Pub Date : 2010-09-01DOI: 10.1007/s00063-010-1106-7
Carl-Peter Criée
Whole-body plethysmography is considered the "gold standard" for intrathoracic gas volume measurements and the measurement of specific airway resistance. These parameters are essential to assess a restrictive impairment, overinflation of the lungs and airflow obstruction.
{"title":"[Whole-body plethysmography].","authors":"Carl-Peter Criée","doi":"10.1007/s00063-010-1106-7","DOIUrl":"https://doi.org/10.1007/s00063-010-1106-7","url":null,"abstract":"<p><p>Whole-body plethysmography is considered the \"gold standard\" for intrathoracic gas volume measurements and the measurement of specific airway resistance. These parameters are essential to assess a restrictive impairment, overinflation of the lungs and airflow obstruction.</p>","PeriodicalId":18420,"journal":{"name":"Medizinische Klinik","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00063-010-1106-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29309977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-09-01Epub Date: 2010-09-28DOI: 10.1007/s00063-010-1107-6
Regina Hermann, Alexander Pfeil, Martin Busch, Christiane Kettner, Daniel Kretzschmar, Andreas Hansch, Paul La Rosée, Gunter Wolf
Background: Thrombotic thrombocytopenic purpura (TTP) is a severe disease with microthrombi in various organs. The idopathic subtype is characterized by reduced ADAMTS13 activity mediated via autoantibodies against this protease. Induction of autoantibodies mechanistically is incompletely understood, but certain drugs can induce anti-ADAMTS13 antibodies through hapten mechanisms.
Case report: A 56-year-old man was admitted from an external hospital because of a rapidly worsening general condition, hemolytic anemia (hemoglobin 4.17 mmol/l, hematocrit 0.19), and thrombocytopenia (22 Gpt/l) for unknown reasons. Additionally, he was found to have an elevated lactate dehydrogenase (45.37 μmol/l/s). 13 days before hospitalization he had received vaccination against H1N1. Laboratory tests revealed an increased total bilirubin (126 μmol/l), and a decreased haptoglobin level (< 0.08 g/l). The blood smear showed 24% fragmentocytes. Direct and indirect Coombs test were negative. TPP was diagnosed based on the clinical presentation and the detection of ADAMTS13 antibodies. Despite daily plasma exchange via plasmapheresis and administration of corticosteroids, there was no significant rise in platelet counts. Immunosuppression with a total of four weekly doses of rituximab (375 mg/m(2) body surface area) was added. Over the next 5 weeks, the platelet count very slowly rose. After a total of 46 sessions, plasmapheresis was ended with complete remission of the disease.
Conclusion: This report emphasizes the immunologic susceptibility of TTP, and suggests the potential, but not proven role of H1N1 vaccination in the pathogenesis of TTP, because no serum before vaccination was available. Severe autoantibody TTP can be successfully treated by administering rituximab in addition to standard treatment with plasmapheresis and corticosteroids.
{"title":"[Very severe thrombotic thrombocytopenic purpura (TTP) after H1N1 vaccination].","authors":"Regina Hermann, Alexander Pfeil, Martin Busch, Christiane Kettner, Daniel Kretzschmar, Andreas Hansch, Paul La Rosée, Gunter Wolf","doi":"10.1007/s00063-010-1107-6","DOIUrl":"https://doi.org/10.1007/s00063-010-1107-6","url":null,"abstract":"<p><strong>Background: </strong>Thrombotic thrombocytopenic purpura (TTP) is a severe disease with microthrombi in various organs. The idopathic subtype is characterized by reduced ADAMTS13 activity mediated via autoantibodies against this protease. Induction of autoantibodies mechanistically is incompletely understood, but certain drugs can induce anti-ADAMTS13 antibodies through hapten mechanisms.</p><p><strong>Case report: </strong>A 56-year-old man was admitted from an external hospital because of a rapidly worsening general condition, hemolytic anemia (hemoglobin 4.17 mmol/l, hematocrit 0.19), and thrombocytopenia (22 Gpt/l) for unknown reasons. Additionally, he was found to have an elevated lactate dehydrogenase (45.37 μmol/l/s). 