Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Sep 2023
[Cardiovascular assessment and management of patients undergoing non-cardiac surgeries - A case based resumé].
In August 2022, the European Society of Cardiology (ESC) published new guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. In order to cope with the complexity of the patients and the multidisciplinary, representatives of the European Society of Anesthesia and Intensive Care Medicine as well as 2 patient representatives were involved in the development of the published document in addition to authors from the European Society of Cardiology. As a result, the document contains 147 recommendations on this complex topic, with more than half of them being grade I recommendations. ⋯ Particular attention was also paid to recommendations for action for a structured preoperative risk stratification. The new guidelines also focus on increasing vigilance for perioperative myocardial damage and identifying it at an early stage. In the following article, some of the essential innovations and revisions will be highlighted using practical clinical case studies.
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For the management of basal cell carcinoma, the primary performance of a risk stratification, which is decisive for the further diagnostic and therapeutic steps, is becoming increasingly important. Various non-invasive methods are available to confirm the clinical diagnosis. Histological confirmation of the diagnosis is recommended in unclear cases. ⋯ The most important preventive measure is consistent textile or chemical UV protection in already affected individuals. In addition, nicotinamide and celecoxib can be used orally for prevention. For follow-up, the current S2k guideline recommends regular self-monitoring and standardized medical check-ups.
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Dtsch. Med. Wochenschr. · Sep 2023
[Preclinical early detection and diagnosis of sepsis - step by step].
Because of very unspecific sepsis symptoms, early recognition of the emergency sepsis is difficult. If the disease is recognized in time it is possible to initiate diagnosis and treatment quickly. Rapid treatment of sepsis leads to lower mortality and less severe long-term consequences. Early detection is therefore of central importance in the diagnostic and therapeutic process, also in the outpatient setting.
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Esophageal motor disorders are an important cause of dysphagia but can also be associated with retrosternal pain and heartburn as well as regurgitation. In extreme cases, patients are not able to eat appropriately and lose weight. Repetitive aspiration can occur and may cause pulmonological complications. ⋯ Balloon dilatation and Heller myotomy are long established and more or less equally effective therapeutic options for patients with achalasia. Peroral endoscopic myotomy (POEM) enhances the therapeutic armamentarium for achalasia and hypertensive/spastic motor disorders since 2010. For hypotensive motor disorders, which may occur as a complication of e.g., rheumatological diseases or idiopathically, therapeutic options are still limited.
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The evidence available today from randomized controlled trials shows that for many patients with CAT, direct FXa-inhibitors are a safer and potentially more effective therapy than long-term treatment with Low Molecular Weight Heparin (LMWH), which has been the gold standard. Oral therapy should be used with caution, particularly in the case of gastrointestinal or urothelial tumors, especially if the tumor is still in situ. ⋯ Incidental VTE are anticoagulated according to the guidelines according to the standard. A less intensive AK may be justifiable in individual cases.