Deutsche medizinische Wochenschrift
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The effective reduction of atherogenic lipoproteins has contributed to the rate of atherosclerosis-related cardiovascular complications being approximately halved over the last 50 years. Nevertheless, cardiovascular disease will be the leading cause of death worldwide in the coming years. The focus of this review is on the clinical significance of the pathophysiology of changes in lipid and lipoprotein metabolism. ⋯ Primary forms of hypercholesterolaemia have a significantly higher ASCVD risk because of the already lifelong LDL elevation (higher cumulative LDL exposure for the vessel wall). Secondary changes in lipid and lipoprotein metabolism (e. g. in diabetes or hypothyroidism) must be excluded or treated. Regulatory key steps in the pathophysiology of lipid metabolism and atherosclerotic plaque are "drug targets" for existing and new lipid and lipoprotein modifying therapies.
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In recent years, clinically significant advances have been made in the management of giant cell arteritis and Takayasu arteritis. This concise review article highlights important aspects of the diagnostic workup and imaging-based treatment surveillance of the large vessel vasculitides.
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Dtsch. Med. Wochenschr. · Nov 2021
[Non-invasive Home-Ventilation: Pathophysiology, Initiation and Follow up].
COPD is the most common reason for hypercapnia. However, it is -by far- not the only reason. In fact, numerous neuromuscular disorders (not only ALS) as well as restrictive thoracic disorders do also lead to clinically highly relevant hypercapnia. ⋯ Firstline settings for a NIV therapy to treat "stable hypercapnia" are as follows: Pressure Support Ventilation Modus, EPAP 5 cmH2O, IPAP 15 cmH2O, Back Up rate 15/Minute. The overall goal of NIV treatment is a successful reduction in CO2. This can be achieved by changing the following variables of the ventilator settings: increase in IPAP ± increase in back up respiratory rate ± use of assisted pressure controlled ventilation mode (APCV).
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Pheochromocytomas and paragangliomas (PPGL) can be related to a uniquely high rate of underlying germline and somatic mutations. Accordingly, they can be assigned into genetic clusters, which are related to a specific biochemical and clinical phenotype as well as a different long term prognosis. The present article discussed how emerging knowledge on the respective clusters allows individual patient management before, during and after occurrence of a PPGL to improve clinical outcome.
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Dtsch. Med. Wochenschr. · Nov 2021
[Intracoronary imaging - how plaque morphology impacts personal medical therapy].
Even with emerging evidence that the use of intracoronary imaging techniques can significantly support the interventional procedure, the use of intracoronary imaging during catheterization procedures still remains comparatively low. With the help of intracoronary imaging percutaneous coronary interventions can be optimized and fundamental information about the plaque morphology can be archived. This is not only beneficial in determining plaque vulnerability but can also assist in the interventional approach of complex lesions including calcified lesions, as well as lesions causing an acute coronary syndrome. Especially in the context of the latter, identification of the underlying entity may provide alternative personalized approaches for patients with acute coronary syndrome.