ABSTRACT
Lightning strikes rarely occur but 85 % of patients have lightning-related neurological complications. This report provides an overview about different modes of energy transfer and neurological conditions related to lightning strikes. Moreover, two case reports demonstrate the importance of interdisciplinary treatment and the spectrum of neurological complications after lightning strikes.
Subject(s)
Lightning Injuries/complications , Lightning Injuries/diagnosis , Nervous System Diseases/diagnosis , Nervous System Diseases/etiology , Brain/physiopathology , Brain Damage, Chronic/diagnosis , Brain Damage, Chronic/etiology , Brain Damage, Chronic/physiopathology , Brain Damage, Chronic/therapy , Brain Edema/complications , Brain Edema/diagnosis , Brain Edema/physiopathology , Brain Edema/therapy , Critical Care/methods , Fatal Outcome , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/etiology , Guillain-Barre Syndrome/physiopathology , Guillain-Barre Syndrome/therapy , Humans , Interdisciplinary Communication , Intersectoral Collaboration , Lightning Injuries/physiopathology , Lightning Injuries/therapy , Male , Multiple Trauma/diagnosis , Multiple Trauma/therapy , Nervous System Diseases/physiopathology , Nervous System Diseases/therapy , Prognosis , Tomography, X-Ray Computed , Young AdultABSTRACT
BACKGROUND: The provision of assistive devices (PAD) is a key element of care in amyotrophic lateral sclerosis (ALS). Since 2011, assistive devices (AD) have been coordinated in an internet-supported care network at university-based ALS centers in Berlin, Bochum, Hannover and Jena. The digitization of PAD processes has facilitated the evaluation of real-life ALS care. OBJECTIVES: Orthotics (OT), augmentative and alternative communication (AAC), supported treadmill (ST) and powered wheelchair (PW) were the PAD groups analyzed for delivery rates (proportion of delivered AD vs. medically indicated AD), rejection by patients and payers and latency of provision of care. RESULTS: Between June 2011 and October 2014 a total of 1479 patients and 12,478 AD were coordinated, among which 3313 PAD were related to OT, AAC, ST or EM. The median delivery rate was 64.3 %. The mean rejection rate by patients was 9.8 % (OT 5.4 %, AAC 9.8 %, ST 10.2 % and PW 15.6 %). Marked differences were noted in the rejection rate by payers and in care provision latency: OT (16.2 %, 68 days, n = 734), AAC (30.4 %, 96 days, n = 392), ST (34.8 %, 113 days, n = 164) and PW (35.6 %, 129 days, n = 259). Analysis of rejection rates showed significant differences among insurers. CONCLUSION: Only two thirds of the medically indicated AD reached the patients. Rejection rates by patients and payers and latency of provision of care were high. The PAD can substantially vary among health insurance companies. The establishment of consented criteria for PAD and their integration into treatment regimens and guidelines are crucial tasks for the future.
Subject(s)
Amyotrophic Lateral Sclerosis/rehabilitation , Case Management/statistics & numerical data , Internet/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Self-Help Devices/supply & distribution , Self-Help Devices/statistics & numerical data , Amyotrophic Lateral Sclerosis/epidemiology , Germany/epidemiology , Health Care Rationing/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Humans , Internet/supply & distribution , Longitudinal Studies , Prevalence , Utilization ReviewABSTRACT
The long term ovariectomized adult rat was used to test the effects of exogenous estradiol, 4-hydroxyestradiol, and 2-hydroxyestradiol on LH secretion. To this end, different doses of estradiol 3-benzoate, 4-hydroxyestradiol 3,4-dibenzoate, and 2-hydroxyestradiol 2,3-dibenzoate were injected daily at 0800 h, and the LH serum levels were measured on 4 experimental days. At a dose of 1 micrograms/day, estradiol benzoate lowered LH secretion, beginning 48 h after the first injection (morning of day 2), and induced a characteristic LH surge 10 h later. 4-Hydroxyestradiol dibenzoate at the same dose produced less suppression of LH on the morning of day 3, but caused a comparable and highly significant surge on the same evening. Higher doses (3 and 10 micrograms/day) resulted in the same pattern seen with estradiol benzoate. 2-Hydroxyestradiol dibenzoate at comparable doses had no effect. Only extremely high doses (129 micrograms/day) caused slight suppression of tonic LH secretion 72 h after the first injection, and inconsistent LH elevations occurred on the same evening. It is concluded that in this model, catecholestrogens act as estrogens with respect to LH suppression and release, with 4-hydroxyestradiol being a potent estrogen and 2-hydroxyestradiol a weak estrogen.
