Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Feb 2024
Review[Compression therapy for inflammatory dermatoses of the legs].
In addition to venous and lymphatic diseases, there is increasing scientific evidence that inflammatory dermatoses of the legs are also indications for compression therapy. Specifically, diseases such as pyoderma gangrenosum, livedoid vasculopathy, cutaneous vasculitides, necrobiosis lipoidica, psoriasis, or erysipelas are conditions for which adjunctive compression therapy may be used when manifestations occur on the lower extremities. ⋯ Especially because of the often problematic pain symptoms, compression therapy can be performed with low resting pressures around 20 mmHg, especially in inflammatory dermatoses. In this review article, the current scientific aspects of compression therapy in inflammatory dermatoses of the legs and the corresponding limitations are presented in a differentiated manner.
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Dtsch. Med. Wochenschr. · Feb 2024
Review[Advanced renal cell carcinoma - an overview of current systemic therapy].
Renal cell carcinoma (RCC) is one of the more common tumor diseases in older adults. The only curative treatment method is surgical resection in the localized stage. Based on current study data, drug (combination) therapy in the metastatic stage is the most effective treatment option for non-resectable/metastatic RCC (mRCC). ⋯ A decision on first-line therapy should be made individually as part of a "shared decision" with the patient. The selection of a second-line systemic therapy is based on individual criteria; the data available for a well-founded classification of a possible therapy sequence after progression to first-line therapy is sparse. Further investigations to optimize systemic therapy (expansion of combination therapy to triple combination of CPI+CPI+TKI) or evaluation of therapy in other histological subtypes of renal cell carcinoma are the subject of ongoing clinical studies.
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Dtsch. Med. Wochenschr. · Feb 2024
[Influence of the Corona pandemic on cardiovascular risk factors - Data from 1775 participants of the ELITE study before and during the Corona pandemic].
The COVID-19 pandemic and its interventions have led to a deficit in medical care and changes in people's lifestyles, which has consequently changed cardio- and cerebrovascular primary and secondary prevention. The existing data are mainly based on surveys. In addition to the problem of the accuracy of self-assessments, the pandemic per se and the massive public reporting may have biased the data.Only a few publications have compared data collected before the pandemic with results during the pandemic. The ELITE study has regularly monitored risk factors (RF) and psychosocial parameters (stress, depression, well-being, diet, brain performance, exercise) in over 5000 participants for years. From this study, data were analyzed from 1775 individuals collected before the onset and again during the pandemic (06/05/2020-25/01/2022). Thus, baseline values were unaffected by the pandemic. ⋯ A not insignificant part of the population experienced significant worsening of RF during the pandemic. This particularly affected blood pressure and depressive symptoms, and more often women.
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Dtsch. Med. Wochenschr. · Feb 2024
[Systems thinking, subjective findings and diagnostic "pigeonholing" in ME/CFS: A mainly qualitative public health study from a patient perspective].
ME/CFS (Myalgic encephalomyelitis/chronic fatigue syndrome) is an illness that is predominantly viewed as a neuroimmunological multisystem disease, which is still unknown to many doctors in Germany or which they classify as a psychosomatic disease. From their perspective, ME/CFS patients report significant deficits in terms of medical treatment and a doctor-patient relationship (DP relationship) that is perceived as problematic. The aim of the present study is to more precisely analyse the process of finding a diagnosis as an influencing factor on the DP relationship in ME/CFS from the point of view of those affected. ⋯ From the point of view of ME/CFS patients, the process of making a diagnosis and the recognition of ME/CFS as a neuroimmunological multisystem disease are the central aspects of a DP relationship that they experience as problematic. In the past, findings classified as "subjective" and thus ignored, the pigeonholing that is characteristic of biomedically oriented medicine and a healthcare system that opposes systemic thinking when making a diagnosis have all been identified as factors that may have a significant impact on the DP relationship.
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Dtsch. Med. Wochenschr. · Feb 2024
Case Reports[Spontaneous femoral arterio-venous fistula in an 80-year-old female patient as an incidental finding].
Spontaneous arteriovenous fistulas (AVF), in contrast to iatrogenic or post-traumatic ones, are extremely rare and only sporadically published in the literature. In the absence of exposure risk, the diagnosis of AVF can be challenging, especially if it is an incidental finding. ⋯ Spontaneous femoral AVF is a rarity. Characteristic clinical findings lead to a targeted use of color duplex sonography with correct interpretation of artifacts that can otherwise be easily missed.