[Fatigue, weight loss and decline in general health in a young patient. Addison disease]

Bei einem 31-jährigen Patienten wird ein Morbus Addison beschrieben. Anschliessend gehen wir auf Ätiologie, Klinik, Diagnostik und Therapie dieses eher seltenen, aber im Alltag dennoch wichtigen Krankheitsbildes ein. Zusätzlich wird die sekundäre Form der Nebennierenrindeninsuffizienz gestreift.

Side-effects of extracorporeal shock wave therapy (ESWT) in the treatment of tennis elbow

Apart from a few observational reports, there are no studies on the side-effects of extracorporeal shock wave therapy (ESWT) in the treatment of insertion tendopathies. Within the framework of a randomised, placebo-controlled, single-blind, multicentre study to test the effectiveness of ESWT in the case of lateral epicondylitis (LE), side-effects were systematically recorded. A total of 272 patients from 15 centres was allocated at random to active ESWT (3 x 2000 pulses, energy flux density ED(+) 0.04 to 0.22 mJ/mm(2) under local anaesthesia) or placebo ESWT. In all, 399 ESWT and 402 placebo treatments were analysed. More side-effects were documented in the ESWT group (OR = 4.3, CI = [2.9; 6.3]) than in the placebo group. Most frequently, transitory reddening of the skin (21.1%), pain (4.8%) and small haematomas (3.0%) were found. Migraine was registered in four and syncopes in three instances after ESWT. ESWT for LE with an energy flux density of ED(+) 0.04 to 0.22 mJ/mm(2) is a treatment method which has very few side-effects. The possibility of migraine being triggered by ESWT and the risk of a syncope should be taken into account in the future. No physical shock wave parameters could be definitely identified as the cause of the side-effects observed.

The value of wildlife

The value of wildlife has been widely ignored or under-rated in the past by the international community. At most, wildlife was considered from the limited aesthetic and touristic aspects. This situation has changed somewhat. In the majority of the veterinary profession, which is largely livestock-oriented, wildlife is increasingly considered in terms of wild animal production and occupies just as relevant a position as domestic animal production. Some economists are now trying to quantify the informal nature of a large portion of the wildlife sector. The importance of wildlife to local communities is now globally recognised in community-based or participatory natural resources management programmes. The authors highlight not only the economic importance of wildlife (which amounts to billions of United States dollars world-wide), through consumptive and non-consumptive uses, but also the present and potential nutritional value, the ecological role as well as the socio-cultural significance of wildlife for human societies of both the developed and the developing worlds. Also addressed in this chapter is a discussion on one of the main threats to wildlife conservation which consists of the reduction or even retrieval of the different values wildlife can offer.

Infectious animal diseases: the wildlife/livestock interface

The long-standing conflict between livestock owners and animal health authorities on the one hand, and wildlife conservationists on the other, is largely based on differing attitudes to controlling diseases of livestock which are associated with wildlife. The authors have attempted to highlight the fact that these disease problems are frequently bi-directional at the wildlife/livestock interface. The different categories of diseases involved are presented. A new dimension being faced by veterinary regulatory authorities is the spectre of emerging sylvatic foci of diseases, such as bovine tuberculosis, bovine brucellosis and possibly rinderpest; these diseases threaten to undermine national and international eradication schemes, which have been implemented and executed with significant success, and at great cost. Conversely, wildlife-based ecotourism world-wide has expanded rapidly over the past decade and is the source of lacking foreign revenue for many developing countries. Traditional subsistence farming is still the largest source of much-needed protein on some continents and this, together with the growth and hunger of historically disadvantaged communities for land, is forcing enterprises and communities with markedly different objectives and land-use practices to operate effectively in close proximity. Some land-users rely exclusively on wildlife, others on livestock and/or agronomy, while yet others need to combine these activities. The net result may be an expansion or intensification of the interface between wildlife and domestic livestock, which will require innovative control strategies that permit differing types of wildlife/livestock interaction, and that do not threaten the land-use options of neighbours, or the ability of a country to market animals and animal products profitably.