Dtsch Arztebl Int
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More than 90% of children with congenital heart defects now survive into adulthood; just a few decades ago, survival was rare, particularly among patients with complex defects. The new population of adults with congenital heart disease presents a special challenge to physicians from all of the involved specialties. ⋯ A complete cure of the congenital heart defect in childhood is exceptional, and most adult patients continue to suffer from residual problems and sequelae. Further surgery or catheter interventions may be needed. Potential late complications include arrhythmias, heart failure, pulmonary hypertension, endocarditis, and thromboembolic events. The management of these patients during pregnancy or non-cardiac surgery remains a challenge. If this evolving patient population is to receive the best possible care, the adequate provision of specialized medical services is a necessary, but not sufficient, condition: patients and their referring physicians will also need to be aware that these services are available, and then actually make use of them. Moreover, optimal communication among all of the involved physicians is essential.
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In negative-pressure wound therapy (NPWT), a wound is covered with an airtight dressing, and negative pressure is applied. This is thought to promote healing. We evaluated NPWT with an updated, systematic review of the literature. ⋯ Although there may be a positive effect of NPWT, we did not find clear evidence that wounds heal any better or worse with NPWT than with conventional treatment. Good RCTs are still needed to evaluate NPWT.
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In negative-pressure wound therapy (NPWT), a wound is covered with an airtight dressing, and negative pressure is applied. This is thought to promote healing. We evaluated NPWT with an updated, systematic review of the literature. ⋯ Although there may be a positive effect of NPWT, we did not find clear evidence that wounds heal any better or worse with NPWT than with conventional treatment. Good RCTs are still needed to evaluate NPWT.
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Pacemakers have been available for 50 years, and implantable cardiac defibrillators for 25. Clear indications for each have been established on the basis of data from randomized clinical trials (RCTs). ⋯ Pacemakers and implantable defibrillators are well-established electrotherapeutic devices that are highly effective and have only rare complications.
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Esophageal adenocarcinoma has attracted more attention among gastroenterologists recently because of its rapidly rising incidence in Western countries. Many new epidemiological findings have been published, and there have been numerous technical advances in diagnostic procedures and in multimodal treatment based on the staging of the disease. ⋯ here have been major recent advances in the diagnosis and treatment of esophageal adenocarcinoma. New refinements in endoscopic techniques now make endoscopic treatment possible for early esophageal carcinoma. New surgical techniques and new strategies of neoadjuvant chemotherapy have lowered the morbidity and improved the outcome of patients with locally advanced disease. Molecular therapies, too, have shown promising initial results.