Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Nov 2021
[Contrast media use in kidney disease - clinical practice recommendations].
Contrast media use in patients with renal disease regularly ensures discussions in everyday clinical practice. Both X-ray and MRI contrast media are predominantly eliminated by the kidneys and therefore closely linked to kidney function. Risk stratification prior to contrast media use in patients with pre-existing renal dysfunction should be based on eGFR-determination. ⋯ Therefore, no further specific procedures preventing contrast-associated kidney injury are recommended. Timing of contrast media injection and dialysis sessions in patients with end stage renal disease is necessary only after MRI contrast media use. Independently, acute kidney injury requires a patient individual decision.
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Gastric and esophago-gastric junction (EGJ) adenocarcinoma are leading causes of cancer mortality and morbidity worldwide. In this short update article, we outline novel key developments in this field. Molecular defined subtypes can guide treatment decisions and create a roadmap for development of future agents in distinct subgroups of gastric cancer. ⋯ First line treatment should include trastuzmab in case of Her2 positivity. Immune checkpoint inhibitors are very effective in microsatellite instable tumors even in late treatment lines. In perspective, checkpoint inhibitors hold promise to become part of the standard treatment in the near future and novel Her2 targeted treatment approaches currently under development show promising results.
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The effective reduction of atherogenic lipoproteins has contributed to the rate of atherosclerosis-related cardiovascular complications being approximately halved over the last 50 years. Nevertheless, cardiovascular disease will be the leading cause of death worldwide in the coming years. The focus of this review is on the clinical significance of the pathophysiology of changes in lipid and lipoprotein metabolism. ⋯ Primary forms of hypercholesterolaemia have a significantly higher ASCVD risk because of the already lifelong LDL elevation (higher cumulative LDL exposure for the vessel wall). Secondary changes in lipid and lipoprotein metabolism (e. g. in diabetes or hypothyroidism) must be excluded or treated. Regulatory key steps in the pathophysiology of lipid metabolism and atherosclerotic plaque are "drug targets" for existing and new lipid and lipoprotein modifying therapies.
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Dtsch. Med. Wochenschr. · Nov 2021
Review[Neoadjuvant and adjuvant therapy of resectable colon cancer - Current standards and developments].
The present review focusses on perioperative diagnosis and treatment of resectable colon cancer. In UICC stages associated with a higher risk of recurrence, adjuvant chemotherapy after resection of the primary tumor is an established standard. While initial data also indicate the benefit of Neoadjuvant, pre-operative chemotherapy, a final evaluation is still pending. ⋯ However, it cannot be considered a predictive factor for the efficacy of adjuvant chemotherapy. Specifically, recent data of the IDEA study have opened the arena for shared decision making between physicians and patients allowing to define individual treatment approaches based on common assessment of risks and benefits. After completion of perioperative treatment, structured follow-up is of great importance and should be carried out according to the recommendations of the S3 guideline.
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In recent years, clinically significant advances have been made in the management of giant cell arteritis and Takayasu arteritis. This concise review article highlights important aspects of the diagnostic workup and imaging-based treatment surveillance of the large vessel vasculitides.