Die Gichtarthritis: Pathogenese, Diagnostik und Behandlung

2020 ◽  
Vol 145 (14) ◽  
pp. 991-1005
Author(s):  
Gernot Keyßer
Keyword(s):  
General Practitioner ◽  
Gouty Arthritis ◽  
Initial Presentation ◽  
Chronic Gout ◽  
Current State ◽  
Therapeutic Measures

AbstractThe initial presentation of gouty arthritis can be a dramatic event. Chronic gout may lead to the destruction of joints, invalidity and increased mortality. The incidence of this disorder is high, despite effective therapeutic measures. The treatment of refractory cases may be a challenge to the general practitioner and the specialist alike. The article presented here summarizes the current state of diagnostics and treatment of acute and chronic gout.

scholarly journals The Study of Cognitive Functioning in the Cardiac Surgery Clinic: Methodology and Promising Areas of Research

2019 ◽  
Vol 8 (4) ◽  
pp. 1-22
Author(s):  
D.A. Eremina
Keyword(s):  
Cardiac Surgery ◽  
Cognitive Functioning ◽  
Brain Activity ◽  
Cognitive Activity ◽  
Current State ◽  
Therapeutic Measures ◽  
Treatment Analysis ◽  
Methodological Approaches ◽  
State Of Research ◽  
Somatic Diseases

Using the study of cognitive functioning in patients with cardiovascular diseases paper discusses problems of changes in brain activity in patients with somatic diseases related to a main pathology and resulting from surgical treatment. Analysis of the current state of research in this area provided. Based on this analysis, promising areas for further research, such as development of methods for predicting an occurrence and development of cognitive impairment, organization of timely diagnosis of changes in cognitive activity, development of preventive and therapeutic measures, exploring the value of cognitive functioning for treatment adherence. In addition, paper discusses the methodological approaches and main organizational aspects of conducting such studies and indicates the most relevant methods for studying cognitive functioning in a cardiac surgery clinic.

scholarly journals Reduction in Late Diagnosis of Colorectal Cancer Following Introduction of a Specialist Colorectal Surgery Service

2006 ◽  
Vol 88 (6) ◽  
pp. 562-565 ◽  
Author(s):  
Amanda L Thorne ◽  
Stuart J Mercer ◽  
Guy JC Harris ◽  
Jay NL Simson
Keyword(s):  
Colorectal Cancer ◽  
General Practitioner ◽  
Colorectal Surgery ◽  
General Hospital ◽  
False Negative ◽  
District General Hospital ◽  
Late Diagnosis ◽  
Initial Presentation ◽  
Barium Studies ◽  
Tumour Biopsy

INTRODUCTION An audit of patients presenting with colorectal cancer to our district general hospital during a 2-year period from November 1994 found that 12.1% of cases were diagnosed later than 6 months after initial presentation to a physician. This audit was repeated for a 2-year period from December 2001, to determine whether the introduction of a specialist coloproctology surgery service had led to a reduction in late diagnosis of colorectal cancer. PATIENTS AND METHODS Case notes were reviewed of all patients presenting with colorectal cancer between December 2001 and November 2003. Late diagnosis was defined as diagnosis of colorectal cancer more than 6 months after their first attendance to either their general practitioner or district general hospital. The results were compared with those of the previous study. RESULTS Of a total of 218 patients presenting with colorectal cancer during the study period, 14 (6.4%; 10 men and 4 women) satisfied the criteria for late diagnosis, with the longest delay being 12.5 months. Reasons for late diagnosis were false-negative reporting of barium studies (n = 3), inaccurate tumour biopsy (n = 2), concurrent pathology causing anaemia (n = 4), inappropriate delay in definitive investigation (n = 3), and refusal of investigation by patients (n = 2). CONCLUSIONS There has been a reduction of nearly 50% (12.1% to 6.4%) in the proportion of patients with a late diagnosis of colorectal cancer compared with our previous audit. It is suggested that an important factor in this improvement in diagnosis has been the introduction of a specialist coloproctology surgery service.

