[Effects of Outpatient Compact Rehabilitation on Physical Performance and Quality of Life in Patients with Work-Related Lung Diseases]. / Effekte einer ambulanten Kompaktrehabilitation auf körperliche Leistungsfähigkeit und Lebensqualität bei Patienten mit Berufskrankheiten der Lunge.

In Germany, pulmonary rehabilitation (PR) traditionally takes place in rehabilitation clinics. According to the current German guideline "Diagnostics and assessment of asbestos-related occupational diseases", PR can also be offered as outpatient program with the essential elements of inpatient PR (compact rehabilitation [CR]). Our project investigated the effects of CR regarding acceptance, physical performance, and quality of life of patients with occupational lung diseases. CR included 24 units of 90 minutes each with physiotherapy and breathing therapy as well as device-supported strength and endurance training. The aim of our study was to investigate the effects of CR in subjects with occupational diseases of the respiratory system and a legally anchored right to PR. Randomization was therefore not planned. A total of 148 insured persons with a confirmed occupational disease of the respiratory system were invited to participate by the employers' liability insurance association; 126 patients (85 %) accepted the invitation, and 78 participants (mean age: 71 years) completed the entire program (53 %). Benign asbestos-related diseases (plaques, pleural thickening, asbestosis) dominated with around 80 %. Ailments, depression, and dementia were typical obstacles. No adverse events occurred with strict observance of the chosen inclusion and exclusion criteria and training conditions. The measurement results at enrolment were compared with those at completion of the CR. CR led to a significant (p < 0.01) improvement in all parameters of physical performance: 6-minute walking test: + 36 m, ergometer test: + 9 watts, hand dynamometry: + 29 N, quadriceps strength test: + 84 MKI. The inspiratory capacity of the respiratory muscles (Pimax: + 1.1 kPa) also improved (p < 0.01). The SF-36 showed an improvement in quality of life (p < 0.05) in the subdomains "mental well-being" (+ 3.7) and "physical role function" (+ 4.2). Therefore, CR proves to be a safe therapy if the inclusion and exclusion criteria are adhered to. CR is widely accepted by patients without severe comorbidities and achieves positive effects comparable to those that have been demonstrated in rehabilitation clinics. Outpatient CR is therefore suitable for eliminating the lack of structured and certified rehabilitation and training offers in rehabilitation clinics and for preserving the effects achieved there for insured patients with work-related respiratory and lung diseases.

[Persistent Diarrhea of an Elderly Lady - How to Combine Blood Pressure and Diarrhea]. / Anhaltende Diarrhö einer älteren Dame ­ wie Blutdruck und Diarrhö zusammengehören.

HISTORY AND CLINICAL FINDINGS: A 72-year-old female presented with a therapy-resistant diarrhea. EXAMINATIONS: In the case of negative stool cultures and inconspicuous radiological imaging, further endoscopic diagnostics were performed. Histological implicated the image of a celiac disease in the duodenum and lymphocytic colitis reaching into the terminal ileum. In the case of negative antibody detection for celiac disease, a medication side effect was considered by differential diagnosis. TREATMENT: When olmesartan was discontinued, she developed a rapid improvement of the symptoms. CONCLUSION AND DIAGNOSIS: For the angiotensin receptor antagonist olmesartan, the occurrence of a sprue-like enteropathy has rarely described. Microscopic colitis is an exception.

[Finger amputation following a minor injury: insurance aspects in Germany and practical approaches]. / Fingeramputation nach Bagatellverletzung ­ versicherungsrechtliche Aspekte in Deutschland und praktische Herangehensweise.

Expert medical assessments are an integral part of a physician's sphere of activity today. Since subspecialisation is constantly advancing, there is often a limited pool of medical experts available for specific assessment matters. Medical experts have to assess the full proof of facts and the probability of correlations. As regards assessments issued to the statutory accident insurance, the issue of possible pre-existing conditions/damage plays an important role in the discussion surrounding the grounds for liability. Occasional causes or minor injuries are relevant for insurance claims and must be recognised.An insured person with an acral, non-arteriosclerotic circulatory disorder (thrombangiitis obliterans) was involved in an accident at work that resulted in a soft tissue skin defect and the need to amputate the finger. A vascular medical examination found that there was no occasional cause. A hand surgery expert proposed a 25 percent reduction in earning capacity. The accident insurance company followed the decision of the medical experts.