Deutsche medizinische Wochenschrift
-
Dtsch. Med. Wochenschr. · Apr 2022
[Diagnosing Alzheimer's dementia - a playground for academics or a sensible clinical measure?]
The number of dementia cases continues to increase with Alzheimer's disease as the leading cause. The diagnostic workup of Alzheimer's dementia is complex, and its clinical relevance debatable considering the current lack of disease-modifying treatments. From this perspective, a stepwise diagnostic approach is recommended. ⋯ In cases remaining unclear, modern biomarker tests are proving increasingly useful. Knowledge of the diagnosis is pivotal for the patients to assess the prognosis, to enable them to make plans for their future and to get access to available treatment. The approval of aducanumab in the USA and other promising monoclonal antibodies currently in phase 3-trials as well as the development of blood biomarkers give us hope for the future.
-
Dtsch. Med. Wochenschr. · Apr 2022
[Lower back pain in the primary care setting - Non-specific and specific pain].
A systematic survey of the symptoms of back pain in terms of triggering event and onset, nature and the extent of influenceability of the pain (lying or standing, under stress, nocturnal pain, localized percussion tenderness, B- symptoms, etc.), as well as structured clinical examination (segment height, radiance, projection, reflex status, sensitivity and motor function) allows an initial and therefore orienting classification of back pain as non-specific or specific. In the primary care setting many patients can be treated extremely effectively and economically from a cost perspective. In addition to the fastest possible pain relief, it is important to prevent the disease becoming chronic. ⋯ Causes of specific back pain include: fractures, infections, radiculopathy, tumors, axial spondylarthritis as well as extravertebral causes. In the further cause of treatment, it may be necessary to consult medical specialists in the fields of radiology, orthopedics, neurology, neurosurgery, rheumatology, psychotherapy, psychiatry, among others. Treatment is managed by the primary care provider, who should also receive and re-evaluate all findings during the course of the disease.
-
Dtsch. Med. Wochenschr. · Apr 2022
[Cardiac computed tomography - Current diagnostic role in cardiology].
Computed tomography (CT) imaging of the heart requires specific equipment and protocols in order to synchronize image generation with the electrocardiogram (ECG), usually achieved via ECG-gated reconstruction or ECG-triggered acquisition. The main application of cardiac CT is coronary artery imaging. ⋯ In addition, CT has the potential to visualize coronary atherosclerotic plaque, even if non-obstructive, and data suggest that this may be a valuable guide towards more intensive risk modification strategy such as statin therapy. In recent years, the use of CT imaging to guide structural heart interventions has become another important application, and many interventions, such as transcatheter aortic valve implantation, substantially depend on CT imaging to plan the procedure, minimize risks, and optimize outcome.
-
Dtsch. Med. Wochenschr. · Apr 2022
[The views of cancer out-patients on the impact of the COVID-19 pandemic].
This study investigates current needs and psychosocial burden of out-patients with cancer during the COVID-19-Pandemic. ⋯ Corona-specific distress of cancer patients relates in particular to the course of therapy, but also to a possible overload of the health care system. Oncology care teams should allow space for questions from their patients, acknowledge possible uncertainties, provide emotional support, and draw attention to reliable sources of information.
-
Dtsch. Med. Wochenschr. · Apr 2022
[Low back pain from an orthopedic and pain medical point of view].
Low back pain is not a diagnosis but a symptom of various causes. The differentiation between specific and non-specific low back pain is diagnostically difficult and only of limited help with regard to the further therapeutic procedure. ⋯ Early recognition and timely adequate therapy are crucial for the prognosis of chronic low back pain. Low back pain at risk of chronicity or chronic low back pain requires early assessment and the initiation of an interdisciplinary multimodal pain therapy program (IMPT).