Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Feb 2008
Review[Needleless connection valves--commentary from a clinical perspective].
Needle-less connection valves (NFCs) for infusion systems, blood drawing- or i. v. injection ports may offer significant benefits to the patient and the attending health care workers. On the other hand, a number of recent reports described a relationship between an increased incidence density of catheter-associated infections and the introduction of certain NFCs in clinical practice. ⋯ In addition, the introduction into clinical practice should be supervised by continuously performed surveillance for catheter-associated infections. Taking these prerequisites into account, NFCs may increase the safety and feasibility of intravenous therapy using central venous catheters in high-risk patients.
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Dtsch. Med. Wochenschr. · Nov 2007
Review[New developments in diagnostic and therapy of asymptomatic carotid stenosis].
Stroke is the leading cause of long-term major disability in developed countries, although several improvements could be achieved in acute stroke therapy (e. g. thrombolysis, stroke-unit treatment, optimized early rehabilitation strategies). Therefore, primary prevention is essential to reduce the burden of stroke. 10 -20 % of all cerebral ischemias are caused due to stenosis or occlusion of the extracranial carotid arteries. This review summarizes the indications, diagnostics as well as the actual data for a medical, endovascular or operative treatment of asymptomatic carotid stenosis.
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Dtsch. Med. Wochenschr. · Nov 2007
Review[Global warming: trailblazer for tropical infections in Germany?].
Since 1850, the CO (2) content of the atmosphere has increased from 280 to 360 ppm, and the average surface temperature has risen from 14.6 to 15.3 C. A further increase between 1.8 and 4.0 C is expected for the 21st century. Temperate and cold climate zones are affected predominantly, but tropical regions are not spared. ⋯ Global warming may lead to the emergence of diseases which at present are not endemic in Germany, like West Nile fever, Dengue fever, or Leishmaniases, and to enhanced transmission of borreliosis and tick-borne encephalitis. Malaria and cholera, in contrast, are influenced more strongly by socioeconomic factors. Improved surveillance and intensified research on the relationship between climate change and infectious diseases is needed.
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Dtsch. Med. Wochenschr. · Oct 2007
Review[Mirror feed-back - a new method for the treatment of neuropathic pain].
The mirror feedback therapy is a method for treatment of neuropathic pain syndromes that are associated with a missing or disordered afferent sensory input. That concerns especially the phantom limb pain, the pain after plexus or spinal nerve root injury and the complex regional pain syndrome. This therapeutic method has been increasingly implemented in the past few years. ⋯ During the therapy the patients are instructed to use the mirror in a way that the image of the mirrored healthy limb seems to appear in the place of the missing or affected extremity. The mirror image produces an illusion of two "healthy" limbs. An ergotherapeutic training program with sensory and motor training elements based on the visual impressions is performed additionally.
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Pain usually is the consequence of tissue damage that is signalled to the brain via the nociceptive system (nociceptive pain). Damage to the nociceptive system - in addition to causing sensory deficit - may paradoxically also induce a chronic pain state (neuropathic pain). Diagnostic workup of patients with neuropathic pain follows the usual procedure of Neurology, i. e. the aim is to identify the location of neural damage and the underlying disorder, so that a mechanism-oriented treatment may be initiated. ⋯ Typical analgesics have little efficacy in neuropathic pain - except for opioids. Major pharmacological treatment options include anticonvulsants (Ca-channel modulators, Na-channel blockers), antidepressants (noradrenaline reuptake inhibitors) and topicals (lidocaine, capsaicin). These medications exert specific molecular pharmacological effects against the pathophysiological mechanisms of neuropathic pain.