Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Feb 2021
Case Reports[EBV-positive MTX-associated lymphoproliferative disorder and Ig M myeloma in rheumatoid arthritis].
An 80-year-old female patient arrived with a pronounced lymphadenopathy and weight loss. 6 years ago she had been diagnosed with rheumatoid arthritis. At the time of arrival, she was administered Methotrexate (MTX) 10 mg/week. ⋯ Based on this case, the association of RA with lymphoproliferative disorders can be confirmed - here as an association of RA with biclonal MTX-LPD or multiple myeloma. Therapy with MTX and reactivation of EBV infection are important influencing factors.
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Dtsch. Med. Wochenschr. · Feb 2021
[Evidence based guideline for cardiac rehabilitation in German speaking countries of Europe].
An evidence based clinical guideline for cardiac rehabilitation (CR) has been published in collaboration between the German Association of Cardiac Rehabilitation and Prevention of Cardiovascular Diseases (DGPR) and the working groups of prevention and rehabilitation of the cardiac societies of Austria (ÖKG) and Switzerland (CPRS). This guideline has been consented by relevant medical societies in Germany (cardiologists, cardiac surgeans, sports medicine, psychosomatic medicine, rehabilitation scientists). In addition, patients suffering from cardiovascular diseases were involved to emphasize shared decision making in the recommendations. ⋯ In addition, psychosocial intervention during CR was evaluated by new meta-analysis as well. Other indications for CR and interventions during CR were evaluated by literature review and were consented between collaborating medical societies. This guideline published on 7th of January 2020 in German language (www.awmf.org).
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Over time, diabetes patients are at increased risk for microvascular and macrovascular complications leading to increased morbidity and mortality compared to metabolically healthy people. In addition, acute life-threatening metabolic derangements at first manifestation as well as during the course of the disease may occur, comprising diabetic ketoacidosis, hyperosmolar hyperglycaemic state and hypoglycaemia. Diabetes-related emergencies require fast diagnosis and early treatment initiation as well as close monitoring of vital signs and laboratory parameters. The present article gives an overview on the acute metabolic complications in diabetes, focussing on diagnostic work-up and treatment goals.
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Acute pancreatitis is one of the most common gastrointestinal diseases requiring acute hospitalization and its incidence is increasing. A particular challenge is the prediction and treatment of severe cases, which only affect a minority of patients, but are associated with mortality rates of up to 30 percent. In this review, we consider the diagnostic evaluation of the disease and provide an overview of current conservative and interventional treatment strategies.
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Patients with lower extremity arterial disease are at increased risk for cardiovascular events. Antithrombotic therapy improves prognosis in these patients especially after peripheral revascularization. After endovascular revascularization duale anti-platelet therapy with Aspirin and Clopidogrel is used for up to 3 months in most cases, although there is only little evidence for this practice. ⋯ In total 6564 patients were included after successful surgical or endovascular lower-extremity revascularization. Rivaroxaban 2.5 mg twice daily plus Aspirin 100 mg reduced cardiac and peripheral events compared with Aspirin 100 mg alone with increased risk for relevant but not for critical bleeding complications. In addition to antithrombotic medication risk factor management and regular follow-up examinations are important improve long-term prognosis after peripheral revascularization.