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Erim Y, Beckmann MB, Gräf J, Beckebaum S, Cicinnati V, Böttcher M, Paul A, Senf W. Abstinenz nach Lebertransplantation: Beurteilungsmethoden und psychische Einflüsse. PPMP - PSYCHOTHERAPIE · PSYCHOSOMATIK · MEDIZINISCHE PSYCHOLOGIE 2009. [DOI: 10.1055/s-0029-1208196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Draxler J, Schuch M, Paul A, Sycha T, Valenta C, Likar R, Gustorff B. [Topical application of morphine and buprenorphine gel has no effect in the sunburn model]. Schmerz 2008; 22:571-4. [PMID: 18438689 DOI: 10.1007/s00482-008-0660-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this placebo-controlled double-blinded cross-over study was to investigate the antihyperalgesic effect of topical morphine and buprenorphine in the sunburn pain model. MATERIAL AND METHODS The study was designed as a double-blind, placebo-controlled cross-over trial, separated into 2 parts each with 16 volunteers. In part A morphine dissolved in Ultrabas-ultrasic ointment at 3 concentrations (0.1, 0.2, 0.4%) and placebo ointment were applied to 4 UVB-induced erythemas on the thighs. In part B buprenorphine at 3 concentrations (0.01, 0.02 and 0.1%) and placebo dissolved in a gel for transcutaneous application, was applied to 4 erythemas on the thighs. Thermal and mechanical hyperalgesia were assessed in the respective erythema by standardized quantitative sensory testing and opioids were compared to the placebo. RESULTS Neither morphine nor buprenorphine showed any significant reduction of hyperalgesia in comparison to the placebo. CONCLUSION The topical application of opioids in this form has no effect on inflamed skin.
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Sotiropoulos GC, Treckmann J, Fouzas I, Molmenti EP, Nowak KM, Broelsch CE, Paul A, Lang H. Eurotransplant special request for high-urgency status after liver transplantation for hepatocellular carcinoma: a case report. Transplant Proc 2008; 40:3211-2. [PMID: 19010237 DOI: 10.1016/j.transproceed.2008.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Hepatic artery thrombosis after liver transplantation remains a major indication for retransplantation. We report the case of a 49-year-old man with a hepatocellular carcinoma in the setting of cirrhosis associated with chronic hepatitis B and C infections who underwent split liver transplantation. The patient experienced a complicated postoperative course, characterized by 2 relaparotomies for necrosis of segment IV, and a late hepatic artery thrombosis, first discovered on postoperative day 20. His subsequent course was characterized by relapsing cholangitis and liver abscesses requiring antibiotics and percutaneous drainage. Transient control of the septic complications allowed for the filing of a special high-urgency status request that was approved by Eurotransplant. The patient underwent retransplantation 1 week later with a full-size deceased donor graft. He is currently alive, well, with no evidence of tumor recurrence at 30 months posttransplantation. The existence of exceptions within the system, such as the "special high-urgency status" of Eurotransplant, as well as the aggressive treatment of complications to obtain a "window of clinical opportunity" saved this patient's life.
