Deutsche medizinische Wochenschrift
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Both exsiccosis and hydropic decompensation occur more frequently in the older persons and are associated with complications, increased morbidity and mortality. This paper presents the age-associated causes and consequences of both conditions, as well as a practical approach to preventive measures, diagnostics, and therapy.
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Nausea (like vomiting) is a symptom and not an independent disease pattern. This makes it difficult to give an accurate number of the incidences in the elderly population. Approximately every 2nd to 3rd elderly person is affected. ⋯ Initially the therapy aims to treat the cause (underlying disease or polypharmacy). Symptom-oriented medication should only be considered as secondary meassure. However, numerous possible drugs are inadequate for elderly people.
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In industrialized countries, stroke is still the most common disease that leads to permanent disability. Of the 250 000 strokes that occur annually in Germany, in about 80 % are cerebral ischemia. ⋯ In 2020, the multidisciplinary S3 guideline for the management of extracranial carotid stenoses was updated. In the following, current aspects and new recommendations for asymptomatic carotid stenosis are presented and important innovations of the guideline are explained.
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Inhaled maintenance therapies in chronic obstructive pulmonary disease (COPD) are based on bronchodilators and inhaled corticosteroids (ICS). Inhaled bronchodilator therapies consist of long-acting beta-2 agonists (LABA) and long-acting muscarinic antagonists (LAMA). LABA or LAMA treatment is recommended in symptomatic COPD patients. ⋯ LABA LAMA combination therapies are used in patients who are highly symptomatic. Adding ICS to bronchodilator treatment is recommended in COPD patients with repeated exacerbations. Recently, fixed triple therapies consisting of LABA, LAMA and ICS in single inhalers became available.
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The state of the art of osteoporosis management and treatment is being continuously refined according to recent progress in data availability, drug development and strategies as determined by health authorities. The recent approval of the sclerostin-antibody romosozumab as a novel first in class anabolic drug is another milestone that enriches our therapeutic portfolio. Neutralisation of the wnt-pathway inhibitor sclerostin by romosozumab leads to rapid stimulation of bone formation and a rise in bone mineral density that translates into robust > 70 % reduction of fracture risk at the lumbar spine. ⋯ Based on all our recent progress and achievement we can more and more individualize the long term management of osteoporosis over decades applying an individual "treat to target" strategy. Basically, osteoporosis is a chronic disease and has to be treated as such. If however for whatever reason treatment regimens using biologicals are being discontinued we have to be aware that such situations need to be stabilized using long-acting bisphosphonates to maintain the therapeutic success and avoid rapid bone loss and fracture risk.