13 days before hospitalization he had received vaccination against H1N1. Laboratory tests revealed an increased total bilirubin (126 μmol/l), and a decreased haptoglobin level (< 0.08 g/l). The blood smear showed 24% fragmentocytes. Direct and indirect Coombs test were negative. TPP was diagnosed based on the clinical presentation and the detection of ADAMTS13 antibodies. Despite daily plasma exchange via plasmapheresis and administration of corticosteroids, there was no significant rise in platelet counts. Immunosuppression with a total of four weekly doses of rituximab (375 mg/m(2) body surface area) was added. Over the next 5 weeks, the platelet count very slowly rose. After a total of 46 sessions, plasmapheresis was ended with complete remission of the disease.</p><p><strong>Conclusion: </strong>This report emphasizes the immunologic susceptibility of TTP, and suggests the potential, but not proven role of H1N1 vaccination in the pathogenesis of TTP, because no serum before vaccination was available. Severe autoantibody TTP can be successfully treated by administering rituximab in addition to standard treatment with plasmapheresis and corticosteroids.</p>","PeriodicalId":18420,"journal":{"name":"Medizinische Klinik","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00063-010-1107-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29309978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-09-01Epub Date: 2010-09-28DOI: 10.1007/s00063-010-1105-8
Wilhelm Kirch, Ralf Gold, Manfred Hensel, Maria Fasshauer, David Pittrow, Dörte Huscher, Marcel Reiser, Martin Stangel, Ulrich Baumann, Michael Borte
Non-modified human immunoglobulins (IgG) are standard of care for replacement therapy with primary (inherited) immunodeficiencies, and secondary immunodeficiencies due to multiple myeloma (MM) or chronic lymphocytic leukemia (CLL). Further, they have effectively been used as immunomodulation in neurological autoimmune diseases such as Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP), and multifocal motor neuropathy (MMN). A variety of IgG preparations for intravenous and subcutaneous use are available. In view of the broad range of indications, data on the utilization of the IgG preparations in everyday clinical care are of high clinical interest. Furthermore, data on the outcomes of IgG therapy outside the setting of controlled clinical trials are needed. Therefore, the SIGNS study (Assessment of Immunoglobulins in a Long-Term Non-Interventional Study) was set up as a non-interventional prospective open-label cohort study and was approved by the ethics committee. Led by an interdisciplinary steering board, hospital- and office-based investigators in 30-40 centers throughout Germany (neurologists, pediatricians, oncologists, other) will document approximately 300 patients, and will follow them for at least 2 years. Patients of both genders and any age are eligible if they have received, or are scheduled for, IgG therapy for primary or severe secondary immunodeficiency or neurological autoimmune diseases, and have provided written informed consent. No exclusion criteria have been defined in order to minimize selection bias. Long-term outcome data will be collected on patient characteristics in the various indications, drug utilization (e.g., treatment and dosing patterns), effectiveness (i.e., number of infections), tolerability, health-related quality of life, and economic variables (number of hospitalizations, sick-leave days, etc.) with the possibility to estimate direct costs. For the neurological autoimmune diseases, detailed data will be gathered, among others, on neurological function, muscular function, physical function (grip strength, INCAT disability scale, etc.) and stabilization or progression of symptoms over time. Data collection in SIGNS is performed using a secure internet site and an MySQL database. A number of quality measures are routinely performed including automated plausibility checks at data entry, queries, and on-site monitoring with source data verification. It is expected that SIGNS will contribute to optimization of therapy in this diverse patient population.
