Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · May 2006
[Guideline conformance for outpatient management of COPD in Germany].
Primary care physicians (PCPs) are the ones mainly responsible for the initial diagnosis and outpatient care of patients with COPD. The aim of the present survey was to investigate their initial management of COPD in Germany based on current guidelines and to identify any deviations. ⋯ The study shows that, despite the high regard in which COPD guidelines are held, deficiencies exist with regard to the diagnosis and treatment of COPD and the practical implementation of educational measures.
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Dtsch. Med. Wochenschr. · May 2006
Review[Dual antithrombotic therapy after implantation of coronary stents].
Dual antiplatelet-aggregation treatment with aspirin and clopidogrel after coronary stent implantation is nowadays standard peri-interventional practice, although its use is not yet licensed for this indication in many European countries. Clopidogrel administration is initiated before PCI with a loading dose of 300 mg when given at least 6 hours before PCI, otherwise 600 mg. The required duration of combined (aspirin + clopidogrel) antiplatelet-aggregation treatment after coronary stent implantation depends on the type of stent and the pre-existing disease. ⋯ Prolonged antiplatelet-aggregation treatment is of benefit especially in patients with a high risk of serious cardiovascular events. Patients with an indication for long-term anticoagulation may require, during the period of highest risk of stent thrombosis after stent implantation, administration of combined aspirin, clopidogrel and anticoagulants with an INR target value in the lower therapeutic range. The increased risk of bleeding must be weighed up against the potential benefit.
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Dtsch. Med. Wochenschr. · May 2006
Review Comparative Study[Bosentan: a new pillar in the treatment of pulmonary hypertension?].
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Dtsch. Med. Wochenschr. · May 2006
Case Reports Comparative Study[Wound botulism in heroin addicts in Germany].
5 heroin addicts (aged 31-44 years; 1 female, 4 men) presented with a history of blurred vision and diplopia followed by dysarthria. 3 of the patients also developed respiratory failure requiring long-term ventilatory support. Physical examination revealed cranial nerve deficits and abscesses at injection sites in 3 of them. ⋯ Progressive cranial nerve pareses in addicts who inject drugs intravenously or intramuscularly should raise the suspicion of wound botulism and require hospitalization. While indirect demonstration of toxin supports the diagnosis, false-negative results are common.