{"title":"Study Did not Deliver on its Promise.","authors":"Stephan Kühne","doi":"10.3238/arztebl.m2024.0065","DOIUrl":"10.3238/arztebl.m2024.0065","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 15","pages":"507"},"PeriodicalIF":6.5,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364780","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}
Johannes Fabian Holle, Volker Limmroth, Wolfram Windisch, Maximilian Zimmerman
{"title":"Neuralgic Amyotrophy.","authors":"Johannes Fabian Holle, Volker Limmroth, Wolfram Windisch, Maximilian Zimmerman","doi":"10.3238/arztebl.m2024.0077","DOIUrl":"10.3238/arztebl.m2024.0077","url":null,"abstract":"<p><strong>Background: </strong>Neuralgic amyotrophy (NA) is a multifactorial, monophasic neuritis that mainly affects the nerves of the shoulder girdle. It is characterized by very severe pain and by weakness that arises some time after the pain. Its reported incidence is high (100 cases per 100 000 persons per year), but our data suggest that many or most cases are diagnosed late or not at all.</p><p><strong>Methods: </strong>This review of the epidemiology, pathophysiology, diagnosis, and treatment of NA is based on pertinent publications retrieved by a selective literature search, and on data provided by the scientific institute of AOK, a German statutory health-insurance carrier.</p><p><strong>Results: </strong>It is currently thought that the combination of a genetic predisposition, an immunological trigger factor, and mechanical stress on the affected nerve segment(s) is pathophysiologically determinative. The prognosis of untreated NA is poor, with 25% of patients remaining unable to work at three years. The main form of treatment is with corticosteroids that are administered as early as possible. If there is evidence of nerve constriction or torsion, surgery may also help. There have only been six controlled cohort studies on the treatment of NA, and no randomized trials. It is not uncommon for the acute phase to develop into a chronic pain syndrome requiring multidimensional treatment.</p><p><strong>Conclusion: </strong>Particularly in view of the high incidence and improved therapeutic options, NA should be included in the differential diagnosis of all patients with suggestive symptoms.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"483-489"},"PeriodicalIF":6.5,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141247583","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":"TSH Concentration by Itself Does not Reflect Successful Treatment.","authors":"Lutz Schomburg, Helena Orfanos-Boeckel","doi":"10.3238/arztebl.m2024.0012","DOIUrl":"10.3238/arztebl.m2024.0012","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 14","pages":"479-480"},"PeriodicalIF":6.5,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343504","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":"Systolic Murmur May Be Missed.","authors":"Rolf Stockhausen","doi":"10.3238/arztebl.m2024.0044","DOIUrl":"10.3238/arztebl.m2024.0044","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 14","pages":"482"},"PeriodicalIF":6.5,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343502","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}
Ulrich Mrowietz, Felix Lauffer, Wiebke Sondermann, Sascha Gerdes, Philipp Sewerin
{"title":"Psoriasis as a Systemic Disease.","authors":"Ulrich Mrowietz, Felix Lauffer, Wiebke Sondermann, Sascha Gerdes, Philipp Sewerin","doi":"10.3238/arztebl.m2024.0064","DOIUrl":"10.3238/arztebl.m2024.0064","url":null,"abstract":"<p><strong>Background: </strong>Psoriasis was long regarded as an inflammatory disease limited to the skin. Data from dermatologic, rheumatologic and cardiologic research now show it to be a systemic disease, for which the term psoriatic disease is used.</p><p><strong>Methods: </strong>This paper is based on a selective literature search with special attention to the findings of clinical trials and other current publications, as well as the recommendations of international guidelines.</p><p><strong>Results: </strong>Immunologically mediated inflammation of the skin, arteries, bones, and joints is a central feature of psoriatic disease. Other diseases that are known to be associated with psoriatic disease include hypertension, metabolic syndrome, and depression. The main risk factor for the development of psoriatic disease is obesity, which also increases the likelihood of psoriatic arthritis. The main known trigger factors are stress, infection, and, less commonly, medication. Psoriatic disease is characterized by complex genetics and by a characteristic pattern of inflammation that involves elements of both innate and acquired immunity and, in particular, the cytokines interleukin 17 and 23. The inflammatory processes underlying psoriatic disease can now be targeted with modern biologic and other therapies.</p><p><strong>Conclusion: </strong>In view of the complexity of psoriatic disease, structured management is now recommended so that physicians and patients can work together to determine the optimal treatment strategy.