Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Oct 2020
[Non-functioning pituitary tumors - short presentation of the first German guideline].
Pituitary tumors are frequent (estimated prevalence in adults up to 10 %). However, diagnostic work-up and therapeutic concepts are not well standardized; especially for non-functioning tumors. In the beginning of 2020, the first German interdisciplinary guideline on these topics was published. ⋯ If the surgical resection was incomplete or if tumors are recurrent, therapeutic modalities (e. g. re-operation, radiotherapy, observation) should be interdisciplinary considered. In all patients with or without therapeutic intervention, long-term follow-up is required. Patient with larger pituitary tumors or former surgery/radiotherapy should be regularly counseled regarding potential symptoms of hormonal insufficiency.
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Dtsch. Med. Wochenschr. · Oct 2020
[How complete is the Germany-wide standardised medication list ("Bundeseinheitlicher Medikationsplan")? An analysis at hospital admission.]
At inpatient admission, the timeliness and completeness of the Germany-wide standardised medication list ("Bundeseinheitlicher Medikationsplan") often seems inappropriate. It is also unclear which characteristics of the lists increase the probability of discrepancies. ⋯ The timeliness, completeness and aspects of patient safety must be comprehensively validated. Medication lists that are older than 1 month should be checked particularly critically with regard to information on strength and dosage and the plan should be updated accordingly at regular intervals.
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Dtsch. Med. Wochenschr. · Oct 2020
[Abdominal Emergencies in The View of an Intensivist - Intra-abdominal Hypertension and Abdominal Compartment Syndrome].
In critically ill patients an intra-abdominal hypertension is a common phenomenon. An IAH is defined as an IAP persistent ≥ 12 mmHg, an abdominal compartment syndrome is defined as an IAP persistent ≥ 20 mmHg in combination with new organ failure. ⋯ The bladder pressure should be measured in a standardized manner. The therapy of IAH should be individualized.
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For decades there were only symptom-oriented therapies for the monogenetic disease cystic fibrosis. With the new modulator therapies there are new hopes to better influence the course of the disease, which has its manifestation in several organs such as the lungs, the liver or pancreas. In addition to ivacaftor, lumacaftor/ivacaftor and tezacaftor/ivacaftor, a triple combination with elexacaftor/tezacaftor/ivacaftor was developed. ⋯ The results are very promising as already after 4 weeks a significant improvement of FEV1 and a significant decrease of the sweat chloride content could be detected. In the USA all patients with at least one F508del mutation can be prescribed the drug. This corresponds to approximately 90 % of all patients with cystic fibrosis and has the potential to change the landscape of cystic fibrosis.
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Dtsch. Med. Wochenschr. · Oct 2020
[Intestinal motility disorders in multimorbidity: between constipation and diarrhea].
The Rome IV criteria for primary chronic obstipation help to distinguish between short-term ailments and a chronic pattern of complaints 1. In general, there are several causes of defecation disorder in the age group of the elderly. Anamnesis and observance of red flags in addition to a geriatric basic assessment make it possible to narrow down the causes. The distinction between low-transit constipation and normal intestinal function can decisively influence the therapeutic consequence. ⋯ In the drug intervention, osmotic laxatives, stimulating laxatives, suppositories and enemas with different additives are still used very frequently. In the second place, the prokinetic prucaloride and for some years methylnaltrexonium bromide can be used as a representative of the peripheral-acting opioid receptor antagonists 2 3. Fibre-rich diet produces more bowel movement and prebiotic additives can influence the microbiome favorably. Additional fibre is not likely to show benefit in case of severe constipation, in particular to patients with low-transit constipation or defecation disorders. When preparing for colonoscopies, it appears that additional movement activation has positive effects on the quality of intestinal cleansing 4.