Praxis
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There are two entities to differentiate: 1. Diabetes in pregnancy (pre-existent type 1 or type 2 diabetes with tendency of deterioration during pregnancy or first occurrence of a type 1 or type 2 diabetes with persistence after pregnancy. 2. Impaired Glucose Tolerance = IGT (Diagnosis of an impairment of glucose tolerance during pregnancy) Aims of the screening are the avoidance of complications for mother and child. ⋯ Pregnancies with diabetes in pregnancy or gestational diabetes are risk pregnancies, which are controlled more intensively. Delivery is ideally at term or with confirmed lung maturity. If an impaired glucose tolerance is diagnosed during pregnancy, an oral 75 g glucose tolerance test as well as annually blood sugar controls are carried out because of the augmented risk of developing a type 2 diabetes later in life.
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Neurology experienced a continuous development in the last decades, in parts because of the advancement of neuroradiological procedures. Earlier and traditionally known as diagnostic branch, neurology developed more and more also as a therapeutic discipline. ⋯ The rapid and correct recognition of symptoms and signs of potentially serious neurological illnesses, the decision about the application of invasive and not always risk-free treatment procedures, as well as the therapeutic management of neurological emergencies became for the neurologist a difficult, but unavoidable challenge. With the presentation of the annual statistic of the neurological emergencies at the university hospital of Zurich (USZ), as well as with the discussion of a few illustrative clinical cases the authors give an overview about this important aspect of clinical neurology.
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Multicenter Study Comparative Study Clinical Trial
[Zolmitriptan as fast-melt tablet in the acute treatment of patients with migraine attacks: the ZORO study].
In an open, prospective study in 27 Swiss neurological practices and polyclinics, the fastmelt formulation of zolmitriptan was tested in 113 migraine patients as a therapeutic agent for migraine attacks (ZORO [= Zomig oro] Studie). A total of 311 attacks with and without aura were analyzed. With the help of a structured diary, the patients documented each attack in detail by recording the time of onset of the migraine, the intensity, when the medication was taken, the duration of the migraine, concomitant symptoms, concurrent medication and adverse effects. ⋯ Further research will be necessary to clarify this situation. With regard to efficacy in headaches, concomitant autonomic symptoms, rapid onset of effect, and acceptance, this fastmelt triptan formulation represents real competition with the other triptans in the usual tablet formulation. It is especially suitable for active migraine patients who would like to have an effective therapeutic agent available for rapid use in all life situations.
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Three patients are presented, who developed a severe skin reaction after brain-irradiation and concomitant phenytoin treatment. A fourth patient from the databAse of the Swiss Drug Monitoring Center, showed a Stevens-Johnson-Syndrome after a severe electric shock and phenytoin treatment. Possible pathogenic mechanisms of these life-threatening complications and possible alternatives to the phenytoin treatment in irradiated patients are discussed.