Assessment of cardiotoxicity during haemopoietic stem cell transplantation with plasma brain natriuretic peptide

Cardiac failure is a known complication of haemopoietic stem cell transplantation (HSCT) and is often difficult to diagnose as patients may have multiple medical problems. Since brain natriuretic peptide (BNP) is largely a hormone of cardiac ventricular origin and is released early in the course of ventricular dysfunction, we have examined the value of serial plasma BNP levels for detecting cardiac failure in patients undergoing cytotoxic conditioning for HSCT. Fifteen patients undergoing HSCT were evaluated (10 undergoing autologous HSCT; five undergoing allogeneic HSCT). BNP was measured by radioimmunoassay prior to therapy and weekly for 5 weeks. Seven patients had a significant rise in BNP level (above a previously established threshold of 43 pmol/l associated with cardiac failure), occurring 1-4 weeks post commencement of conditioning. In three of these patients, cardiac failure was subsequently diagnosed clinically 3, 9 and 23 days after a BNP level of 43 pmol/l had been detected. These three patients had the highest peak BNP levels for the group and in each case elevation in BNP level occurred for a period exceeding 1 week. Although numbers were relatively small, a BNP >43 pmol/l was significantly associated with the inclusion of high-dose cyclophosphamide in the preparative regimen (P = 0.02). BNP levels showed no relationship to febrile episodes. In conclusion, these results show that plasma BNP may be used as a marker for early detection of cardiac dysfunction in patients undergoing HSCT, particularly if levels are increased for periods exceeding 1 week. Measurement of BNP during HSCT may be helpful in patients at risk of cardiac failure, in complex clinical situations and in monitoring the cardiotoxicity of preparative regimens

Whiplash, Real or Not Real?:A Review and New Concept

Whiplash-associated disorder (WAD) describes a heterogeneous group of symptoms, which develops frequently after an unexpected rear-end car collision. In some of these patients, the symptoms persist for years. There is an ongoing scientific debate about the existence of tissue injury to support this disorder, due to the lack of findings with current diagnostic techniques and the prevalence of emotional traits as risk factors. The purpose of this chapter is to (1) overview the scientific data regarding the presence of an injury mechanism as a consequence of the whiplash trauma, (2) remark the unexpectedness of the accident as essential, and (3) present a new concept according to which WAD symptoms are the result of a mismatch between aberrant information from the cervical spinal cord and the information from the vestibular and visual systems, all of which are integrated in the mesencephalic periaqueductal gray and adjoining regions

The disability insurance legal assessment in Switzerland against the background of the latest legislative amendments and new jurisprudence

In der Schweiz gibt es 11 verschiedene, historisch gewachsene Sozialversicherungen, deren grundsätzliche Ausgestaltung im Allgemeinen Teil des Sozialversicherungsgesetzes (ATSG) dargelegt ist. Die soziale Sicherung für behinderte Menschen und solche mit chronischen Erkrankungen wird u. a. von der Invalidenversicherung gewährleistet, die durch das Bundesgesetz über die Invalidenversicherung – aktuell in der 6. Revision – geregelt wird. Da sich die Rechtsprechung bezüglich der Invalidenversicherung in den letzten 10 Jahren erheblich gewandelt hat – was sich insbesondere auf die Leistungszusprache bei psychischen Störungen auswirkt – soll der vorliegende Beitrag einen Überblick über die für den medizinischen Experten relevanten juristischen Aspekte geben. Es ist hervorzuheben, dass die Rechtsprechung Prinzipien zur Einordung von Folgen spezifischer Krankheitsentitäten normativ festgelegt und diese im letzten Jahrzehnt weiterausgebaut hat. Die vom Rechtsanwender vorgenommene Prüfung der „willentlichen Überwindbarkeit“ stellt dabei auf einen Kriterienkatalog ab, der aus medizinischer Sicht nicht ausreichend belegt ist. In der juristischen Literatur der Schweiz wird diese gegenwärtige (Rechts-)Praxis kontrovers diskutiert, und Anpassungen werden erwogen. = There are 11 different historically established social security insurances in Switzerland. Social security for disabled and chronically ill people is mostly covered by the disability insurance. The disability insurance is governed by a federal law which has been revised six times, the last amendments having been introduced in 2012. The disability insurance legislation has changed much in the past 10 years and this has had a particularly great impact on the benefits awarded for psychiatric disorders. This article outlines several important facets of the disability insurance legislation relevant to psychiatric work capacity evaluations. Of particular interest are the special legal rules applied to specific illness groups, which have been expanded during the last decade. The concept of “voluntary surmountability” has arguably had the most impact and is based on a catalogue of criteria with an insufficient scientific foundation. The impact and possible changes of the current jurisdiction is currently being discussed in the Swiss juristic literature and amendments are under consideration