Deutsche medizinische Wochenschrift
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Approximately 50 % of chronic gastrointestinal symptoms in primary care can be attributed to functional gastrointestinal disorders (FGID). The most frequent gastrointestinal disorders are functional dyspepsia and irritable bowel syndrome. FGID are heterogenous with regards to the amount of symptoms and associated patient's impairment as well as to the underlying pathophysiological mechanisms. ⋯ In addition, these guidelines include recommendations how to explain the disorder and the management to the patient to establish a trustful doctor-patient relationship. FGID are diagnosed by the history of a typical cluster of symptoms and by guideline - recommended exclusion of somatic gastrointestinal disorders. FGID should be managed according to the main symptoms, the associated impairment and patients' preferences in a graduated approach by education and by dietary, pharmacological and psychological treatments.
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This review provides an update on the diagnosis, differential diagnosis and management of functional cardiovascular symptoms. Typical heart-related symptoms like non-cardiac chest pain and palpitations are frequently complemented by other symptoms like dyspnea, sweating, trembling, dizziness and also further somatic symptoms like pain and fatigue. ⋯ Successful management depends on an attitude of realizing and confirming the reality and seriousness of the symptoms despite the absence of a clear structural organic cause. Good cooperation with psychotherapists is helpful for stepped care strategies that start with supportive communication with the patient and biopsychosocial self-help activities, leading, if necessary, to formal psychotherapy.
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Autoimmune gastritis (AIG) is a chronic immune-mediated inflammation of the gastric corpus/fundus mucosa leading to progressive atrophy of the oxyntic gastric glands (AOM) and their consecutive loss of function. Possible clinical consequences of AIG include iron deficiency anemia, pernicious anemia, gastric neuroendocrine tumors (gNET), and gastric adenocarcinoma. This article provides a review of interdisciplinary aspects of the diagnosis and treatment of AIG.
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Dtsch. Med. Wochenschr. · Apr 2022
Case Reports[BCG-therapy as a rare reason for postrenal failure].
In the following case report, we describe a patient with acute renal failure due to an urinary congestion level II-III under BCG-(Bacillus Calmette-Guérin)-therapy because of bladder cancer. Cystoscopy revealed the diagnosis of BCG-induced intramural narrowing of distal ureters bilaterally. ⋯ Although postrenal failure is relatively rare (5 %), also seldom causes such as medication-induced (e. g. BCG) ureter stenosis has to be included into the differential diagnosis.
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Dtsch. Med. Wochenschr. · Apr 2022
Case Reports[First clinical manifestation of chronic hepatitis C in painless progressive atrophic monoparesis of the right leg].
A 60-year-old male patient was admitted with a painless reduction in the circumference of the right calf with mild gait disturbance that had been increasing for 6 months. Neurological findings included atrophic monoparesis of the right lower leg with preserved muscle reflexes without sensory disturbances. ⋯ Chronic hepatitis C may be rarely associated with painless progressive monoparesis. With regard to pathogenesis, the significance of CSF requires further studies.