Deutsche medizinische Wochenschrift
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Both in hospitals and outpatient settings, fewer fluoroquinolones have been prescribed in Germany in recent years. The consumption of cephalosporins also decreased somewhat in favor of penicillin derivatives. The aminoglycosides, which have only rarely been prescribed, can now be used again as a suitable alternative - but only parenterally - due to their relatively favorable activity and low resistance rates among typical urinary tract infection pathogens. ⋯ These betalactams should be given with extended infusion times, e. g. over 4 hours. Linezolid should be considered as a reserve drug and not be used empirically, but only in targeted therapy. With regard to an alleged penicillin allergy, the risk of true allergic reactions can be differentiated by careful taking of the history; on that ground patient subgroups can be defined that may be re-exposed without further allergological examinations.
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Dtsch. Med. Wochenschr. · Dec 2020
[Anemia and iron deficiency - treatment options in chronic kidney disease and in chronic heart failure].
Anemia and iron deficiency are highly prevalent in chronic kidney disease (CKD) and in chronic heart failure. Both may epidemiologically predict future renal and/or cardiovascular events. ⋯ Finally, HIF stabilizers are a new treatment option for anemia in chronic kidney disease, and safety studies are currently ongoing in CKD patients. Whether patients suffering from chronic heart failure might also benefit from this treatment is currently unknown.
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Dtsch. Med. Wochenschr. · Dec 2020
[What is new in the diagnosis and therapy of malignant melanoma?]
Melanoma incidence and mortality rates are increasing. The sentinel lymph node biopsy plays an important prognostic role and is pivotal for the decision to undergo an adjuvant therapy making it an important diagnostic tool. The lack of survival benefit in patients with sentinel lymph node-positive (SLN+) melanoma upon immediate complete lymphadenectomy (CLND) suggest a parallel and not stepwise development of lymph node metastasis and distant metastasis thus questioning the role of immediate CLND. ⋯ Another novelty in the therapy of malignant melanoma is the approval of the first oncolytic virus, Talimogene laherparepvec, for the treatment of unresectable stage III and IV (M1a) melanoma. Significant progress has also been made in the treatment of patients with cerebral melanoma metastasis since studies indicate that both BRAF/MEK inhibitors and the immunotherapy with CTLA4 and PD-1 inhibitors are efficient in this group of patients. With this wide range of possible systemic therapies for advanced melanoma further studies regarding therapy sequence, combinations between targeted therapies and immunotherapy as well as biomarkers for treatment response are needed to help guide physicians find the optimal therapy for patients with advanced malignant melanoma.
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Dtsch. Med. Wochenschr. · Nov 2020
Review[The Gastrointestinal Tract in Intensive Care Medicine - Overview 2020].
Gastrointestinal dysfunctions and failure are common clinical incidents in critically ill patients, which are recognized as both, primary and even more often as secondary diagnoses as consequence of an already existing disease or as a corollary of intensive care treatment. These functional complications may aggravate into life-threatening emergencies and are highly associated with prognosis and increased mortality. This article gives an overview about the pathophysiology, diagnostics and therapy of three very relevant current topics in intensive care medicine: prophylaxis and management of gastrointestinal bleeding, gastrointestinal motility and absorption disorders as well as different forms of liver dysfunctions.