Deutsche medizinische Wochenschrift
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We present the case of an 89-year-old patient with impaired consciousness for whom the emergency services were called. She was soporose and showed a pronounced generalized muscle rigidity. Due to a third-party history the incorrect use of a fentanyl patch was found out to be at cause. ⋯ The application of fentanyl via the skin in the form of transdermal therapeutic systems (TTS) has become more popular over the years. Incorrect administration causes intoxication with the leading symptoms of loss of consciousness and respiratory depression. This case report extends the spectrum of symptoms to include skeletal muscle rigidity otherwise only described in connection with intravenous administration, especially in anaesthetic settings.
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An elevated intra-abdominal pressure (IAP) above 12 mmHg is a pathological finding in critically ill patients. IAP are classified into different degrees of intra-abdominal hypertension and, in the presence of associated organ failure, as abdominal compartment syndrome. Both disease entities represent an underestimated factor in intensive care patients and are associated with increased mortality and prolonged intensive care and hospital stay. ⋯ If risk factors are present, intra-abdominal pressure should be monitored every 4 hours. Bladder pressure measurement is the gold standard for determining intra-abdominal pressure. The measurement is a non-invasive, cost-effective, easy to perform bedside and safe method for the patient.
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Dtsch. Med. Wochenschr. · Sep 2021
[Specialist examination: Is the current format still up-to-date?]
The non-standardized oral specialist examination is the final step of the specialist medical training in Germany. The debate on its current format has long been at the centre of discussions on further training policies. The purpose of this article is to draw attention to relevant structural deficits of the German specialist examination - also in comparison to German-speaking neighboring countries and pan-European developments - and to provide possible approaches to a more structured oral examination.
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Dtsch. Med. Wochenschr. · Sep 2021
[Managing transition - Medical follow-up care for adults with congenital heart defects].
Currently, due to medical advances, more than 500 000 patients with congenital heart defects (CHD) are living in Germany, including more than 330 000 adults. In CHD, the aspect of transition from childhood and adolescence to adulthood is becoming increasingly important to ensure long-term success of the provided treatments. ⋯ Adults with congenital heart defects in Germany are insufficiently managed by existing specialized and accredited care structures, despite the great need for follow-up, and their care is largely provided by primary care physicians (general practitioners and internists) and non-specialized cardiologists. Optimized, future-oriented care requires regular follow-up and the possibility of interdisciplinary, integrated medical care of CHD in the long-term course.
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Type-2-diabetes (T2D) increases the risk for several cancers and cancer has become the major cause of death of T2D-patients. T2D is causally associated with colorectal, pancreatic, gallbladder, biliary, hepatocellular, gastric, esophageal, oral, breast, endometrial, ovary, kidney and thyroid cancers as well as leukemias. When T2D goes along with tobacco smoking, alcohol use, physical inactivity, excess body weight, poor diet, familial risk or certain chronic infections, the cumulative cancer risk rises, and T2D-patients often suffer from cancer disease at younger age. T2D-patients should be encouraged to join cancer screening programmes even at younger age than the average non-diabetic population.