Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Jan 2020
[Focused Abdominal Ultrasound in Emergency, Perioperative and Intensive Care Medicine].
The rising impact of perioperative sonography is mainly based on mobile high quality ultrasound systems. Relevant bleedings or functional limitations of the abdomen are easy to identify with sonography. The FAST-Concept can be the first access to continue proceedings in ultrasound examination of the abdomen. ⋯ Just outside of the normal working time the ultrasound experts are often not promptly available. The demonstrated techniques allow in acute medicine to make a diagnosis and to decide fast in critical situations. Perspective in view of the many benefits and possibilities, point-of-care ultrasound will be a high-ranking skill in the field of anaesthesia, emergency medicine or intensive care.
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Hypertension is defined as resistant to treatment when treatment fails to lower office systolic and diastolic blood pressure values to < 140/90 mmHg. The treatment strategy should include lifestyle measures and appropriate doses of three or more drugs acting by different mechanisms including a diuretic. An updated definition of treatment resistance includes all patients with ≥ 4 antihypertensive agents of different classes irrespective of their on-treatment blood pressure. ⋯ While the prevalence of apparent resistance may be in the range of 10-15 % of treated patients, the exact prevalence of true resistance remains unknown due to the lack of appropriate studies but is likely to be rather small including a high proportion of patients with secondary forms of hypertension. Once identified most patients with true treatment resistance should receive intensified drug treatment primarily by expanded diuretic usage. Thus, resistant hypertension is primarily a diagnostic challenge: identifying patients with true resistance and those with secondary hypertension.
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Dtsch. Med. Wochenschr. · Jan 2020
Case Reports[Bouveret Syndrome: the stone that broke the camel's back (and stomach)].
A 76-year-old woman was hospitalized because of increasing pain in the upper abdomen, nausea and non-bilious vomiting. A normal food intake had been impossible for one week. She had a medical history of a biliary necrotizing pancreatitis five years ago. The patient had refused to undergo cholecystectomy in the past. ⋯ Bouveret syndrome is a rare form of gallstone ileus. Besides gastroscopy, contrast-enhanced computer tomography should be first choice of medical imaging. Primary goal of all intervention is the removal of the obstructing gallstone. Endoscopy is the treatment of choice. Additional surgery is debatable and remain an individual decision. However, it should be performed as a two-stage procedure or not at all.
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Dtsch. Med. Wochenschr. · Jan 2020
[Prevalence of malnutrition risk in patients of cancer outpatient clinics - a cross-sectional survey].
The nutritional status of patients with tumor diseases in German out-patient clinics is largely unknown. This cross-sectional survey on patients with tumor diseases aimed to assess the prevalence of the risk of malnutrition in this group. ⋯ Every third patient with a diagnosed tumor disease in out-patient care exhibits an increased risk of malnutrition. The results of this survey clearly indicate the need for a systematic screening for malnutrition and an evidence-based nutrition management of tumor patients under ambulatory care.
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Dtsch. Med. Wochenschr. · Jan 2020
[Mild Hypertension: What are the Limits, Who Should Be Treated How?]
For decades, it was not clear how to deal with mild hypertension in patients, especially with low cardiovascular risk. In particular, the findings of the therapy studies, which have rarely examined the uncomplicated mild case of hypertension due to the low expected event rate, certainly suggest that therapy of mild hypertension in a period of 10 years has little effect on the patients. With a longer observation period and also through insights from register analyzes, especially with systematic follow-up, it becomes clear that it makes sense to treat a mild hypertension even at low cardiovascular risk. ⋯ Patients well below the age of 65 years with mild hypertension and low overall cardiovascular risk should be offered the option to adjust blood pressure even with systolic targets below 130 mmHg. If the patient is older than 65, target blood pressure achievement should not be so ambitious anymore, but also dependent on the tolerance of the patient. Certainly, the practitioner must explain clearly to the younger patient that regular therapy will not necessarily bring him an advantage over the next 10 years, and that the effects may not really materialize until 20 years, and then reduce the risk of stroke or heart attack.