Raguna Nagy, J. Heuckmann, H. Mennel, J. Klosterkötter, J. Kuhn
{"title":"[Frontotemporal dementia].","authors":"Raguna Nagy, J. Heuckmann, H. Mennel, J. Klosterkötter, J. Kuhn","doi":"10.32388/009133","DOIUrl":"https://doi.org/10.32388/009133","url":null,"abstract":"BACKGROUND\u0000Among the primary degenerative dementias, frontotemporal dementia (FTD, Pick's disease) is very important along with Alzheimer's disease. The estimated prevalence is 15:100,000 in the 45- to 64-year-old population; thus, it appears that the FTD as a cause for so-called presenile dementia is nearly as common as Alzheimer's disease.\u0000\u0000\u0000CASE REPORT\u0000The case of a 52-year-old woman is described that presented with slowly progressive lack of concentration and disturbance of memory. Furthermore, the immediate family had noticed a change in her premorbid personality. Due to additional depressive symptoms, she was misdiagnosed with depressive pseudodementia first.\u0000\u0000\u0000CONCLUSION\u0000Since the clinical presentation of FTD is variable and the correct classification has been uncertain for a long time, clinical diagnosis can be very difficult, so that the disease is often detected too late or remains completely misdiagnosed. On this basis, pathology, clinical aspects, diagnosis, and therapeutic options of FTD will be demonstrated according to current standards of knowledge.","PeriodicalId":18420,"journal":{"name":"Medizinische Klinik","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76056585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Hepatic encephalopathy].","authors":"P. Hilgard, G. Gerken","doi":"10.1002/9781119376293.ch114","DOIUrl":"https://doi.org/10.1002/9781119376293.ch114","url":null,"abstract":"Hepatic encephalopathy (HE) may develop within the course of acute or chronic liver failure and is characterized by a complex of psychomotor symptoms. In addition, HE can be induced by portocaval shunting even in the absence of any apparent liver disease. HE is caused by substances, which are either reabsorbed from the gut or are a product of the body metabolism. Normally, these substances are effectively eliminated during their first passage through the liver. However, a decreasing number of functional hepatocytes or the presence of portocaval collaterals in liver disease may significantly impair hepatic detoxification. Ammonia seems to take a central position in the pathogenesis of HE, although the exact cerebral effects of this metabolite are still not known in detail. The actual pathogenetic hypotheses are subject of this review. Depending on the underlying liver disease, HE is divided into an acute and a chronic form. Chronic HE may be present as a persistent or an episodic form, the latter being usually induced by defined precipitating factors, such as diet failures, infection and gastrointestinal-bleeding. With regard to the psychomotor symptoms and the coma depth, the clinical picture is classified into five grades (West Haven criteria). Diagnosis is made by clinical examination of the mental status after relevant differential diagnoses have been excluded. The only causal therapeutic option in the presence of acute or chronic liver failure is liver transplantation. Therefore, the indication for transplantation has to be evaluated in all forms of HE. Symptomatic treatment has three principal aims: (1) stabilization of circulation, oxygen supply, blood sugar and nutrition; (2) identification of the precipitating factor and its removal; (3) reduction of ammonia and other potential toxins in the circulation. In the case of acute HE, these therapeutic aims are complemented by an effective prophylaxis or therapy of brain edema.","PeriodicalId":18420,"journal":{"name":"Medizinische Klinik","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90719368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Vornholz, J. Sander, S. Keuter, Kirsten Küsel, J. Ast, Carmen E. Wurzbacher, Muriel C. F. van Teeseling, Khadija Aichane, Miriam Herbert, Daniela Kruck
{"title":"Journal Club","authors":"L. Vornholz, J. Sander, S. Keuter, Kirsten Küsel, J. Ast, Carmen E. Wurzbacher, Muriel C. F. van Teeseling, Khadija Aichane, Miriam Herbert, Daniela Kruck","doi":"10.1007/s00063-010-1098-3","DOIUrl":"https://doi.org/10.1007/s00063-010-1098-3","url":null,"abstract":"","PeriodicalId":18420,"journal":{"name":"Medizinische Klinik","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78360368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Journal Club","authors":"Robert W. Gruber, M. Schmuth","doi":"10.1007/s00063-009-1169-5","DOIUrl":"https://doi.org/10.1007/s00063-009-1169-5","url":null,"abstract":"","PeriodicalId":18420,"journal":{"name":"Medizinische Klinik","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89627686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Medizinische KlinikPub Date : 2010-12-01Epub Date: 2011-01-16DOI: 10.1007/s00063-010-1154-z
Christoph T Baltin, Christina Smaczny, Thomas O Wagner
