Asunto(s)
Infecciones por Helicobacter/diagnóstico por imagen , Infecciones por Helicobacter/terapia , Helicobacter pylori , Úlcera Péptica/diagnóstico por imagen , Úlcera Péptica/terapia , Guías de Práctica Clínica como Asunto , Medicina Basada en la Evidencia , Gastroenterología/normas , Alemania , Infecciones por Helicobacter/virología , Humanos , Resultado del TratamientoAsunto(s)
Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/efectos adversos , Inhibidores de la Ciclooxigenasa/administración & dosificación , Inhibidores de la Ciclooxigenasa/efectos adversos , Enfermedades Gastrointestinales/inducido químicamente , Enfermedades Reumáticas/tratamiento farmacológico , Antiinflamatorios/administración & dosificación , Antiinflamatorios/efectos adversos , Antirreumáticos/administración & dosificación , Antirreumáticos/efectos adversos , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Monitoreo de Drogas/métodos , Medicina Basada en la Evidencia , Enfermedades Gastrointestinales/inmunología , Enfermedades Gastrointestinales/prevención & control , Humanos , Enfermedades Reumáticas/diagnóstico , Enfermedades Reumáticas/inmunología , Resultado del TratamientoRESUMEN
In the line "bismuth-containing quadruple therapy" of Table 7 (p 342), in the column "dosage" incorrectly at the three antibiotics respectively 1-1-1-1. The correct is: 3-3-3-3.
RESUMEN
NSAIDs exert their anti-inflammatory and analgesic effects by inhibition of COX2, a key enzyme for proinflammatory prostanoid synthesis. Therapy with NSAIDs is limited by their typical gastrointestinal, cardiovascular and renal side effects, which are caused by inhibition of COX1 (gastrointestinal toxicity), COX2 (cardiovascular side effects) or both COX-isoenzymes (renal side effects). Appropriate prevention strategies should be employed in patients at risk. If gastrointestinal risk factors are present, co-administration of a proton pump inhibitor or misoprostol is recommended; in patients with cardiovascular risk, coxibs, diclofenac and high-dose ibuprofen should be avoided. Furthermore, drug interactions and contraindications should be considered. In patients with renal impairment (GFR < 30 ml/min) all NSAIDs must be avoided. Ulcer anamnesis is a contraindication for traditional NSAIDs. Preexisting cardio- or cerebrovascular diseases are contraindications for coxibs. Treatment decisions should be individually based with a continuous monitoring of the risk - benefit ratio and exploitation of non-pharmacological treatment options.
Asunto(s)
Antiinflamatorios no Esteroideos/administración & dosificación , Artralgia/diagnóstico , Artralgia/tratamiento farmacológico , Hemorragia Gastrointestinal/prevención & control , Guías de Práctica Clínica como Asunto , Reumatología/normas , Antiinflamatorios no Esteroideos/efectos adversos , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Hemorragia Gastrointestinal/inducido químicamente , Alemania , Humanos , Dimensión del Dolor/efectos de los fármacos , Dimensión del Dolor/normas , Resultado del TratamientoRESUMEN
The irradiation facility at an old medical cyclotron (Ep=17 MeV; Ed=10 MeV) was upgraded by extending the beam line and incorporation of solid state targetry. Tests performed to check the quality of the available beam are outlined. Results on nuclear data measurements and improvement of radiochemical separations are described. Using solid targets, with the proton beam falling at a slanting angle of 20°, a few radionuclides, e.g. (75)Se, (120)I, (124)I, etc. were produced with medium currents (up to 20 µA) in no-carrier-added form in quantities sufficient for local use. The extended irradiation facility has considerably enhanced the utility of the medical cyclotron.
Asunto(s)
Ciclotrones/instrumentación , Marcaje Isotópico/instrumentación , Radiofármacos/síntesis química , Diseño de Equipo , Análisis de Falla de Equipo , Marcaje Isotópico/métodos , Dosis de RadiaciónRESUMEN
BACKGROUND: This prospective study evaluated the relationship between arthralgia and compliance during the first year of adjuvant anastrozole therapy in postmenopausal women with hormone receptor-positive early breast cancer. PATIENTS AND METHODS: COMPliance and Arthralgia in Clinical Therapy (COMPACT) was an open-label, multicenter, noninterventional study conducted in Germany. Patients had started adjuvant anastrozole 3-6 months before the study start. The primary end points were arthralgia, compliance, and the relationship between compliance and arthralgia, assessed at specific time points. RESULTS: Overall, 1916 patients received upfront anastrozole. Mean arthralgia scores were increased from baseline at each visit up to 9 months. Compliance with anastrozole therapy gradually decreased over time from baseline to 9 months (P<0.001). At 9 months, investigators estimated that >95% of patients were compliant versus patient reports of <70%. There was a significant association between arthralgia mean scores and noncompliance at 6 months (P<0.0001), 9 months (P<0.0001), and overall (P<0.0001). Over time, new events or impairment of existing arthralgias were reported in 14% (3 months), 11% (6 months), and 9% (9 months) of patients. CONCLUSION: Arthralgia is important in the clinical management of women with early breast cancer and may contribute to noncompliance and clinical outcomes. CLINICALTRIALSGOV IDENTIFIER: NCT00857012.
