Deutsche medizinische Wochenschrift
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In case of obstructive, interstitial and malignant respiratory and lung diseases, occupational causes must always be searched for. The sensitivity and specificity of specific IgE determinations in the diagnosis of occupational asthma are only slightly above 70 %, even for high-molecular allergens. If the patient's medical history is positive, further diagnostics must be carried out, if necessary up to specific exposure testing in specialised institutions. ⋯ Patients with lung carcinoma should also be investigated for occupational causes. Here too, questionnaires and tables are available in simple language. In future lung cancer caused by long-term exposure to passive smoke will be considered an occupational disease.
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Diabetes is a very important comorbidity in patients with heart failure. When both diseases are present, mortality is greatly increased. Therefore, it is important to sufficiently diagnose and treat patients with diabetes and heart failure to improve outcome. This article provides an overview on epidemiology, pathogeneses, diagnostic and therapeutic options.
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There is an ongoing change in the indications of orthotopic liver transplantation (OLT) with non-alcoholic and alcoholic liver disease and hepatocellular carcinoma (HCC) becoming the main indications whereas the numbers of cirrhosis due to chronic viral hepatitis are declining. 6-MONTH ABSTINENCE RULE: : The directive of the German Federal Medical Association requires absolute abstinence from alcohol for at least 6 months. New data show that patients with severe alcoholic hepatitis for the first time who do not show a response to medical treatment may benefit from OLT. For these patients an individual exception for OLT listing can be requested. ⋯ OLT using organs from HBV- or HCV-infected patients represents a relevant strategy to mitigate organ shortage and can be safely and effectively be performed due to the excellent therapeutic options against these infections which are available now. In addition, machine perfusion, a novel tool for organ conservation and conditioning, may help preserving organs for transplantation that formerly could not be used.
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Dtsch. Med. Wochenschr. · Aug 2020
[Thyroid nodules: The Guidelines of the American Thyroid Association from a European Perspective].
In Germany and in other regions with former iodine deficiency, thyroid nodules and nodular goiter are still much more frequent than in the U. S. A. ⋯ Another difference relates to the recommendation of scintigraphy that according to the guideline is restricted to patients with decreased TSH. In regions with former iodine deficiency, it has been demonstrated that thyroid autonomy may be present even if TSH is in the lower normal range. Therefore, in Germany scintigraphy is recommended for preoperative evaluation of all patients with thyroid nodules or nodular goiter.