Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Apr 2021
[Endoscopic tunneling procedures in achalasia and gastroparesis].
Since the first publication of peroral endoscopic myotomy (POEM) by Haruhiro Inoue et al. in 2008 in Japan, various novel endoscopic procedures have been established, which are performed after iatrogenic creation of a submucosal tunnel as a "new space" 1. Through the artificially formed access in the tela submucosa, interventions in the muscular layer of the esophagus and stomach can be performed while carefully sparing the mucosal layer 2. ⋯ Further indications include splitting of Zenker diverticulum in POEM technique ("Z-POEM") as well as the removal of subepithelial tumors (STER: submucosal tunneling, endoscopic resection). The long-term therapeutic success (with > 80 % response) of these innovative procedures has now been proven by controlled studies, especially in achalasia 2 3 4 5 6.
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Thrombus formation due to atrial fibrillation is the most common cause of embolic stroke. Anticoagulation offers an effective prophylaxis. ⋯ The most commonly and best studied devices for this are the WATCHMAN™ and the AMPLATZER Amulet™ Occluders. In this How-To article, the aim is to offer a general overview of the indications, contraindications and complications as well as the implantation and postoperative management of patients receiving LAA closure by example of the WATCHMAN FLX™ Occluder.
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Dtsch. Med. Wochenschr. · Apr 2021
Case Reports[De novo thombotic microangiopathy (TMA) after incompatible AB0 renal transplantation].
We report a 57-year-old patient admitted to our hospital for planned AB0-incompatible living kidney transplantation. ⋯ It has to be discussed whether an early use of eculizumab in cases of suspected de novo TMA is a safe way to prevent graft dysfunction and thus to improve the poor prognosis for graft and recipient described in the literature.
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Dtsch. Med. Wochenschr. · Apr 2021
[Diagnostic approach and differential diagnosis of mon- and oligoarthritis].
Reasons of mon- and oligoarthritis are heterogeneous. The diagnostic approach includes a detailed medical anamnesis, physical examination and imaging (conventional X-ray, sonography, MRI and, CT). ⋯ In addition to crystal arthropathies and septic arthritis, differential diagnosis of mon-/oligoarthritis includes reactive arthritis, arthrosis and monarthritic courses of SpA/PsA. A rheumatologist should be consulted particularly in the case of persistent monarthritides, in order to initiate a specific therapy to prevent secondary damage.
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The chances of therapeutic success are a recognized criterion in allocating scarce medical resources. The approach aims to maximize the number of individual lives saved. There is good reason also to consider the number of life years saved in each case.