Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Oct 2016
Review[Pulmonary hypertension in grown-ups with congenital heart disease: Recommendations of the Cologne Consensus Conference 2016].
The 2015 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension are also valid for Germany. The guidelines contain detailed recommendations for different forms of PH, and specifically address PH associated with congenital heart disease (CHD). However, the practical implementation of the European Guidelines in Germany requires the consideration of several country-specific issues and already existing novel data. ⋯ This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, a number of working groups was initiated, one of which was specifically dedicated to PH in grown-ups with congenital heart disease (GUCH). This article summarizes the results and recommendations of this working group.
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Dtsch. Med. Wochenschr. · Oct 2016
Review[Sacubitril / Valsartan in patients with diabetes and heart failure].
Sacubitril / Valsartan proofed to be an effective treatment compared to enalapril in reducing heart failure hospitalisations and mortality in patients with severe "Heart failure with reduced ejection fraction" (HFREF). Recent European cardiology guidelines attributed a class IB recommendation for Sacubitril / Valsartan in HFREF patients who remain symptomatic despite optimal treatment with ACE-I, a beta-blocker, and a mineralocorticoid receptor antagonist. ⋯ Overall, Sacubitril / Valsartan is obviously a treatment option in diabetics with HFREF. However, diabetic cardiomyopathy needs to be recognised as a specific disease condition.
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Autosomal dominant polycystic kidney disease (ADPKD) is the most common monogenetic kidney disease. The clinical course is highly variable, association to certain genetic mutations only weak. Great progress has been made in recent years in determining the pathophysiology of the disease. ⋯ This therapy should be restricted to cases with rapid progressive and early renal failure due to costs and side effects. The value of this agent in later stages of chronic renal failure is currently being evaluated in clinical studies. Additional specific therapies are in early clinical evaluations.
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Dtsch. Med. Wochenschr. · Sep 2016
Case Reports[Severe hypoglycemia following tramadol intake in a 79 year old non-diabetic patient].
History and clinical findings | We report about a 79 year old non-diabetic patient who was admitted to the emergency room with severe hypoglycemia (blood glucose level: 36 mg / dl and Glasgow Coma Scale Score: 3). After the infusion of G40 % her blood glucose level stabilised. The patient reported to have taken 50 mg of Tramadol during the night to treat her headache. ⋯ Conclusions | Hypoglycemia is a little known adverse effect after tramadol intake, which has only been published in few cases. Tramadol, a weak opioid analgesic classified as step 2 of the WHO cancer pain ladder, is used in moderate pain. Given the continuous rise in tramadol prescription due to better management of chronic pain, further investigation of this issue seems needed as well as an increased awareness amongst physicians.
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New studies increase the evidence, that different applications of physical therapy are effective. In patients with rheumatoid arthritis (RA) physiotherapy of the hands improve strength, joint mobility and activity without increased risk of pain nor inflammation. A theory-based physiotherapy of the hands shows clinical effectiveness and cost-utility. ⋯ Static resting splints reduce the risk of hand deformities. Local and whole body cryotherapy show short term improvement of pain and inflammatory activity. German S3-guidelines recommend enhanced utilisation of physical therapy as well as coordinated multiprofessional team care and rehabilitation.