Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Feb 2021
[New aspects of therapeutic plasma exchange in critical care medicine].
Therapeutic plasma exchange (TPE) is used to eliminate toxins, hormones or antibodies from the blood and replace the lost volume with fresh frozen plasma, albumin or crystalloids. In this article, recent advances in the usage for TPE for four different critical disease entities are explored: Septic shock, acute liver failure, catastrophic antiphospholipid syndrome (CAPS) and thyrotoxic storm.
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As the pandemic continues, there is increasing hope vaccinations are becoming available. As a solution for a nationwide immunization against the virus, a compulsory vaccination is repeatedly discussed. However, some opponents of vaccination are threatened by the idea of a possible mandatory vaccination. ⋯ This article discusses the current legal situation in Germany. The introduction of a potential compulsory vaccination against the SARS-CoV-2 virus represents an encroachment on the fundamental right of physical integrity. According to § 20 (6) IfSG, a protective vaccination for threatened parts of the population is permissible by statutory order, if a transmissible disease with clinically severe courses occurs and its epidemic spread can be expected.
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Dtsch. Med. Wochenschr. · Feb 2021
[Evidence based guideline for cardiac rehabilitation in German speaking countries of Europe].
An evidence based clinical guideline for cardiac rehabilitation (CR) has been published in collaboration between the German Association of Cardiac Rehabilitation and Prevention of Cardiovascular Diseases (DGPR) and the working groups of prevention and rehabilitation of the cardiac societies of Austria (ÖKG) and Switzerland (CPRS). This guideline has been consented by relevant medical societies in Germany (cardiologists, cardiac surgeans, sports medicine, psychosomatic medicine, rehabilitation scientists). In addition, patients suffering from cardiovascular diseases were involved to emphasize shared decision making in the recommendations. ⋯ In addition, psychosocial intervention during CR was evaluated by new meta-analysis as well. Other indications for CR and interventions during CR were evaluated by literature review and were consented between collaborating medical societies. This guideline published on 7th of January 2020 in German language (www.awmf.org).
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Deficiencies in B-vitamins have recently been recognized as risk factors for stroke and dementia. With increasing age there is an increased prevalence of metabolic and nutritional changes leading to increased vulnerability of vitamin deficiency. ⋯ With regard to the knowledge about the water-soluble B vitamins (B6, B12, folic acid and homocysteine as well as B1), there have recently been new findings and recommendations by various professional societies. An overview of the basics, causes, diagnostic and therapeutic concepts of B-vitamins and the current state of research in this area is given.
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Dtsch. Med. Wochenschr. · Feb 2021
[Treatment of soft tissue sarcomas including GIST - Update 2021].
Soft tissue sarcomas are rare tumors that represent a major challenge due to varying clinical presentations and often interdisciplinary treatment concepts. Gold standard for the treatment of localized resectable soft tissue sarcomas is complete surgical removal. So far, multimodality treatment does not represent a clininal standard. ⋯ Recently, avapritinib has been approved for treatment of patients with the so far resistant D842V mutation in the PDGFRA exon 18. Ripretinib has shown very promising activity in forth and further lines of therapy and is already approved in the US. The use of adjuvant imatinib therapy in patients with completely resected localized GIST with a high risk of recurrence has significantly improved overall survival with a treatment duration of 3 years. These results have now been confirmed with a 10 years follow-up analysis.