Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Aug 2024
[Community-Acquired Bacterial Meningoencephalitis: The New Guideline].
Updating the vaccination recommendations against meningococci and pneumococci, in particular the introduction of the B vaccine as the standard vaccination for infants from January 2024 and the adaptation of the pneumococcal vaccination strategy for infants and adults aged 60 and over with the latest conjugate vaccines (PCV13, PCV15, PCV20). Emphasis on the need for rapid diagnostic lumbar puncture and simultaneous serum and cerebrospinal fluid analysis to increase diagnostic precision. The introduction of procalcitonin (PCT) in serum as an additional biomarker to differentiate between bacterial and viral meningitis. ⋯ Adaptation of antibiotic recommendations based on the current resistance situation, in particular for meningococcal meningitis, consideration of penicillin G only after resistance testing. Clarification of the areas and duration of use of dexamethasone in bacterial meningitis, particularly in pneumococcal meningitis and the controversial data situation in Listeria meningitis. New findings on the safe use of heparin in septic sinus thrombosis without increased risk of hemorrhage.
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Dtsch. Med. Wochenschr. · Aug 2024
[Nuclear medicine approaches in the diagnosis and treatment of neuroendocrine neoplasms].
Despite, or perhaps because of the rarity of neuroendocrine neoplasms, the diagnosis and treatment of these malignancies is of particular importance. Nuclear medicine can make an important contribution to this challenge. ⋯ This theragnostic (fusion of therapeutic and diagnostic) concept is based on the frequent overexpression of somatostatin receptors on neuroendocrine tumor cells. Using diagnostic and therapeutic pharmaceuticals based on analogues from somatostatin, most applications from the nuclear medicine are successful, an additional therapeutic method is SIRT, also known as TARE, in which the hypervascularization of NEN-metastases is used as a therapeutic target.
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Dtsch. Med. Wochenschr. · Aug 2024
Review[Monitoring of cardiovascular emergencies in the emergency department].
In the emergency department, patients with potential or confirmed cardiovascular diseases constitute a significant portion of the overall patient population. Monitoring for cardiovascular surveillance of these patients, until and during the diagnostics and acute therapy often presents an interdisciplinary and interprofessional challenge. This is partly due to the limited number of monitoring spaces in emergency departments. ⋯ The provision of an intensive care bed for further care within one hour is aimed for according to the directive of the Federal Joint Committee on staged emergency care in hospitals. Often, at the beginning of the emergency department visit, a definitive diagnosis is not yet established - this is addressed accordingly with symptom-oriented considerations. The present review article focuses on the practical Implementation and modalities of monitoring, as well as its application in a selection of cardiovascular diagnoses in the emergency department.