No abstract

In the summer of 2016, delegates from the German Respiratory Society, the German Society of Cardiology and the German Society of Pediatric Cardiology met in Cologne, Germany, to define consensus-based practice recommendations for the management of patients with pulmonary arterial hypertension (PAH). These recommendations were built on the 2015 European Pulmonary Hypertension guidelines aiming at their practical implementation, considering country-specific issues, and including new evidence, where available. To this end, a number of working groups was initiated, one of which was specifically dedicated to general measures (i.e. physical activity/supervised rehabilitation, pregnancy/contraception, elective surgery, infection prevention, psychological support, travel) and supportive therapy (i.e. anticoagulants, diuretics, oxygen, cardiovascular medications, anaemia/iron deficiency, arrhythmias) for PAH. While the European guidelines provide detailed recommendations for the use of targeted PAH therapies as well as supportive care, detailed treatment decisions in routine clinical care may be challenging, and the relevance of supportive care is often not sufficiently considered. In addition, new evidence became available, thus requiring a thorough reevaluation of specific recommendations. The detailed results and recommendations of the working group on general measures and supportive therapy for PAH, which were last updated in the spring of 2018, are summarized in this article.

The 2015 European Guidelines on Pulmonary Hypertension did not cover only pulmonary arterial hypertension (PAH), but also other significant subgroups of pulmonary hypertension (PH). In June 2016, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany to discuss open and controversial issues surrounding the practical implementation of the European Guidelines. Several working groups were initiated, one of which was dedicated to the diagnosis and treatment of chronic thromboembolic pulmonary hypertension (CTEPH). In every patient with PH of unknown cause CTEPH should be excluded. The primary treatment option is surgical pulmonary endarterectomy (PEA) in a specialized multidisciplinary CTEPH center. Inoperable patients or patients with persistent or recurrent CTEPH after PEA are candidates for targeted drug therapy. For balloon pulmonary angioplasty (BPA), there is currently only limited experience. This option - as PEA - is reserved to specialized centers with expertise for this treatment method. In addition, a brief overview is given on pulmonary artery sarcoma, since its surgical treatment is often analogous to PEA. The recommendations of this working group are summarized in the present paper.

Chronic venous leg ulcers are common and cause considerable burden of disease for affected patients with significant costs for health care systems worldwide. The complex pathophysiology of chronic venous leg ulcers is still not entirely understood. In addition, reliable pathogenic and/or prognostic parameters are not known. Published data suggest that patients with chronic venous leg ulcers reveal congenital or acquired thrombophilia. We examined the serum Lipoprotein (a) [Lp(a)] level, a proatherogenic and prothrombotic risk factor, in patients with chronic venous leg ulcers (n=210, stratified into patients with postthrombotic syndrome or without) and in a healthy control group (n=341). Forty-two percent of all patients, compared with 20% of healthy controls, revealed significantly increased Lp(a) serum concentrations above 0.3 g/L. Furthermore, 49% without postthrombotic syndrome but only 35% with postthrombotic syndrome showed increased Lp(a) levels. The increase of Lp(a) level was significantly different between all three groups (p<0.001). There was no correlation of Lp(a) levels and CRP values in all groups. Based on these data, it is conceivable that Lp(a) plasma level is a novel pathogenic parameter for chronic venous leg ulcers. Elevated concentrations may contribute to the pathogenesis through induction of thrombogenic microcirculatory dysregulations, impaired extravascular fibrinolysis, or other mechanisms like proinflammatory effects.

Pharmacotherapy of children and adolescents with psychotropic medication ongoing public debate in Germany. Increasing use of psychotropic medication was sometimes interpreted as overprescribing. In this systematic review prescribing patterns of stimulants, antidepressants and antipsychotics for children and adolescents and its development from 2000 to 2012 have been analyzed. An increase of prescriptions was observed in stimulants, antidepressants and antipsychotics. Compared with international data frequency of prescribed medication cannot be considered as overprescribing in general. Antipsychotics seem to be used mainly in behavioral use with an increasing frequency. Data indicates a trend towards more prescribing based on guidelines and evidence based treatments. Next to child and adolescent psychiatrists, pediatricians are most important prescribers.

Coercive Measures in Child and Adolescent Psychiatry To keep the use of coercive measures in child and adolescent psychiatry low or reduce them completely, there needs to be a specific knowledge of the starting point. The study provides an overview of the current situation using a systematic literature review of published studies from the European and the outer European regions between 2005 and 2015. In summary only twelve publications addressed the topic, differentiated in four studies from inner and eight studies from outer European countries. In the studies from Europe, girls in their late adolescence experienced coercive measures more often, whereas the outer European studies identified more boys in early school age. Regarding the diagnoses of the respective patients, no distinct trend could be identified, as coercive measures were applied with a range of different diagnoses. In the European studies, coercive measures were more often used with children and adolescents fitting in the ICD-10-category F9. Results point to a lack of empirical studies concerning coercive measures in the context of child and adolescent psychiatry. Besides, clinical practice between the countries varies tremendously, resulting in difficulties comparing the findings. One possibility to address these issues might be a central register for every kind of coercive measure, as it was introduced in Baden-Württemberg lately and is currently in development for North Rhine-Westphalia.

Based on these data, it is conceivable that thrombophilia contributes to the pathogenesis of CVU, possibly through induction of microcirculatory dysregulations.

No abstract