Deutsche medizinische Wochenschrift
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Biliary tract cancer (BTC) is a rare disease with a heterogeneous nomenclature. Carcinomas of the intra- and extrahepatic biliary tract as well as gallbladder cancer are oftentimes combined in clinical research and treatment algorithms. However, these different cancer types vary not only in their anatomical features, but also in the underlying molecular alterations. ⋯ For second-line treatment, the combination of 5-FU, folinic acid and oxaliplatin (FOLFOX) is a treatment option based on preliminary data from a randomized phase 3 study. Potential targeted therapies showing efficacy in prospective clinical studies are, for example, IDH-, BRAF-/MEK- and FGFR-inhibitors as well as immunotherapy. Therefore, in the era of personalized medicine, molecular testing should be offered to all patients with advanced disease and indication for systemic treatment.
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Dtsch. Med. Wochenschr. · Apr 2020
[Barrett Esophagus - Update of clinical management and therapy options].
Adenocarcinomas of the esophagus are very similar to those of the stomach and most likely develop in the gastric cardia, from where proliferating cells expand into the esophagus and form benign Barrett's mucosa. An additional genomic instability leads to the clonal evolution of certain cells, which can lead to the development of adenocarcinoma. ⋯ The curatively intended endoscopic resection is the standard therapy for dysplastic Barrett's metaplasia, mucosal (T1a m) and superficial submucosal (T1a sm1) adenocarcinoma. Here, cap and ligature resection as well as endoscopic submucosal dissection (ESD) represent the recommended resection techniques and, in combination with radiofrequency ablation, the therapy according to guidelines.
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Dtsch. Med. Wochenschr. · Apr 2020
[Lipid management 2020 - medical therapy and lipid apheresis in context].
The recently updated 2019 European Society of Cardiology/European Atherosclerosis Society Guidelines for the management of dyslipidaemias set new, ambitious goals for lipid lowering based on recently generated evidence from large outcome trials. Noninvasive imaging as well as measurement of lipoprotein(a) as a non-traditional risk factor is advocated for the refinement of risk stratification. ⋯ If needed, lipid apheresis can complement the medical armamentarium. Moreover, lipid apheresis remains the only approved treatment modality for lowering lipoprotein(a), however medical treatments are under current investigation.
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Rhythm control therapy, comprising antiarrhythmic drugs, cardioversion, and AF ablation, is an important component in the management of patients with atrial fibrillation (AF). Catheter ablation for AF, mainly targeting isolation of the pulmonary veins (AF ablation), has markedly improved the effectiveness of rhythm control therapy. Rhythm control improves symptoms and quality of life in patients with symptomatic AF. ⋯ AF ablation appears to improve left ventricular function in a subset of patients. Summarized, rhythm control therapy in patients with symptomatic AF is safe and improves quality of life, including elderly patients with stroke risk factors. Further studies are needed to determine whether rhythm control therapy reduces AF-related complications while improving patient outcome with regard to prognosis.
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Dtsch. Med. Wochenschr. · Apr 2020
[Sequential Natriuretic Peptide Measurements to Monitor Treatment and Prognosis During Heart Failure Therapy].
Natriuretic peptide serum levels (NP) are the most robust predictors of heart failure (HF) diagnosis and prognosis. Therefore, international HF guidelines give highest evidence and recommendation on their clinical usage, particular in patients with dyspnea. Key message of this review is to inform about the concept of sequential NP measurements as quantifiable plasma biomarker to objectify sodium-water-dynamics and clinical therapy response during recompensation of HF patients. Essentially, three clinical scenarios result of sequential NP measurements and might have a valuable role in HF risk stratification, prognosis and need of therapy optimization of in- and outpatient care.