Dtsch Arztebl Int
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Prevalence rates for depression in children and adolescents are estimated up to 8.9%. Symptoms in this age group are different from those of depression in adults. Both neurobiological and psychosocial factors are involved in its development. ⋯ The treatment of depression in childhood and adolescence should be based on multimodal interventions including psychotherapy, including cognitive behavioral therapy, which has proven effectiveness, psychosocial interventions and medications in severe cases. Patients with severe depression, especially suicidal minors, should be treated in patients units.
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The choice of type of heart valve prosthesis is determined by the patient's age since bioprostheses have a limited lifespan. This article reviews current recommendations and the literature on cardiac valve replacement. ⋯ The choice of heart valve prosthesis should be tailored to each patient taking into account the patient's age, life expectancy, comorbidities, and life style. Different decisions may be made now than those based on earlier recommendations resulting in an individualized treatment, in patients over the age of 65 or 70.
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Polycythemias are characterized by an increased concentration of red blood cells. Because blood cell counts are a routine investigation, these disorders present to non-hematologic physicians. Polycythemia vera (PV), an acquired stem cell disease, is the most important variant. ⋯ Erythropoietin, which is produced in the kidneys, and its receptor system in the bone marrow, are of critical importance in polycythemia. Congenital polycythemias are caused by mutations of the Erythropoietin-receptor gene, hemoglobin variants, 2,3-bisphosphoglycerate mutase deficiency or by disturbances of renal oxygen sensing. Acquired polycythemias can occur secondary to hypoxia at high altitudes, or primarily through acquired mutations in the EPO-receptor signaling system (JAK2 mutations). Alternatively they may be caused by pulmonary or renal disease. An artificial erythrocytosis is induced by athletes through doping. Differential diagnosis comprises erythropoietin determination, JAK2 mutation analysis and if necessary hemoglobin electrophoresis. Only PV requires immediate treatment, because of a high thromboembolic risk. Epidemiological studies on polycythemias in German speaking countries are urgently needed.
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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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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.