Asunto(s)
Antineoplásicos Hormonales/efectos adversos , Artralgia/epidemiología , Neoplasias de la Mama/tratamiento farmacológico , Nitrilos/efectos adversos , Triazoles/efectos adversos , Anciano , Anastrozol , Antineoplásicos Hormonales/uso terapéutico , Artralgia/inducido químicamente , Quimioterapia Adyuvante , Sustitución de Medicamentos , Femenino , Humanos , Incidencia , Cumplimiento de la Medicación , Persona de Mediana Edad , Nitrilos/uso terapéutico , Estudios Prospectivos , Resultado del Tratamiento , Triazoles/uso terapéuticoRESUMEN
The treatment of musculoskeletal pain is often difficult. For this reason opioids are increasingly being used for chronic musculoskeletal complaints despite poor or lacking evidence for their pain relieving and function improving effects. However, side effects are common and can be severe. Opioid-induced hyperalgesia can lead to higher doses and stronger pain and increase the risk of side effects. Long-term treatment of rheumatic pain with opioids should be carried out with caution.
Asunto(s)
Analgésicos Opioides/uso terapéutico , Artralgia/etiología , Artralgia/prevención & control , Cuidados Paliativos/normas , Fiebre Reumática/complicaciones , Fiebre Reumática/tratamiento farmacológico , Reumatología/normas , Analgésicos Opioides/efectos adversos , Alemania , HumanosRESUMEN
Following the EULAR recommendations published in 2010 German guidelines for the medical treatment of rheumatoid arthritis were developed based on an update of the systematic literature search and expert consensus. Methotrexate is the standard treatment option at the time of diagnosis, preferably in combination with low dose glucocorticoids. Combined disease-modifying antirheumatic drugs (DMARD) therapy should be considered in patients not responding within 12 weeks. Treatment with biologicals should be initiated in patients with persistent high activity no later than 6 months after conventional treatment and in exceptional situations (e.g. early destruction or unfavorable prognosis) even earlier. If treatment with biologicals remains ineffective, changing to another biological is recommended after 3-6 months. In cases of long-standing remission a controlled reduction of medical treatment can be considered.
Asunto(s)
Algoritmos , Antirreumáticos/administración & dosificación , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/tratamiento farmacológico , Guías de Práctica Clínica como Asunto , Reumatología/normas , Antirreumáticos/efectos adversos , Europa (Continente) , HumanosRESUMEN
This guideline updates a prior consensus recommendation of the German Society for Digestive and Metabolic Diseases (DGVS) from 1996. It was developed by an interdisciplinary cooperation with representatives of the German Society for Hygiene and Microbiology, the Society for Pediatric Gastroenterology and Nutrition (GPGE), and the German Society for Rheumatology. The guideline is methodologically based on recommendations of the Association of the Scientific Medical Societies in Germany (AWMF) for providing a systematic evidence-based S 3 level consensus guideline and has also implemented grading criteria according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) process. Clinical applicability of study results as well as specifics for Germany in terms of epidemiology, antibiotic resistance status, diagnostics, and therapy were taken into account.
Asunto(s)
Gastroenteritis/diagnóstico , Gastroenteritis/terapia , Gastroenterología/normas , Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/terapia , Helicobacter pylori , Úlcera Péptica/diagnóstico , Úlcera Péptica/terapia , Alemania , HumanosRESUMEN
This guideline updates a prior concensus recommendation of the German Society for Digestive and Metabolic Diseases (DGVS) from 1996. It was developed by an interdisciplinary cooperation with representatives of the German Society for Microbiology, the Society for Pediatric Gastroenterology and Nutrition (GPGE) and the German Society for Rheumatology. The guideline is methodologically based on recommendations of the Association of the Scientific Medical Societies in Germany (AWMF) for providing a systematic evidence-based consensus guideline of S 3 level and has also implemented grading criteria according to GRADE (Grading of Recommendations Assessment, Development and Evaluation). Clinical applicability of study results as well as specifics for Germany in terms of epidemiology, antibiotic resistance status, diagnostics and therapy were taken into account.
