Der Internist
-
Comparative Study
[Rehabilitation for digestive and metabolic diseases. Quo vadis?].
The position of rehabilitation in gastroenterology, hepatology and metabolic diseases has changed little in the last 25 years. Initial improvements in quality are oriented more to the content of rehabilitative measures and less to organizational basic conditions. Nevertheless, there is an urgent need for action if rehabilitation medicine is to achieve an equivalent and recognized position in the interaction between primary care and other medical specialties. In this article suggestions for expedient prerequisites and utilization options of rehabilitation in the fields of hepatogastroenterology and metabolism will be presented, which are also oriented to the exemplary implemented concepts from Sweden and The Netherlands.
-
Geriatric rehabilitation is a cornerstone of every treatment plan in elderly persons in the inpatient, day clinic and outpatient settings. Geriatric patients tend to be more in need of care and to have a loss of domestic independence due to multimorbidities. ⋯ Geriatric rehabilitative treatment is based on functionality (ICF) and is therefore indicated in a wide spectrum of diseases. The demographic shift necessitates an increase in geriatric treatment structures with innovative concepts such as geronto-traumatological interdisciplinary units or geriatric outpatient office groups with a better networking of different care structures.
-
The full clinical picture of aspirin intolerance - the association of aspirin-induced bronchial asthma, aspirin sensitivity and nasal polyps - has been described as Morbus Widal or later as the "Samter triad". Today the term Aspirin-exacerbated respiratory disease (AERD) is preferred to account for the progressive nature of this inflammatory airway condition with its unrelenting course even in the absence of non steroidal anti-inflammatory drugs (NSAID). This acquired idiosyncrasy appears to be related to an abnormal arachidonic acid metabolism. ⋯ While a typical history and endoscopic findings can be suggestive of AERD, a definite diagnosis relies on appropriate challenge tests. AERD is often refractory to standard asthma treatment with systemic and inhaled steroids, β(2)-agonists, leukotrien-antagonists. Adaptive desactivation can induce a reversible tolerance to NSAID which also leads to an improvement in signs and symptoms of the underlying AERD.