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"467-472"},"PeriodicalIF":6.5,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854113","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":"Regional Deprivation and Suicide.","authors":"Matthias Hans Belau","doi":"10.3238/arztebl.m2024.0069","DOIUrl":"10.3238/arztebl.m2024.0069","url":null,"abstract":"<p><strong>Background: </strong>Regional deprivation due to regional economic and social differences can increase the risk of suicide. This study investigated whether regional structural deprivation in Germany is associated with a higher rate of suicide.</p><p><strong>Methods: </strong>Data from cause-of-death statistics for the years 2015-2021 were analyzed. A regression analysis for data with a negative binomial distribution was used to study the association between suicide mortality and the German Index of Multiple Deprivation (GIMD), which is based on data from 2015 and includes 401 districts and independent cities in Germany.</p><p><strong>Results: </strong>Among the districts and independent cities covered by the GIMD, the quintile with the highest deprivation had higher suicide rates than the quintile with the lowest deprivation (relative risk [RR]: 1.85; 95% confidence interval [1.72; 2.00]). A sensitivity analysis revealed similar associations when the analysis was restricted to men (RR = 1.99 [1.80; 2.18]) or women (RR = 1.69 [1.49; 1.92]). A stronger association, however, was found in a comparison of rural (RR = 2.29 [2.04; 2.57]) with urban areas (RR = 1.51 [1.36; 1.68]).</p><p><strong>Conclusion: </strong>These findings document an association between regional deprivation and suicide. They highlight the need for a more targeted approach to suicide prevention in deprived regions. At the same time, more research is needed into the mechanisms and effects of regional deprivation on mortality due to suicide.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"449-453"},"PeriodicalIF":6.5,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876063","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":"Contrary to the Guideline.","authors":"Spitczok von Brisinski","doi":"10.3238/arztebl.m2024.0011","DOIUrl":"10.3238/arztebl.m2024.0011","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 14","pages":"479"},"PeriodicalIF":6.5,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343497","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}
J Christoph Katthagen, Michael J Raschke, Karen Fischhuber, Janette Iking, Ursula Marschall, Julia Sußiek, Andreas Faldum, Josef Stolberg-Stolberg, Jeanette Köppe
{"title":"Conservative Versus Operative Treatment of Proximal Humerus Fractures in Older Individuals.","authors":"J Christoph Katthagen, Michael J Raschke, Karen Fischhuber, Janette Iking, Ursula Marschall, Julia Sußiek, Andreas Faldum, Josef Stolberg-Stolberg, Jeanette Köppe","doi":"10.3238/arztebl.m2024.0059","DOIUrl":"10.3238/arztebl.m2024.0059","url":null,"abstract":"<p><strong>Background: </strong>Little is known about the frequency and results of conservative treatment of proximal humerus fractures (PHF) in older individuals.</p><p><strong>Methods: </strong>Billing data of the BARMER health insurance carrier for all patients of age ≥ 65 for the years 2005-2021 were retrospectively analyzed with multivariable Cox regression models, taking account of the patients' age, sex, and individual comorbidity profiles. The defined primary endpoints were overall survival (OS), major adverse events (MAE), thromboembolic events (TE), and complications of surgery or of trauma. Multivariable p-values for the effect of treatment on all primary endpoints were jointly adjusted using the Bonferroni-Holm method.</p><p><strong>Results: </strong>Of 81 909 patients, 54% were treated conservatively. Conservative treatment was more common in those who received their diagnosis as outpatients (79.5%, vs. 37.2% for inpatients). Operative treatment was associated with significantly longer overall survival (long-term hazard ratio [HR] 0.89, 95% confidence interval [0.86; 0.91]), fewer MAE (0.90 [0.88; 0.92]), and fewer TE (0.89 [0.87; 0.92]), but more complications due to surgery or trauma (1.66 [1,.4; 1.78]; all p < 0.001). By 6 months after diagnosis, 3.1% of the patients who were initially treated conservatively had undergone surgery. Risk factors for failure of conservative treatment were alcohol abuse, obesity, cancer, diabetes mellitus, Parkinson disease, and osteoporosis.</p><p><strong>Conclusion: </strong>The conservative treatment of PHF is associated with a lower overall rate of complications due to surgery or trauma, but also with more MAE, more TE, and higher mortality. These findings underline the need for individualized and risk-adjusted treatment recommendations.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"454-460"},"PeriodicalIF":6.5,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856740","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":"Tinnitus as an Indication of Head Injury.","authors":"Theo Evers, Matthias Tisch","doi":"10.3238/arztebl.m2024.0045","DOIUrl":"10.3238/arztebl.m2024.0045","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 14","pages":"482"},"PeriodicalIF":6.5,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343503","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}
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