Radiographic Bone Damage in Chronic Gout Is Negatively Associated with the Inflammatory Cytokines Soluble Interleukin 6 Receptor and Osteoprotegerin

2010 ◽  
Vol 38 (3) ◽  
pp. 485-491 ◽  
Author(s):  
JUNG-YOON CHOE ◽  
GEON HO LEE ◽  
SEONG-KYU KIM
Keyword(s):  
Inflammatory Cytokines ◽  
Gouty Arthritis ◽  
Fasting Blood Glucose ◽  
Nuclear Factor Κb ◽  
Radiographic Damage ◽  
Negatively Associated ◽  
Chronic Gout ◽  
Damage Indices ◽  
Foot Joints ◽  
Bone Damage

Objective.We investigated the risk factors for radiographic bone damage to foot joints in patients with chronic gout among various patient characteristics and serum inflammatory cytokines such as interleukin 1ß (IL-1ß), IL-6, soluble IL-6 receptor (sIL-6R), osteoprotegerin (OPG), and receptor activator of nuclear factor-κB ligand (RANKL).Methods.Fifty consecutive male patients with gout and 54 age-matched healthy male controls were enrolled. Serum levels of cytokines including IL-1ß, IL-6, sIL-6R, OPG, and RANKL were measured using ELISA. Radiographic damage indices including erosion scores, narrowing scores, and total scores for foot joints were assessed according to a modified Sharp-van der Heijde system.Results.There were significant differences in serum IL-1ß, IL-6, sIL-6R, OPG, and RANKL levels between patients with gout and the controls, after adjustment for confounding factors such as age, body mass index, blood urea nitrogen, creatinine, triglyceride, and fasting blood glucose (p = 0.034 for IL-1ß, p < 0.001 for IL-6, p = 0.040 for sIL-6R, p = 0.002 for OPG, and p = 0.018 for RANKL). Radiographic damage indices (erosion, narrowing, and total scores) were negatively associated with serum sIL-6R and OPG levels in multivariable-adjusted regression analysis. Serum sIL-6R levels in patients without radiographic damage were higher than in those with damage (p = 0.006).Conclusion.Radiographic damage in patients with chronic gouty arthritis was negatively associated with serum sIL-6R and OPG. Further study on the role of inflammatory cytokines in the pathogenesis of radiographic damage in gout is needed.

scholarly journals INTRAABDOMINAL HYPERTENSION SYNDROME: CURRENT STATE OF THE PROBLEM

2020 ◽  
pp. 35-42
Author(s):  
V. A. Samartsev ◽  
V. A. Gavrilov ◽  
B. S. Pushkarev
Keyword(s):  
Abdominal Cavity ◽  
Abdominal Pressure ◽  
Current Trends ◽  
Current State ◽  
Abdominal Hypertension ◽  
Practical Research ◽  
Intraabdominal Hypertension ◽  
Therapeutic Measures ◽  
Methods Of Treatment ◽  
Extensive Surgery

Syndrome of intra-abdominal hypertension (SIAH) is a dangerous complication that can occur in patients with a surgical profile after surgery in the abdominal cavity. Only in the past 25 years has the SIAH been recognized. According to W. Ertel et al., In one third of patients with peritonitis, pancreatic necrosis, injuries of the abdominal cavity and after extensive surgery, there is an increase in intra-abdominal pressure (IAP), while SIAH develops in 5.5% of such patients. Mortality in SIAH is 42–68%. The reason for the development of so many deaths is the presence of diagnostic, preventive and therapeutic measures, as well as differences in the interpretation of terms. Today, much attention is paid to the study of SIAH, official attempts are being made to standardize and define terms and recommended methods of treatment, but this problem needs further study. The review presents data on the current state of the problem, current trends in the diagnosis, prevention and treatment of patients with IAP and SIAH, their use in practical research.

scholarly journals Navigating possible endometriosis in primary care: a qualitative study of GP perspectives

2021 ◽  
pp. BJGP.2021.0030
Author(s):  
Sharon Dixon ◽  
Abigail McNiven ◽  
Amelia Talbot ◽  
Lisa Hinton
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
Qualitative Study ◽  
Wide Spectrum ◽  
Initial Presentation ◽  
Therapeutic Interventions ◽  
Diagnosis And Treatment ◽  
Diagnostic Tools ◽  
Telephone Interviews

