Der Internist
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Polymyalgia rheumatica (PMR) is a common chronic inflammatory rheumatic disease with unknown aetiology, affecting predominately people of middle age and older. Besides clinical symptoms and diagnostics, imaging techniques including sonography and magnetic resonance imaging may provide evidence of typical inflammatory lesions with bilateral bursitis subdeltoidea or subacromialis, tenosynovitis of the biceps tendon sheath and/or synovitis of the shoulder joints and thus may support the diagnosis of this disease in difficult cases. Corticosteroids are the cornerstone of treatment of PMR, but adverse events because of chronic corticosteroid use are observed in more than 50% of treated patients. Whether immunosuppressants, such as methotrexate and tumour necrosis factor-alpha inhibitors are effective in the therapy of PMR has still not yet been clarified.
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Chronic myeloproliferative diseases (CMPD) are haematopoetic neoplasias with indolent course and preserved cellular function of the maturing malignant cells. In Philadelphia-positive chronic myeloid leukaemia the discovery of molecular disease mechanisms led to the successful introduction of targeted therapy with imatinib. Ph-negative CMPD are conventionally treated by cytoreduction and low dose ASS in order to minimise the risk of vascular complications. For all CMPD, lifelong surveillance and therapy are necessary.
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There are different treatment options for obstructive sleep apnea, which are selectively used based on severity of sleep apnea, physical structure of the upper airway, and other medical aspects including co-morbidities. Weight loss as well as avoidance of alcohol and other CNS depressants is generally recommended. ⋯ In patients with central sleep apnea or Cheyne-Stokes respiration (CSA/CSR) diagnosis and treatment of the underlying cause is mandatory. Adaptive servo-ventilation appears to be an effective treatment modality for patients with complex sleep apnea and with CSA/CSR that is resistant to CPAP.