Zeitschrift für ärztliche Fortbildung und Qualitätssicherung
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Z Arztl Fortbild Qualitatssich · Nov 2004
Review[Methadone substitution--a scientific review in the context of out-patient therapy in Germany].
The German Betäubungsmittelverschreibungsverordnung BtmVV (prescription regulation of narcotics), 5 part 2, 01 July 2001 commissioned the German Medical Association to establish guidelines on methadone maintenance therapy according to the medical-scientific state of the art. A joint commission of the German Medical Association and the National Association of Statutory Health Insurance Physicians developed guidelines for substitution therapy of opiate dependence which were adopted by the board of the German Medical Association in March 2002 and were published in the Deutsche Arzteblatt in May 24, 2002. The present study is a systematic review of the scientific literature on successful treatment in general, as well as on particular aspects of methadone substitution therapy considered by the German Medical Association's guidelines. ⋯ Older randomised controlled trials and more recent quasi-experimental studies provide evidence that methadone maintenance therapy is an effective strategy to reduce illicit drug use, to improve the health situation of drug users, to diminish criminal behaviour, and to promote rehabilitation of opiate-dependent individuals. The evaluation of international studies clearly shows that access criteria to substitution therapy beyond the diagnosis of opiate dependence, e.g. the presence of a life-threatening co-morbidity, is not a prerequisite for substitution in other countries, and therefore is not discussed in the international literature. Study evidence shows that the German Medical Association's guidelines for substitution therapy of opiate dependence reflect the best evidence available from scientific studies and apply it to the conditions of the German healthcare system.
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Z Arztl Fortbild Qualitatssich · Nov 2001
Review[Diagnosis and differential diagnosis of bronchial asthma].
Asthma and COPD (chronic obstructive pulmonary disease) are the most important obstructive pulmonary diseases. Patient's history and physical evaluation give major hints of the underlying disease. Further diagnostic measures comprise lung function analysis including spirometry, plethysmography and--in severe cases--blood gas analysis. ⋯ Thus, allergy tests--particularly skin prick tests--have to be carried out. To further define an underlying allergy, in some cases even specific inhalative provocation tests have to be performed. X-ray of the thorax and other imaging techniques, detailed blood analysis, further diagnosis of the upper respiratory tract and the cardiac system may have to be carried out a) to quantify the effects of a severe form of asthma or COPD on other organs, and b) for differential diagnostic examinations.
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Z Arztl Fortbild Qualitatssich · May 1999
Review[Therapy of increased intracranial pressure in space-occupying media infarcts].
Following complete middle cerebral artery (MCA) infarction, up to 10% of all patients develop space-occupying brain edema. Despite intensive care therapy, 80% of these patients die due to transtentorial herniation. Over the past years, two alternative therapeutical options for the therapy of space-occupying MCA infarction have been developed. ⋯ Moderate hypothermia induced within the first hours after stroke has been shown to decrease ICP as well. However, the routine use of this therapy should not be recommended since further clinical studies are available. Knowledge on indications and limitations of different antiedema therapies will allow an effective therapy of increased ICP.
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Z Arztl Fortbild Qualitatssich · Jun 1998
Review[Urologic complications after kidney transplantation (II)].
Urological complications after renal transplantation are often responsible for postoperative morbidity and mortality in spite of a decrease in incidence and severity of such complications in the last decades. It is of particular interest to detect this complications early and to treat them in an adequate manner especially in regard to the increasing lack of human organs for transplantation. The number of transplanted patients in the population is still increasing and they are treated not only in transplant centers but also by general practitioners, nephrologists and urologists in private consultings. ⋯ Questions concerning impotence and incontinence are discussed in detail. Attention must be paid to the fact of immunosuppression and its peculiarities in transplanted patients. In this way the outcome of patients and transplants can be prolonged.
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Acute scrotal swelling is a potential urologic emergency. There are many conditions which may present with scrotal swelling including spermatic cord torsion, torsion of testicular appendages, epididymitis, orchitis, incarcerated scrotal hernia, hydrocele, varicocele, trauma, tumor and testicular pain in vasculitis syndromes such as Schoenlein-Hennoch purpura. Testicular torsion is the most important condition that must be proven or ruled out to avoid loss of testicular function. ⋯ Using these tools, three diagnostic categories will be defined: Torsion, non-torsion or equivocal diagnosis. In every doubtful case scrotal evaluation is done surgically. Non-torsion is treated according to the different diseases.