Therapeutische Umschau. Revue thérapeutique
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Substance use disorders (SUD) include substance abuse and dependence as well as acute intoxication, withdrawal, and various psychiatric disorders. In the course of the SUD, severe comorbid disorders and somatic consequences can occur. The treatment of withdrawal symptoms focuses on the relief of immediate symptoms and the prevention of complications. ⋯ There is consistent evidence for methylphenidate in treating cocaine dependence co-occurring with attention-deficit/hyperactivity disorder. For opioid dependence, methadone or buphrenorphine treatment is the pharmacotherapy of first choice. Nicotine replacement therapy, Bupropion and Vareniclin are efficacious in smoking cessation.
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Ingestions of plants rarely lead to life-threatening intoxications. Highly toxic plants, which can cause death, are monkshood (Aconitum sp.), yew (Taxus sp.) and autumn crocus (Colchicum autumnale). Lethal ingestions of monkshood and yew are usually suicides, intoxications with autumn crocus are mostly accidental ingestions of the leaves mistaken for wild garlic (Allium ursinum). ⋯ There exist only two antidotes: Anti-digoxin Fab fragments can be used with cardenolide glycoside-containing plants (Digitalis sp., Oleander). Physostigmine is the antidote for severe anticholinergic symptoms of the CNS. Antibodies against colchicine, having been developed in France, are not available at the moment.
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Caustic injuries of the eye usually occur accidentally and can result in minor eye irritations to total loss of vision. All chemical exposures to the eye require immediate decontamination by copious irrigation with an aqueous solution for at least 15-30 minutes up to two hours in single cases of massive exposure. Tap water is readily available, safe, and effective and, thus, the preferred irrigation fluid. ⋯ Endoscopic dilatation or insertion of intraluminal stents should not be performed within the first 6 weeks. Patients with grade 3b injuries may underwent prompt surgical resection in single cases, even if no perforation is confirmed. Perforation, evolution of a mediastinitis or peritonitis with multi-organ failure are devastating complications with extremely high mortality and warrants immediate surgical treatment.
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With the exception of anticoagulant therapy this article reviews pharmacotherapy for patients with coronary artery disease based on indications, clinical trials and current guidelines. Mechanisms of action, contraindications, and interactions are reviewed in this article. Only an appropriate use of available drugs according to guidelines permits to achieve the best relation of benefit and risk.
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Cataract is the leading cause of blindness or severe visual handicap worldwide (20 Million people). The majority of cataracts are age-dependent. The only known treatment so far is surgery, which therefore has become the most frequent performed surgery in all industrialized countries. ⋯ The majority of patients undergoes the surgery under topical anaesthesia and as outpatient procedure. Major complication are rare (< 1 %), may however lead to permanent visual disability (< 1 per thousand). New developments are nowadays mainly in the design and additional features of the artificial lens i.e. blueblocker, multifocal and toric lenses.