrazolone und die Anilinderivate. Der weiteren Abgrenzung dieser Klasse dienen im wesentlichen zwei weitere Hauptwirkungen, die antipyretische und die antiphlogistische, die oft auch in die Bezeichnung einflie?en, z. B. antipyretische Analgetika. Da diese Analgetika bei gelegentlichem Gebrauch bei akuten Schmerzen neben einer zuverl?ssigen und raschen Wirksamkeit kaum fa?bare Nebenwirkungen offenbaren, werden sie oft auch rezeptfrei in den Apotheken abgegeben. Für den Einsatz in der Therapie chronischer Schmerzen sind jedoch nicht alle zur Verfügung stehenden Analgetika der Nicht-Opioid-Kategorie gleicherma?en geeignet. Zus?tzlich verlangen pharmakokinetische Besonderheiten (Resorptions-und Eliminationsschwankungen) eine überlegte Verordnungsweise. Unter der Vielzahl der nichtsteroidalen Antiphlogistika finden sich die analgetischen Wirkungen meist als Folge der antiphologistischen und nicht als analgetische per se. So ist für die Praxis zu schlu?folgern, da? eine indikationsgerechte Verordnung von Medikamenten mit analgetischen Wirkungen an den Hauptwirkungen orientiert sein mu?. Schlie?lich wird die Gabe von Analgetika auch bestimmt durch die Auspr?gung des Nebenwirkungsprofils. Vor allem die Interaktionen mit anderen Pharmaka, die bei chronischen Prozessen oft eine immense Bedeutung aufweisen, müssen in diesem Zusammenhang berücksichtigt werden. Ein vernünftiges Nutzen-Risiko-Verh?ltnis zu wahren, ist natürlich. Aufgabe des praktizierenden Arztes. Es mangelt jedoch an zuverl?ssigen Statistiken, die der Einsch?tzung des tats?chlichen Risikos dienlich sein k?nnten. Besonders die Langzeitverordnung von sogenannten schwachen Analgetika, die in ihren Nebenwirkungen manchmal doch “stark” sind, wird beim multimorbiden schmerzkranken Patienten schwer kalkulierbar riskant. Eine wissenschaftliche Verordnungsweise kann sich nur auf die kontinuierliche individuelle Abw?gung des Nutzen-Risiko-Verh?ltnisses stützen.     

European seroepidemiology network 2: Standardisation of assays for seroepidemiology of varicella zoster virus.

BACKGROUND: The aim of the European Sero-Epidemiology Network (ESEN2) is to harmonise the serological surveillance of vaccine-preventable diseases in Europe. OBJECTIVE: To allow comparison of antibody prevalence in different countries by standardising results into common units. STUDY DESIGN: For varicella zoster virus (VZV), a reference laboratory established a panel of 148 samples, characterised by indirect enzyme-immunoassay (ELISA), indirect immunofluorescence, and complement fixation test. Fifty-seven samples were also studied by the fluorescence antibody to membrane antigen test. The geometric mean of the antibody activity (GMAA) obtained from four ELISA determinations was used to characterise each sample of the panel as positive (GMAA: >100 mIU/ml), equivocal (GMAA: 50-100 mIU/ml) or negative (GMAA: <50 mIU/ml) for antibody to VZV (anti-VZV). Thirteen laboratories, using five different ELISA tests, tested the panel. RESULTS: Agreement with the reference laboratory was above 85% in all cases, and the R(2) values obtained from regression analysis of the quantitative results were always higher than 0.87. Finally, the regression equations could be used to convert national values into a common unitage. CONCLUSION: This study confirmed that results for anti-VZV obtained by different ELISA methods can be converted into common units, enabling the comparison of the seroprevalence profiles obtained in the participant countries.     

Ophthalmic masquerades of the atherosclerotic carotids

Patients with carotid atherosclerosis can present with ophthalmic symptoms. These symptoms and signs can be due to retinal emboli, hypoperfusion of the retina and choroid, opening up of collateral channels, or chronic hypoperfusion of the globe (ocular ischemic syndrome). These pathological mechanisms can produce many interesting signs and a careful history can bring out important past symptoms pointing toward the carotid as the source of the patient''s presenting symptom. Such patients are at high risk for an ischemic stroke, especially in the subsequent few days following their first acute symptom. It is important for clinicians to be familiar with these ophthalmic symptoms and signs caused by carotid atherosclerosis for making an early diagnosis and to take appropriate measures to prevent a stroke. This review elaborates the clinical features, importance, and implications of various ophthalmic symptoms and signs resulting from atherosclerotic carotid artery disease.     

Expression and characterization of αvβ5 integrin on intestinal macrophages

Macrophages play a crucial role in maintaining homeostasis in the intestine, but the underlying mechanisms have not yet been elucidated fully. Here, we show for the first time that mature intestinal macrophages in mouse intestine express high levels of αvβ5 integrin, which acts as a receptor for the uptake of apoptotic cells and can activate molecules involved in several aspects of tissue homeostasis such as angiogenesis and remodeling of the ECM. αvβ5 is not expressed by other immune cells in the intestine, is already present on intestinal macrophages soon after birth, and its expression is not dependent on the microbiota. In adults, αvβ5 is induced during the differentiation of monocytes in response to the local environment and it confers intestinal macrophages with the ability to promote engulfment of apoptotic cells via engagement of the bridging molecule milk fat globule EGF‐like molecule 8. In the absence of αvβ5, there are fewer monocytes in the mucosa and mature intestinal macrophages have decreased expression of metalloproteases and IL 10. Mice lacking αvβ5 on haematopoietic cells show increased susceptibility to chemical colitis and we conclude that αvβ5 contributes to the tissue repair by regulating the homeostatic properties of intestinal macrophages.     

Bilateral optic disc pit with maculopathy in a patient with cleft lip and cleft palate

Optic disc pit (ODP) is small, gray-white, oval depression found at the optic nerve head. It is a congenital defect that occurs due to imperfect closure of superior edge of the embryonic fissure. Cleft lip and palate are also congenital midline abnormalities occurring due to defect in the fusion of frontonasal prominence, maxillary prominence and mandibular prominence. There is only one case report describing the occurrence of ODP in a young patient with cleft lip and palate who also had basal encephalocele. We describe a 52-year-old patient with congenital cleft lip and palate with bilateral ODP with maculopathy but without any other midline abnormality.