Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Oct 2008
Review[Update in basic research in the therapy of pulmonary arterial hypertension].
Pulmonary hypertension is a vasculoproliferative disorder which is characterized by vasoconstriction and proliferation of vascular cells within the vessel wall. Mostly addressing the increased vascular tone, prostacyclin and its analogues, endothelin-receptor antagonists and phosphodiesterase type 5 inhibitors have been approved for treatment of PAH and represent the current therapeutic options. Currently, research focuses on the development of causal treatment regimens aiming a normalization of the vessel structure. ⋯ For some of these agents clinical trials are already initiated which will address safety and efficacy. In addition, there is further development of new vasodilators addressing well known and new signaling pathways. Taken together, there is advanced research in the field of pulmonary vascular diseases and the efficacy of several new drugs is currently addressed in clinical trials.
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During pregnancy, the changes of cardiovascular physiology can impose additional load and risk on the cardiovascular system of women with heart disease. Care of women with heart disease and childbearing potential should include preconception risk stratification and counselling. Risk stratification rests on a carefully obtained history and examination, electrocardiography and echocardiography. ⋯ In addition to sodium restriction, treatment of heart failure consists of loop diuretics, vasodilators, digoxin and beta-blockers, if appropriate. Coronary heart disease and myocardial infarction are rare during pregnancy but should be considered in women with chest pain. Pharmacological therapy of rhythm disorders should be reserved for arrhythmias resulting in maternal or fetal hemodynamic compromise and for arrhythmias with intolerable symptoms.
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Dtsch. Med. Wochenschr. · Jun 2008
Review[Driving ability under opioids: current assessment of published studies].
Opioids are more frequently used in the treatment of chronic non-cancer pain. The aim is not only to reduce pain intensity, but also the patients' reintegration into their social environment, including the possibility of driving their own car. Various studies have investigated the impact of opioids on driving ability. ⋯ These results indicate that stable opioid treatment does not necessarily impair driving ability of patients in chronic pain. However, so far published studies do not provide clear evidence for saying that persons on sustained opioid treatment can drive a car without any problem. Nor do they indicate that such persons should not drive.
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Dtsch. Med. Wochenschr. · Jun 2008
Review[Influence of opioids on the psychomotor ability of patients in chronic pain].
Studies have provided no evidence that effective and stable long-term opioid treatment of pain necessarily impairs psychomotor abilities. Assessment of psychomotor abilities, especially of those involved in driving, can only be made in the individual case. Such abilities are affected especially by drug combination and such individual factors as age and driving experience.