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Michalsen A, Lehmann N, Paul A, Budde T, Moebus S, Lanhghorst J, Kerckhoff G, Dobos G. Long-term effects of an integrative medicine and lifestyle modification intervention in patients with coronary artery disease on cardiovascular risk factors, need of medication and coronary calcium. Eur J Integr Med 2008. [DOI: 10.1016/j.eujim.2008.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Audrézet MP, Bolch GL, Floch V, Yaouanc JJ, Clément J, des Abbayes H, Mercier B, Paul A, Férec C. Novel Cationic Phosphonolipids Agents for in Vitro Gene Transfer to Epithelial Cell Lines. J Liposome Res 2008. [DOI: 10.3109/08982109709035502] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vogt T, Lüssi F, Paul A, Urban P. Langzeittherapie fokaler Dystonien und des Hemispasmus facialis mit Botulinum-Toxin A. DER NERVENARZT 2008; 79:912-7. [PMID: 18551268 DOI: 10.1007/s00115-008-2486-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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232
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Paul A, Lewis A. Safety goggles: are they adequate to prevent eye injuries caused by rotating wire brushes? Emerg Med J 2008; 25:385. [DOI: 10.1136/emj.2007.054759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Saad S, Arns W, Paul A, Nagelschmidt M, Heiss M, Treckmann J. [The way to establish laparoscopic donor nephrectomy as the method of choice in live kidney donation--a single centre experience]. Zentralbl Chir 2008; 133:188-92. [PMID: 18415910 DOI: 10.1055/s-2008-1004740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In contrast to the USA, laparoscopic donor nephrectomy is rarely practised in German transplant centres. Safety concerns and difficulties with the learning curve of this advanced laparoscopic procedure are the main obstacles to the establishment of this operation. PATIENTS AND METHODS From 1998-2005, we performed laparoscopic kidney procurement in 50 live kidney donors on an intention to treat basis harvesting a total of 29 left and 21 right kidneys for transplantation. RESULTS Negative adverse effects on the donor side were temporary nerve irritation (2 patients) and postoperative retroperitoneal hematoma. Reasons to convert to open nephrectomy were bleeding (2 patients) and adhesions (1 patient). On the recipient side, one kidney was lost due to renal vein thrombosis. Three patients required short-time dialysis after transplantation. All other kidney transplants worked without any problems. CONCLUSION Laparoscopic donor nephrectomy is a safe procedure and has been established as the method of choice for live kidney donation in our hospital.
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Li J, Frilling A, Nadalin S, Paul A, Malagò M, Broelsch CE. Management of concomitant hepatic artery injury in patients with iatrogenic major bile duct injury after laparoscopic cholecystectomy. Br J Surg 2008; 95:460-5. [PMID: 18161898 DOI: 10.1002/bjs.6022] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Concomitant hepatic artery injury is a rare but severe complication associated with bile duct injury during laparoscopic cholecystectomy (LC). METHODS Sixty patients referred with biliary injury after LC between April 1998 and December 2005 were divided into two groups according to the time elapsed between injury and definitive surgical revision; patients in group 1 were referred early (within 4 days) after operation and those in group 2 were referred later. Hepatic rearterialization was performed in addition to biliary reconstruction when technically possible. RESULTS Damage to the hepatic artery was detected in ten patients. Hepatic rearterialization was carried out in five patients by end-to-end anastomosis (one), or by using an autologous graft (three) or allogeneic vascular graft (one). Three patients in group 2 underwent right hemihepatectomy without arterial reconstruction owing to liver necrosis or lobar atrophy. Three of ten patients died from postoperative complications. CONCLUSION Combined bile duct and hepatic artery injury during LC led to a complicated clinical course, with a high mortality rate. Reconstruction of the right hepatic artery might be helpful in reducing hepatic ischaemia, but is usually feasible only if the injury is identified early.
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Chaudhuri K, Paul A. Glucocorticoids and rheumatoid arthritis—a reappraisal. INDIAN JOURNAL OF RHEUMATOLOGY 2008. [DOI: 10.1016/s0973-3698(10)60075-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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236
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Wendel HP, Hoffmann J, Paul A, Walker T, Scheule A, Ziemer G. Self-endothelialization of vascular prostheses by immobilized capture molecules for circulating endothelial progenitor cells. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1037879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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237
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Paul A, Rahim A, Mikhail M, Burke J, Stafanous SN. An unusual case of complete ptosis and failure of elevation due to severe facial trauma. Orbit 2007; 26:323-5. [PMID: 18097978 DOI: 10.1080/01676830600987367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The authors describe the case of 49-year-old female teacher who had sustained severe facial lacerations following a minor fall on the kerb. The severe shearing force by which the flap was ripped off the forehead caused complete ptosis and complete failure of elevation of the left eye, which was presumed to be due to mechanical damage to the superior rectus and levator complex. The management by a multidisciplinary approach and clinical course of the patient are described with documentary photographs. This presentation is meant to highlight an unusual case of severe facial trauma resulting from a minor injury, and its successful management with gratifying results for both patient and the surgeon.
