Deutsche medizinische Wochenschrift
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Fever is common in patients in intensive care units. Sources of fever can be infectious or non-infectious. ⋯ Typical examples of non-infectious fever include thromboembolic events, myocardial infarction, autoimmune disease, withdrawal symptoms or a drug-fever. Every new onset of fever prompts diagnostic decisions, treatment with antipyretics should be discussed critically.
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Dtsch. Med. Wochenschr. · May 2012
Review[Cholesterol embolism syndrome: a rare, but severe complication in patients with atherosclerosis].
Cholesterol embolization is a serious complication of atherosclerosis. Mainly, vascular manipulations during endovascular procedures or vascular surgery can release cholesterol crystals from atheromatous plaques. About 20 % are spontaneous emboli without precipitating event. ⋯ Prognosis is limited. About 30-55 % patients with renal involvement need renal replacement therapy. Mortality is high with 15-30 % of patients dying during the first year.
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Dtsch. Med. Wochenschr. · Mar 2012
Review[Idiopathic pulmonary fibrosis: modern guideline-concordant diagnostics and innovative treatment].
Interstitial lung diseases are a heterogenic group of diseases who share in common manifestation of the disease process in the distal airways and alevolo-capilary membrane. Idiopathic pulmonary fibrosis (IPF) is of special interest as it is the most prevalent entity within the idiopathic interstitial pneumonias and it is associated with the worst prognosis. Diagnosis of IPF necessitates confirmation of a "usual interstitial pneumonia" (UIP) pattern on high-resolution computed tomography or on histology from a surgical lung biopsy. ⋯ In IPF-patients who cannot receive pirfenidone high-dose N-acetylcysteine is an "off-label-use" option that also has been shown to slow disease progression, however, based on low quality of evidence only. Recent studies suggest that anti-inflammatory therapies (prednione, azathioprine) may be harmful in IPF patients and cannot be recommended. Besides medical therapies IPF patients should receive best supportive care, which includes long-term oxygen therapy in hypoxemic patients and pulmonary rehabilitation as well as lung transplantation for eligible patients.
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Dtsch. Med. Wochenschr. · Feb 2012
Review Practice Guideline[The German National Disease Management Guideline "Chronic Heart Failure"].
Chronic heart failure (CHF) is an illness mostly affecting elderly people. In Germany CHF is one of the most common causes of death and at the same time one of the most common diagnosis in inpatient care. Due to the expected increase in life expectancy in the next few years experts predict a further step-up of the incidence. ⋯ Quality improvement though can only happen when the NDMG CHF is adopted into daily routine. To support implementation a patient version of the guideline was developed. The article compiles the most relevant recommendations and algorithms of the National Disease Management Guideline (NDMG) Chronic Heart Failure (CHF).