Deutsche medizinische Wochenschrift
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The measurement quality of systems used for determination of glucose concentrations has to be sufficiently high to obtain measurement results that are reliable in a clinical context regarding the intended use (e. g., diabetes diagnosis and monitoring). The "Richtlinie der Bundesärztekammer zur Qualitätssicherung laboratoriumsmedizinischer Untersuchungen" (guideline of the German Medical Association on quality assurance in medical laboratory examinations) includes specifications on the internal and external quality assurance that are legally binding for glucose measurements in healthcare. ⋯ With systems for continuous glucose monitoring, there are currently no technological means to regularly check measurement quality. Additionally, repeated manufacturer-independent evaluations, which could lead to improved measurement quality, are not available.
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Dtsch. Med. Wochenschr. · Apr 2022
[Functional somatic symptoms: Clinical varieties, diagnostic challenges, therapeutic principles].
Functional somatic symptoms are common and multiform. They occur in all genders and age groups, with and without somatic or mental comorbidity. Dysfunctional illness behaviour on the patients' (e. g., excessive attention or anxiety) and also on the caregivers' side (e. g., nocebo messages, redundant investigations or risky treatments) can promote chronification. Empathy, well balanced diagnostics, comprehensible information within individual multifactorial explanatory models, refocussing, activation, and - in more severe forms - additional measures such as psychotherapy are recommended.
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Dtsch. Med. Wochenschr. · Apr 2022
[New therapeutic developments in the treatment of type 2 diabetes mellitus].
Diabetes mellitus has become a widespread disease worldwide. In recent years, there has been a rapid development of therapeutic options in the field of diabetology. ⋯ The article focuses, among other things, on the new findings of SGLT-2-inhibitors in cardiac and chronic renal failure and the further development of incretin-based drugs toward dual GIP/GLP-1-receptor agonists. Once-weekly insulin and the selective mineralocorticoid receptor antagonist finerenone will also be presented.
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Dtsch. Med. Wochenschr. · Apr 2022
Case Reports[BCG-therapy as a rare reason for postrenal failure].
In the following case report, we describe a patient with acute renal failure due to an urinary congestion level II-III under BCG-(Bacillus Calmette-Guérin)-therapy because of bladder cancer. Cystoscopy revealed the diagnosis of BCG-induced intramural narrowing of distal ureters bilaterally. ⋯ Although postrenal failure is relatively rare (5 %), also seldom causes such as medication-induced (e. g. BCG) ureter stenosis has to be included into the differential diagnosis.
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Functional diagnostics by rational echocardiography are the base of a verifiable and reliable analysis of ventricular and valvular function. The most important functional parameters in echocardiography are cardiac volumes - especially total and effective left ventricular stroke volume -, global longitudinal strain, effective orifica areas in valvular stenoses and effective regurgitant volumes, regurgitant fraction and regurgitant orifice areas in valvular regurgitations. Standardized documentation and correct measurements are the prerequisites for accurate echocardiographic estimations. ⋯ In addition, calculation of the effective orifice areas using the continuity equation needs methodological accuracy and standardization. Finally, assessment of regurgitant volumes, regurgitant fraction, and regurgitant orifice is often inconsistent with stable hemodynamic conditions - especially by functional assessment the 2D-PISA method. Thus, functional diagnostics by echocardiography in valvular heart diseases should focus on a plausible hemodynamic assessment.