Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Nov 2016
Review[Severe hypercapnic respiratory failure in acute exacerbation of COPD: significance of ventilation and extracorporal CO2 removal].
In acute exacerbations of COPD with acute hypercapnic respiratory failure and a pH 7.25 - 7.35, the initiation of non-invasive ventilation is the gold standard. However, absolute and relative contraindications have to be taken into account. The implementation of non-invasive ventilation in case of a severe respiratory acidosis necessitates a skilled therapeutic team and a close monitoring in order to avoid or perceive a NIV failure in time. ⋯ However, its general and primary use without optimizing medical therapy and mechanical ventilation is not indicated. ECCO2R is an experimental therapy in COPD with acute hypercapnic respiratory failure, its significance is still ambiguous. Therefore, it should only be applied in individual situations by a specialist team trained in its use.
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Vertigo and dizziness are with an annual incidence of more than 10% and a lifetime prevalence of more than 30% among the most frequent symptoms. The keys to the diagnosis are the patient history and the bedside examination: a) for the patient history the time course, type and triggers of symptoms and accompanying symptoms, b) for the clinical examination of the vestibular system the head-impulse test (HIT), the examination for a spontaneous nystagmus, a displacement of subjective visual vertical, a positional nystagmus and the Romberg test, and c) for the differentiation between an acute peripheral and central vestibular lesion the skew deviation, central fixation nystagmus, gaze-evoked nystagmus, saccadic smooth pursuit and a normal HIT. The various forms of vertigo are treated with pharmacological therapy, physical therapy, psychotherapeutic measures and, rarely, surgery. For pharmacotherapy there are basically eight groups of drugs that can be used: anti-emetics, -inflammatory, -menières, -migraineous medications, anti-depressants, -convulsants, aminopyridines and acetyl-DL-leucine, however, with a currently often low level of evidence.
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Acute myeloid leukemia (AML) has been genetically characterized extensively and can now be subdivided into 9 to 11 pathogenetically different subtypes according to their profile of driver mutations. In clinical practice karyotyping and molecular analysis of NPM1, cEBPa and FLT3-ITD are required for treatment stratification and potentially genotype specific treatment. Some markers such as NPM1 not only offer prognostic information but can also serve as markers of minimal residual disease and thus have the potential to guide therapy in the future. ⋯ This entity used to be a problematic AML subgroup because of its frequent coagulation disturbances and potentially fatal bleeding problems. Today patients with APL can be treated with a chemotherapy free combination of ATRA - a differentiating agent - and Arsenic Trioxide - an apoptosis inducing agent. In patients with a leukocyte count < 10 000 / µl a cure rate of > 90 % can now be achieved.
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Dtsch. Med. Wochenschr. · Oct 2016
Review Meta Analysis[How to individualize drug therapy based on pharmacogenetic information? A systematic review of published guidelines].
Background | Differences (polymorphisms) in genes encoding drug targets, drug transport proteins, or drug metabolizing enzymes may be responsible, among other factors, for the observed variation in patients' responses to medications. The field of pharmacogenetics aims to identify patients at higher genetically-determined risk of adverse effects or poor response to medication. This information would allow for modification of dosage or substitution with alternative therapy. ⋯ Even with low-quality evidence, strong recommendations can be made in favour of pharmacogenetic modification of prescription, such as for abacavir and the HLA-B genotype, if there is a large and certain difference between the benefits and harms. For other drug-gene pairs, such as vitamin K antagonists and CYP2C9/VKORC1, the net benefit from the pharmacogenetic-based dosing strategy is small and matter of debate. Because pharmacogenetics is playing a growing role in drug development and pre-prescription genotyping will become more widespread, specific pharmacogenetic guidance for treating physicians will become increasingly important.