Dtsch Arztebl Int
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Most hilar cholangiocarcinomas (Klatskin tumors) are diagnosed at an advanced stage. This article aims to review the literature of resection and palliative treatment in patients with hilar cholangiocarcinoma. ⋯ The prognosis of patients with Klatskin tumors has been significantly improved by extended resection procedures. The combination of stenting and PDT is a useful palliative approach.
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The so-called poster exhibition is an established element of medical meetings which often receives little attention. The aim of this study was to analyze the organization, acceptance and value of poster exhibitions. ⋯ The option of additional personal discussion with the poster presenter may lead to an increase of the rather modest participation of attendees at poster exhibitions. Poster exhibitions are of value in particular for young scientists and poster chairpersons.
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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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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.