Deutsche medizinische Wochenschrift
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The insulin replacement is essential in the treatment of type 1 diabetes. Insulin therapy has been coupled with relevant side effects such as hypoglycemia and weight gain. Glucagon-like Peptide 1(GLP-1) analogues (liraglutide) and incretin mimetics (exenatide) are approved only for the treatment of type 2 diabetes mellitus. This review aims to answer the question of what effects exercise GLP-1 analogues on glucose metabolism in people with type 1 diabetes mellitus. ⋯ The delayed gastric emptying and reduction of glucagon is the main mechanism of the improved glycemic control in the glucose metabolism of type 1 diabetes. The present literature shows promising results for the additional substitution of GLP-1 analogues in the treatment of type 1 diabetes mellitus. Based on the current data, there is a need to carry out large randomized-controlled trials.
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Thyroid dysfunction may impair fertility, course of pregnancy and fetal development. Physiological alterations of thyroid function parameters, that occur during pregnancy need to be distinguished from pathophysiological states of hypo- and hyperthyroidism. We performed a literature search (PubMed 1990-2013) and review relevant publications as well as consensus and practice guidelines of international thyroid/endocrine societies. ⋯ Hashimoto's thyroiditis is associated with impaired fertility and miscarriage, and may first manifest in pregnancy due to the increased thyroid hormone requirement. Graves' disease often shows a characteristic course in pregnancy with amelioration of thyrotoxicosis in the second half of pregnancy and exacerbation after delivery. In addition transplacental passage of maternal TSH receptor antibodies may lead to thyrotoxicosis in the fetus and/or newborn.
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Dtsch. Med. Wochenschr. · Oct 2014
Review[State of the art treatment of progressive or refractory multiple myeloma].
Multiple myeloma (MM) is with an incidence of 4-6/100 000 inhabitants a fairly frequent malignancy of B cells. The incidence increases markedly with age. In this review changes in the treatment of relapsed / refractory myeloma during the last decade have been analysed. The present standard of care in the progressive or refractory myeloma was elaborated by the working group "Refractory Multiple Myeloma" using an extensive literature search for studies published between 2003 and 2013. Outside of clinical trials, high-dose therapy with stem cell transplantation is recommended in fit patients up to 75 years without significant comorbidities. Ongoing studies address the question about the least toxic and the most effective treatment. Therefore, inclusion of patients in therapeutic trials and use of novel agent combinations is highly recommended, e.g. with 3(rd) generation-IMIDs (pomalidomide), new proteasome inhibitors, such as carfilzomib, ixazomib or oprozomib, antibodies, such as elotuzumab, daratumumab or SAR650984, siltuximab, tabalumab, denosumab, romosozumab, BTK-, HSP-inhibitors and other innovative phase I/II agents. ⋯ Based on new insights in the pathogenesis of the disease, treatment options for MM have changed significantly in recent years. There is a significantly larger treatment diversity, i.e. more MM-active agents and combinations are available today. Even with relapsed MM, patients with the disease often live longer and have fewer complications.
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Dtsch. Med. Wochenschr. · Oct 2014
[Episodic breathlessness: translation and consenting of the international definition using the Delphi method].
Similar to pain, refractory breathlessness can occur episodically. Episodic Breathlessness is a distressing symptom in patients with advanced life-limiting disease. The lack of a universal definition impedes symptom understanding in clinical practice and effective management, respectively. The aim of the study was to formally consent a German translation of the English definition and terminology of episodic breathlessness. ⋯ The formally consented German definition and terminology of episodic breathlessness enable clearer symptom understanding and provide a precise basis for education and research on the symptom and its management also in Germany. Effective management options are warranted to improve quality of life of suffering patients and their relatives.
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Dtsch. Med. Wochenschr. · Oct 2014
[Transnodal ultrasound-guided lymphangiography for thoracic duct embolization in chylothorax].
To evaluate the feasibility of ultrasound-guided transnodal lymphangiography as an modified technique for visualization of the abdomino-thoracic lymphatic system for thoracic duct embolization in patients with chylothorax after thoracic surgery. ⋯ Ultrasound-guided transnodal lymphangiography is a less technically challenging technique for opacification of the abdomino-thoracal lymphatic system for subsequent thoracic duct embolization.