Deutsche medizinische Wochenschrift
-
Dtsch. Med. Wochenschr. · Jun 2023
[Current management and new treatment strategies of chronic myeloid leukemia].
The introduction of orally available tyrosine kinase inhibitors (TKI) into the treatment of chronic myeloid leukemia (CML) 25 years ago has substantially improved the clinical outcome of affected patients and resulted in a near-normal life expectancy in chronic phase (CP). Despite of a significant fraction of currently about one third of newly diagnosed CP patients eventually reaching treatment-free remission, the majority of patients still remain on life-long treatment with TKIs. ⋯ Given that nowadays, severity and degree of preexisting comorbidities might predict long-term survival of individual patients more significantly than the underlying CML itself, it becomes most important to properly and thoroughly select the TKI of choice on this basis as well as on the individually required co-medications. Given the variety of 2nd, 3rd and now allosteric TKIs available for the molecular targeting of the disease-driving BCR-ABL oncogene in addition to the "class-defining" Imatinib, personalization of CML therapy should now be further extended towards a better appreciation of comorbidities and co-medications before selection of an individual's TKI treatment complemented by a long-term oriented, patient-centered management and prevention of (sometimes irreversible) TKI side effects.
-
Dtsch. Med. Wochenschr. · Jun 2023
[Exocrine pancreatic cancer - what is new in the update of the S3 guideline?].
In 2020, worldwide 495,773 people were diagnosed with pancreatic ductal adenocarcinoma and 466,003 patients died from pancreatic cancer. Pancreatic cancer ranks 13th among cancer diagnosis and is the 7th most common cause of cancer-related deaths 1. In Germany, each year approximately 10,000 people develop pancreatic cancer and around the same number of patients die from this disease 2. ⋯ This is reflected by the high rate of early metastases and the small number of patients with long-term survival after surgery with curative intent. The S3 guideline exocrine pancreatic cancer aims to present the available evidence on epidemiology, molecular alterations, diagnostics, surgical and non-surgical treatment as well as palliative measures in order to support all those involved in the treatment of this tumor and to improve the care of patients. To better address this need, the S3 guideline was updated again in 2022 and also changed to a living guideline with regular updates to further improve the timeliness of the guideline.
-
Pulse oximetry has high sensitivity but low specificity for detecting hypoxemia. Arterial blood gas analyses are the gold standard for monitoring O2 therapy. Venous blood gas analyses should not be used in this setting. ⋯ These patients should always be monitored with arterial blood gases-in the case of peripheral VA-ECMO on the right arm and downstream of the oxygenator. HIGH-FLOW OXYGEN THERAPY FOR ACUTE HYPERCAPNIC RESPIRATORY FAILURE: High-flow oxygen therapy (HFNC) was not associated with reduced in-hospital mortality compared with conventional O2 in a meta-analysis of predominantly patients with acute hypoxemia (type I respiratory failure), although intubation rates were reduced. Also, in acute hypercapnic respiratory failure (type II), HFNC with high flow rates is not inferior to noninvasive ventilation (NIV).
-
We report on a 66-year-old patient who had had painful swelling of his left big toe for about 9 months with subjectively stopped growth. ⋯ As in the case presented, retronychia is often misdiagnosed. The knowledge of groundbreaking clinical and anamnestic parameters and the correct therapy options allows a quick, inexpensive, and long-term successful treatment.
-
The physician has to make numerous and legally far-reaching determinations in the course of the post-mortem examination. These can have considerable consequences for relatives and, moreover, for society. Therefore, the correct performance of post-mortem examinations and the correct evaluation of the findings is an extremely responsible task that every physician should master.