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Treckmann J, Paul A, Ozcelik A, Saner F, Malagó M, Nadalin S, Lang H, Malamutman E, Gerken G, Broelsch CE. Efficacy of C0 and C2 monitoring in adult liver transplant recipients treated with neoral, mycophenolate mofetil, and steroids. Transplant Proc 2007; 39:3234-6. [PMID: 18089361 DOI: 10.1016/j.transproceed.2007.06.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Revised: 12/04/2006] [Accepted: 06/06/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Adjustment of induction therapy with Neoral after liver transplantation according to C2 levels yields a reduced incidence of rejection compared with C0 monitoring. A combination with mycophenolate mofetil may further reduce episodes of acute rejection. The purpose of this analysis was to evaluate the predictive value of C0 and C2 monitoring and the influence of primary dysfunction in liver transplant recipients receiving induction therapy with Neoral, mycophenolate mofetil, and steroids. PATIENTS AND METHODS One hundred consecutive adult liver transplant recipients were analyzed. Neoral doses were solely adjusted according to C0 target levels in the first week by daily analysis of C0 levels. C2 levels were also measured, but results did not influence the decision process of daily Neoral adjustments. RESULTS The 3-month survival rate for all patients was 83%. For a further analysis, 35 patients were excluded, the remaining 65 patients experienced 15 rejections (23.1%). Patients who did reach C0 target levels by days 3, 5, or 7 had rejection rates no different from those who did not reach C0 target levels. The patients who did reach C2 target levels by day 7 showed a significantly lower rejection rate compared with those who did not reach these levels. Comparison of rejection rates among patients with primary function grades I and II versus grades III and IV revealed a significant difference. There was no correlation between Model for End-Stage Liver Disease (MELD) score and acute rejection episodes. CONCLUSION Achievement of C2 target levels by day 7, especially in the combination of Neoral with mycophenolate mofetil, led to a remarkably low acute rejection rate following liver transplantation.
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Sotiropoulos GC, Fouzas I, Paul A, Nadalin S, Molmenti EP, Valentin-Gamazo C, Radtke A, Kühl H, Malagó M, Broelsch CE. Inferior vena cava thrombosis after right hepatectomy for live donor liver transplantation: a major donor complication and a satisfactory treatment modality. Am J Transplant 2007; 7:2836-7. [PMID: 17949459 DOI: 10.1111/j.1600-6143.2007.02008.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Huhn K, Paul A, Seyferth M. Modeling sediment transport patterns during an upwelling event. ACTA ACUST UNITED AC 2007. [DOI: 10.1029/2005jc003107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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241
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Saad S, Paul A, Treckmann J, Nagelschmidt M, Heiss M, Arns W. Laparoscopic live donor nephrectomy for right kidneys: Experience in a German community hospital. Surg Endosc 2007; 22:674-8. [PMID: 17623244 DOI: 10.1007/s00464-007-9459-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Laparoscopic live donor nephrectomy has become the new gold standard for kidney procurement in many high-volume transplant centres worldwide, but it is often limited to left-sided donor kidneys. Concerns about adequate anatomical renal vessel length and sufficient surgical exposure are the main obstacles to the use of the laparoscopic approach for right kidney live donors as well. MATERIAL AND METHODS From 1998 to 2006 we performed laparoscopic kidney procurement in 73 live kidney donors on an intention-to-treat basis, harvesting a total of 48 left (LKG) and 25 right kidneys (RKG) for transplantation. We compared these two groups with respect to operating time, conversion rate, complications, hospital stay, and recipient outcome. RESULTS There were no differences in outcome of donor patients after left (D-LKG) or right laparoscopic donor nephrectomy (D-RKG). Operating time was 160 min in D-RKG versus 164 min in D-LKG. Warm ischemia was below 150 s in both groups. Hospital stay was 7.0 (D-RKG) versus 6.7 days (D-LKG). Negative events on the donor site were one temporary nerve irritation in each group and one postoperative retroperitoneal hematoma in the left kidney group. Reasons to convert to open nephrectomy were bleeding in two patients in the left kidney group and adhesions in one patient in the right kidney group. The outcome of the recipients after left (R-LKG) or right kidney (R-RKG) transplantation was similar. One kidney was lost due to renal vein thrombosis (R-LKG). Postoperative ureter complications occurred in one patient of each group. One patient of the R-RKG and two patients of the R-LKG required lymphocele fenestration. All other kidney transplants worked without problems. CONCLUSION Laparoscopic donor nephrectomy is a safe procedure and has been established as the method of choice for live kidney donation in our clinic. Laparoscopic procurement of right and left kidneys can be performed with comparable quality and outcome for donors and recipients.
