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Steinfeldt T.,Universitatsklinikum Giessen und Marburg
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie | Year: 2015

Abstract Regional anaesthesia has significant advantages compared to general anaesthesia with an opiate-based postoperative analgesia in injuries of the upper extremity. Severe pain may be considered a risk factor for the development of chronic postoperative pain syndromes in adults and children. Depending on the anticipated postoperative pain level, a catheter procedure should be used. Fractures of the upper extremity are common and may also be associated with seemingly minor injuries with a high postoperative pain level. Nerve damage can be caused mainly by traumatic fractures, or iatrogenically during surgical procedures. Reduced possible neurological evaluability should not prevent the excellent pain control which regional anesthesia can provide. Since the brachial plexus is predominantly responsible for the sensory innervation of the entire upper extremity, therefore all known block techniques in regional anaesthesia apply. Since the introduction of ultrasound in regional anaesthesia (USGRA), older methods like the supraclavicular approach, which were previously banned due to high complication rates, are now being rediscovered. Both new and old blockade methods are much more effective and safe with ultrasound support because of the rapid visualization of the anatomy and needle. © Georg Thieme Verlag Stuttgart.

Klaus D.,Eh. Medizinische Klinik des Klinikums Dortmund | Hoyer J.,Universitatsklinikum Giessen und Marburg
Deutsches Arzteblatt | Year: 2010

Background: Restricting the dietary intake of sodium chloride is associated with a reduction of the arterial blood pressure by approxi mately 4/2 mm Hg in hypertensive patients and by approximately 1/0.6 mm Hg in normotensive persons. As the cardiovascular risk is known to rise steadily with systolic blood pressure values starting from 115 mm Hg, lowering the mean blood pressure of the general population by dietary salt restriction would seem to be a practicable form of primary prevention of cardiovascular disease. Method: Selective literature search and review. Results: Multiple studies have shown dietary salt restriction to be associated with lower cardiovascular morbidity and mortality. The reduction of adjusted relative risk in controlled observational studies ranges from 25% over 15 years to 41% over three years. Conclusion: On the basis of the available studies, it seems likely that a moderate lowering of the daily intake of sodium chloride by the general population from 8 to 12 grams per day (the current value) to 5 to 6 grams per day would be a useful public health measure, with economic benefits as well. The potential risks for certain groups of individuals are foreseeable and controllable. A general reduction of dietary salt intake can only be achieved by reducing the sodium chloride content of in dustrially processed foods, as these account for 75% to 80% of the sodium chloride consumed daily. Aside from a general reduction of dietary salt intake, further important primary prevention measures for the general population include changes in lifestyle and in dietary habits.

Stockley R.A.,Lung Investigation Unit | Miravitlles M.,Hospital Universitari Vall dHebron | Vogelmeier C.,Universitatsklinikum Giessen und Marburg
Orphanet Journal of Rare Diseases | Year: 2013

Background: Intravenous augmentation therapy is the only specific treatment available for emphysema associated with alpha-1 antitrypsin deficiency. Despite large observational studies and limited interventional studies there remains controversy about the efficacy of this treatment due to the impracticality of conducting adequately powered studies to evaluate the rate of decline in lung function, due to the low prevalence and the slow progression of the disease. However, measurement of lung density by computed tomography is a more specific and sensitive marker of the evolution of emphysema and two small placebo-controlled clinical trials have provided evidence supporting a reduction in the rate of decline in lung density with augmentation therapy. The problem. Where augmentation therapy has become available there has been little consideration of a structured approach to therapy which is often introduced on the basis of functional impairment at diagnosis. Data from registries have shown a great variability in the evolution of lung disease according to patient acquisition and the presence of recognised risk factors. Avoidance of risk factors may, in many cases, stabilise the disease. Since augmentation therapy itself will at best preserve the presenting level of lung damage yet require intravenous administration for life with associated costs, identification of patients at risk of continued rapid or long term progression is essential to select those for whom this treatment can be most appropriate and hence generally more cost-effective. This represents a major reconsideration of the current practice in order to develop a consistent approach to management world wide. Purpose of this review. The current review assesses the evidence for efficacy of augmentation therapy and considers how the combination of age, physiological impairment, exacerbation history and rate of decline in spirometry and other measures of emphysema may be used to improve therapeutic decision making, until a reliable predictive biomarker of the evolution of lung impairment can be identified. In addition, individual pharmacokinetic studies may permit the selection of the best regimen of administration for those who need it. Summary. The rarity and variable characteristics of the disease imply the need for an individualised approach to therapy in specialised centres with sufficient experience to apply a systematic approach to monitoring and management. © 2013 Stockley et al.; licensee BioMed Central Ltd.

Steinfeldt T.,Universitatsklinikum Giessen und Marburg
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie | Year: 2012

Permanent nerve injury as a complication of peripheral regional anaesthesia is fortunately rare with an estimated incidence of 0,03%. However, transient neurological symptoms are more frequent with an occurrence of 3-8%. The pathophysiology and etiology of nerve injury depends on a number of different factors. The needle-nerve trauma, cytotoxicity of local anaesthetics, patient factors (i.e. morbidity) and factors which are related to surgical interventions should be considered. Regarding pathophysiology, trauma-related inflammation should be acknowledged as an important interference during nerve recovery. Needle-nerve contacts, nerve perforation and local cytotoxicity of local anaesthetics should be reduced to a minimum by application of nerve stimulation, ultrasound and an adequate dosage of local anaesthetics with less locotoxicity.

Vestbo J.,University of Southern Denmark | Vestbo J.,University of Manchester | Vogelmeier C.,Universitatsklinikum Giessen und Marburg | Small M.,REAL WORLD | Higgins V.,REAL WORLD
Respiratory Medicine | Year: 2014

Study objectives The aim of this analysis was to understand the implications of the GOLD 2011 multidimensional system for the assessment and management of COPD, using data from a real-world observational study. Methods Data were drawn from the Adelphi Respiratory Disease Specific Programme, a cross-sectional survey of consulting patients in five European countries and in the US undertaken between June and September 2011. Patients were classified using both the GOLD 2010 and revised GOLD 2011 criteria, and profiled with regards to demographics, disease characteristics and treatment patterns. Results Information on 3813 COPD patients was collected. Disease characteristics showed a general tendency to worsen in parallel with worsening of symptoms. When comparing dual versus single risk criteria, the inclusion of exacerbation history resulted in an increase in the number of patients in high risk groups. The highest proportions of patients receiving inhaled corticosteroids (ICS) were in group D. However, a considerable proportion of patients in low risk groups were receiving ICS/long-acting β2 agonists. Conclusions Our analysis confirmed the relationship between higher symptomatic burden, increased airflow limitation and exacerbation, and further illustrated the importance of including exacerbation history in the assessment of COPD to identify patients at high risk. As based on data from current clinical practice, this study also highlighted the frequent and potentially inappropriate use of ICS and bronchodilators in patients at low risk of experiencing exacerbations. © 2014 Elsevier Ltd. All rights reserved.

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