Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete
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A 37-year-old woman twice developed a life-threatening anaphylactic reaction after eating galettes, a special French pancake from Brittany. She had tolerated ordinary pancakes and crepes for many years. ⋯ In contrast to wheat, buckwheat is not a cereal but a gluten-free knot-grass, initially from Asia. Whenever a patient suffers from allergic reactions due to pastries, a buckwheat allergy should be considered.
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Clinical Trial Controlled Clinical Trial
[Antipruritic therapy with the oral opioid receptor antagonist naltrexone. Open, non-placebo controlled administration in 133 patients].
The perception of pruritus is modified by endogenous and exogenous opioids via central opiate receptors and can be suppressed with opioid receptor antagonists. The aim of this investigation was to describe the efficacy and safety of naltrexone, an orally active opiate antagonist, in the treatment of severe, otherwise intractable pruritus of varying origins. ⋯ The oral opiate antagonists may well be an effective, well-tolerated therapy for intractable pruritus in many diseases.
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Progress in cell culture and biomaterial technologies has resulted in commercially available autologous and allogeneic skin substitutes that are composed of keratinocytes and/or fibroblats, in part combined with allogeneic (fibrin) or xenogeneic (collagen, hyaluronan) matrix substances. So far, clinical testing of tissue-engineered products focused on chronic wounds (vascular leg ulcers, diabetic foot ulcers); another major indication, however, is large acute skin defects (burns). During the last decade, partly-controlled clinical trials have been performed with several cultured skin substitutes, studying primarily vascular leg ulcers; a few of these products have been approved for defined indications by the regulatory authorities of various countries. To fulfill regulatory requirements and be eligible for reimbursement, safety as well as cost-effectiveness have to be documented for these novel therapies in contrast to established methods for clearly defined clinical settings; this, in combination with restricted health care resources, is actually hampering the clinical breakthrough of tissue engineering in the treatment of skin wounds, despite undiminished research activities.
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Since January 2004, all German hospitals have been obliged to operate with a new hospital funding system based on DRGs. For the DRG system to serve as a fair basis for reimbursement requires that the dermatologic services be adequately covered in the classification system. The German Dermatologic Society (DDG) in cooperation with the DRG-Research Group of the University Hospital Muenster carried out a DRG evaluation study. Based on these results, suggestions for the adjustment of the G-DRG system were proposed by the DDG in the G-DRG adaptation round for 2004. ⋯ The G-DRG system 2004 will need to be continuously adapted in the field of dermatology. Based on this work, the German Dermatologic Society has made suggestions to be adapted in the G-DRG system 2005 and submitted them to the German DRG Institute.
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Comparative Study
[Current syphilis therapies and serological control. Commentary on the article by M. Hartmann in Hautarzt, Volume 2 (2004)].
Penicillin is currently the drug of choice for therapy of syphilis. Clemizole and procaine penicillin are no longer available. ⋯ Treatment with doxycyline or ceftriaxone is also conceivable. Suitable serological methods are necessary to control the safety of the therapy.