未修饰的人免疫球蛋白(IgG)是原发性(遗传性)免疫缺陷和多发性骨髓瘤(MM)或慢性淋巴细胞白血病(CLL)继发性免疫缺陷的替代治疗的标准护理。此外,它们已被有效地用于神经自身免疫性疾病的免疫调节,如格林-巴勒综合征(GBS)、慢性炎症性脱髓鞘性多神经病变(CIDP)和多灶性运动神经病变(MMN)。各种IgG制剂静脉注射和皮下使用是可用的。鉴于适应症范围广泛,在日常临床护理中使用IgG制剂的数据具有很高的临床意义。此外,还需要对照临床试验之外的IgG治疗结果数据。因此,sign研究(Assessment of Immunoglobulins in a Long-Term Non-Interventional study)被设置为一项非介入性前瞻性开放标签队列研究,并得到伦理委员会的批准。在跨学科指导委员会的领导下,德国30-40个中心的医院和办公室调查员(神经科医生,儿科医生,肿瘤科医生,其他)将记录大约300名患者,并将对他们进行至少2年的随访。如果已经接受或计划接受针对原发性或严重继发性免疫缺陷或神经自身免疫性疾病的IgG治疗,并提供书面知情同意,则男女和任何年龄的患者都有资格。为了尽量减少选择偏差,没有定义排除标准。将收集关于各种适应症、药物利用(如治疗和给药模式)、有效性(即感染次数)、耐受性、与健康有关的生活质量和经济变量(住院次数、病假天数等)的患者特征的长期结果数据,并有可能估计直接成本。对于神经自身免疫性疾病,将收集详细的数据,其中包括神经功能、肌肉功能、身体功能(握力、INCAT残疾量表等)以及症状随时间的稳定或进展。sign的数据收集是通过一个安全的网站和一个MySQL数据库进行的。常规地执行了许多质量度量,包括在数据输入、查询和带有源数据验证的现场监控时的自动合理性检查。预计体征将有助于在这种不同的患者群体中优化治疗。
{"title":"[Assessment of immunoglobulins in a long-term non-interventional study (SIGNS Study). Rationale, design, and methods].","authors":"Wilhelm Kirch, Ralf Gold, Manfred Hensel, Maria Fasshauer, David Pittrow, Dörte Huscher, Marcel Reiser, Martin Stangel, Ulrich Baumann, Michael Borte","doi":"10.1007/s00063-010-1105-8","DOIUrl":"https://doi.org/10.1007/s00063-010-1105-8","url":null,"abstract":"<p><p>Non-modified human immunoglobulins (IgG) are standard of care for replacement therapy with primary (inherited) immunodeficiencies, and secondary immunodeficiencies due to multiple myeloma (MM) or chronic lymphocytic leukemia (CLL). Further, they have effectively been used as immunomodulation in neurological autoimmune diseases such as Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP), and multifocal motor neuropathy (MMN). A variety of IgG preparations for intravenous and subcutaneous use are available. In view of the broad range of indications, data on the utilization of the IgG preparations in everyday clinical care are of high clinical interest. Furthermore, data on the outcomes of IgG therapy outside the setting of controlled clinical trials are needed. Therefore, the SIGNS study (Assessment of Immunoglobulins in a Long-Term Non-Interventional Study) was set up as a non-interventional prospective open-label cohort study and was approved by the ethics committee. Led by an interdisciplinary steering board, hospital- and office-based investigators in 30-40 centers throughout Germany (neurologists, pediatricians, oncologists, other) will document approximately 300 patients, and will follow them for at least 2 years. Patients of both genders and any age are eligible if they have received, or are scheduled for, IgG therapy for primary or severe secondary immunodeficiency or neurological autoimmune diseases, and have provided written informed consent. No exclusion criteria have been defined in order to minimize selection bias. Long-term outcome data will be collected on patient characteristics in the various indications, drug utilization (e.g., treatment and dosing patterns), effectiveness (i.e., number of infections), tolerability, health-related quality of life, and economic variables (number of hospitalizations, sick-leave days, etc.) with the possibility to estimate direct costs. For the neurological autoimmune diseases, detailed data will be gathered, among others, on neurological function, muscular function, physical function (grip strength, INCAT disability scale, etc.) and stabilization or progression of symptoms over time. Data collection in SIGNS is performed using a secure internet site and an MySQL database. A number of quality measures are routinely performed including automated plausibility checks at data entry, queries, and on-site monitoring with source data verification. It is expected that SIGNS will contribute to optimization of therapy in this diverse patient population.</p>","PeriodicalId":18420,"journal":{"name":"Medizinische Klinik","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00063-010-1105-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29309976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-09-01Epub Date: 2010-09-28DOI: 10.1007/s00063-010-1101-z
Bettina-Maria Taute, Hannes Melnyk, Hubert Podhaisky
Background and purpose: Unclear extremity complaints are common symptoms of inpatients. In a subset of these patients, a clinical suspicion of deep vein thrombosis (DVT) results; this needs to be quickly and definitively clarified by a vascular physician. The question arose of how often a clinical suspicion of DVT was confirmed in an inpatient population and which alternative diagnoses were able to be made by angiologists.
Patients and methods: In a retrospective analysis, all inpatients in the Angiologic Vascular Diagnostics Center of the University Hospital Halle, Germany, examined in 2007 for a suspicion of DVT were evaluated with respect to the definitively made diagnosis.
