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Krefeld, Germany

Kroger K.,HELIOS Klinikum Krefeld GmbH | Gareis R.,Karl Olga Krankenhaus
Medizinische Welt | Year: 2013

The current literature divides the peripheral arterial disease (PAD) in a prognostically favourable stage of the stable intermittent claudication and in a prognostically unfavourable stage of chronic critical ischemia (CCI). Reducing the high cardiovascular morbidity and mortality by secondary prevention is the most important step in PAD patients. The specific treatment of claudication is increasingly dominated by interventional techniques. Controlled exercise training in PAD is still an established treatment strategy and may be supported by the vasoactive drugs Naftidrofuryl or Cilostazol. Specific treatment of CCI is difficult and must be individually planned. Due to the poor prognosis of the limb primarily interventional and surgical revascularization is mandatory. Prostanoids are the only alternative drugs with some benefit. To preserve the limb all aspects of modern pain management and wound healing are required. © Schattauer 2013. Source

Kroger K.,HELIOS Klinikum Krefeld GmbH | Bohner H.,Chirurgische Abteilung | Pourhassan S.,Praxis Gefasschirurgie
Gefasschirurgie | Year: 2013

The basic aspects in treating deep vein thrombosis (DVT) are immediate anticoagulation and compression. Nowadays the therapy of DVT aims at the patients' safety concerning pulmonary embolism and bleeding, while the removal of the clot is not intended. Important current issues are the following: (1) patients with a high clinical probability of DVT should receive anticoagulation as soon as possible and before the diagnosis has been confirmed. (2) Cessation of anticoagulation should only been performed answering the question "When may I stop anticoagulation?" and not as it was to the question "How long is anticoagulation to be performed?" All patients with DVT remain at increased risk for recurrence for life time. (3) Investigation for thrombophilia can wait until after anticoagulation has been stopped for it does not affect standard therapy. (4) Among the new oral anticoagulants, rivaroxaban is the only one currently approved for DVT therapy, although approval of other substances is likely in the future for positive study results. (5) A mobile patient with acutely diagnosed DVT does not need to be immobilized regardless of the extent of DVT. However, it is unclear when an immobile patient with acutely diagnoses DVT can be mobilized. © 2013 Springer-Verlag Berlin Heidelberg. Source

Kroger K.,HELIOS Klinikum Krefeld GmbH | Lehmann N.,University of Duisburg - Essen | Moebus S.,University of Duisburg - Essen | Schmermund A.,Cardioangiological Center Bethanien | And 6 more authors.
Vasa - Journal of Vascular Diseases | Year: 2013

Background: On the basis of the Heinz Nixdorf RECALL Study (HNR) we estimated the impact of classical atherosclerotic risk factors on different ankle-brachial-index (ABI) criteria. Patients and methods: In a subgroup of participants (n = 2586) who had normal ABI at baseline ABI measurement was repeated at a 5 years follow-up and 3 diff erent ABIs were defined: "ABI-high" calculated from the higher pressure, "ABI-low" from the lower pressure of both foot arteries of each leg. "Pure- ABI-low" was defined by exclusion of participants with ABI high from those with ABI-low. Mönckebergs Mediacalcinosis (MC) was accepted in case of ABI-high > 1.4 in one leg. Results: According to ABI-high 2 %, to ABI-low 7.8 % and pure-ABI-low 5.8 % of the participants developed peripheral arterial disease (PAD) (ABI < 0.9) and 3.6 % developed MC within the 5 years. Age did not play any role whereas female gender, diabetes mellitus and smoking were associated with an increased relative risk of pathologic ABI-high and ABIlow. Looking at the pure-ABI-low group only, female gender and smoking showed significant associations. None of the analysed risk factors except gender had an impact on the development of MC. Conclusions: Classical risk factors have different impact on incidence of PAD as defined by different ABI criteria. © 2013 Hans Huber Publishers, Hogrefe AG, Bern. Source

Kroger K.,HELIOS Klinikum Krefeld GmbH | Schwertfeger M.,Sanofi S.A. | Pittrow D.,TU Dresden | Diehm C.,University of Heidelberg
International Journal of Clinical Practice | Year: 2010

Background: Studies in the primary care setting are of high interest for assessing the management situation of patients with manifestations of atherothrombosis. Aims: Therefore, we documented diagnostic procedures, characteristics, and management of patients with symptomatic and asymptomatic peripheral arterial disease (PAD). Materials & Methods: Prospective cross-sectional study in primary care practices throughout Germany. Results: A total of 671 patients with newly diagnosed PAD were included (mean age 69.1 years; 62.1% men). Cardiovascular risk factors were highly prevalent in the total PAD group: arterial hypertension in 84.2%, hyperlipidaemia in 75.5%, present smoking in 45.0% and diabetes mellitus in 47.3%. Atherothrombotic comorbidities were also frequent: coronary artery disease in 44.9% and cerebrovascular disease in 28.1%. For confirmation of diagnosis, patients were referred to specialists in 66.9% of cases. Overall, ankle brachial index was measured in 89.0%, and a clinical PAD score assessed in 66.6% (agreement of both measures with Cohen's kappa only, κ = 0.039; p = 0.209). Drug treatment of risk factors (as secondary prophylaxis) in line with current guidelines was reported in a high percentage of patients: 88.6% with any antiplatelet drug, 69.3% with statins, 62.4% with angiotensin converting enzyme inhibitors, 23.5% with AT1 receptor blockers and 43.9% with beta-blockers. Between asymptomatic and symptomatic PAD, differences in the risk factor/comorbidity profiles were small; however, the latter group received intensified treatment. Conclusion: Our findings confirm that patients with PAD pose a substantial challenge to physicians because of their high number of comorbidities. Compared with previous studies, management of such patients appears to have improved. © 2010 Blackwell Publishing Ltd. Source

Kroger K.,HELIOS Klinikum Krefeld GmbH | Babadagi-Hardt Z.,Kranken und Altenpflege GmbH | Fitzler K.,Praxis fur Allgemeinmedizin | Senge H.,Pflegeakademie Niederrhein
Hygiene + Medizin | Year: 2015

In Germany, the politics try to regulate methicillin-resistant Staphylococcus aureus (MRSA) decolonisation in private households by law. However, the applicable regulations only pertain to patients who are officially assigned a level of care by the German statutory nursing care insurance, who suffer from chronic wounds, who undergo dialysis or have an indwelling catheter. However, responsibilities and cost absorption have not yet been clearly defined. This paper describes the current state of implementation and financing of MRSA decolonisation in ambulatory care in Germany. Source

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