Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Jan 2020
Review[Anti B-cell-antibody treatment for maintenance of remission in granulomatosis with polyangiitis and microscopic polyangiitis].
Granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) are the most frequent primary necrotizing small vessel vasculitides. In these formerly fatal diseases remission can be induced by stage- and activity-adapted immunosuppressive regimens in the majority of patients. This does not lead to drug-free long-term remission or even cure. ⋯ Recent randomized controlled trials demonstrated that maintenance treatment with the anti-B-cell antibody Rituximab, administered 6-monthly as opposed to azathioprine leads to a significantly lower relapse rate but a similar profile of adverse events. These data enabled the extension of the approval of Rituximab for maintenance of remission treatment of GPA and MPA in Germany in 2018. Guidelines and expert recommendations concerning measures of infection prevention and vaccination of immunosuppressed patients as well as the management of hypogammaglobulinemia and cytopenia on Rituximab are presented in this review.
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Education of medical students requires teaching students how to navigate in the broad field of medical research. The objective of this article is to provide an overview about medical research and to show how to denote a medical study in a concise fashion. Medical research can be classified into categories according to the object of investigation. ⋯ Each research category uses a specific set of study types with names such as cross-sectional study, case-control study etc. The article describes the principles of the study types. Together, research category and study type briefly describe the design of a medical study.
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Dtsch. Med. Wochenschr. · Jan 2020
Case Reports[Bouveret Syndrome: the stone that broke the camel's back (and stomach)].
A 76-year-old woman was hospitalized because of increasing pain in the upper abdomen, nausea and non-bilious vomiting. A normal food intake had been impossible for one week. She had a medical history of a biliary necrotizing pancreatitis five years ago. The patient had refused to undergo cholecystectomy in the past. ⋯ Bouveret syndrome is a rare form of gallstone ileus. Besides gastroscopy, contrast-enhanced computer tomography should be first choice of medical imaging. Primary goal of all intervention is the removal of the obstructing gallstone. Endoscopy is the treatment of choice. Additional surgery is debatable and remain an individual decision. However, it should be performed as a two-stage procedure or not at all.
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Dtsch. Med. Wochenschr. · Jan 2020
[Prevalence of malnutrition risk in patients of cancer outpatient clinics - a cross-sectional survey].
The nutritional status of patients with tumor diseases in German out-patient clinics is largely unknown. This cross-sectional survey on patients with tumor diseases aimed to assess the prevalence of the risk of malnutrition in this group. ⋯ Every third patient with a diagnosed tumor disease in out-patient care exhibits an increased risk of malnutrition. The results of this survey clearly indicate the need for a systematic screening for malnutrition and an evidence-based nutrition management of tumor patients under ambulatory care.
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Dtsch. Med. Wochenschr. · Jan 2020
[Mild Hypertension: What are the Limits, Who Should Be Treated How?]
For decades, it was not clear how to deal with mild hypertension in patients, especially with low cardiovascular risk. In particular, the findings of the therapy studies, which have rarely examined the uncomplicated mild case of hypertension due to the low expected event rate, certainly suggest that therapy of mild hypertension in a period of 10 years has little effect on the patients. With a longer observation period and also through insights from register analyzes, especially with systematic follow-up, it becomes clear that it makes sense to treat a mild hypertension even at low cardiovascular risk. ⋯ Patients well below the age of 65 years with mild hypertension and low overall cardiovascular risk should be offered the option to adjust blood pressure even with systolic targets below 130 mmHg. If the patient is older than 65, target blood pressure achievement should not be so ambitious anymore, but also dependent on the tolerance of the patient. Certainly, the practitioner must explain clearly to the younger patient that regular therapy will not necessarily bring him an advantage over the next 10 years, and that the effects may not really materialize until 20 years, and then reduce the risk of stroke or heart attack.