Results: In 213 (28.6%) of 745 suspected cases of DVT, a DVT was confirmed. In 532 patients (71.4%), DVT was excluded. In 314 of these patients, 436 alternative diagnoses were recorded in the diagnostic reports of angiologic examinations. In 38.6% (n = 168), other venous causes could be confirmed as the most common alternative diagnosis. There were chronic venous diseases in 28% (n = 122), superficial thrombophlebitis (n = 27), and tumor-related pelvic vein compression (n = 19). 17.4% (n = 76) exhibited lymphedema. In 13.3% (n = 58), a generalized edema was diagnosed. Arthrogenic causes followed with 12.8% (n = 56). Lipedema (5.3%) and hematoma (5%) could be verified as other important differential diagnoses. Rare causes were symptomatic or ruptured Baker's cysts (2.5%), erysipelas (2.5%), abscess, aneurysm, muscle tears, and tumors.
Conclusion: The variety of alternative diagnoses in patients with clinical suspicion of DVT is high. The knowledge and systematic examination of potential, even rare differential diagnoses after exclusion of DVT are part of the repertoire of the vascular physician. Unnecessary and expensive, as well as onerous, diagnostic procedures on the patient can be avoided. Anticoagulation that was begun as a result of the suspicion of DVT can quickly be stopped.
{"title":"[Alternative sonographic diagnoses in patients with clinical suspicion of deep vein thrombosis].","authors":"Bettina-Maria Taute, Hannes Melnyk, Hubert Podhaisky","doi":"10.1007/s00063-010-1101-z","DOIUrl":"https://doi.org/10.1007/s00063-010-1101-z","url":null,"abstract":"<p><strong>Background and purpose: </strong>Unclear extremity complaints are common symptoms of inpatients. In a subset of these patients, a clinical suspicion of deep vein thrombosis (DVT) results; this needs to be quickly and definitively clarified by a vascular physician. The question arose of how often a clinical suspicion of DVT was confirmed in an inpatient population and which alternative diagnoses were able to be made by angiologists.</p><p><strong>Patients and methods: </strong>In a retrospective analysis, all inpatients in the Angiologic Vascular Diagnostics Center of the University Hospital Halle, Germany, examined in 2007 for a suspicion of DVT were evaluated with respect to the definitively made diagnosis.</p><p><strong>Results: </strong>In 213 (28.6%) of 745 suspected cases of DVT, a DVT was confirmed. In 532 patients (71.4%), DVT was excluded. In 314 of these patients, 436 alternative diagnoses were recorded in the diagnostic reports of angiologic examinations. In 38.6% (n = 168), other venous causes could be confirmed as the most common alternative diagnosis. There were chronic venous diseases in 28% (n = 122), superficial thrombophlebitis (n = 27), and tumor-related pelvic vein compression (n = 19). 17.4% (n = 76) exhibited lymphedema. In 13.3% (n = 58), a generalized edema was diagnosed. Arthrogenic causes followed with 12.8% (n = 56). Lipedema (5.3%) and hematoma (5%) could be verified as other important differential diagnoses. Rare causes were symptomatic or ruptured Baker's cysts (2.5%), erysipelas (2.5%), abscess, aneurysm, muscle tears, and tumors.</p><p><strong>Conclusion: </strong>The variety of alternative diagnoses in patients with clinical suspicion of DVT is high. The knowledge and systematic examination of potential, even rare differential diagnoses after exclusion of DVT are part of the repertoire of the vascular physician. Unnecessary and expensive, as well as onerous, diagnostic procedures on the patient can be avoided. Anticoagulation that was begun as a result of the suspicion of DVT can quickly be stopped.</p>","PeriodicalId":18420,"journal":{"name":"Medizinische Klinik","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00063-010-1101-z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29313217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-08-01Epub Date: 2010-09-08DOI: 10.1007/s00063-010-1096-5
Franziska Wiesent, Jutta Weinerth
Digital ulcers in systemic sclerosis are painful ischemic necrotic lesions of the acra. Optimal treatment consists of conventional wound management and medication: iloprost infusions promote primary healing of the ulcers, while the dual endothelin receptor antagonist bosentan is used for secondary prophylaxis of new ulcers. The described case illustrates the essential interdisciplinary collaboration for optimal management of these patients.
