Therapeutische Umschau. Revue thérapeutique
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The tibialis posterior muscle is a powerful flexor and supinator of the hind foot. Considering the plantar extension of its distal tendon, it represents a true antagonist of the short peroneal muscle. It works as a dash-pot for foot pronation under load. ⋯ Treatment depends upon the stage of the lesion. Reconstruction may be performed by augmentation with the flexor digitorum longus tendon. Palliative treatment by triple arthrodesis may be performed in more advanced cases.
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Many endocrine diseases can cause fatigue. Tiredness is a frequent symptom of primary and secondary hypothyroidism, hyperthyroidism, excessive glucocorticoid or mineralocorticoid production, primary and secondary adrenal insufficiency, primary and secondary hypogonadism and hyperprolactinemia in the male, acromegaly, diabetes mellitus and diabetes insipidus. ⋯ The pathogenesis of tiredness caused by endocrine or medical illnesses, i.e. how the sensation of fatigue is produced, is not clear. The fatigue of the various endocrine or other medical diseases is not disease-specific, i.e. its characteristics do not differentiate it from the fatigue of other illnesses.
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In acute as well as in chronic ischemic heart disease, congestive heart failure indicates a poor prognosis. Treatment after acute myocardial infarction should differentiate between specific subsets. In cardiogenic shock due to extensive ischemic damage, acute revascularization by PTCA or CABG improves the otherwise poor outcome substantially. ⋯ In chronic ischemic heart disease, congestive heart failure is a clearly defined indication for complete revascularization, if possible. As to drug treatment, progression of the disease characterized by a cardiomyopathy of overload as well as neurohormonal and peripheral maladaptation should be stopped in parallel with symptom relief. Therefore, ACE-Inhibitors are combined very early with diuretic treatment, and digitalis should be added in refractory patients.
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Nitrates, molsidomin, betablockers, calcium antagonists, inhibitors of platelet aggregation and anticoagulants are the most important drugs for the management of the different forms of angina pectoris. Their use in chronic stable, unstable and vasospastic angina pectoris and for secondary prophylaxis are discussed.
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Comparative Study
[Regional or general anesthesia in patients with pulmonary risks?].
Such partial functions of the respiratory system as ventilation, gas exchange, bronchomotor tone, respiratory regulation, secretion within the airways, mucociliary clearance, etc., are less impaired by such procedures as peridural or spinal anaesthesia than by general anaesthesia. As a result, it is often concluded that regional anaesthesia should always be used preferentially in the case of patients with a pulmonary risk. ⋯ These are factors that cannot readily be influenced by anaesthesiological measures. For this reason, the pre-operative diagnostic evaluation and preparation, post-operative prophylaxis and treatment, including the components pain elimination, physiotherapy, respiratory therapy, broncholysis and secretolysis, are more important than the anaesthetic procedure itself.