Deutsche medizinische Wochenschrift
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Understanding genetic predisposition has a significant impact on the management of patients with endocrine tumours, including therapy, early detection and prevention. These tumours, which develop as part of a familial predisposition, often manifest early in life and frequently affect several endocrine organs. In the following article, both common syndromes, such as multiple endocrine neoplasia (MEN) syndromes, and rare syndromes, such as familial isolated pituitary adenoma (FIPA), are presented based on their indicator diseases.
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Suicidal tendencies are all thoughts, feelings and actions that are aimed at ending one's own life. GPs should recognize and address this in their patients, as they can intervene and coordinate further treatment. However, not every patient discloses - and it is not always possible to prevent suicide.
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Dtsch. Med. Wochenschr. · Mar 2024
[Reflux symptoms and upper abdominal pain: Reflux, Gastritis and whatever could be behind it].
Reflux symptoms and upper abdominal pain are very common symptoms in general population. Both symptoms are visceral and thus cannot be linked to an organ or a disease. Diagnostic work-up revealed organic disease in up to 30%, when patients present with dyspeptic symptoms. Gastroesophageal reflux disease (GERD) and functional dyspepsia (FD) represent the most frequent and important disorders in western countries, when diagnostic work-up is done in patients with reflux symptoms and abdominal pain.
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Dtsch. Med. Wochenschr. · Mar 2024
[A desperate family member. Suggestions for a successful interaction].
In everyday clinical practice relatives are often perceived as an additional burden, as a problem. Relatives appear, for example, to be overwhelmed, desperate, (co-)affected, demanding, or in some cases even (verbally) abusive. ⋯ Such judgements are often made intuitively and without reflection and are therefore a permanent obstacle to further communication on the ward. This article is therefore intended to provide a deeper understanding of the situation of distressed relatives and to show ways of achieving a successful relationship with these relatives.
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Dtsch. Med. Wochenschr. · Mar 2024
[Venous thromboembolism - was is new in the revised AWMF guideline?].
For the diagnosis of a lower-extremity deep vein thrombosis (LEDVT), venous duplex ultrasound is the method of first choice. If a qualified ultrasonography is not timely available, D-dimer testing, and limited ultrasound protocols (point-of-care ultrasound, POCUS) can contribute to therapeutic decision-making when clinical probability is low. A DOAC-based treatment regimen is preferable to a vitamin K antagonist for both acute therapy and secondary prophylaxis of venous thromboembolism (VTE). ⋯ Weight restrictions are no longer recommended for apixaban and rivaroxaban, but determination of DOAC trough and peak levels is recommended in the extremely obese and patients after bariatric surgery. In cancer-associated VTE, the direct factor Xa inhibitors are a good and safe alternative to low-molecular weight heparins (LMWH) for many patients; the adherence to oral therapy is also higher. Meaningful initial documentation and structured follow-up after LEDVT and pulmonary embolism (PE) are important in order to make an individualized risk-benefit assessment at the end of the therapy phase with regard to continued pharmacological secondary prophylaxis and to reassess patients' symptoms indicating post-thrombotic syndrome (PTS) or chronic thromboembolic pulmonary hypertension (CTEPH).