Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Mar 2013
Meta Analysis[Clinical experience with pirfenidone for the treatment of idiopathic pulmonary fibrosis].
Idiopathic pulmonary fibrosis (IPF) is a progressive and fatal lung disease with an estimated median survival of only 3 years after diagnosis. Pirfenidone is the only medication approved in the European Union for the treatment of adults with mild to moderate lung fibrosis. We analyzed data on safety and efficacy of pirfenidone in the treatment of patients with IPF in our centre. ⋯ Pirfenidone alone or in combination with NAC and/or corticosteroids was generally well tolerated. Severe side effects were rare. The course of the disease was stable during treatment with pirfenidone in two out of three patients. Our results are in line with the previous published safety and efficacy data on pirfenidone as treatment for IPF.
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Dtsch. Med. Wochenschr. · Mar 2013
Case Reports["Catecholamine refractory" cardiogenic shock? "Bridging-to-recovery" by implantation of a percutaneous cardiac assist device].
A 27-year-old man presented with acute dyspnea and a previous respiratory tract infection with progressive dyspnoea and chest pain over 2 weeks. Clinical findings revealed severe cardiac failure with development of cardiogenic shock and need for adrenergic drug therapy for circulatory support. ⋯ A drug-only circulatory support very often does not enable stabilization of a patient in progressive cardiogenic shock and cannot prevent multiorgan dysfunction. Therefore implantation of an assist device facilitates a "bridging-to-recovery" or a "bridging-to transplant" concept in critically ill patients presenting with cardiogenic shock. The bridging also allows for reviewing etiology and evaluation of further treatment options. In case of recovery continuous care in a specialized Heart Failure Clinic can help to maintain the clinical status and offer frequent reevaluation of cardiac status and therapeutic concepts.
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Sarcoidosis is a multisystemic granulomatous disorder of unknown origin, which can involve multiple organs. However the lymph node and lung manifestations dominate. Most frequent symptoms are cough, fatigue, dyspnea and exercise limitations. ⋯ In chronic disease corticosteroids are effective in the majority of patients. Other immunosuppressives, cytotoxic and immunomodulatory agents are reserved for patients with severe side-effects to steroid-therapy or for patients, who cannot maintained on reasonable low doses of steroids. Lung transplantation is an option for life-threatening cases failing medical therapy.