Bhidayasiri R.,Chulalongkorn University |
Bhidayasiri R.,University of California at Los Angeles |
Reichmann H.,Universitatsklinikum Carl Gustav Carus
Journal of Neural Transmission | Year: 2013
As there are no definite diagnostic tests or reliable biomarkers for Parkinson disease (PD), its diagnosis still relies on the presence of a combination of cardinal motor features, along with the exclusion of other causes of Parkinsonism and the presence of some of supportive features. To date, several diagnostic criteria have been developed for different purposes through expert opinions or comprehensive review of the literature. However, none of them are without limitations. In this article, we review different diagnostic criteria for PD which have been published in the English medical literature, highlighting specific limitations and pitfalls. With considerable progress in the understanding of PD, particularly in a view of diverse clinical symptomatology and its evolution, it will be difficult to establish a single criterion that is capable of capturing all cases at different disease stages. Rather, we should aim to develop a set of criteria which include a consensus on clinical gold standard or reliable biomarkers at different levels of diagnostic certainty for different purposes. Despite a more refined set of criteria that may aid in the recognition of PD, the accuracy of its diagnosis still largely depends on the observational skills and clinical sensitivity of the treating physician. © 2013 Springer-Verlag Wien.
Rammelt S.,University Hospital Carl Gustav Garus |
Rammelt S.,Universitatsklinikum Carl Gustav Carus |
Zwipp H.,University Hospital Carl Gustav Garus
International Orthopaedics | Year: 2013
Hindfoot malunions after fractures of the talus and calcaneus lead to severe disability and pain. Corrective osteotomies and arthrodeses aim at functional rehabilitation and reduction of pain resulting from post-traumatic arthritis, eccentric loading and impingement due to hindfoot malunion. Preoperative analysis should include the three-dimensional outline of the malunion, the presence of post-traumatic arthritis, non-union, or infection, the extent of any avascular necrosis or comorbidities. In properly selected, compliant patients with intact cartilage cover little or no, AVN, and adequate bone quality, a corrective joint-preserving osteotomy with secondary internal fixation may be carried out. In the majority of cases, realignment is augmented by arthrodesis for post-traumatic arthritis. Fusion is restricted to the affected joint(s) to minimise loss of function. Correction of the malunion is achieved by asymmetric joint resection, distraction and structural bone grafting with corrective osteotomies for severe axial malalignment. Bone grafting is also needed after resection of a fibrous non-union, sclerotic or necrotic bone. Numerous clinical studies have shown substantial functional improvement and high subjective satisfaction rates from pain reduction after corrective osteotomies and fusions for post-traumatic hindfoot malalignment. This article reviews the indications, techniques and results of corrective surgery after talar and calcaneal malunions and nonunions based on an easy-to-use classification. © 2013 Springer-Verlag Berlin Heidelberg.
Fetomaternal pharmacology: Anesthesiological approach in surgical interventions during pregnancy [Fetomaternale Pharmakologie: Anästhesiologisches Vorgehen bei chirurgischen Eingriffen in der Schwangerschaft]
V. Neindorff M.,Universitatsklinikum Carl Gustav Carus
Anaesthesist | Year: 2010
The choice of anesthesia procedure for surgical interventions in pregnancy is particularly important considering the responsibility for the unborn child and the patient. Uncertainties with the treatment of this patient group and lacking routine are common. Nevertheless, 0.5-2% of pregnant women require non-gynecological surgery. In this respect knowledge about the interrelationship between physiological changes and pharmacological effects with potentially negative impact for the embryo, fetus or neonate is of particular importance. In this article the physiology relevant for anesthesia during pregnancy is discussed and commonly used drugs are reviewed to enable anesthesiologists to formulate concepts to preclude adverse effects for the mother and child and to provide an adequate therapy. © 2010 Springer-Verlag.
Rollig C.,Universitatsklinikum Carl Gustav Carus
Urologe - Ausgabe A | Year: 2011
Current limitations in health services research (HRS) in Germany are caused by issues of research funding, interest-driven commissioning, and restricted research conditions due to the structural and organizational context of the German health system. Methodological challenges arise in the validation and generalizability of routine data. There are substantial risks of bias in non-controlled interventional studies. In order to overcome these limitations and to improve the standing and quality of HRS in Germany, political opinion leaders and stakeholders need to be provided with continuous information on the need and potential of HRS. Methodological standards are needed for the evaluation of routine data, and principles of evidence-based medicine must be applied in all research addressing the effectiveness of health care interventions. © 2011 Springer-Verlag.
Schwarz P.E.,Universitatsklinikum Carl Gustav Carus
Diabetologe | Year: 2013
The aims of diabetes prevention are reduction of visceral obesity at the physiological level, the implementation of prevention managers at the structural level and realization of measures for primary prevention of diabetes in the daily routine at the conceptual level. The IMAGE toolkit for diabetes prevention is one of the products of a European study group of the IMAGE project. It is based on IMAGE evidence-based guidelines and the IMAGE training curriculum for prevention managers. It includes practical examples and worksheets which substantially facilitate the implementation of a prevention program and can be directly transferred from the toolkit. After a European curriculum for prevention managers was developed within the framework of the IMAGE project, it could be implemented in Germany over the previous 2 years and intensively evaluated. Since the beginning of 2013 a German curriculum for the further training to prevention manager is available and can currently be appreciated in Dresden. Various healthcare insurances rely on this model and intend to increase the use of preventive measures by the linking of prevention and healthcare treatment. The check-up 35+ can be such a measure. This article reports on these and other elements of prevention. © 2013 Springer-Verlag Berlin Heidelberg.
