Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Jun 2020
[What is new in the diagnosis and therapy of renal cell carcinoma?]
Renal cell carcinomas (RCC) include different tumor entities, of which clear cell RCC is the most common tumor with approx. 75 % followed by the papillary RCC with 10-15 %. RCC are increasingly being diagnosed incidental in the context of abdominal diagnostics from other indications using sonography or cross-sectional imaging. ⋯ The combinations lead to a higher response rate and longer survival. In the second line and subsequent lines, there is no evidence-based data after combination therapies, but drugs can be used that were not yet part of the first-line therapy.
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Dtsch. Med. Wochenschr. · Jun 2020
[Prevention of stroke and dementia in general practice: evaluation of the project INVADE].
Stroke and dementia have several modifiable risk factors in common. In the primary care prevention project INVADE (INtervention project on VAscular brain diseases and Dementia in the district of Ebersberg), these vascular risk factors were recorded systematically and treated according to evidence-based guidelines. ⋯ clinicaltrials.gov, NCT1107548, registration date: 21.04.2010, drks.de, DRKS00011348, registration date: 29.12.2016.
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Dtsch. Med. Wochenschr. · Jun 2020
[Antidiabetic SGLT-2 inhibitors prevent progression of chronic kidney disease].
Several interventional trials that studied cardiovascular safety of antidiabetic drugs in patients with diabetes mellitus and elevated risk of cardiovascular disease suggested potential nephroprotective effects of SGLT-2 inhibitors. Subsequently, the CREDENCE study confirmed reduced progression of chronic kidney disease (CKD) towards dialysis-dependency in diabetic patients with mildly or moderately impaired glomerular filtration rate and high albuminuria. ⋯ The final publication of DAPA-CKD is expected in late 2020. Parallelly, new treatment guidelines from the Kidney-Disease:-Improving-Global-Outcomes (KDIGO)-Initiative will recommend SGLT-2 inhibitors as standard treatment for CKD patients with diabetes mellitus, even though these drugs are not yet licensed for patients with moderately-to-severely reduced renal function.
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Dtsch. Med. Wochenschr. · Jun 2020
[Current Recommendations for the First-Line Therapy of Symptomatic Multiple Myeloma].
Due to the introduction of novel therapeutic agents, the prognosis of Multiple Myeloma has greatly improved over the last decades. The current standard for fit patients is a bortezomib-based induction therapy, followed by high-dose chemotherapy and autologous stem cell transplantation and lenalidomide-based maintenance therapy. For older, non-transplant-eligible patients, daratumumab in combination with bortezomib or lenalidomide offers a well-tolerated, effective treatment option. Despite large improvements, there is still no cure for most myeloma patients, the aim of therapy is therefore to reach a deep remission to prevent lasting damage followed by a continuous maintenance therapy to uphold the remission and prolong overall survival.
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Dtsch. Med. Wochenschr. · Jun 2020
Case Reports[Paraneoplastic Cushing's syndrome as cause of refractory hypokalemia].
A 58-year-old man presented with refractory hypokalemia and rapid weight gain. On examination, he had high blood pressure, central obesity and bilateral pitting edema. ⋯ The diagnosis of paraneoplastic Cushing's syndrome can be challenging, since classical clinical features of hypercortisolism may still be absent, even if the underlying cancer is already advanced. Therefore high clinical suspicion is warranted, especially in patients presenting with new-onset refractory hypokalemia, metabolic alkalosis and arterial hypertension.