Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Apr 2020
[Lipid management 2020 - medical therapy and lipid apheresis in context].
The recently updated 2019 European Society of Cardiology/European Atherosclerosis Society Guidelines for the management of dyslipidaemias set new, ambitious goals for lipid lowering based on recently generated evidence from large outcome trials. Noninvasive imaging as well as measurement of lipoprotein(a) as a non-traditional risk factor is advocated for the refinement of risk stratification. ⋯ If needed, lipid apheresis can complement the medical armamentarium. Moreover, lipid apheresis remains the only approved treatment modality for lowering lipoprotein(a), however medical treatments are under current investigation.
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Rhythm control therapy, comprising antiarrhythmic drugs, cardioversion, and AF ablation, is an important component in the management of patients with atrial fibrillation (AF). Catheter ablation for AF, mainly targeting isolation of the pulmonary veins (AF ablation), has markedly improved the effectiveness of rhythm control therapy. Rhythm control improves symptoms and quality of life in patients with symptomatic AF. ⋯ AF ablation appears to improve left ventricular function in a subset of patients. Summarized, rhythm control therapy in patients with symptomatic AF is safe and improves quality of life, including elderly patients with stroke risk factors. Further studies are needed to determine whether rhythm control therapy reduces AF-related complications while improving patient outcome with regard to prognosis.
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Dtsch. Med. Wochenschr. · Apr 2020
Case Reports[Acute exacerbation of reactivated chronic hepatitis-b after stopping antiviral medication followed by loss of HBsAg].
A 66-year-old women with chronic hepatitis-b and antiviral therapy was presented with icterus and sickness 2 weeks after cold symptoms. The treatment was stopped by patient 6 month before. The liver was enlarged, the abdomen and further body status unsuspicious. ⋯ Acute exacerbation of chronic hepatitis-b followed stopping antiviral treatment can lead to healing by loss of HBsAg.
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Dtsch. Med. Wochenschr. · Apr 2020
[Abdominal Sonography in Medical Emergencies: do Complete Abdominal Scans offer Advantages over a Focused Strategy?]
To determine, whether in case of abdominal emergencies, complete abdominal ultrasound scans offer advantages over a goal-directed strategy in regard to problem-solving and detection of relevant pathologies. ⋯ In medical abdominal emergencies, ultrasound scans of the complete abdomen detect more relevant pathologies and solve more problems than focused sonography does.
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Dtsch. Med. Wochenschr. · Apr 2020
[Sequential Natriuretic Peptide Measurements to Monitor Treatment and Prognosis During Heart Failure Therapy].
Natriuretic peptide serum levels (NP) are the most robust predictors of heart failure (HF) diagnosis and prognosis. Therefore, international HF guidelines give highest evidence and recommendation on their clinical usage, particular in patients with dyspnea. Key message of this review is to inform about the concept of sequential NP measurements as quantifiable plasma biomarker to objectify sodium-water-dynamics and clinical therapy response during recompensation of HF patients. Essentially, three clinical scenarios result of sequential NP measurements and might have a valuable role in HF risk stratification, prognosis and need of therapy optimization of in- and outpatient care.