Deutsches Arzteblatt international最新文献

{"title":"Congestive Heart Failure: Perioperative Risk Assessment and Therapeutic Consequences.","authors":"Vera von Dossow, Giovanni Lurati Buse, Tau Hartikainen, Martin Mirus, Johannes T Neumann","doi":"10.3238/arztebl.m2025.0215","DOIUrl":"10.3238/arztebl.m2025.0215","url":null,"abstract":"<p><strong>Background: </strong>Three million people in Germany, and approximately 20% of older people undergoing surgery, suffer from chronic congestive heart failure. Perioperative hospital mortality is 4.8% in patients known to have chronic congestive heart failure and only 0.78% in other patients (adjusted odds ratio 2.15, 95% confidence interval [2.09; 2.22]). Congestive heart failure is often inadequately diagnosed and treated, and there is often a lack of preoperative guideline-based risk assessment and individualized strategic planning.</p><p><strong>Methods: </strong>This narrative review is based on pertinent guidelines and publications retrieved by a selective literature search (PubMed/Medline).</p><p><strong>Results: </strong>The frequency of acute postoperative decompensation is 2.5% among the entire population of patients with congestive heart failure (whether newly diagnosed or previously present as a chronic condition). The 1-year mortality rate is 44% (which can be compared to 11% without cardiac decompensation; adjusted HR, 1.66 [1.3; 2.2]). Patients at risk should be identified and classified at an early stage with biomarker screening and echocardiography so that they can be managed perioperatively in accordance with the guidelines. Extended cardiovascular monitoring (preload, contractility, afterload) enables individualized volume and fluid substitution. Frequent reexamination in the early postoperative phase allows clinical deterioration to be detected early and treated with drugs. After discharge, the patient's further course must be monitored by his or her primary care physician.</p><p><strong>Conclusion: </strong>Guideline-based pharmacotherapy, risk stratification, and interdisciplinary perioperative monitoring at close intervals are indispensable for lowering risk and preventing acute decompensation. Randomized clinical trials have been performed for the general treatment of congestive heart failure, but not for its perioperative management.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":""},"PeriodicalIF":7.1,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145762599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consent in Intensive Care: The Concurrence of Patients' and Families' Viewpoints. A Simulation Study","authors":"Olaf Boenisch, Lena Schirmer, Antonia Zapf, Dagmar Lühmann, Burkhard Grein, Katrin Bangert-Tobies, Tobias B Huber, Hermann Reichenspurner, Stefan Blankenberg, Geraldine de Heer, Peter Tohsche, Martin Scherer, Ingmar Schäfer, Stefan Kluge","doi":"10.3238/arztebl.m2025.0242","DOIUrl":"10.3238/arztebl.m2025.0242","url":null,"abstract":"<p><strong>Background: </strong>Many patients in intensive care cannot communicate their preferences about treatment, therapeutic goals, and expectations of quality of life, and physicians must therefore speak to their families to determine what they would want. We studied the accordance between patients' preferences about intensive care and the worst impairment of quality of life that they would be willing to accept and their families' assessment of these preferences.</p><p><strong>Methods: </strong>Inpatients on non-intensive-care wards at risk for future need of intensive care and their relatives were separately asked about the patient's wishes concerning eight treatment options and six quality-of-life goals. Degrees of accordance were studied with simple matching and Manhattan Distance Scores, and associations between patient features and degrees of accordance were determined by linear regression analysis.</p><p><strong>Results: </strong>Actual and presumed patient wishes agreed in 82.1% of cases on average. Depending on the measure in question, 1.0% to 8.6% of families wrongly thought that the patient would reject it, and 0% to 6.7% wrongly thought that the patient would accept it. The postulated and actual wishes of the patient about tolerable impairments of quality of life agreed in 86.4% of cases on average. Degrees of accordance were greater when the family members' wishes for themselves more closely resembled those of the patient (adjusted mean differences: 0.52, 95% confidence interval [0.39; 0.65], p < 0.001 and 0.66 [0.51; 0.81], p < 0.001).</p><p><strong>Conclusion: </strong>When patients' wishes are misjudged, the treatment they receive may not be in their best interest. Clear communication ahead of time between patients and their relatives, as well as the provision of information on this topic in advance by medical personnel, may lessen uncertainty about future intensive care.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":""},"PeriodicalIF":7.1,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drugs for Migraine Prophylaxis.","authors":"Hans Christoph Diener, Julia Grans, Uwe Reuter","doi":"10.3238/arztebl.m2025.0234","DOIUrl":"10.3238/arztebl.m2025.0234","url":null,"abstract":"<p><strong>Background: </strong>Frequent or severe migraine attacks are an indication for drug and nondrug prophylaxis.</p><p><strong>Methods: </strong>In this narrative review, we summarize the guideline of the International Headache Society concerning the treatment and prophylaxis of migraine with drugs, with additional consideration of meta-analyses on monoclonal antibodies and gepants.</p><p><strong>Results: </strong>In episodic migraine with an average of 8 migraine or headache days/month at baseline, oral prophylactic drugs lowered the number of migraine days per month by 1.27 (beta-blockers), 0.44 (flunarizine), 1.2 (amitriptyline), and 1.4 (topiramate) compared to placebo. Monoclonal antibodies against calcitonin gene-related peptide (CGRP) or the CGRP receptor are effective against both episodic and chronic migraine: Eptinezumab lowered the number of migraine days per month by 0.7-3.2, fremanezumab by 1.3-3.8, galcanezumab by 1.1-3.7, and erenumab by 1.0-2.5. High-level evidence also supports the efficacy of the CGRP receptor antagonist atogepant (0.7-2.4 fewer migraine days per month) in both episodic and chronic migraine. The monoclonal antibodies, atogepant, and onabotulinum toxin A are well-tolerated and have been found effective even in patients for whom previous oral migraine prophylactic drugs were ineffective, as well as in chronic migraine both with and without acute drug overuse.