Deutsche medizinische Wochenschrift
-
Dtsch. Med. Wochenschr. · Feb 2024
Review[Compression therapy for inflammatory dermatoses of the legs].
In addition to venous and lymphatic diseases, there is increasing scientific evidence that inflammatory dermatoses of the legs are also indications for compression therapy. Specifically, diseases such as pyoderma gangrenosum, livedoid vasculopathy, cutaneous vasculitides, necrobiosis lipoidica, psoriasis, or erysipelas are conditions for which adjunctive compression therapy may be used when manifestations occur on the lower extremities. ⋯ Especially because of the often problematic pain symptoms, compression therapy can be performed with low resting pressures around 20 mmHg, especially in inflammatory dermatoses. In this review article, the current scientific aspects of compression therapy in inflammatory dermatoses of the legs and the corresponding limitations are presented in a differentiated manner.
-
Dtsch. Med. Wochenschr. · Feb 2024
Review[Advanced renal cell carcinoma - an overview of current systemic therapy].
Renal cell carcinoma (RCC) is one of the more common tumor diseases in older adults. The only curative treatment method is surgical resection in the localized stage. Based on current study data, drug (combination) therapy in the metastatic stage is the most effective treatment option for non-resectable/metastatic RCC (mRCC). ⋯ A decision on first-line therapy should be made individually as part of a "shared decision" with the patient. The selection of a second-line systemic therapy is based on individual criteria; the data available for a well-founded classification of a possible therapy sequence after progression to first-line therapy is sparse. Further investigations to optimize systemic therapy (expansion of combination therapy to triple combination of CPI+CPI+TKI) or evaluation of therapy in other histological subtypes of renal cell carcinoma are the subject of ongoing clinical studies.
-
Dtsch. Med. Wochenschr. · Feb 2024
[Influence of the Corona pandemic on cardiovascular risk factors - Data from 1775 participants of the ELITE study before and during the Corona pandemic].
The COVID-19 pandemic and its interventions have led to a deficit in medical care and changes in people's lifestyles, which has consequently changed cardio- and cerebrovascular primary and secondary prevention. The existing data are mainly based on surveys. In addition to the problem of the accuracy of self-assessments, the pandemic per se and the massive public reporting may have biased the data.Only a few publications have compared data collected before the pandemic with results during the pandemic. The ELITE study has regularly monitored risk factors (RF) and psychosocial parameters (stress, depression, well-being, diet, brain performance, exercise) in over 5000 participants for years. From this study, data were analyzed from 1775 individuals collected before the onset and again during the pandemic (06/05/2020-25/01/2022). Thus, baseline values were unaffected by the pandemic. ⋯ A not insignificant part of the population experienced significant worsening of RF during the pandemic. This particularly affected blood pressure and depressive symptoms, and more often women.
-
Dtsch. Med. Wochenschr. · Feb 2024
[Current therapy of heart failure with mildly reduced or preserved left ventricular ejection fraction].
Based on the results of recent clinical trials investigating patients with heart failure and a mildly reduced (HFmrEF) or preserved (HFpEF) left ventricular ejection fraction, an update of the ESC guidelines on acute and chronic heart failure as well as the German `Nationale Versorgungsleitlinie Herzinsuffizienz' has been released. Consistently, they now recommend the use of SGLT2 inhibitors also in these patients' groups. ⋯ In patients with HFmrEF, intravenous application of iron can be considered to improve quality of life in iron-depleted patients. Patients experiencing a heart failure related hospitalization shall receive the foundational guideline-directed pharmacotherapy already while in hospital and undergo a timely post discharge visit to further optimize treatment.
-
Phosphate is essential for bone metabolism and for energy provision. Phosphate homeostasis is achieved by hormonal feedback mechanisms, predominantly parathyroid hormone, fibroblast growth factor 23 and calcitriol, with renal phosphate absorption taking on a special role. ⋯ Essentially, the clinically relevant disturbances in phosphate balance can be attributed to three mechanisms: 1. shifts of phosphate between the extracellular space and the cytosol; 2. inadequate phosphate reabsorption in the kidney; 3. decreased intestinal phosphate absorption. Knowledge of physiology enables diagnosis and therapy of phosphate disorders.