Dtsch Arztebl Int
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Neoplasms of the vermiform appendix are rare. They comprise a heterogeneous group of entities requiring differentkinds of treatment. ⋯ 0.5% of all tumors of the gastrointestinal tract arise in the appendix. Their treatment depends on their histopathologicalclassification and tumor stage. The mucosal epithelium gives rise to adenomas, sessile serrated lesions, adenocarcinomas,goblet-cell adenocarcinomas, and mucinous neoplasms. Neuroendocrine neoplasms originate in neuroectodermal tissue. Adenomasof the appendix can usually be definitively treated by appendectomy. Mucinous neoplasms, depending on their tumorstage, may require additional cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC). Adeno -carcinomas and goblet-cell adenocarcinomas can metastasize via the lymphatic vessels and the bloodstream and should thereforebe treated by oncological right hemicolectomy. Approximately 80% of neuroendocrine tumors are less than 1 cm in diameterwhen diagnosed and can therefore be adequately treated by appendectomy; right hemicolectomy is recommended if the patienthas risk factors for metastasis via the lymphatic vessels. Systemic chemotherapy has not been shown to be beneficial forappendiceal neoplasms in prospective, randomized trials; it is recommended for adenocarcinomas and goblet-cell adenocarcinomasof stage III or higher, in analogy to the treatment of colorectal carcinoma.
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Review
Chronic Primary Pelvic Pain Syndrome in Men—Differential Diagnostic Evaluation and Treatment.
Chronic primary pelvic pain syndrome in men (CPPPSm) can be associated with urogenital pain, urinary symptoms, sexual dysfunction, and emotional disturbance. Its clinical heterogeneity and incompletely understood pathogenesis make it more difficult to treat. This article is intended to familiarize the reader with basic aspects of the manifestations, pathophysiology, diagnostic evaluation, differential diagnosis, and treatment of this condition. ⋯ The management of patients with CPPPSm should consist of a comprehensive differential diagnostic evaluation and an individually oriented treatment strategy.
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Artificial intelligence (AI) is increasingly being used in patient care. In the future, physicians will need to understand not only the basic functioning of AI applications, but also their quality, utility, and risks. ⋯ AI has the potential to improve patient care while meeting the challenge of dealing with an ever-increasing surfeit of information and data in medicine with limited human resources. The limitations and risks of AI applications require critical and responsible consideration. This can best be achieved through a combination of scientific.
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Acute rupture of the fibular ligament complex is one of the commonest injuries in sports. Prospective randomized trials in the 1980s led to a paradigm shift from primary surgical repair to conservative functional treatment. ⋯ Conservative functional treatment is now the standard treatment in acute fibular ligament rupture of the ankle because it is low-risk, low-cost, and safe. Primary surgery is indicated in only 0.5% to 4% of cases. Physical examination for tenderness to palpation and for stability, as well as stress ultrasonography, can be used to differentiate sprains from ligamentous tears. MRI is superior only for the detection of additional injuries. Stable sprains can be successfully treated with an elastic ankle support for a few days, and unstable ligamentous ruptures with an orthosis for 5 to 6 weeks. Subsequent physiotherapy with proprioceptive exercises is the best way to prevent recurrent injury.
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Chronic obstructive pulmonary disease (COPD) is the third most common cause of death around the world. The affected patients suffer not only from impaired lung function, but also from a wide variety of comorbidities. Their cardiac comorbidities, in particular, lead to increased mortality. ⋯ As patients with COPD are often multimorbid, the early diagnosis and adequate treatment not only of their lung disease, but also of their extrapulmonary comorbidities are very important. Well-established diagnostic instruments and well-tested treatments are available and are described in detail in the guidelines concerning the comorbidities. Preliminary observations suggest that more attention should be paid to the potential positive effects of treating comorbidities on the lung disease itself, and vice versa.