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Mackie T, Caporaso G, Sampayan S, Chen Y, Blackfield D, Harris J, Hawkins S, Holmes C, Nelson S, Paul A, Poole B, Rhodes M, Sanders D, Sullivan J, Wang L, Watson J, Reckwerdt P, Schmidt R, Pearson D, Flynn R, Matthews D, Purdy J. TH-C-AUD-09: A Proposal for a Novel Compact Intensity Modulated Proton Therapy System Using a Dielectric Wall Accelerator. Med Phys 2007. [DOI: 10.1118/1.2761668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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243
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Suwandinata F, Grüßner S, Paul A, Tinneberg HR. Chirurgische Maßnahmen bei symptomatischen Myomen in der Schwangerschaft. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-984681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Oka K, Belalcazar LM, Dieker C, Nour EA, Nuno-Gonzalez P, Paul A, Cormier S, Shin JK, Finegold M, Chan L. Erratum: Sustained phenotypic correction in a mouse model of hypoalphalipoproteinemia with a helper-dependent adenovirus vector. Gene Ther 2007. [DOI: 10.1038/sj.gt.3302952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ramstad KM, Nelson NJ, Paine G, Beech D, Paul A, Paul P, Allendorf FW, Daugherty CH. Species and cultural conservation in New Zealand: maori traditional ecological knowledge of tuatara. CONSERVATION BIOLOGY : THE JOURNAL OF THE SOCIETY FOR CONSERVATION BIOLOGY 2007; 21:455-64. [PMID: 17391195 DOI: 10.1111/j.1523-1739.2006.00620.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Traditional ecological knowledge can be highly informative and integrated with complementary scientific knowledge to improve species management. This is especially true for abundant species with which indigenous peoples have frequent interactions (e.g., through harvest), but has been studied less frequently in isolated or declining species. We examined Maori traditional ecological knowledge of tuatara (Sphenodon spp., reptiles that resemble lizards but are the last living representatives of the order Sphenodontia) through semidirected interviews of elders of Te Atiawa, Ngati Koata, and Ngati Wai Iwi (similar to tribes), the guardians of several islands currently inhabited by tuatara. Maori are indigenous to New Zealand, having settled 800 to 1000 years ago. Tuatara are endemic to New Zealand, have declined in numbers since human settlement, and are now restricted to 37 offshore islands. The detail and volume of tuatara traditional ecological knowledge were less than that recorded in studies of more abundant or accessible species. In addition, traditional knowledge of the cultural significance of tuatara was more common and detailed among the elders than traditional knowledge of tuatara biology or ecology. The traditional knowledge collected, however, provided the first evidence of seven former sites of tuatara occupation, suggested five additional sites tuatara may currently occupy, contained novel hypotheses for scientific testing, and described tuatara cultural roles that have not been reported previously. We conclude that, in at least some cases, traditional ecological knowledge may persist as species decline and may serve as a valuable source of ecological information for conservation.
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Ozçelik A, Treckmann J, Paul A, Witzke O, Sotiropoulos G, Nadalin S, Malago M, Broelsch CE. Results of Kidney Transplantation With Simultaneous Implantation of Vascular Graft. Transplant Proc 2007; 39:509-10. [PMID: 17362769 DOI: 10.1016/j.transproceed.2006.12.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Arteriosclerosis and calcification of iliac arteries are common in patients on dialysis. This study sought to evaluate the outcome after kidney transplantation and simultaneous implantation of vascular grafts. PATIENTS AND METHODS In a single center study we evaluated donor and recipient data among 443 kidney transplantations in adults performed between January 2002 and October 2006. In 11 recipients (2.5%) a vascular graft (Gore-Tex) was implanted due to severe arterioscleroses of the iliac vessels. RESULTS Reconstruction of the lower limb blood supply was performed with an ileofemoral Gore-Tex-Bypass in 9 of 11 patients, with an aortofemoral bypass in 1 patient, and with a femoroiliac crossover bypass in 1 patient. Overall, 8 of 11 patients (73%) had an uneventful postoperative course. Six of 11 patients had primary graft function. CONCLUSIONS This analysis demonstrated that vascular reconstruction during kidney transplantation has to be performed rarely but has a strong impact on further life and kidney function. In 8 of 11 patients, kidney function at 6 months was good. Severe arteriosclerosis is usually not a contraindication for kidney transplantation. However, training in vascular surgery seems to be important to achieve satisfying results. In this series, simultaneous implantation of vascular prosthetic grafts was safe since there were no infectious complications of the graft itself.
