Patienten-Leitlinie: Behandlung von Angststörungen

Ängste gehören zu den normalen Bestandteilen menschlichen Lebens. Jeder Mensch kennt dieses Gefühl, es erfüllt bestimmte Schutzfunktionen, es kann sogar lebensrettend sein. Bei manchen Menschen entsteht aber etwas, was man als Angststörung bezeichnet. Angststörungen sind in erster Linie dadurch gekennzeichnet, dass Menschen in bestimmten Lebenssituationen, aber auch plötzlich und unvermittelt starke bis stärkste Ängste erleben, die den Betroffenen selbst und auch ihrer Umwelt als nicht angemessen oder unange- bracht erscheinen. Solche Angststörungen können zu einer deutlichen Beeinträchtigung der Lebensqualität führen. Vielleicht ist eine solche Angststörung bei Ihnen, einem Angehörigen oder einem Bekannten aufgetreten, oder Sie haben die Vermutung, dass dies so sein könnte. Diese Patienten-Leitlinie soll Ihnen eine Informationsquelle zur Verfügung stellen, die es Ihnen erleichtert, sich über diese Störungsbilder zu informieren. Hierbei handelt es sich um wissenschaftlich gesicherte Informationen darüber, was Angststörungen sind, wie sie erkannt und behandelt werden können. Den Kontakt zu einem behandelndem Arzt oder Psychologischen Psychotherapeuten kann diese Patienten-Leitlinie natürlich nicht ersetzen. Vielmehr möchten wir Sie ermutigen, im Zweifelsfall ein fachliches Beratungsgespräch zu suchen

Influence of Surfactants on Lipase Fat Digestion in a Model Gastro-intestinal System

In the present study, we use a model gastro-intestinal system to study the influence of different food-grade surface-active molecules (Sn-2 monopalmitin, β-lactoglobulin, or lysophosphatodylcholine) on lipase activity. The interfacial activity of lipase and surfactants are assessed with the pendant drop technique, a commonly used tensiometry instrument. A mathematical model is adopted which enables quantitative determination of the composition of the water–oil interface as a function of bulk surfactant concentration in the water–oil mixtures. Our results show a decrease in gastric lipolysis when interfacially active molecules are incorporated into a food matrix. However, only the Sn-2 monopalmitin caused a systematic decrease in triglyceride hydrolysis throughout the gastro-intestinal tract. This effect is most likely due to exclusion of both lipase and triglyceride from the water–oil interface together with a probable saturation of the solubilization capacity of bile with monoglycerides. Addition of β-lactoglobulin or lysophopholipids increased the hydrolysis of fat after the gastric phase. These results can be attributed to an increasing interfacial area with lipase and substrate present at the interface. Otherwise, β-lactoglobulin, or lysophopholipids reduced fat hydrolysis in the stomach. From the mathematical modeling of the interface composition, we can conclude that Sn-2 monopalmitin can desorb lipase from the interface, which, together with exclusion of substrate from the interface, explains the gradually decreased triglyceride hydrolysis that occurs during the digestion. Our results provide a biophysics approach on lipolysis that can bring new insights into the problem of fat uptake

Multidetector CT imaging of mechanical prosthetic heart valves: quantification of artifacts with a pulsatile in-vitro model

Item does not contain fulltextOBJECTIVES: Multidetector computed tomography (MDCT) can detect the cause of prosthetic heart valve (PHV) dysfunction but is hampered by valve-induced artifacts. We quantified artifacts of four PHV using a pulsatile in-vitro model and assessed the relation to leaflet motion and valve design. METHODS: A Medtronic Hall tilting disc (MH), and Carbomedics (CM), St Jude (SJM), and ON-X bileaflet valves underwent CT in an in-vitro model using retrospective gating with a 64 detector CT system in stationary and pulsatile conditions. Artifacts and radiopaque component volumes were quantified with thresholds based on surrounding structures and valvular components. RESULTS: Hypodense artifacts volumes (mm(3)) were 1,029 +/- 147, 535 +/- 53, 371 +/- 16, and 366 +/- 18 for the SJM, MH, CM and ON-X valves (p < 0.001 except for the latter two valves p = 0.43). Hyperdense artifact volumes were 3,546 +/- 141, 2,387 +/- 103, 2,003 +/- 102, and 3,033 +/- 31 for the SJM, MH, CM and ON-X valve, respectively (all differences p < 0.001). Leaflet motion affected hypodense (F = 41.5, p < 0.001) and hyperdense artifacts (F = 53.7, p < 0.001). Closed and moving leaflets were associated with the least and the most artifacts respectively (p < 0.001, both artifact types). CONCLUSION: Both valve design and leaflet motion affect PHV-induced artifacts. Best imaging results may be expected for the CM valve during phases in which the leaflets are closed

Dabigatran in patients with atrial fibrillation: perioperative and periinterventional management

In any type of invasive surgery, the patient’s individual risk of thromboembolism has to be weighed against the risk of bleeding. Based on various everyday situations in clinical routine, the purpose of the present expert recommendations is to provide appropriate perioperative and periinterventional management for patients with atrial fibrillation undergoing long-term treatment with the thrombin inhibitor dabigatran. As we currently have no routine laboratory test to measure therapeutic levels of the substance or the risk of bleeding, general measures such as a standardized documentation of the patient’s history, a sufficient time interval between the last preoperative dose and the procedure, and careful control of local hemostasis should be given special attention

Lipase-catalyzed Reactions at Interfaces of Two-phase Systems and Microemulsions

This work describes the influence of two polar lipids, Sn-1/3 and Sn-2 monopalmitin, on the activity of lipase in biphasic systems and in microemulsions. In previous communications, we have shown that Sn-2 monoglycerides can replace Sn-1,3 regiospecific lipases at the oil–water interface, causing a drastically reduced rate of lipolysis. We here demonstrate that even if the lipase is expelled from the interface, it can catalyze esterification of the Sn-2 monoglyceride with fatty acids in both macroscopic oil–water systems and in microemulsions, leading to formation of di- and triglycerides