Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Feb 2002
[Sudeck's atrophy: pathophysiology and treatment of a complex pain syndrome].
Sudeck's atrophy: pathophysiology and treatment of a complex pain syndrome. ⋯ The "Morbus Sudeck" or Complex Regional Pain Syndrome (CRPS) forms a typical triad of motor, sensory and autonomic symptoms. It is clinically characterized by spontaneous pain and hyperalgesia not limited to a single nerve territory and disproportionate to the inciting event. An underlying pathophysiology which could explain the whole symptomatology of CRPS is still unknown. Therefore, nowadays therapy is still symptomatic. However, recent research led to a better understanding of the disease and to the beginning of a pathophysiologically orientated therapy.
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Dtsch. Med. Wochenschr. · Feb 2002
Comparative Study[The "Adjusted Annual Index" (aJaX): A proposal for the use of the IMPP results in the evaluation of teaching at German medical faculties].
Teaching evaluations should create an incentive to improve academic teaching quality. Teaching also gains importance in the performance-oriented allocation of resources. The results of the country wide written examinations conducted by the Federal Institute for Medical and Pharmaceutical Examination Questions (IMPP) are obvious indicators for purposes of comparative evaluation. However, a comparison of medical faculties is confounded by heterogeneous proportions of students in the so called "reference group" This group includes students who attend their examinations within the regular duration of study; these candidates achieve significantly better results than other students. This contribution describes a comparative educational achievement index (aJaX) adjusting for the varying proportions of students in the reference group. ⋯ The results of the medical faculties in the uniform examinations can be compared using an adjusted annual index aJaX. Advantages of the aJaX lie in its stability and neutrality, which are obtained by the annual aggregation of data and the reference group adjustment. The low degree of scatter emphasises a high standardisation in academic medical teaching. However, the aJaX measures only one output of teaching. For the assessment of teaching efficiency in the sense of an input/output relation, inputs must also be taken into account, such as the final school grades of the entering and transferring students.
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Dtsch. Med. Wochenschr. · Feb 2002
Case Reports Comparative Study[Wound botulism after drug injection].
A 32-year old male drug user presented with diplopia, ataxia and general weakness. The patient had abscesses on arms and legs at injection sites, bilateral ptosis, a bifacial weakness, nasal speech, severely reduced ability to raise his arms and a positive Trendelelenburg sign with normal motor neuron reflexes and normal sensation. ⋯ After exclusion of any other possible diagnosis, it is possible to establish an early diagnosis of injection related wound botulism by its typical symptoms and signs. These are presented as wound abcesses at intramuscular drug injection sites together with rapidly progressive descending paralysis with preserved sensation. Treatment consists of surgical excision of wound debris combined with antitoxin and penicillin administration in order to prevent a possible build-up of residues. Early diagnosis and associated therapy overcome the necessity of intubation and prolonged intensive care.