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Schwickert M, Langhorst J, Paul A, Michalsen A, Dobos GJ. [Stress management in the treatment of essential arterial hypertension]. MMW Fortschr Med 2007; 148:40-2; quiz 43. [PMID: 17168187 DOI: 10.1007/bf03364845] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Between 60 and 90% of patients consult their family doctor for stress-associated complaints. Not infrequently, a considerable number of these patients already have elevated blood pressure. The positive effect on high blood pressure of relaxation techniques has been confirmed in various studies. Accordingly, stress management should now have a permanent place in effective antihypertensive treatment. Appropriate relaxation techniques include, for example, autogenic training, progressive muscle relaxation, visualization and breathing exercises, chi gong and yoga. These practices are incorporated in various lifestyle programs. They act in different ways, and can be offered to the patient in accordance with his/her individual wishes.
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Almeida L, González O, Sanz O, Paul A, Centeno M, Odriozola J, Montes M. Fischer-tropsch catalyst deposition on metallic structured supports. STUDIES IN SURFACE SCIENCE AND CATALYSIS 2007. [DOI: 10.1016/s0167-2991(07)80112-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Lenin Babu V, Rana MM, Arumilli BRB, Dean T, Brown C, Paul A. Chronic expanding haematomas with interesting presentations. THE IOWA ORTHOPAEDIC JOURNAL 2007; 27:108-11. [PMID: 17907441 PMCID: PMC2150659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The unusual presentation of our two cases posed a diagnostic dilemma between a chronic expanding haematoma and soft tissue sarcoma even after all investigations and biopsy reports were complete. Salient points to differentiate between the two are discussed along with literature review.
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Saner F, Gensicke J, Rath P, Fruhauf N, Gu Y, Paul A, Radtke A, Malagó M, Broelsch C. Safety Profile of Concomitant Use of Caspofungin and Cyclosporine or Tacrolimus in Liver Transplant Patients. Infection 2006; 34:328-32. [PMID: 17180587 DOI: 10.1007/s15010-006-5657-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Accepted: 05/29/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND Caspofungin is the first substance of a new class of antifungal agents, the echinocandins that interfere with fungal cell wall synthesis by inhibition of glucan synthesis. Alanine aminotransferase (ALT) elevations were seen in phase I studies of patients receiving caspofungin and cyclosporine A (CyA). Actually, there is no information regarding hepatotoxicity in liver transplant patients treated concomitantly with caspofungin and immunosuppressant agents like CyA or tacrolimus (TAC). PATIENTS AND METHODS We conducted a retrospective study in 12 liver transplant patients (9 patients Child C, 3 patients acute liver failure) to assess the hepatic safety of simultaneous administration of caspofungin with CyA or TAC. Caspofungin was administered as first-line agent to patients for a 2-week period with either proofed invasive fungal infection (IFI) (n = 4), IFI-probable (n = 4), and IFI-possible (n = 4). All patients received concomitantly CyA or TAC as immunosuppressant agent. RESULTS Two patients died within the first 10 days after start of treatment, caused by gram-negative rods. All other ten patients completed the 14-day treatment period. No liver enzyme elevation was recorded in these patients and administration of caspofungin with CyA or TAC was well tolerated without hepatotoxicity. CONCLUSION The concomitant use of caspofungin with CyA or TAC in liver transplant patients is safe and seemed to be without hepatotoxic effect.
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