Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Jun 2020
[Primary aldosteronism - why is it still underdiagnosed in clinical practice?]
Primary aldosteronism (PA) represents the leading cause of endocrine hypertension, accounting for 4-13 % of all cases. Simultaneously, it is the most common endocrine form of hypertension that can be cured by surgery. Estimates suggest that 2.5 million people in Germany are affected, yet only 8 % of hypertensive patients undergo the proper diagnostic screening for PA. ⋯ Since PA patients carry an increased risk of cardio- and cerebrovascular events as well as metabolic comorbidities, early screening and diagnosis is crucial. This manuscript highlights the current guidelines of screening and diagnosing PA and addresses some currently published findings regarding this area. The aim is to raise awareness when it comes to diagnosing and screening for PA in the everyday management of hypertensive patients.
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The recommended indications for short-term use of human albumin in patients with decompensated cirrhosis are the following: prevention of paracenteses induced circulatory dysfunction, treatment of hypovolemia, prevention of hepatorenal syndrome in high-risk patients with spontaneous bacterial peritonitis, as well as treatment of hepatorenal syndrome. Liver cirrhosis is associated with systemic inflammation, which is further increased in decompensated cirrhosis and acute-on-chronic liver failure. Besides its function as plasma expander, albumin is known to have pleiotropic non-oncotic properties. ⋯ Recent studies suggest, that long-term albumin administration in patients with cirrhosis and ascites improves survival, prevents complications, facilitates the management of ascites and reduces hospitalizations. Moreover, during infections albumin may prevent development of acute-on-chronic liver failure. Still, further studies are needed to confirm these disease-modifying effects of albumin, define its optimal dosage and administration schedule and detect patients who benefit most from albumin administration in different scenarios.
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Dtsch. Med. Wochenschr. · Jun 2020
[Recurrent Therapy of Multiple Myeloma - Individualized Concepts from The Arsenal of Diverse Options].
The prognosis of patients with multiple myeloma has improved significantly over the past 20 years. However, the patient population in the relapse situation is very heterogeneous due to increasing age and the previous course of the disease and therapy. In particular, the approval of new targeted substances offers numerous treatment options that can be adapted to the individual situation. ⋯ In frail patients, a combination of two can also be used. The new substances also offer very good therapeutic options for high-risk cytogenetics or renal insufficiency. The monoclonal antibodies Daratumumab and Elotuzumab are well tolerated except for infusion reactions and are highly effective in various combinations, even in high-risk cytogenetics.
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Dtsch. Med. Wochenschr. · Jun 2020
[From a trail to an official path: new recommendations for the treatment of mild asthma].
Accumulating evidence suggests that a symptom-driven therapy with fixed combinations of inhaled corticosteroids (ICS) and formoterol is safer and more feasible in patients with mild asthma than a treatment with short-acting beta-2-agonists (SABA) alone. Therefore, the new international GINA asthma guideline (2019) recommends, for the first time, as needed low dose ICS-formoterol as the preferred controller in treatment step 1. This radical paradigm shift will have a major impact on asthma care in the future.