Dtsch Arztebl Int
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Deep vein thrombosis is associated with a risk of pulmonary embolism and post thrombotic syndrome (PTS). ⋯ The most important therapeutic measure is prompt and adequate anticoagulation with heparin or fondaparinux. Thrombolysis or thrombectomy is only indicated in highly selected severe cases. The risk of PTS can be reduced by immediate ongoing treatment with compression stockings. Prevention of relapse is achieved using vitamin K antagonists with a target INR of 2.0 to 3.0. The duration of anticoagulation should be tailored to the localisation and etiology of the thrombosis, from at least three months to indefinite treatment. The ongoing risk of bleeding secondary to anticoagulation should be reevaluated at regular intervals as a cost-benefit analysis. New anticoagulants for acute and long term treatment will soon be available for clinical use.
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The treatment of preterm infants at the lower margin of viability is carried out amid growing tension between increasing survival rates, uncertain clinical outcomes, and financial and ethical considerations. The three German speaking countries have released guidelines on this issue, based on a previous common guideline. That is why the differences in national guidelines between the three countries is of peculiar interest in respect of medical ethics. ⋯ All three guidelines call for a pragmatic approach. National guidelines can only predetermine the framework, with long-term collection of sound local data on morbidity and mortality forming a prerequisite for decision-making, and also in discussions with parents.
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The use of ionizing radiation is regulated by legislative bodies to limit both individuals' and the population's exposure to radiation. Germany has implemented the European 97/43/EURATOM directive in national law by updating the existing radiation protection regulations. The German Commission on Radiological Protection regularly publishes statements and recommendations on radiation protection in medicine and diagnostic radiology, such as the introduction of diagnostic reference levels and referral guidelines for radiological and nuclear medicine imaging. ⋯ Referring doctors should be sure to use existing guidelines for medical imaging, and liaise with radiologists and nuclear medicine specialists, with whom they share the responsibility for choosing appropriate imaging modalities.
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We report the case of a woman who presented to the medical emergency room with upper thoracic inlet syndrome six months after being treated for cancer of the left breast with surgery, radiation, and chemotherapy. A port-related occlusion of the superior vena cava was diagnosed on the basis of the history, physical findings, and diagnostic images. ⋯ Implanted port systems facilitate the treatment of the chronically ill by enabling easy and safe venous access. As the number of patients with such systems is growing, there is an increased need for optimized handling and care, awareness of the risks (such as catheter occlusion, thrombosis, and infection), and recognition of complications when they arise.