Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Mar 2023
[Fluid Management in Intensive Care Patients - New Strategies and optimal target?].
Adequate therapy with intravenous fluids is crucial in the initial treatment of critically ill patients. Both hypovolemia and hypervolemia are associated with organ dysfunction and adverse outcomes. A recent international randomized trial investigated a restrictive volume management in comparison with a standard volume regimen. 90-day-mortality was not significantly reduced in the group with restrictive fluid administration. ⋯ Regarding the absence of evidence-based criterias and treatment goals for volume management in shock patients, an individualised approach resorting to diverse monitoring tools should be considered. UItrasound-based assessment of IVC diameter and echocardiography are excellent non-invasive tools to evaluate volume status. Passive leg raising (PLR) test represents a valid method for the assessment of volume responsiveness.
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The CRB-65 score is recommended as a risk predictor, as well as consideration of unstable comorbidities and oxygenation. ⋯ Patients after community-acquired pneumonia have increased acute and long-term mortality due to cardiovascular events in particular. The focus of research is on improved pathogen identification, a better understanding of the host response with the potential of developing specific therapeutics, the role of comorbidities, and the long-term consequences of the acute illness.
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Dtsch. Med. Wochenschr. · Mar 2023
Case Reports[Devil with angel wings - when vitamin A saves lives].
A 40-year-old male patient presented to our emergency department with a new onset of hemorrhagic diathesis. Clinically, there were marked bleeding stigmata with extensive ecchymosis in the thigh area and oral mucosal hemorrhage with otherwise general well-being. ⋯ Acute promyelocytic leukemia accounts for approximately 10-15% of all acute myeloid leukemias. Often, association with marked coagulation abnormalities due to disseminated intravascular consumption coagulopathy, which is present at diagnosis, APL becomes fatal if untreated. Rapid therapy initiation with ATRA and coagulation optimization, initiated as soon as the diagnosis is suspected, are crucial for prognosis.
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Male breast cancer is an unknown field for many practitioners. Patients often see different doctors before the correct diagnosis is made - often too late. This article is intended to point out risk factors, initiation of diagnostics and therapy. In the dawning age of molecular medicine, we will also take a look at genetics.
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Dtsch. Med. Wochenschr. · Mar 2023
[Treatment of acromegaly - data from the German Acromegaly Register].
Acromegaly is a rare disease in which chronic growth hormone overproduction (usually from an anterior pituitary adenoma) leads to various systemic complications. The management of acromegaly and the comorbidities of the disease is complex and requires a multidisciplinary approach. Early diagnosis is extremely important, as then the chances of a complete cure are significantly higher. ⋯ With good patient information and guidance, the drug therapy of acromegaly patients in specialized practices and clinics can usually lead to biochemical control and thereby normalization of mortality risk. As with numerous rare diseases, care in specialized centers and recording and evaluation in registry studies can contribute to better patient care and the optimization of therapy and diagnostic guidelines. We assume that with the help of the German Acromegaly Registry, which currently includes more than 2500 patients with acromegaly, we will be able to present a realistic picture of the care situation in Germany in the coming years.