Rammelt S.,Universitatsklinikum Carl Gustav Carus |
Grass R.,Universitatsklinikum Carl Gustav Carus |
Zwipp H.,Universitatsklinikum Carl Gustav Carus
Journal of Orthopaedic Trauma | Year: 2013
Displaced intra-articular fractures of the calcaneus can lead to severe pain and disability if not treated appropriately. Failure to treat may require fusion of the subtalar joint, supplemented by additional osteotomies. Occasionally, these fractures are seen after the fracture has just healed, and the decision to treat can be a difficult one. Over the course of 10 years, 5 patients were treated with a corrective osteotomy along the primary fracture line, joint realignment, soft tissue balancing, and secondary internal fixation at a mean of 2.9 months after the injury. At a mean of 4.1 years (range, 2-10 years), all patients were satisfied with their result. Two patients underwent implant removal and subtalar arthrolysis 1 year after correction. No secondary fusions were required. The mean American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score improved significantly from 19.0 preoperatively to 81.2 at follow-up (P < 0.001). The radiographic parameters (the Böhler angle, talocalcaneal height, and heel width) were substantially corrected. A joint-preserving osteotomy with axial realignment can be a treatment option for malunited intra-articular calcaneal fractures encountered early on, before the development of subtalar arthrosis. Copyright © 2013 by Lippincott Williams & Wilkins.
Folprecht G.,Universitatsklinikum Carl Gustav Carus
Deutsche Medizinische Wochenschrift | Year: 2013
The treatment of patients with colorectal liver metastases has been changed with the improved surgical techniques and the increasingly effective systemic therapy. It represents therefore a model for the therapy in other situations with limited metastatic disease. Because the overall survival is associated with metastasectomy, the treatment of patients with liver metastases should be discussed in a team with experienced liver surgeons. Options to increase or to achieve resectability are especially "conversiono" chemotherapy, but also i. e. portal vein embolization and two step resections. © Georg Thieme Verlag KG, Stuttgart.
Platzbecker U.,Universitatsklinikum Carl Gustav Carus
Seminars in Hematology | Year: 2012
Despite new developments in innovative and potentially targeted drugs like hypomethylating agents (HMA), allogeneic hematopoietic stem cell transplantation (HCT) is still the only potentially curative treatment option for patients with myelodysplastic syndromes (MDS). Improvements in donor selection and supportive care, as well as the introduction of reduced-intensity conditioning, have improved the feasibility of this approach by reducing early mortality. As a result, the number of allogeneic HCTs performed in MDS patients mainly above the age of 60 years has significantly increased over the last decade. However, the main drawbacks of this procedure, including graft-versus-host disease (GVHD) and hematologic relapse, remain a challenge in daily patient care. Thus, optimization of the pretransplant remission status and post-transplant outcome, eg, by new GVHD prophylaxis regimens or pharmacological maintenance or pre-emptive therapy of minimal residual disease to prevent relapse, is an important goal of current clinical research. There is an urgent need for prospective randomized trials to identify the subgroup of MDS patients who could achieve a better long-term disease control by allogeneic HCT compared to treatment with current standards of care, including HMA. © 2012 Elsevier Inc.
Medical nutrition therapy in patients with type 2 diabetes mellitus - Much more than providing energy and essential nutrients [Ernährungsmedizin bei Typ-2-Diabetes - Die aktuelle Studienlage - Weit mehr als eine Versorgung des Körpers mit Nährstoffen]
Weser G.,Universitatsklinikum Carl Gustav Carus
Diabetes Aktuell | Year: 2015
The "medical nutrition therapy" in patients with type 2 diabetes mellitus is much more than providing energy and all essential nutrients. Considering the complex dysregulation of the glucose metabolism in patients with type 2 diabetes mellitus it rather is a valuable strategy to avoid uncontrolled blood glucose - besides the pharmacological treatment. Above all fiber intake may still be one of the most important approaches to smooth blood glucose curves and to delay gastric emptying. Additionally it is arguable, whether current recommendations on restricted fruit intake for patients with type 2 diabetes mellitus are still justified and whether this area may present a underutilised source for an increased intake of fibers, vitamins and phytochemicals. Micronutrient deficiencies are common in people with diabetes type 2 mellitus as well, which often is associated with the discussion about the benefits and risks of supplementation. Current studies related to the supplementation of chromium show how differentially the evaluation needs to be done in that case. © 2015, Georg Thieme Verlag. All rights reserved.
Zwipp H.,Universitatsklinikum Carl Gustav Carus
Trauma und Berufskrankheit | Year: 2010
Fractures of the talus, calcaneus and tarsal are associated with a significant reduction in earning capacity. Their diagnosis and therapy, therefore, are of particular importance. In order to avoid overlooking these injuries, well-lit and standardised X-rays in three defined planes are required; in the case of even slight doubt, thin-slice computer tomography in two planes is necessary. Talus fractures are anatomically set, central talus fractures are treated using stable screw fixation, while peripheral fractures are treated using mini-screw fixation. Calcaneus fractures are treated using anatomical and stable surgical internal fixation, while second and third degree open fractures can often only be covered using free flaps. Tarsal fractures of the Chopart and Lisfranc joints remain today the most frequently overlooked or insufficiently treated foot fractures. They usually require an open procedure with anatomic repositioning and fixation; in the case of multiple fractures, anatomic and angle-stable titanium implants are required. © Springer Medizin Verlag 2009.