Deutsche medizinische Wochenschrift
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For decades there were only symptom-oriented therapies for the monogenetic disease cystic fibrosis. With the new modulator therapies there are new hopes to better influence the course of the disease, which has its manifestation in several organs such as the lungs, the liver or pancreas. In addition to ivacaftor, lumacaftor/ivacaftor and tezacaftor/ivacaftor, a triple combination with elexacaftor/tezacaftor/ivacaftor was developed. ⋯ The results are very promising as already after 4 weeks a significant improvement of FEV1 and a significant decrease of the sweat chloride content could be detected. In the USA all patients with at least one F508del mutation can be prescribed the drug. This corresponds to approximately 90 % of all patients with cystic fibrosis and has the potential to change the landscape of cystic fibrosis.
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Dtsch. Med. Wochenschr. · Oct 2020
[Intestinal motility disorders in multimorbidity: between constipation and diarrhea].
The Rome IV criteria for primary chronic obstipation help to distinguish between short-term ailments and a chronic pattern of complaints 1. In general, there are several causes of defecation disorder in the age group of the elderly. Anamnesis and observance of red flags in addition to a geriatric basic assessment make it possible to narrow down the causes. The distinction between low-transit constipation and normal intestinal function can decisively influence the therapeutic consequence. ⋯ In the drug intervention, osmotic laxatives, stimulating laxatives, suppositories and enemas with different additives are still used very frequently. In the second place, the prokinetic prucaloride and for some years methylnaltrexonium bromide can be used as a representative of the peripheral-acting opioid receptor antagonists 2 3. Fibre-rich diet produces more bowel movement and prebiotic additives can influence the microbiome favorably. Additional fibre is not likely to show benefit in case of severe constipation, in particular to patients with low-transit constipation or defecation disorders. When preparing for colonoscopies, it appears that additional movement activation has positive effects on the quality of intestinal cleansing 4.
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Acute abdomen is a common and sometimes dramatic clinical condition, which can be fatal if diagnosis is not made in time. A large number of diseases can cause an acute abdomen which makes a targeted and rapid diagnostic approach utterly important. ⋯ Further diagnostics, including laboratory markers, imaging and - if necessary - interventional diagnostics should be initiated quickly after the first clinical assessment in order to confirm the suspected diagnosis or to further classify unclear cases. The clinical assessment is the leading diagnostic tool that determines further diagnostic approaches for patients with an acute abdomen and thus enables adequate and timely therapy.
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Abdominal pain is one of the most common complaints that lead to an emergency department visit. Depending on the interpretation of the definition, 20-40 % of these patients present with an acute abdomen. This term summarizes a variety of diseases that often occur in the abdominal cavity, mostly acute, and can be accompanied by symptoms such as nausea and vomiting. ⋯ The goal must be to move from symptom-based to causal therapy as quickly as possible and to clarify whether a patient needs to be referred to an emergency operation or whether there is time for further differential diagnostic measures. The prognosis of the acute abdomen often depends on the time latency until the definitive therapy is initiated. Rapid and determined action by the experienced initial examiner are important prerequisites for a favorable course of the disease process.