{"title":"[Digital ulcers in systemic sclerosis--an interdisciplinary challenge].","authors":"Franziska Wiesent, Jutta Weinerth","doi":"10.1007/s00063-010-1096-5","DOIUrl":"https://doi.org/10.1007/s00063-010-1096-5","url":null,"abstract":"<p><p>Digital ulcers in systemic sclerosis are painful ischemic necrotic lesions of the acra. Optimal treatment consists of conventional wound management and medication: iloprost infusions promote primary healing of the ulcers, while the dual endothelin receptor antagonist bosentan is used for secondary prophylaxis of new ulcers. The described case illustrates the essential interdisciplinary collaboration for optimal management of these patients.</p>","PeriodicalId":18420,"journal":{"name":"Medizinische Klinik","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00063-010-1096-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29291954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-08-01Epub Date: 2010-09-08DOI: 10.1007/s00063-010-1092-9
Hermann Heimpel, Heinz Diem, Thomas Nebe
In clinical practice, the reticulocyte count is the most useful method to estimate red cell life span and red cell production. However, experience of hematologists as well as surveys have shown that counting of reticulocytes is often neglected in the diagnostic work-up of unclassified anemias, and many physicians have difficulties in interpreting the results. Formerly, this was partly due to the low precision of manual counts. Today, this method is largely replaced by flow cytometry, available in almost all larger systems for automated blood count analysis, at low costs and sufficient analytic precision. Interpretation is supported by calculated parameters such as the Reticulocyte Production Index. Here, the authors discuss the limits of the analytic methods and the problems of interpretation in the context of the laboratory profile and the clinical setting.
{"title":"[Counting reticulocytes: new importance of an old method].","authors":"Hermann Heimpel, Heinz Diem, Thomas Nebe","doi":"10.1007/s00063-010-1092-9","DOIUrl":"https://doi.org/10.1007/s00063-010-1092-9","url":null,"abstract":"<p><p>In clinical practice, the reticulocyte count is the most useful method to estimate red cell life span and red cell production. However, experience of hematologists as well as surveys have shown that counting of reticulocytes is often neglected in the diagnostic work-up of unclassified anemias, and many physicians have difficulties in interpreting the results. Formerly, this was partly due to the low precision of manual counts. Today, this method is largely replaced by flow cytometry, available in almost all larger systems for automated blood count analysis, at low costs and sufficient analytic precision. Interpretation is supported by calculated parameters such as the Reticulocyte Production Index. Here, the authors discuss the limits of the analytic methods and the problems of interpretation in the context of the laboratory profile and the clinical setting.</p>","PeriodicalId":18420,"journal":{"name":"Medizinische Klinik","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00063-010-1092-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29291949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-08-01Epub Date: 2010-09-08DOI: 10.1007/s00063-010-1090-y
Marie-Luise Manow, Nesrin Paulsen, Meike Rybczynski, Thomas Mir, Alexander M J Bernhardt, Hendrik Treede, Gunda Ohm, Bettina Fuisting, Uwe Rehder, Florian Meier, Marina Vogler, Thomas Meinertz, Karin Overlack, Yskert von Kodolitsch
Background: The Marfan syndrome is a typical rare disease with multiorgan involvement and the need for specialized interdisciplinary medical care. A novel German legal directive according to section sign 116 b of the Social Statutes Book V (116 b SGB V) improves options for reimbursement and thus encourages specialized hospitals to provide ambulatory care for rare diseases such as Marfan syndrome. The authors provide the first economic analysis of section sign 116 b in a German Marfan center.
Methods: The costs were assessed in 184 cases with Marfan syndrome receiving medical care in the Hamburg Marfan Clinic. The authors assessed the financial profit both according to payments received from invoices established according to the 116 b directive [reimbursement (116b)] and from calculations according to section sign 117 SGB V [reimbursement (117)].
Results: A total of 117 patients traveled to the Marfan clinic (64%) < 50 km, 27 patients (15%) between >or= 50 and 100 km. The total costs for ambulatory care were 71,606.28 Euro. The reimbursement (116b) was 55,549.87 Euro and the reimbursement (117) was 11,776.00 Euro.
Conclusion: Many patients accept long distances of traveling to receive specialized ambulatory medical care. However, for optimal patient management specialized centers need to cooperate intensively with local health care providers. The novel legal directive according to section sign 116 b has significantly improved reimbursement for Marfan centers and allows for improving the quality of medical care.
