Deutsche medizinische Wochenschrift
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A large German registry on superficial vein thrombosis (SVT) documents that risk profiles, clinical presentation and treatment patterns are highly variable in patients with SVT, including a large variation in anticoagulation treatment modalities, intensities and durations. Inspite of a high percentage of initial anticoagulation there is a substantial risk of subsequent venous thromboembolism (VTE), recurrences or extension after three months. Inspite of current guideline recommendations, one third of the patients receives heparins, oral anticoagulants or no anticoagulation at all. At initial presentation about one quarter of the patients with SVT have a concomitant, frequently asymptomatic VTE. Risk factors for this complication include prior hospitalization, immobilization, prior VTE, autoimmune disorders, higher age, cancer and SVT occurring in a non-varicose veins or SVT-extension into the perforator veins. These risk factors are also associated with thromboembolic complications during follow-up. ⋯ Based on a large placebo-controlled trial with clinical endpoints (The CALISTO-Study), guidelines recommend Fondaparinux 2.5 mg once daily administered over 4 to 6 weeks. Alternatively, an intermediate dose of low molecular weight heparin can be considered. In high-risk patients, rivaroxaban 10 mg once daily was noninferior compared to Fondaparinux. A rebound of VTE recurrences was observed in both study arms after treatment had been discontinued after 45 days. Further studies are required to determine whether treatment needs to be extended beyond 45 days in high-risk patients.
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5-year survival data from the KEYNOTE-024 trial confirm the sustained efficacy of immuno-oncologic monotherapy in patients with NSCLC with high PD-L1 expression (≥ 50 %). DUAL IMMUNOTHERAPY IN COMBINATION WITH CHEMOTHERAPY AS FIRST-LINE THERAPY FOR NSCLC: Nivolumab plus impilimumab in combination with 2 cycles of platinum-containing chemotherapy improves survival in NSCLC patients. ⋯ The nationwide network nNGM provides NSCLC patients with access to state-of-the-art molecular diagnostics and the latest treatment options.
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The article presents an organizational structure for the psycho-oncological treatment of cancer patients that is unique in Germany, in which professional therapeutic support is provided by practioners from a wide range of professions "under one roof". In addition, from the perspective of a psychooncologist, the intra-psychic processes that cancer patients can go through during their illness are described, as well as their psychooncological-psychotherapeutic treatment. ⋯ In conclusion, it is stated that psychooncology in its best sense can help patients to recognize the value of their lives and, regardless of the time span left to live, to make life worth living. This claim requires for the psychooncological approach a holistic therapy offer, which also includes existential and trauma-oriented dimensions in the treatment.
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Autoimmune thyroiditis (AIT) is not only one of the most prevalent human autoimmune diseases, but also the most frequent cause of primary hypothyroidism. It is characterized by lymphocytic infiltration of the thyroid gland with subsequent gradual destruction and fibrous replacement of thyroid tissue. Genetic predisposition, epigenetic modifications and environmental factors are suspected as disease triggers. ⋯ It not only depends on the level of TSH-elevation, but also on other factors, such as patient age, presence of comorbidities and clinical symptoms of hypothyroidism. In contrast, overt hypothyroidism and subclinical hypothyroidism with a TSH-level > 10 mIU/L is a strong indication for LT4 administration, aiming at rapid achievement of euthyroidism. In patients with dissatisfaction due to persistence of symptoms despite optimal LT4-treatment LT4/T3-combination therapy should be considered, based on expert opinion.
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Thyroid dysfunctions are common endocrine disorders. With an increasing number of older persons in European societies, the number of older patients affected will also rise. The physiology of thyroid hormones and their regulation change with increasing age. ⋯ Patients older than 65 years with subclinical hypothyroidism and a TSH level > 10 mU/l should also be treated, in particular when cardiovascular comorbidities are present. Levothyroxine treatment has to be monitored on a regular basis, as overdosing is also harmful. For patients with TSH concentrations between 7 and 10 mU/l there is no clear indication to initiate a levothyroxine treatment, as they do not have a clearly elevated mortality and morbidity, also quality of life does not improve.