Background: Endometriosis affects approximately 10% of women, with well-documented delays between initial presentation with symptoms and diagnosis. In England, women typically seek help first in primary care, making this setting pivotal in women’s pathways to diagnosis and treatment. English General Practitioner (GP) perspectives on managing possible endometriosis have not been previously reported. Aim: To explore what GPs identify as important considerations when caring for women with symptoms that raise the possibility of endometriosis. Design and Setting: English primary care. Method: Semi-structured scenario-based telephone interviews with 42 GPs based around a fictional scenario of a woman presenting to primary care with symptoms suggesting possible endometriosis. Interviews were thematically coded and analysed. Results: Managing possible endometriosis in primary care brings challenges. While knowledge and awareness were pre-requisites for considering endometriosis, other important considerations were raised. Symptoms suggestive of endometriosis are non-specific, making endometriosis one possible consideration of many. GPs move through a diagnostic hierarchy to exclude sinister causes and utilise trials of treatment as both therapeutic interventions and diagnostic tools – processes which take time. An endometriosis label or diagnosis has advantages and risks. GPs reported sharing decisions about investigation and referral whilst holding women’s priorities as pivotal. These conversations were underpinned by their knowledge of uncertainties and unknowns, including the wide spectrum and unpredictability of endometriosis. Conclusion: GPs considerations are more complex than simply lacking awareness. The unknowns surrounding endometriosis matter to GPs. Further research and tailored resources for primary care, where women present with undifferentiated symptoms, are needed.

scholarly journals Where do we come from, where are we now, and where are we going? The Evolution of Collegiate Recovery Science

2018 ◽  
Vol 1 (2) ◽  
pp. 13
Author(s):  
Robert D Ashford ◽  
Austin M Brown ◽  
Thomas Kimball
Keyword(s):  
Initial Presentation ◽  
Large Impact ◽  
Future Directions ◽  
Impact Studies ◽  
Current State ◽  
The Future ◽  
Alumni Survey

Attendees will be provided with a brief history/timeline of collegiate recovery as a field, through the lens of research (with a focus on the explosive growth in knowledge in the last decade). This initial presentation will be followed by a synopsis of the current state of collegiate recovery science, focusing on recent studies in the field (CRP alumni survey; meta-reviews; and any large impact studies published in the last year up to month of the conference). The session will end with a presentation on the directions for the future, making clear calls that not only does the research need to continue and in what suggested ways, but also serving to inspire students to engage in the process as they are our best hope to continue the work in innovative ways we haven't thought of. The current landscape of collegiate recovery research and recovery science overall. Additionally, attendees will be able to describe future directions for this type of inquiry.  

scholarly journals Patients with Diabetes Complicated by Peripheral Artery Disease: the Current State of Knowledge on Physiotherapy Interventions

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Katarzyna Hap ◽  
Karolina Biernat ◽  
Grzegorz Konieczny
Keyword(s):  
Peripheral Artery Disease ◽  
Life Quality ◽  
Vascular Complications ◽  
Complementary Therapy ◽  
Peripheral Artery ◽  
Current State ◽  
Patients With Diabetes ◽  
Therapeutic Measures ◽  
Artery Disease ◽  
Improve Patient

Diabetes mellitus (DM) is one of the major public health problems that account for morbidity, mortality, and disability worldwide. The presence of DM increases the risk of peripheral artery disease (PAD), as well as accelerates its course, making these patients more susceptible to ischemic events and impaired functional status. Unfortunately, alternative treatments for vascular complications in diabetes are poorly researched. Physiotherapy (kinesitherapy combined with different physical therapy agents) in individuals with DM and coexisting PAD may offer an important complementary therapy alternative. Early therapeutic measures can significantly improve patient outcomes, reduce cardiovascular risk, and improve daily life quality. The article provides an update on the current state of knowledge on physiotherapy interventions in the course of DM in patients with coexisting PAD.