背景:马凡氏综合征是一种典型的罕见的多器官累及疾病,需要专业的跨学科医疗护理。根据《社会法规》第五卷第116 b节(116 b SGB V),一项新的德国法律指令改善了报销选择,从而鼓励专科医院为马凡综合征等罕见疾病提供门诊护理。作者首次对德国马凡中心1116b路段进行了经济分析。方法:对184例在汉堡马凡氏门诊就诊的马凡氏综合征患者进行费用评估。作者根据根据1116b指令[报销(116b)]建立的发票所收到的款项和根据SGB V[报销(117)]节标志117的计算来评估财务利润。结果:共有117例患者(64%)到马凡诊所的路程< 50公里,27例患者(15%)在>或= 50至100公里之间。门诊护理的总费用为71,606.28欧元。偿还额(116b)为55,549.87欧元,偿还额(117)为11,776.00欧元。结论:许多患者愿意长途旅行接受专科门诊治疗。然而,为了优化患者管理,专业中心需要与当地卫生保健提供者密切合作。根据第116 b节的新法律指示,大大改善了对马凡中心的报销,并允许提高医疗保健的质量。
{"title":"[Analysis of costs and profits of ambulatory care of Marfan patients after initiation of a novel German legal directive (116 b SGB V)].","authors":"Marie-Luise Manow, Nesrin Paulsen, Meike Rybczynski, Thomas Mir, Alexander M J Bernhardt, Hendrik Treede, Gunda Ohm, Bettina Fuisting, Uwe Rehder, Florian Meier, Marina Vogler, Thomas Meinertz, Karin Overlack, Yskert von Kodolitsch","doi":"10.1007/s00063-010-1090-y","DOIUrl":"https://doi.org/10.1007/s00063-010-1090-y","url":null,"abstract":"<p><strong>Background: </strong>The Marfan syndrome is a typical rare disease with multiorgan involvement and the need for specialized interdisciplinary medical care. A novel German legal directive according to section sign 116 b of the Social Statutes Book V (116 b SGB V) improves options for reimbursement and thus encourages specialized hospitals to provide ambulatory care for rare diseases such as Marfan syndrome. The authors provide the first economic analysis of section sign 116 b in a German Marfan center.</p><p><strong>Methods: </strong>The costs were assessed in 184 cases with Marfan syndrome receiving medical care in the Hamburg Marfan Clinic. The authors assessed the financial profit both according to payments received from invoices established according to the 116 b directive [reimbursement (116b)] and from calculations according to section sign 117 SGB V [reimbursement (117)].</p><p><strong>Results: </strong>A total of 117 patients traveled to the Marfan clinic (64%) < 50 km, 27 patients (15%) between >or= 50 and <or= 100 km, and 40 patients (22%) > 100 km. The total costs for ambulatory care were 71,606.28 Euro. The reimbursement (116b) was 55,549.87 Euro and the reimbursement (117) was 11,776.00 Euro.</p><p><strong>Conclusion: </strong>Many patients accept long distances of traveling to receive specialized ambulatory medical care. However, for optimal patient management specialized centers need to cooperate intensively with local health care providers. The novel legal directive according to section sign 116 b has significantly improved reimbursement for Marfan centers and allows for improving the quality of medical care.</p>","PeriodicalId":18420,"journal":{"name":"Medizinische Klinik","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00063-010-1090-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29292054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-08-01Epub Date: 2010-09-08DOI: 10.1007/s00063-010-1094-7
Harald Hoensch, Elke Richling, Wolfgang Kruis, Wilhelm Kirch
Background: Valid, sustained and safe clinical means of colorectal cancer prevention are still lacking, but they are urgently needed to lower the incidence of colorectal cancer. Dietary factors and phytochemicals such as flavonoids play an important role for prevention.
Methods: A selective search of the literature using PubMed was performed with the following key words: flavonoids, cancer, therapy, colorectal cancer focused on clinical queries. Results of clinical studies including the authors' own were compared.
Results: In vivo and in vitro studies with animals, cell cultures and subcellular components provide ample evidence for antimutagenic and anticarcinogenic effects of flavonoids as shown for multiple biological and molecular endpoints. Isoflavonoids in vitro have been shown to induce proliferation of breast cancer cells. Epidemiologic trials (cohort, case-control and cross-sectional studies) yielded inconsistent results for flavonoid protection. Systematic reviews and meta-analyses support the protective role of tea flavonoids on adenoma incidence. An interventional pilot study with sustained flavonoid supplementation was shown to reduce the rate of neoplasia in patients with resected colorectal cancer.
Conclusion: Selected flavonoids possess antimutagenic and anticarcinogenic properties and could reduce the incidence of colorectal neoplasias as shown in epidemiologic trials. Randomized controlled clinical studies with flavonoid intervention are necessary to provide evidence for their role in colorectal cancer prevention.
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