</p><p><strong>Conclusion: </strong>The new prophylactic drugs against migraine are effective, well-tolerated, and especially useful for patients for whom traditional oral migraine prophylactic drugs and onabotulinum toxin A are ineffective, not tolerated, or contraindicated.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":""},"PeriodicalIF":7.1,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Four-Valve Endocarditis Initially Presenting With Peripheral Embolism.","authors":"Matthäus Zerdzitzki, Jan Becher","doi":"10.3238/arztebl.m2025.0195","DOIUrl":"10.3238/arztebl.m2025.0195","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 5","pages":"145"},"PeriodicalIF":7.1,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presentation Is Incomplete.","authors":"Susanne Saha, Christina Hecker, Katharina Schwede","doi":"10.3238/arztebl.m2025.0244","DOIUrl":"10.3238/arztebl.m2025.0244","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 5","pages":"m1057"},"PeriodicalIF":7.1,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13101458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Painful Horner Syndrome as a Warning Sign.","authors":"Juri Mattern, Nadine Weyrauch, Jürgen Majolk","doi":"10.3238/arztebl.m2025.0147","DOIUrl":"10.3238/arztebl.m2025.0147","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 5","pages":"128"},"PeriodicalIF":7.1,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13101459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pretreatment MRI Versus Postoperative Pathology in Locoregional Staging of Rectal Cancer: A Germany-Wide Multicenter Re-Evaluation Study in Non-Pretreated Patients Based on the OCUM Study.","authors":"Sigmar Stelzner, Matthias Kuhn, Reinhard Ruppert, Jörg Baral, Thomas Kittner, Gina Brown, Theodor Junginger, Susanne Merkel, Stefan Fichtner-Feigl, Peter Kienle, Anton J Kroesen, Volker Kahlke, Ingo Roeder, Ines Gockel, Lars Grenacher, Ulrike I Attenberger, Kristina I Ringe, Andreas G Schreyer, Markus Juchems, Johannes Wessling","doi":"10.3238/arztebl.m2025.0226","DOIUrl":"https://doi.org/10.3238/arztebl.m2025.0226","url":null,"abstract":"<p><strong>Background: </strong>Magnetic resonance imaging (MRI) is the standard diagnostic technique for the locoregional assessment of rectal cancer. The pertinent guidelines recommend neoadjuvant therapy depending on cT and cN categories. In this experimental study, we examined the accuracy of pretreatment MRI staging.</p><p><strong>Methods: </strong>MRIs of 50 patients from the OCUM study (non-pretreated, 24 women, histologically confirmed rectal adenocarcinoma, located ≤12cm from the anal verge, stages I-III) were re-assessed by 74 radiologists affiliated with certified colorectal cancer centers. The radiologically determined Union for International Cancer Control (UICC) stages were compared with the histopathological findings, which were unknown to the radiologists. The degree of agreement between the radiologists' assessments and the histopathology was analyzed with κ_Gold, a weighted average of Brennan-Prediger agreement coefficients.</p><p><strong>Results: </strong>2915 complete assessments were performed for cTcN (UICC stages); 740 cases (25.4%) were not classifiable because of cTX (0.1%) or cNX (25.3%). The UICC stage accorded with the histopathology in 979 cases (33.6%); there was overstaging in 737 cases (25.3%) and understaging in 459 (15.7%). The κ_Gold for agreement was 0.114 (95% confidence interval, [0.032-0.20]). Agreement was also low for T- and N-categories (κ_Gold=0.354 and κ_Gold=0.235, respectively), but was better for distance to the mesorectal fascia (MRF) (κ_Gold=0.736) and extramural vascular invasion (EMVI) (κ_Gold=0.579).</p><p><strong>Conclusion: </strong>Although MRI remains the standard diagnostic technique for the locoregional assessment of rectal cancer, its accuracy for T- and N-staging in rectal cancer is low, particularly with regard to the distinction of T2 from T3a/b and the assessment of lymph nodes. The assessment of MRF and EMVI is much more reliable.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":""},"PeriodicalIF":7.1,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pretreatment MRI: One of the Key Components of Treatment Planning.","authors":"Marian Grade, Michael Ghadimi","doi":"10.3238/arztebl.m2026.0023","DOIUrl":"10.3238/arztebl.m2026.0023","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 5","pages":"127-128"},"PeriodicalIF":7.1,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13101457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Course of Rehabilitation of Ventilated and Tracheally Cannulated Patients in Neurological-Neurosurgical Early Rehabilitation.","authors":"Tobias Schmidt-Wilcke, Frederick Benjamin Junker, Andreas Bender, Vannessa Born, Christoph Bucka, Cay Cordes, Imanuel Dzialowski, Martin Gross, Christiane Haack, Michael Hartwich, Marcel Klimes, Sven Lukhaup, Jens Rollnik, Annette Schälich, Joachim Scheßl, Christian Weimar, Daniel Wertheimer, Thomas Platz, Marcus Pohl","doi":"10.3238/arztebl.m2025.0241","DOIUrl":"10.3238/arztebl.m2025.0241","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 5","pages":"136-137"},"PeriodicalIF":7.1,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13101456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Reply.","authors":"Robin Janzik","doi":"10.3238/arztebl.m2025.0245","DOIUrl":"10.3238/arztebl.m2025.0245","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 5","pages":"m1057-m1058"},"PeriodicalIF":7.1,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13101455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}