Asunto(s)
Antibacterianos/uso terapéutico , Antiulcerosos/uso terapéutico , Medicina Basada en la Evidencia , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori , Úlcera Péptica/tratamiento farmacológico , Adolescente , Adulto , Niño , Estudios Transversales , Quimioterapia Combinada , Mucosa Gástrica/microbiología , Mucosa Gástrica/patología , Gastroscopía , Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/epidemiología , Humanos , Linfoma de Células B/patología , Linfoma de Células B/prevención & control , Linfoma de Células B de la Zona Marginal/patología , Linfoma de Células B de la Zona Marginal/prevención & control , Estadificación de Neoplasias , Úlcera Péptica/diagnóstico , Úlcera Péptica/epidemiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Neoplasias Gástricas/patología , Neoplasias Gástricas/prevención & controlAsunto(s)
Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Antiinflamatorios no Esteroideos/efectos adversos , Antiinflamatorios no Esteroideos/uso terapéutico , Antirreumáticos/efectos adversos , Artritis Reumatoide/etiología , Quimioterapia Combinada , Glucocorticoides/efectos adversos , Glucocorticoides/uso terapéutico , Humanos , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Metotrexato/efectos adversos , Metotrexato/uso terapéutico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidoresRESUMEN
It is well documented that the aromatase inhibitors (AIs) are superior to tamoxifen as adjuvant endocrine therapy in postmenopausal women with hormone receptor-positive breast cancer. However, compared with tamoxifen, an elevated incidence of arthralgia has been observed during AI treatment. Concerns have been raised that AI-induced arthralgia may dissuade patients from completing their full AI treatment course, and may also deter physicians from prescribing an AI if they feel that patients may be at risk of permanent joint damage. Patient education about the possibility of experiencing arthralgia, and effective management of symptoms if they appear, are important in helping patients adhere to AI treatment, and consequently improving breast cancer outcomes. In this paper, we discuss the potential mechanisms behind AI-induced arthralgia, review the frequency with which arthralgia occurs, and propose for the first time an algorithm specifically for the treatment of AI-induced arthralgia. As with joint pain in non-breast cancer patients, a sequential approach to disease management is recommended, involving modifying the patient's lifestyle in addition to taking a stratified approach to pharmacological intervention with analgesia and anti-inflammatory medication. Knowing that joint symptoms can be managed in most patients may encourage patient-physician communication and treatment compliance.
Asunto(s)
Antineoplásicos Hormonales/efectos adversos , Inhibidores de la Aromatasa/efectos adversos , Artralgia/inducido químicamente , Neoplasias de la Mama/tratamiento farmacológico , Algoritmos , Antiinflamatorios no Esteroideos/uso terapéutico , Artralgia/tratamiento farmacológico , Quimioterapia Adyuvante , Ensayos Clínicos como Asunto , Femenino , Humanos , Neoplasias Hormono-Dependientes/tratamiento farmacológico , Educación del Paciente como AsuntoAsunto(s)
Analgésicos Opioides/administración & dosificación , Antiinflamatorios no Esteroideos/uso terapéutico , Inhibidores de la Ciclooxigenasa 2/uso terapéutico , Osteoartritis/tratamiento farmacológico , Osteoartritis/fisiopatología , Dolor/tratamiento farmacológico , Dolor/etiología , Administración Cutánea , Administración Oral , Antiinflamatorios no Esteroideos/administración & dosificación , Buprenorfina/administración & dosificación , Buprenorfina/uso terapéutico , Inhibidores de la Ciclooxigenasa 2/administración & dosificación , Humanos , Naloxona/uso terapéutico , Factores de Riesgo , Tilidina/administración & dosificación , Tilidina/uso terapéutico , Tramadol/administración & dosificación , Tramadol/uso terapéuticoRESUMEN
Treatment of pain in rheumatoid arthritis must take into account the gastrointestinal and cardiovascular risk of individual patients. Adequate results are not yet available, and until they are, treatment recommendations must take into account, not only the more favourable gastrointestinal risk profile of selective COX-2 inhibitors, but also the potential atherothrombotic risk of any NSAID or selective COX-2 inhibitor treatment.
Asunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Aterosclerosis/inducido químicamente , Trombosis/inducido químicamente , Plaquetas/efectos de los fármacos , Plaquetas/metabolismo , Inhibidores de la Ciclooxigenasa 2/efectos adversos , Inhibidores de la Ciclooxigenasa/efectos adversos , Humanos , Tromboxano A2/metabolismoRESUMEN
Recommendations for treatment with NSAIDs that take into account the latest study results must note that both the duration of treatment and the NSAID dose must be kept as small as possible. Elevated gastrointestinal risk is the rationale for the use of selective COX-2 inhibitors in place of conventional NSAIDs, or, where indicated, co-medication with a proton pump inhibitor. A manifest cardiovascular risk is aggravated by the use of coxibs, but probably also by the administration of traditional NSAIDs. Cardioprotective medication in the form of low-dose acetyl salicylic acid can probably reduce the cardiovascular risk, but at the same time increases the gastrointestinal risk. In such cases, proton pump inhibitors can offer some relief. However, the latter have no effect on the situation in the lower gastrointestinal tract. In patients with an elevated cardiovascular risk, the use of coxibs, and probably also NSAIDs for the treatment of pain, is problematical. The decision on what treatment to apply should be made on the basis of a benefit/risk assessment, and consideration should be given to alternative therapeutic strategies.
Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Antirreumáticos/uso terapéutico , Inhibidores de la Ciclooxigenasa/uso terapéutico , Enfermedades Reumáticas/tratamiento farmacológico , Anciano , Antiinflamatorios no Esteroideos/efectos adversos , Antirreumáticos/efectos adversos , Aspirina/uso terapéutico , Enfermedades Cardiovasculares/inducido químicamente , Enfermedades Cardiovasculares/prevención & control , Ensayos Clínicos como Asunto , Inhibidores de la Ciclooxigenasa/efectos adversos , Enfermedades Gastrointestinales/inducido químicamente , Enfermedades Gastrointestinales/prevención & control , Humanos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Inhibidores de la Bomba de Protones , Medición de Riesgo , Factores de RiesgoAsunto(s)
Inhibidores de la Ciclooxigenasa/normas , Antiinflamatorios no Esteroideos/efectos adversos , Antiinflamatorios no Esteroideos/economía , Arteriosclerosis/prevención & control , Inhibidores de la Ciclooxigenasa/efectos adversos , Inhibidores de la Ciclooxigenasa/economía , Tracto Gastrointestinal/efectos de los fármacos , Humanos , Inhibidores de la Bomba de Protones , Factores de RiesgoAsunto(s)
Enfermedades Cardiovasculares/inducido químicamente , Enfermedades Cardiovasculares/prevención & control , Isoxazoles/efectos adversos , Lactonas/efectos adversos , Enfermedades Reumáticas/tratamiento farmacológico , Sulfonamidas/efectos adversos , Sulfonas/efectos adversos , Antirreumáticos/efectos adversos , Antirreumáticos/uso terapéutico , Seguridad de Productos para el Consumidor , Inhibidores de la Ciclooxigenasa/efectos adversos , Inhibidores de la Ciclooxigenasa/uso terapéutico , Aprobación de Drogas , Alemania , Humanos , Isoxazoles/uso terapéutico , Lactonas/uso terapéutico , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina , Sulfonamidas/uso terapéutico , Sulfonas/uso terapéuticoAsunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Isoxazoles/uso terapéutico , Animales , Antiinflamatorios no Esteroideos/efectos adversos , Europa (Continente) , Humanos , Isoxazoles/efectos adversos , Leflunamida , Metotrexato/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Sulfasalazina/uso terapéutico , Resultado del TratamientoRESUMEN
The leading symptom of arthrosis and arthritis is pain. As in the case of pharmacotherapy fortumor pain, a stepped approach is also recommended for rheumatic complaints. Mild-to-moderate pain in noninflammatory arthrosis can be ameliorated by paracetamol or low-dose ibuprofen. If inflammation is present, nonsteroidal anti-inflammatory drugs (NSAIDs) must be employed. If this treatment does not suffice to manage systemic arthritis, oral short-acting corticosteroids are applied. Intra-articular corticosteroid injections can be used to individual inflamed active joints. For chronic pain, opioids may be necessary in addition to NSAID treatment. The use of NSAIDs is limited by gastrointestinal side effects. In the case of risk patients, therefore, preventive measures must be taken, and PPI or, instead of NSAIDs, coxibs employed in addition.