Therapeutische Umschau. Revue thérapeutique
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This review describes some natural proteins, which can be employed, either as factor concentrates derived from human plasma or as recombinant drug, to modulate the coagulation system. I will address some biochemical characteristics and the physiological role of von Willebrand factor, the coagulation factors of the extrinsic and intrinsic pathways, and the physiological anticoagulant protein C. ⋯ In particular, I will address some treatment topics of general medical interest, such as the treatment of massive bleeding, the correction of the coagulopathy induced by vitamin K-antagonists in patients with cerebral haemorrhage, and of the coagulopathy of meningococcemia. Finally, I will describe some properties and practical clinical applications of the recombinant anticoagulans lepirudin and bivalirudin, which are derived from hirudin, the natural anticoagulant of the medical leech.
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Biosimilars are biological medicinal products referring to an existing biological originator product and submitted to regulatory authorities formarketing authorization by an independent applicant after the patent has expired. The European Medicines Agency (EMA) has issued overarching and specific guidelines that should be fulfilled in order to receive approval as biosimilar. ⋯ Points to consider when switching from the innovator product to a biosimilar, or from one biosimilar to another, are reported. INN-naming, labelling, pharmacovigilance issues, interchangeability, and substitution of biosimilars are still a matter of discussion.
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Neuropathic pain arises from damage, or pathological change, in the peripheral or central nervous system. As such, the term neuropathic pain represents a varying set of symptoms rather than a single diagnosis. There is no diagnostic gold standard for neuropathic pain and so making a diagnosis is based on clinical judgement. ⋯ The aim is to identify altered sensation in the painful area and so responses should be compared with a non-painful adjacent or contra-lateral area. A combination of characteristic painful symptoms in an area of altered sensation on bedside testing is usually enough to make a diagnosis of neuropathic pain. When doubt arises, more detailed examination using Quantitative Sensory Testing or conventional electrophysiology can be helpful.
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When conservative treatment modalities provide inadequate relief, interventional techniques play an important role in the management of chronic pain patients. They are performed in diagnostic or therapeutic intention (or both) and either directly target the pain generating anatomic structure (e.g. intraarticular joint injections) or the neural structures which are thought to mediate the experience of pain (e.g. facet joint nerve blocks, spinal cord stimulation). ⋯ CT- or Ultrasound-guided techniques are also performed. This article is an overview of the indications and results of the most commonly performed interventional techniques used in chronic pain treatment with focus on spinal interventional procedures.
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This is an overview of development, aspects of content, importance and evidence of multidisciplinary rehabilitation programs. In subacute and chronic pain, bio-psycho-social factors act together in a complex manner. The importance of multi-modal treatment programs will, thus, be focused. However, present study data show only few positive effects in this field.