Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Feb 2017
Case Reports[Dentogene Focus as a Rare Cause of Necrotizing Fasciitis].
History and clinical findings We elaborate the case of a 72-year-old patient who presented with a painful swelling of the lower jaw in the emergency unit. Investigations and diagnosis In the clinical examination and the CT scan, a widespread cervical emphysema was found which raised suspicion for the presence of a necrotizing fasciitis of the head and neck due to aerogenic infection. Close spatial vicinity to the teeth of the left upper and lower jaw was present, so that the necrotizing fasciitis was assumed to be odontogenic. ⋯ Immediately performed therapy included sternotomy and extended surgical debridement of necrosis. Conclusion The presented case emphasizes that necrotizing fasciitis due to gas-producing infections should be considered as a differential diagnosis for cervical soft tissue emphysema for which an odontogenic focus is the most common cause. Rapid diagnosis is essential for successful treatment consisting of immediate surgical debridement and intravenous antibiotics.
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Dtsch. Med. Wochenschr. · Jan 2017
Controlled Clinical Trial[Pulmonary Rehabilitation after Acute Exacerbation of COPD Reduces the Rate of Reexacerbations].
Objective Acute exacerbation of COPD (AECOPD) provides for patients a significant hazard and is crucial for the prognosis. Data on the effects of pulmonary rehabilitation (PR) on the frequency of reexacerbations after AECOPD are inconsistent. A prospective, case-control study was conducted with the aim of measuring the impact of PR on the frequency of reexacerbations after AECOPD. ⋯ The intergroup comparison also showed a significantly lower number of exacerbations for the PR-group (0.97 ± 1.52 vs 2.16 ± 1.25; p < 0.001). Conclusion It was shown that the exacerbation rate after an AECOPD could be significantly reduced in the PR-group in comparison to the KG-group during the investigation period of one year by PR. More prospective studies are required to define the value of PR in the context of AECOPD.
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Physical frailty is a physiological syndrome of older people. It is characterized by a reduced reserve, a reduced stressor resistance, and vulnerability to negative health outcomes. The assessment of physical frailty is increasingly applied to identify high risk patients prior to medical or surgical interventions. The present article describes Fried's frailty phenotype, which is the most frequently applied diagnostic instrument of physical frailty, together with evidence based treatment options.
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Dtsch. Med. Wochenschr. · Nov 2016
[ESC guidelines 2015 pulmonary hypertension: diagnosis and treatment].
Pulmonary hypertension (PH) is characterized by an increase in PAPmean > 25 mmHg associated with a reduced life expectancy. Recent advances in the management of these patients provided the basis for the updated recommendations of the 2015 joint guidelines of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS) on the diagnosis and treatment of pulmonary hypertension. ⋯ In addition, risk stratification and PH treatment were profoundly modified, introducing novel drugs and improved treatment strategies such as early combination therapy. Finally, the new ESC /ERS guidelines provide formal recommendations for the management of PH due to left heart or chronic lung disease and chronic thromboembolic pulmonary hypertension, and define criteria for specialized PH expert centers.
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Dtsch. Med. Wochenschr. · Nov 2016
Review[Pulmonary Hypertension: Cologne Consensus Conference 2016].
Recently, the updated European Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension (PH) have been published. The practical implementation of the guidelines considering country-specific aspects, current data and individual features is essential for clinical patient care. ⋯ To this end, 10 working groups were initiated, each of which was dedicated to one specific topic. This article summarizes some of the results that were obtained by interdisciplinary consensus.