{"title":"[Drug treatment of cystic fibrosis - cost patterns and savings potential for outpatient treatment].","authors":"Christoph T Baltin, Christina Smaczny, Thomas O Wagner","doi":"10.1007/s00063-010-1154-z","DOIUrl":"https://doi.org/10.1007/s00063-010-1154-z","url":null,"abstract":"<p><strong>Background and purpose: </strong>Drug treatment of cystic fibrosis (CF) is associated with significant costs. To help ensure sustainable care, this study assesses the costs associated with outpatient treatment of adult CF patients in Germany. It identifies main cost drivers, evaluates the potential for cost savings from \"aut idem\" substitution and presents a projection of lifelong medication costs.</p><p><strong>Methods: </strong>The analysis is based on a complete set of prescriptions for adult CF patients from the outpatient clinic of the university hospital of Frankfurt am Main during 2007 (n = 124 patients). Annual treatment costs were calculated on the basis of the \"Rote Liste\", while the potential for cost savings from \"aut idem\" drug substitution was obtained through ABDATA Pharma Data Service.</p><p><strong>Results: </strong>The annual outpatient drug costs for an adult patient with CF averages € 17,219 (n = 124), which increases to € 21,782 if i.v. therapies are included. With an average life expectancy at birth of 39.7 years, total lifetime drug treatment costs amount to € 824,159 (reference year 2007, inflation rate 2.7%, 3% discount rate). \"Aut idem\" substitution with cheaper drugs could reduce pharmaceutical expenditures by 4.1%.</p><p><strong>Conclusion: </strong>Our results confirm the costly nature of drug treatment for CF patients, both on an annual and in particular on a lifelong basis. At the same time, the potential for cost savings through \"aut idem\" substitution with cheaper drugs remains limited. The added transparency around a small set of costdriving drugs, which is offered in this study, represents a solid contribution to assess treatment choices and financing options to help secure adequate yet sustainable care for CF patients.</p>","PeriodicalId":18420,"journal":{"name":"Medizinische Klinik","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00063-010-1154-z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29604786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Medizinische KlinikPub Date : 2010-12-01Epub Date: 2011-01-16DOI: 10.1007/s00063-010-1150-3
Sven Süfke, Hasib Djonlagić, Thomas Kibbel
{"title":"[Impairment of cardiac autonomic nervous system and incidence of arrhythmias in severe hyperglycemia].","authors":"Sven Süfke, Hasib Djonlagić, Thomas Kibbel","doi":"10.1007/s00063-010-1150-3","DOIUrl":"https://doi.org/10.1007/s00063-010-1150-3","url":null,"abstract":"<p><strong>Background and purpose: </strong>Deterioration of cardiac autonomic nervous system in diabetics is associated with increased cardiac and arrhythmogenic mortality. Therefore, the present study engaged in the question how heart rate variability is acutely changed in diabetic ketoacidosis or hyperglycemic hyperosmolar syndrome. Moreover was evaluated how blood pressure, heart rate and incidence of arrhythmias can be explained by figures of heart rate variability.</p><p><strong>Patients and methods: </strong>In a prospective observation of time course we investigated in 4 years consecutively 12 intensive care patients with DKA and 2 with HHS (10 male, 4 female, 19-62 years, initial plasma glucose 404-1192 mg/dl). All patients received a standardized treatment to international current guidelines. In addition to hemodynamic and clinical-chemical monitoring HRV analysis was performed continuously for at least 48 hours. Simultaneously, we determined supraventricular and ventricular arrhythmic episodes.</p><p><strong>Results: </strong>HRV was diminished over the whole spectrum in dependence on blood glucose concentration. Thus, sympathovagal balance (LF/HF ratio) was initially sympathetic predominated in blood glucose levels < 600 mg/dl (relatively prevailing LF power) and vagal predominated in blood glucose levels > 600 mg/dl (relatively prevailing HF power). In correlation analysis of HRV parameters with blood glucose rS-coefficients from -0.934 to -0.821 were achieved (p < 0.001). Further, the initial mean blood pressure correlated with the LF/HF ratio in HRV minimum (rS = 0.711, p = 0.004). The initial heart rate in relation to assumed intrinsic frequency correlated with minimal found Total Power (rS = -0.656, p = 0.011). In the period of whole 48 hours, more arrhythmic events occurred in consequence to initial glucose levels (rS = 0.693, p = 0.006). But the maximum of arrhythmic episodes was usually later ascertained than the minimum of HRV (p < 0.001). At the time of each arrhythmic maximum the sympathovagal balance (LF/HF) showed no uniform figures. Only similar in all cases was that the LF/HF ratio was found either > 4 or < 1.</p><p><strong>Conclusion: </strong>Clinical complications in high glucose levels must be seen in the context of a nearly complete blockade of sympathetic and parasympathetic activity. Basically to extreme autonomic restriction, sympathetic and vagal predominance can change rapidly into each other. This retarded vulnerable predisposition may declare the arrhythmic potential. An important progress in the monitoring of patients could be achieved by implementation of a continuous HRV measurement because hereby the actual risk potential can be ascertained timely and reliably.</p>","PeriodicalId":18420,"journal":{"name":"Medizinische Klinik","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00063-010-1150-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29603764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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