Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Oct 2007
Review[Mirror feed-back - a new method for the treatment of neuropathic pain].
The mirror feedback therapy is a method for treatment of neuropathic pain syndromes that are associated with a missing or disordered afferent sensory input. That concerns especially the phantom limb pain, the pain after plexus or spinal nerve root injury and the complex regional pain syndrome. This therapeutic method has been increasingly implemented in the past few years. ⋯ During the therapy the patients are instructed to use the mirror in a way that the image of the mirrored healthy limb seems to appear in the place of the missing or affected extremity. The mirror image produces an illusion of two "healthy" limbs. An ergotherapeutic training program with sensory and motor training elements based on the visual impressions is performed additionally.
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Pain usually is the consequence of tissue damage that is signalled to the brain via the nociceptive system (nociceptive pain). Damage to the nociceptive system - in addition to causing sensory deficit - may paradoxically also induce a chronic pain state (neuropathic pain). Diagnostic workup of patients with neuropathic pain follows the usual procedure of Neurology, i. e. the aim is to identify the location of neural damage and the underlying disorder, so that a mechanism-oriented treatment may be initiated. ⋯ Typical analgesics have little efficacy in neuropathic pain - except for opioids. Major pharmacological treatment options include anticonvulsants (Ca-channel modulators, Na-channel blockers), antidepressants (noradrenaline reuptake inhibitors) and topicals (lidocaine, capsaicin). These medications exert specific molecular pharmacological effects against the pathophysiological mechanisms of neuropathic pain.
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Dtsch. Med. Wochenschr. · Oct 2007
Multicenter Study[Liposomal amphotericin B in the treatment of severe fungal infections. Results of a clinical cohort trial].
Activity and efficacy of liposomal amphotericin B have been established for the treatment of severe fungal infections. Nephrotoxic side effects, especially during prolonged administration, are regarded as a major disadvantage. In this study we examined the response rates and side effects, particularly nephrotoxicity, of treatment with liposomal amphotericin B in a large cohort of patients. ⋯ Liposomal amphotericin B is a safe and efficacious antifungal drug in the treatment of severe invasive fungal infections and fever of unknown origin. Nephrotoxicity is usually not a limiting factor when using liposomal amphotericin B, if it is administered in approved dosage.
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Dtsch. Med. Wochenschr. · Oct 2007
Comparative Study[Prevention, life expectancy and health expenditures: generation of a hypothesis, what Germany can learn from Japan].
Germany is one of those OECD-countries with the highest per-capita-expenses in public healthcare, but is lagging behind in life-expectancy compared to other countries like Japan, where life expectancy is highest at comparatively low costs. This article investigates reasons for this discrepancy in costs and outcome, and tries to form a hypothesis how this gap could be narrowed. ⋯ While reasons for this development are plenty-fold, one relevant factor could be the early introduction of the "Nutritional Guidelines for the Japanese People", with which the Japanese Government started to implement a dedicated prevention policy. The positive developments in Japan provide an indication of how this can be achieved in other countries as well and to increase life expectancy without significantly increasing expenses.
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Dtsch. Med. Wochenschr. · Oct 2007
Case Reports[Severe leukopenia and bone marrow hypoplasia with gelatinous transformation in anorexia nervosa].
A 26-year-old woman was admitted because of excessive weight loss: her body mass index was 11.3 kg/m (2). She reported an adequate food intake and denied fear of gaining weight. ⋯ Severe weight loss in anorexia nervosa may lead to leukopenia and gelatinous bone marrow transformation. The abnormal leukocyte count can become normal by maintaining body weight within the normal range.