Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Jun 2009
Multicenter Study Comparative Study[Costs of antihyperglycemic drugs and consumables and treatment satisfaction in patients with type 2 diabetes. Results of the health care research study LIVE-DE (long-acting insulin glargine compared with NPH insulin in Germany)].
Economic aspects and patient-reported outcomes play an increasing role in the choice of therapeutic options. The aim of the LIVE-DE study (Long-acting insulin glargine versus NPH insulin cost evaluation in Germany[DE]) was to assess expenditures incurred in the care of diabetic patients, as well treatment satisfaction of patients with type 2 diabetes treated with insulin glargine (GLAR) or NPH insulin (NPH). ⋯ Based on the comparison of total diabetes treatment costs under real-life conditions between glargine and NPH insulin based treatment regimens, these results indicate that the choice of a given treatment should be determined by medical advantages and patients' preferences. Because of a lower injection rate and a higher patient treatment satisfaction, the use of glargine as first-line therapeutic approach is justified in order to achieve target glycemic control in insulin dependent type 2 diabetics.
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Dtsch. Med. Wochenschr. · Jun 2009
Review[Chronic obstructive pulmonary disease (COPD) as a systemic disease].
Chronic obstructive pulmonary disease (COPD) is defined as a progressive, usually only partially reversible, obstruction of the airways The disease is associated with an inflammatory response of the lungs to noxious particles, particularly cigarette smoke. Numerous epidemiological studies have shown a significant association between impaired lung function and the presence of cardiovascular, metabolic or other extrapulmonary comorbidities. Systemic inflammation may be the missing link between COPD and its extrapulmonary manifestations, although the exact mechanism of this relationship remains unclear. ⋯ Based on the concept of COPD as a systemic disease, a concept is needed which describes in detail the pharmacological treatment of the pulmonary and extrapulmonary manifestations of the disease. In addition, the part of the disease that is treatable with physiotherapy and rehabilitation must be fully taken into account. Such multimodal treatment regimens have so far not been implemented into clinical guidelines.
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The critically ill patient in acute heart failure continues to present an exceptional challenge concerning diagnostic procedures, monitoring and treatment. The European Society of Cardiology guidelines was the first to classify patients in acute heart failure into distinct clinical entities. Further management and choice of monitoring relies on this classification. ⋯ The greater the increase in tidal volume for the same lung compliance, the greater is the transient decrease in venous return and the subsequent decrease in left ventricular output. Variations in systolic pressure or pulse pressure are reliable measures of preload responsiveness. More clinical validation of these measures must be done before they can become standard measures of monitoring patients in acute heart failure.
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Dtsch. Med. Wochenschr. · Jun 2009
Case Reports[Prolonged fever and monocytosis after hemorrhoidectomy and treatment with methotrexate--listeriosis with cerebral abscess].
A 58-year-old man was admitted because of septic fever for about one week with onset two weeks after an hemorrhoidectomy. He had been receiving methotrexate (MTX) since boyhood for severe psoriasis. Fifteen years before he had undergone a splenectomy after abdominal trauma. The patient was found to have diminished cognitive functions and memory disturbance, but no focal neurological deficits. ⋯ Lack of pathological levels of CRP, procalcitonin and white blood cell count does not exclude cerebral abscess in a patient with prolonged fever and without marked neurological deficits. Preceding treatment with immunosuppressive drugs, especially MTX, and failing response to cephalosporins should lead to consideration of listeriosis in the differential diagnosis.