Respiratory Insufficiency and Chronic Cor Pulmonale

PEDIATRICS ◽  
1956 ◽  
Vol 18 (1) ◽  
pp. 71-71
Keyword(s):  
Carbon Dioxide ◽  
Respiratory Insufficiency ◽  
Pulmonary Ventilation ◽  
Cor Pulmonale ◽  
Current State ◽  
Congestive Failure ◽  
Low Concentrations ◽  
Therapeutic Measures ◽  
Pathologic Physiology ◽  
Chronic Cor Pulmonale

This is a review of the current state of our knowledge of pulmonary function in relation to cardiac physiology and the effects of pathologic processes in the lungs on these systems. The pathologic physiology, diagnosis and treatment of respiratory insufficiency and chronic cor pulmonale are thoroughly considered. The article is based on observations of chronic pulmonary disease in adults. The findings and recommendations are directly applicable to conditions which occur in childhood, especially in the pulmonary complication of cystic fibrosis of the pancreas. Pediatricians occupied with the care of the latter condition will find this review particularly enlightening. Efforts to relieve cynosis and hypoxia due to disturbed pulmonary ventilation in children with fibrocystic disease of the pancreas by treatment with oxygen are not without hazard. The respiratory centers are usually unresponsive to carbon dioxide and correction of the hypoxemia may lead to hypoventilation and retention of carbon dioxide with ensuing acidosis and death. Oxygen should be administered in low concentrations, intermittently, and only when it seems absolutely necessary. Digitalis has been shown to be beneficial in the treatment of congestive failure when chronic cor pulmonale develops as a complication of respiratory insufficiency. Detailed discussion of other therapeutic measures is provided. The incidence of cor pulmonale in respiratory insufficiency in diseases of childhood will undoubtedly be found to be greater when the techniques of clinical and pathologic examination described in this review are applied.

scholarly journals The collaboration between the cardiologist and general practitioner – the key of post-myocardial infarction management

2015 ◽  
Vol 62 (2) ◽  
pp. 125-129
Author(s):  
Alexandru Scafa-Udrişte ◽  
◽  
Oana Tăutu ◽  
Carmen Zaharescu ◽  
Vlad Bătăilă ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Myocardial Infarction ◽  
General Practitioner ◽  
Therapeutic Strategy ◽  
The Status ◽  
Long Time ◽  
Therapeutic Measures ◽  
The One ◽  
Main Factor

The therapeutic strategy for a discharged patient who suffered a miocardial infarction implies a complexity of therapeutic measures and recommendations that guide the mid- and long-time outcome. A main factor of this process is represented by the thrust the patient has in the physician, physician being the person who prescribes and adjusts the treatment, and decides upon the investigations that need to be done. This is a dinamic process, the status of a patient who suffered a miocardial infarction being able to vary at any time during this evolution, especially in associated pathologies. The patient may be evaluated by multiple doctors, the therapeutic strategy being established by a cardiologist, general practitioner, or a team composed of cardiologist and general practitioner. However, the one who knows this best is the patient. This study is exclusively addressed to the patients (structured as a qestionnaire), future discussion being based on their answers. In this context, following the guideline recommandations concerning monitorization, recovery and the quality of life of the patient suffering from miocardial infarction, best result are obtained when the therapeutic strategy is established by a team formed from cardiologist and general practitioner.

scholarly journals Molecular Biomarkers for Prediction of Neurological Outcome after Sudden Circulatory Arrest (Review)

2018 ◽  
Vol 14 (3) ◽  
pp. 68-81 ◽  
Author(s):  
A. M. Golubev ◽  
A. N. Kuzovlev ◽  
V. V. Antonova ◽  
V. E. Zakharchenko ◽  
M. V. Petrova ◽  
...  
Keyword(s):  
Neurological Outcome ◽  
Clinical Laboratory ◽  
Circulatory Arrest ◽  
Molecular Biomarkers ◽  
Neurological Outcomes ◽  
Current State ◽  
International Data ◽  
Therapeutic Measures ◽  
Instrumental Methods

The purpose of this review of the 81 publications is to discuss the current national and international data on the prediction of neurological outcomes after sudden circulatory arrest (SCA) using molecular biomarkers. The review discusses the current state of the problem of neurological outcomes after a sudden circulatory arrest, the principal therapeutic measures to improve these outcomes and currently available clinical, laboratory, and instrumental methods of diagnosis and prediction of neurological outcomes after a sudden circulatory arrest. 

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