Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Aug 2021
[Update on primary spontaneous pneumothorax - conservative or primarily surgical therapy?]
Spontaneous pneumothorax is a potentially life-threatening situation. Therefore, it is mandatory to treat it safely. The incidence is approximately 10 out of 100 000 residents per year. ⋯ After diagnosis pneumothorax is traditionally treated by an insertion of a thoracic tube. Recently, thoracic ultrasound gained influence in diagnosis of pneumothorax and primarily conservative treatment strategies have been shown to be safe and equally effective in particular groups of patients. This article aims to present and discuss these upcoming strategies.
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Interventional radiology plays a crucial role in oncology. The most common interventional treatments are transarterial embolisation as well as percutaneous thermal ablations. Transarterial embolisation, such as transarterial chemoembolization (TACE) or selective internal radiation therapy (SIRT) are well established, usually palliatively intended treatment options for primary and secondary hepatic malignancies. ⋯ New interventional treatments are high intensity focused ultrasound (HIFU) and irreversible electroporation (IRE). HIFU allows a non-invasive, imaging-guided thermoablation that is currently certified for uterine myoma, prostate cancer and bone tumors. IRE is a minimal invasive non-thermal ablation that is especially established for locally advanced tumors that show a close relationship to large vessels, for example pancreatic cancer.
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Dtsch. Med. Wochenschr. · Aug 2021
[Non-invasive cardiac imaging in the work-up of coronary artery disease].
Cardiovascular imaging has experienced and is still experiencing tremendous advancements as far as hardware as well as software technology is concerned. In every day clinical routine, crucial decisions are daily being taken based on imaging findings. ⋯ Furthermore, a growing body of scientific evidence is currently available that show the clinical relevance of different imaging methods in the clarification of different disease constellations. This article describes various imaging modalities that are used in the work-up of CAD in everyday cardiac routine.
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Dtsch. Med. Wochenschr. · Aug 2021
Review[Risk profile of disease-modifying antirheumatic drugs: an update from the RABBIT register].
This article provides an overview of current results from the German biologics register RABBIT on the safety of biologic and targeted synthetic disease-modifying antirheumatic drugs in rheumatoid arthritis. Collaborative data from the European biologics registries show no evidence for an overall increased risk of malignancy with TNF inhibitors. Venous thromboembolism occurs less frequently under TNF inhibitors than under conventional synthetic DMARDs. ⋯ There is no evidence of increased facial paresis with tocilizumab. Janus kinase inhibitors increase the risk for the occurrence of herpes zoster. New data on biosimilars suggest that they can be used with a comparable safety profile to originator drugs.
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Dtsch. Med. Wochenschr. · Aug 2021
[Organ donation: A treatment option in end-of life intensive care?]
A newly issued policy statement of the German Medical Association considers organ donation as an integral part of end-of-life intensive care in patients with devastating brain afflictions. Hence, patients' wishes towards organ donation and medical suitability should be evaluated when prognosis is considered futile and goals of treatment need to be reconsidered. ⋯ Thus, a potential recovery of transplantable organs is supported by appropriate intensive care treatment. Decisions to employ extended intensive care options (like extracorporeal circulatory support or cardiopulmonary resuscitation) in potential organ donors should be carefully outbalanced with patients' wishes, organ donation being considered an achievable goal and even potential frictions in medical teams.