Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Dec 2019
Historical Article[Natural Science as a Kind of Natural Poetry: A Statement by Christoph Wilhelm Hufeland (1762-1832) Against Natural Philosophical Medicine].
At the turn to the 19th century, medicine in Germany became strongly influenced by the teachings of John Brown, who was a scottish physician. He had advocated a theory which regards and treats disorders as caused by defective or excessive excitation. His teachings were welcomed by natural philosophers like Schelling or Hegel. ⋯ As viewed from today, evidence based medicine eventually established our modern ways for successfully diagnosing and treating disease. However, Hufelands disapproval appears to be still relevant. There are many people that even now advocate alternative ways and who consult quacks, healers etc.
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On August 26 in 1753, Balthasar Neumann's wife wrote a letter to the Abbot of Neresheim describing her husband's disease one week after his death. This article outlines Neumann's medical history and builds connections towards the understanding of diseases in these times. As an example - and probably Neumann's ailment - the gastric cerarcinoma is discussed with special attention in this report.
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Dtsch. Med. Wochenschr. · Dec 2019
[Gastrointestinal complications of the new immune checkpoint inhibitor therapies].
In recent years, immune checkpoint inhibitors (ICPI) have become established as an integral part of drug tumor therapy. They belong to a group of monoclonal antibodies that promote anti-cancer cell immune response. Inhibitory signaling pathways are interrupted by binding to CTLA-4 and PD-1 or PD-L1, which increases the activity of cytotoxic T lymphocytes and reduces the immunological tolerance to tumor cells. ⋯ Immune-mediated hepatitis is a potential side effect which occurs about 6 to 14 weeks after initiation of therapy. It is usually asymptomatic and characterized by an increase in serum transaminases. Lipasemia, without clinical signs of acute pancreatitis, is a common laboratory finding, which usually has no therapeutic consequence.
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Dtsch. Med. Wochenschr. · Dec 2019
[Lung Cancer screening? Who should get it and how it should be done].
In large clinical studies, lung cancer screening has been demonstrated to be effective in reducing lung cancer mortality in defined high risk populations using low-dose CT techniques. However, in different studies, results and definitions of persons of high risk have varied which needs to be taken into account when screening programmes should be implemented in clinical routine. In order those programmes to be as effective as possible, the careful definition of a risk population is crucial as much as the careful use of radiant exposure. Ideally, the number of false positive findings should be as low as possible with the best reduction in lung cancer mortality and limited financial burden.
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Dtsch. Med. Wochenschr. · Dec 2019
[Pharmacologic treatment of heart failure with reduced ejection fraction in chronic kidney disease].
Medical management of patients with co-existing Heart Failure with reduced Ejection Fraction (HFrEF) and chronic kidney disease (CKD) poses a significant challenge to treating physicians. On the one hand, the traditional therapeutic strategies such as betablockers, angiotensin converting enzyme inhibiotors, angiotensin receptor blockers and mineralocorticoid receptor antagonists have been evaluated in clinical trials that broadly excluded patients with significant CKD. On the other hand, inhibition of the renin angiotensin aldosterone system can lead to worsening of renal function and hyperkalemia potentially causing harm. ⋯ New therapeutic strategies are under current investigation. Sodium glucose transporter 2 inhibitors show promising results in HFrEF and in CKD trials. In addition, Sacubitril/Valsartan significantly reduced events in HFrEF and might reduce renal events in HFpEF.