fiat-500-1

Plädoyer für eine positive Lebenseinstellung

26. August 2016

Prof. Dr. med. Curt Diehm

In seinem heutigen Gastbeitrag bricht Prof. Dr. med. Curt Diehm eine Lanze für eine positive Lebenseinstellung. Und untermauert seinen Appell mit wissenschaftlichen Veröffentlichungen.
Es war der Kaufmann Rolf Nitsch, der einmal so schön formulierte: „Achtung: meiden Sie auf alle Fälle Pessimisten, Kleindenker, Schwarzseher und Armutsfetischisten, solche Leute treiben Sie in den Misserfolg und lenken sie von Ihren wahren Bestimmungen ab.“ Da ist etwas daran. Nicht nur für die generelle Lebensgestaltung, auch in der Medizin spielt eine optimistische Grundhaltung eine große Rolle.  Weiterlesen

Sodbrennen – nicht zu unterschätzen !

19. August 2016

Prof. Dr. med. Curt Diehm

Wie kommt es zu Sodbrennen und was kann man dagegen tun? Das erklärt Prof. Dr. med. Curt Diehm in seinem heutigen Gastbeitrag.
Sodbrennen ist zu einer sehr verbreiteten Krankheit geworden. Über 40 Prozent aller Deutschen leiden an Sodbrennen. Es wird verursacht, wenn der Verschlussmechanismus zwischen Magen und Speiseröhre nicht mehr funktioniert. Dann fließt Magensäure zurück aus dem Magen in die Speiseröhre und kann dort die Schleimhaut angreifen. Eigentlich sollte ein ringförmiger Muskel am Mageneingang (der „Pförtner“) den Rückfluss von Magensäure in die Speiseröhre verhindern. Wenn dieser Muskel aber erschlafft ist, etwa durch massives Übergewicht und wenn beispielsweise Bauchfett den Magen nach oben drückt, dann kann der Pförtner nicht mehr richtig arbeiten. Spezielle Nahrungsmittel wie Coca-Cola, Weiswein mit viel Säure und Kaffee können Risikofaktoren für die auch Reflux genannte Krankheit sein. Natürlich kann auch Stress zu ähnlichen Problemen führen.  Weiterlesen

Amputations and mortality in in-hospital treated patients with peripheral artery disease and diabetic foot syndrome

Nasser M. Malyar a,⁎, Eva Freisinger a, Matthias Meyborg a, Florian Lüders a, Katrin Gebauer a, Holger Reinecke a, Holger Lawall b

a Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany b Praxis für Herzkreislauferkrankungen und Akademie für Gefäßkrankheiten, Ettlingen, Germany

article info

Article history:

Received 16 February 2016
Received in revised form 30 March 2016 Accepted 31 March 2016
Available online 4 April 2016

Keywords:

Amputation
Diabetes
Diabetic foot syndrome Mortality
Peripheral artery disease

1. Introduction

The prevalence of diabetes mellitus (DM) is increasing world- wide (Murray, Barber, Foreman et al., 2015; Zimmet, Magliano, Herman, & Shaw, 2014) just as the diabetes-associated complica- tions (Gregg, Li, Wang, et al., 2014) such as peripheral artery disease (PAD) and especially diabetic foot syndrome (DFS). Patients with DM have a lifetime probability of 15%–25% for developing foot ulcers (Abbott, Carrington, Ashe, et al., 2002; Singh, Armstrong, & Lipsky, 2005; Wild, Roglic, Green, Sicree, & King, 2004) which are a precursor of limb amputation, particularly in the presence of

Funding: No sources of funding.

Conflict of interest: H. Reinecke has received grants for participation in multicenter trials from Bard, Bayer, Biotronik, and Pluristem and consultant fees from BMS and Pluristem. N.M. Malyar has received travel support from Bard, Bayer, Cordis, Daiichi-Sankyo, and Medtronic and speaker honoraria from Medac and UCB Pharma. The other authors have nothing to declare.

⁎ Correspondingauthorat:DivisionofVascularMedicine,DepartmentofCardiovascular Medicine, University Hospital Muenster, Albert-Schweitzer-Campus 1Gebäude A1, 48149 Muenster, Germany. Tel.: +49 251 8347688; fax: +49 251 834 5101.

E-mail address: nasser.malyar@ukmuenster.de (N.M. Malyar).

http://dx.doi.org/10.1016/j.jdiacomp.2016.03.033

1056-8727/© 2016 Elsevier Inc. All rights reserved.

abstract

Aims: The prevalence of diabetes mellitus (DM) and its associated complications such as peripheral artery disease (PAD) and diabetic foot syndrome (DFS) are increasing worldwide. We aimed to determine the contemporary acute and long-term outcome of patients with PAD and DFS in Germany.
Methods: Nationwide, anonymized data of 40,335 patients hospitalized for PAD and/or DFS from the years 2009–2011 were analyzed and followed up until 2013. Patients were classified into 3 groups: DFS, PAD+DM and PAD without DM. In-hospital and long-term outcome (1156 days, 95% CI 1.151–1.161) regarding major and minor amputation and mortality was assessed. Cumulative amputation-free survival and overall survival rates were calculated using Kaplan–Meier analysis.

Results: The proportion of DFS, PAD+DM and PAD only was 17.3%, 21.5% and 61.2%, respectively. At index-hospitalization, DFS patients had the highest amputation (31.9% vs. 11.1% vs. 6.0%), yet the lowest revascularization rate (18.2% vs. 67.8% vs. 71.6%) compared to patients with PAD only and PAD+DM (P b 0.001). Cumulative 4-year survival (57.4%, 60.8% and 70.0%) and amputation-free-survival (45.4%, 74.4% and 86.5%) were lowest for DFS followed by PAD+DM and PAD only (P b 0.001).

Conclusions: Patients with diabetes, particularly those with DFS, have persistent high rates of limb amputation and of mortality in a real-world setting. Our data emphasize the need for further dedicated research to identify and target the underlying causes of the extraordinary poor outcome in this high risk population.

© 2016 Elsevier Inc. All rights reserved.

ischemia and infection. Concomitant PAD is present in approxi- mately 50%–70% of diabetic foot ulcers and is a strong predictor of adverse outcome in ulcer healing, limb amputation, morbidity, and mortality (Prompers, Huijberts, Apelqvist, et al., 2007; Prompers, Schaper, Apelqvist, et al., 2008). Moreover, both PAD and DM are associated with extensive resource utilization and costs (Prompers, Huijberts, Schaper, et al., 2008).

Measures such as campaigns to increase the awareness of DM-associated vascular complications (World Health Organization: Diabetes Care and Research in Europe: The St. Vincent Declaration. Geneva, World Health Org, 1989) alongside with the progress in medical and interventional treatment modalities during the last decades might be suggestive of an improved outcome of patients with DM and PAD. Indeed, a continuous advance in integrated manage- ment of DM has resulted in considerable decrease of DM-related complications during the last two to three decades (Gregg, Li, et al., 2014; Gregg et al., 2014). Even in patients with DFS a dedicated multidisciplinary approach resulted in favorable short- and long-term outcome (Apelqvist et al., 2011; Apelqvist, Bakker, van Houtum, Schaper, & International Working Group on the Diabetic Foot (IWGDF) Editorial Board, 2008; Apelqvist & Larsson, 2000; Krishnan,

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