Dtsch Arztebl Int
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Many new antitumor drugs have been approved in recent years. Their side-effect profiles are distinct from those of older drugs, and their adverse effects are sometimes highly specific, particularly with respect to the skin. ⋯ The recognition and proper management of cutaneous adverse effects is an important part of treatment with new antitumor drugs.
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Chronic abdominal pain, bloating, constipation, diarrhea, and stool irregularity are common symptoms in primary care and gastroenterology. A routine diagnostic evaluation fails to reveal any underlying somatic condition in about half of the affected patients, who are therefore said to have a functional bowel disorder. Physicians are often unsure how extensive the work-up must be to exclude a somatic cause. ⋯ The diagnosis of a functional bowel disorder is based on a thorough history (positive criteria) and a small battery of diagnostic tests to exclude somatic disease. Both the diagnostic assessment and the treatment should be carried out in accordance with published guidelines.
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The care of severely and multiply injured patients is an interdisciplinary challenge. The only existing German-language guideline up to now has been the S1-guideline issued in 2002 by the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, DGU). In this article, we present a new, comprehensive, evidence and consensus based S3-guideline for the treatment of severely and multiply injured patients in the pre-hospital and early in-hospital phases which has been developed with the aim of structural and procedural quality optimization. Its implementation should lower these patients' mortality and improve their quality of life. ⋯ This guideline can only improve outcomes if it is implemented in routine practice. Aside from the guideline itself, the DGU trauma network (www.dgu-traumanetzwerk.de) has issued a set of directions as an aid to its implementation.
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Some 40 000 lower limb amputations are performed in Germany each year, 70% of them in diabetics. About 80% of all major amputations may be preventable with the use of new interventional and vascular surgical procedures, particularly on the arteries of the leg and foot. We present the current state of the art in revascularization techniques and evaluate their usefulness for preservation of the lower limb. ⋯ Though the data are still sparse, the high reported rates of limb preservation imply that peripheral revascularization techniques can play a major role in the treatment of chronic critical limb ischemia (CLI). Therefore, these techniques are recommended without exception by the current guidelines.
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Hyperphosphatemia has been identified in the past decade as a strong predictor of mortality in advanced chronic kidney disease (CKD). For example, a study of patients in stage CKD 5 (with an annual mortality of about 20%) revealed that 12% of all deaths in this group were attributable to an elevated serum phosphate concentration. Recently, a high-normal serum phosphate concentration has also been found to be an independent predictor of cardiovascular events and mortality in the general population. Therefore, phosphate additives in food are a matter of concern, and their potential impact on health may well have been underappreciated. ⋯ Prospective controlled trials are currently unavailable. In view of the high prevalence of CKD and the potential harm caused by phosphate additives to food, the public should be informed that added phosphate is damaging to health. Furthermore, calls for labeling the content of added phosphate in food are appropriate.