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Siegen, Germany

Lollgen H.,Innere Medizin
Herzschrittmachertherapie und Elektrophysiologie | Year: 2015

Introduction: There has been a long standing controversy on the role of a resting electrocardiogram (ECG) in the preparticipation examination of athletes, as well as in children and adolescents, in leisure time and competitive athletes. Besides other arguments, this was due to the limited validity, which led to false positive and false negative findings. Methods: Recent studies from different research groups yielded a significant improvement in establishing ECG criteria in athletes to discriminate normal from abnormal or pathological findings in athletes. This is additionally supported and improved by a software-based ECG device considering the new Seattle criteria. These new criteria from the Seattle conference reliably discriminate normal from abnormal findings. Frequent ECG findings in athletes, especially in those engaged in endurance sports are sinus bradycardia, atrioventricular (AV) block and signs of left ventricular hypertrophy. Results: Abnormal findings are related to structural left ventricular alterations due to cardiomyopathy, mainly hypertrophic with or without outflow tract obstruction, arrhythmogenic right ventricular cardiomyopathy (ARVC) and dilated cardiomyopathy. The ECG findings suggestive of electrical conductance disorders are observed in channelopathies, Wolff-Parkinson-White (WPW) syndrome supraventricular arrhythmias or disturbances of cardiac conduction. The main diseases are long or short QT syndrome, Brugada syndrome and catecholaminergic polymorphic ventricular tachycardia. Atrial fibrillation, mostly paroxysmal, is also now more frequently observed especially in middle aged endurance athletes. Conclusion: Interpretation of ECG in young and older athletes requires in-depth knowledge in cardiology and sports medicine. The interpretation can only be carried out by considering medical history, clinical examination and ethnicity. Profound and long-term experience of athlete’s ECG interpretation is required to protect athletes and to prevent cardiac emergencies. © 2015, Springer-Verlag Berlin Heidelberg.

Submucosal tumors of stomach and esophagus are often detected incidentally during endoscopy and further characterized by endoscopic ultrasonography. After risk estimation such submucosal tumors are either controlled by watchful waiting or surgically resected. Nevertheless, symptomatic submucosal tumors should be treated. Endoscopic submucosal excavation (ESE) and submucosal tunneling endoscopic resection (STER) may represent an alternative non-surgical therapeutic option. Two cases of complete endoscopic resection of symptomatic submucosal tumors are reported: a small gastrointestinal stroma tumor (GIST) of the antrum and a 12 cm long esophageal lipoma. For selected cases, ESE of symptomatic submucosal tumors of stomach and esophagus represents a useful alternative compared to surgical removal particularly if mass is located in antrum or corpus, sized < 20 mm and clearly defined by endoscopic ultrasonography. © Georg Thieme Verlag KG Stuttgart · New York.

The incidence of in-flight medical emergencies (IMEs) on board commercial aircraft is increasing annually due to the rising numbers of passengers, increasing average age, and development of ul tra-high capacity aircraft. Since systematic studies are not available, the number of IMEs in com mercial air traffic is difficult to estimate. In general one should expect 0.25-1 IMEs per 10,000 pas sengers transported. The majority of events turn out to be of a relatively harmless nature. A possi ble life-threatening situation may be present in 10% of cases. The vast majority of IMEs consists of syncopal episodes while a true cardiologic condition is found in 6% of cases. For enhanced under standing of the pathophysiologic fundamentals and adapted strategies for treatment in the aviation setting, this article describes the determining factors of altitude physiology, organizational and le gal circumstances of in-flight medical response, organizational preventive measures, as well as ap propriate medical emergency equipment of selected airlines. This information may be used to de velop optimal strategies for treatment of selected cardiologic conditions in airliners. © Springer-Verlag 2011.

Schmidt W.A.,Innere Medizin
Aktuelle Rheumatologie | Year: 2014

In polymyalgia rheumatica imaging techniques show inflammation in shoulders and hips as well as in paravertebral regions. Positron emission tomography and magnetic resonance imaging provide a good overview. However, in clinical practice ultrasound is more commonly used because of availability and cost issues. New classification criteria are more specific when including an algorithm with ultrasound. In addition, ultrasound of temporal and axillary arteries, if necessary with other imaging modalities, should be performed for diagnosing or excluding concomitant giant cell arteritis. © Georg Thieme Verlag KG Stuttgart · New York.

Objective: Data were collected concerning the patient satisfaction in the treatment of chronic constipation with laxatives. Method: An internet-based survey of female patients with chronic constipation and an online enquiry addressed to gastroenterologists in Germany were carried out. Results: 492 female patients and 104 physicians participated in the survey. Only 20 % of the patients were currently consuming laxatives. Around one-third of those not using laxatives have had unsatisfactory experiences. Only 32 % of the participants currently taking laxatives were totally satisfied with their drugs. As a general rule several different preparations were tried. The laxatives most closely associated with satisfied patients were bisacodyl and sodium picosulfate, followed by macrogol. The main reasons for dissatisfaction were an insufficient relief of the constipation and a bloated feeling. The majority of the participants expressed an interest in new drugs for the treatment of constipation. The participating physicians stated that they saw several female patients per week who were not satisfied with their constipation treatment, but probably overestimate the proportion. Conclusion: The present survey shows that the majority of women suffering from constipation do not take laxatives and also that about half of them were not satisfied with the agents tried. Only about one-third of the chronic users were totally satisfied. Thus, there is a clear need for new laxatives. © Georg Thieme Verlag KG Stuttgart · New York.

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