Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Jun 2023
[Drug therapy of the acute migraine attack and prophylaxis of migraine].
Migraine has a prevalence of 10 % in Germany, making it the most common neurological disorder. Migraine is a prevalent disorder not only for neurologist, it's an everyday topic for general physicians and internal medicine as well. ⋯ Medications include beta-blockers, flunarizine, anticonvulsants, amitriptyline or, in the case of chronic migraine, onabotulinumtoxinA. If these drugs are not effective, are not tolerated or contraindicated, monoclonal antibodies against calcitonin gene-related peptide (CGRP) or the CGRP receptor can be used.
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The symptom "headache" is an interdisciplinary clinical picture with multiple differential diagnoses. On the one hand, headache can be a symptom of harmless diseases, on the other hand, it can be an expression of a serious condition with a high-risk potential for the patient. Radiological cross-sectional imaging, laboratory investigations or a diagnostic lumbar puncture are absent in the prehospital setting. ⋯ Recognition of potentially dangerous causes is also essential for mission tactical reasons (target hospital). A reliable distinction is not always possible prehospital, so that in case of doubt, a presentation to the hospital should be made. Therapeutically, the focus is on treatment according to the ABCDE scheme and symptomatic therapy.
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Complement is a central part of the immune system. In the human body, complement is responsible for recognition of infectious microbes, for coordinating the adaptive immune response, controlling homeotic reactions and for the non-inflammatory removal of modified self-cells and infectious microbes. Complement is also closely linked to another proteolytic cascade, the coagulation system. ⋯ In addition, clinical guidelines are developed for Diagnosis and Therapy of complement mediated diseases, new biomarkers are evaluated in clinical studies, and diagnostic guidelines are in development. The recent Covid infections showed a clear link of complement in thrombo inflammation, which ultimately results in kidney damage. These aspects have increased further the focus of complement inhibitors in COVID infections.
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Headaches are one of the most frequent causes of consultations in general practice. Of more than 350 known headache tendencies, tension-type headache and migraine are particularly common in general practice. Medication overuse headache (MOH) is also common but rarely diagnosed. ⋯ A detailed neurological examination completes the basic diagnosis. Additional laboratory and instrumental diagnostics follow in cases of atypical headache or clinical suspicion of secondary headache. This article focuses on the diagnosis and treatment of Tension-type Headache, migraine and Medication Overuse Headache.
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Dtsch. Med. Wochenschr. · Jun 2023
[Exocrine pancreatic cancer - what is new in the update of the S3 guideline?].
In 2020, worldwide 495,773 people were diagnosed with pancreatic ductal adenocarcinoma and 466,003 patients died from pancreatic cancer. Pancreatic cancer ranks 13th among cancer diagnosis and is the 7th most common cause of cancer-related deaths 1. In Germany, each year approximately 10,000 people develop pancreatic cancer and around the same number of patients die from this disease 2. ⋯ This is reflected by the high rate of early metastases and the small number of patients with long-term survival after surgery with curative intent. The S3 guideline exocrine pancreatic cancer aims to present the available evidence on epidemiology, molecular alterations, diagnostics, surgical and non-surgical treatment as well as palliative measures in order to support all those involved in the treatment of this tumor and to improve the care of patients. To better address this need, the S3 guideline was updated again in 2022 and also changed to a living guideline with regular updates to further improve the timeliness of the guideline.