The purpose of this review is to give an overview of the rehabilitation measures provided for cardiac patients in Germany and to outline its legal basis and outcomes. In Germany the cardiac rehabilitation system is different from rehabilitation measures in other European countries. Cardiac rehabilitation in Germany since 1885 is based on specific laws and the regulations of insurance providers. Cardiac rehabilitation has predominantly been offered as an inpatient service, but has recently been complemented by outpatient services. A general agreement on the different indications for offering these two services has yet to be reached. Cardiac rehabilitation is mainly offered after an acute cardiac event and bypass surgery. It is also indicated in severe heart failure and special cases of percutaneous coronary intervention. Most patients are men (>65%) and the age at which events occur is increasing. The benefits obtained during the 3-4 weeks after an acute event, and confirmed in numerous studies, are often later lost under 'usual care' conditions. Many attempts have been made by rehabilitation institutions to improve this deficit by providing intensive aftercare. One instrument set up to achieve this is the nationwide institution currently comprising more than 6000 heart groups with approximately 120000 outpatients. After coronary artery bypass grafting or acute coronary syndrome cardiac rehabilitation can usually be started within 10 days. The multidisciplinary rehabilitation team consists of cardiologists, psychologists, exercise therapists, social workers, nutritionists and nurses. The positive effects of cardiac rehabilitation are also important economically, for example, for the improvement of secondary prevention and vocational integration.

Catheterization of Labbé's vein and of a pial branch of the middle cerebral artery has been performed on anesthetized baboons. Closure of the skull has enabled the reaction of the venous outflow from Labbé's vein to be monitored in response to pressure step increases in the pial arterial pressure induced by gas compression of a perfusion mixture connected to the arterial line. Rapid changes in cerebrovascular resistance with swift emergence of regulatory constancy have been shown, and the time characteristics of the resistance changes strongly suggest that they are primarily myogenic in origin. Induction of hypercapnia did not interfere with this autoregulatory mechanism to increased perfusion pressure, which indeed appeared to be more effective at raised arterial P CO 2 , but the mechanism was abolished by the induction of ischemia from middle cerebral occlusion.

No abstract

Madopar HBS (125 mg) is a controlled-release dosage form with 100 mg L-dopa and 25 mg benserazide. The ‘hydrodynamically balanced system’ (HBS) used for this novel dosage form of Madopar is a dosage form which, when in contact with gastric fluid and after dissolution of the gelatine shell of the capsule, forms a mucous body and a bulk density of less than 1 and releases the drug(s) at a desired rate whereas the dosage form remains in the stomach for a prolonged period of time. Drugs – in the present case L-dopa and benserazide – are released through the hydrated layer by diffusion principle. This system is valuable for drugs which are soluble at lower pH. By varying the composition of the excipients, desired release rates can be achieved. The in vitro dissolution rate of Madopar HBS formulation is as follows: L-dopa t_75% = about 6 h and benserazide t_75% = about 4 h. The floating behavior was tested in an in vitro test. These in vitro floating properties could be confirmed in man and were investigated in 10 healthy volunteers by means of gamma camera measurements using a poly-marker technique carried out in connection with a Valium CR study. It is expected that this novel drug delivery system proffers a valuable dosage form which delivers the drug at a specific rate allowing a better control of fluctuations in parkinsonian patients.

CARRISMA facilitates the application of knowledge of the current literature in the individual patient in a user-friendly manner allowing a more detailed and yet time-efficient risk stratification and risk management in primary prevention, particularly in the intermediate risk range.

No abstract

No abstract

No abstract