Deutsche medizinische Wochenschrift
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Abdominal pain is one of the most common complaints that lead to an emergency department visit. Depending on the interpretation of the definition, 20-40 % of these patients present with an acute abdomen. This term summarizes a variety of diseases that often occur in the abdominal cavity, mostly acute, and can be accompanied by symptoms such as nausea and vomiting. ⋯ The goal must be to move from symptom-based to causal therapy as quickly as possible and to clarify whether a patient needs to be referred to an emergency operation or whether there is time for further differential diagnostic measures. The prognosis of the acute abdomen often depends on the time latency until the definitive therapy is initiated. Rapid and determined action by the experienced initial examiner are important prerequisites for a favorable course of the disease process.
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Dtsch. Med. Wochenschr. · Oct 2020
[Breast cancer - state of the art - Short overview of the current standard of treatment].
Breast cancer is the most frequently diagnosed type of cancer in women and there are continuously new findings in research for further treatment approaches. ⋯ The detection of an ESR1 mutation could possibly be used as a predictive marker regarding endocrine therapy in the future. Furthermore, there are promising results for blocking the PD-1 axis in primary systemic chemotherapy for triple-negative breast cancer.
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Hyponatremia is a common condition affecting hospitalized and ambulatory patients as well. The clinical spectrum of hyponatremia can range from asymptomatic laboratory findings to severely symptomatic conditions such as acute epileptic seizures. ⋯ As hyponatremia can be a potentially life-threatening condition, it requires an efficient management with the goal of identifying the etiology and to subsequently provide adequate treatment, while avoiding treatment-related adverse effects such as overcorrection and pontine myelinolysis. This article summarizes the pathophysiology and differential diagnosis, as well as useful diagnostic tests and therapy of hyponatremia in a practice-oriented manner.
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Dtsch. Med. Wochenschr. · Oct 2020
[Intestinal motility disorders in multimorbidity: between constipation and diarrhea].
The Rome IV criteria for primary chronic obstipation help to distinguish between short-term ailments and a chronic pattern of complaints 1. In general, there are several causes of defecation disorder in the age group of the elderly. Anamnesis and observance of red flags in addition to a geriatric basic assessment make it possible to narrow down the causes. The distinction between low-transit constipation and normal intestinal function can decisively influence the therapeutic consequence. ⋯ In the drug intervention, osmotic laxatives, stimulating laxatives, suppositories and enemas with different additives are still used very frequently. In the second place, the prokinetic prucaloride and for some years methylnaltrexonium bromide can be used as a representative of the peripheral-acting opioid receptor antagonists 2 3. Fibre-rich diet produces more bowel movement and prebiotic additives can influence the microbiome favorably. Additional fibre is not likely to show benefit in case of severe constipation, in particular to patients with low-transit constipation or defecation disorders. When preparing for colonoscopies, it appears that additional movement activation has positive effects on the quality of intestinal cleansing 4.