Deutsches Arzteblatt international最新文献_第3页

The Health and Medical Care of People Without Regular Health Insurance—An Exploratory Cross-Sectional Study. 无正规医疗保险者的健康和医疗保健--一项探索性横断面研究。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-12-13 DOI: 10.3238/arztebl.m2024.0169

Anke Dickmann, Sabrina Kastaun, Marie-Therese Schmitz, Jacqueline Warth

引用次数: 0

Incidental Pulmonary Nodules: Differential Diagnosis and Clinical Management. 偶发肺结节：鉴别诊断和临床处理。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-12-13 DOI: 10.3238/arztebl.m2024.0177

Philip Baum, Kai Schlamp, Laura V Klotz, Martin E Eichhorn, Felix Herth, Hauke Winter

{"title":"Incidental Pulmonary Nodules: Differential Diagnosis and Clinical Management.","authors":"Philip Baum, Kai Schlamp, Laura V Klotz, Martin E Eichhorn, Felix Herth, Hauke Winter","doi":"10.3238/arztebl.m2024.0177","DOIUrl":"10.3238/arztebl.m2024.0177","url":null,"abstract":"Background: According to data from the USA, the incidence of incidentally discovered pulmonary nodules is 5.8 per 100 000 person- years for women and 5.2 per 100 000 person-years for men. Their management as recommended in the pertinent guidelines can substantially improve clinical outcomes. More than 95% of all pulmonary nodules revealed by computerized tomography (CT) are benign, but many cases are not managed in conformity with the guidelines. In this article, we summarize the appropriate clinical approach and provide an overview of the pertinent diagnostic studies and when they should be performed.Methods: This review is based on relevant publications retrieved by a selective search in PubMed. The authors examined Englishlanguage recommendations issued since 2010 for the management of pulmonary nodules, supplemented by comments from the German lung cancer guideline.Results: In general, the risk that an incidentally discovered pulmonary nodule is malignant is low but rises markedly with increasing size and the presence of risk factors. When such a nodule is detected, the further recommendation, depending on size, is either for follow-up examinations with chest CT or else for an extended evaluation with positron emission tomography-CT and biopsy for histology. The diagnostic evaluation should include consideration of any earlier imaging studies that may be available as an indication of possible growth over time. Single nodules measuring less than 6 mm, in patients with few or no risk factors, do not require any follow-up. Lung cancer is diagnosed in just under 10% of patients with a nodule measuring more than 8 mm.Conclusion: The recommendations of the guidelines for the management of incidentally discovered pulmonary nodules are intended to prevent both overand undertreatment. If a tumor is suspected, further care should be provided by an interdisciplinary team.","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"853-860"},"PeriodicalIF":6.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307282","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}

引用次数: 0

The Diagnosis and Treatment of Neuropathic Pain. 神经病理性疼痛的诊断与治疗》。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-12-13 DOI: 10.3238/arztebl.m2024.0215

Rezvan Ahmadi, Rohini Kuner, Norbert Weidner, Jens Keßler, Martin Bendszus, Sandro Manuel Krieg

{"title":"The Diagnosis and Treatment of Neuropathic Pain.","authors":"Rezvan Ahmadi, Rohini Kuner, Norbert Weidner, Jens Keßler, Martin Bendszus, Sandro Manuel Krieg","doi":"10.3238/arztebl.m2024.0215","DOIUrl":"10.3238/arztebl.m2024.0215","url":null,"abstract":"Background: The reported prevalence of neuropathic pain in the general population in Germany is from 6.9% to 10%. There are both medical and surgical treatment options.Methods: This review is based on pertinent publications retrieved by a selective search in PubMed, with consideration of clinical trials, meta-analyses, and guidelines.Results: Neuropathic pain is diagnosed when pain of the appropriate character is accompanied by further features such as hypesthesia/anesthesia, allodynia, or hyperalgesia. It is generally treated initially with drugs (antidepressant drugs, anticonvulsant drugs, opioids, topical agents, and others); the number needed to treat (NNT) is between 7 and 8 for gabapentin and 3.6 for amitryptiline, as estimated in meta-analyses. For nerve compression and entrapment syndromes, surgical decompression is a treatment directed against the cause of the problem, which can therefore be curative. Microvascular decompression (MVD) is often used to treat supposed compression syndromes of cranial nerves, above all classic trigeminal neuralgia; according to a meta-analysis, MVD brings about a pain-free state in 92.9% [89.1; 96.8] of patients after 5 months to 5 years of follow-up. Ablative surgical procedures are used for symptom control in patients with refractory and/or cancer-related pain. Further symptomdirected treatment options for medically intractable neuropathic pain include neuromodulatory techniques, which involve minimally invasive electrical stimulation of neural structures, and the chronic intrathecal application of drugs such as opioids and ziconotide.Conclusion: The treatment of neuropathic pain can be either cause-directed or symptom-directed, depending on its origin. Multidisciplinary collaboration can facilitate both the diagnostic evaluation and the selection of the optional modality and timing of treatment.","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"825-832"},"PeriodicalIF":6.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544238","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}

引用次数: 0

Effects of a Central Point of Assessment with Digitally Assisted Triage in an Integrated Emergency Center.

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-12-13 DOI: 10.3238/arztebl.m2024.0201

Felix Patricius Hans, Michael Clemens Röttger, Jan Kleinekort, Matthias Kühn, Leo Benning, Jochen Brich, Dominik Gottlieb, Ferdinand Christian Wagner, Hans-Jörg Busch

引用次数: 0

Spinal Intramedullary Tumors. 脊髓髓内肿瘤。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-12-13 DOI: 10.3238/arztebl.m2024.0213

Belal Neyazi, Aiden Haghikia, Christian Mawrin, Elke Hattingen, Dirk Vordermark, I Erol Sandalcioglu

{"title":"Spinal Intramedullary Tumors.","authors":"Belal Neyazi, Aiden Haghikia, Christian Mawrin, Elke Hattingen, Dirk Vordermark, I Erol Sandalcioglu","doi":"10.3238/arztebl.m2024.0213","DOIUrl":"10.3238/arztebl.m2024.0213","url":null,"abstract":"Background: Intramedullary tumors are a subgroup of spinal tumors and are associated with high morbidity and mortality. The estimated incidence of spinal tumors in general is 0.74 to 1.6 per 100 000 persons per year, with intramedullary tumors making up 10% to 30% of the total. The diagnosis is often delayed because of the insidious onset of symptoms, which are often nonspecific at first.Methods: This review is based on pertinent publications about intramedullary tumors that were retrieved by a selective search in the PubMed database.Results: Intramedullary tumors often cause diffuse neurologic symptoms of gradually increasing severity, progressing, in advanced cases, to a complete spinal cord transection syndrome. Magnetic resonance imaging of the spine without and with intravenous contrast is the standard diagnostic technique. The histopathological origin of most intramedullary tumors is from glial cells, but other types of intramedullary tumor exist as well. The primary treatment of all intramedullary tumors is surgical resection. 9% to 34% of patients may experience a worse neurological deficit after surgery than before, but such problems resolve completely in 25% to 41% of cases. The extent of resection is the main factor affecting the risk of tumor recurrence and progression. The extent of resection also determines the possible indication for adjuvant treatment, which is needed, in particular, for high-grade and subtotally resected tumors, and for those that display progression. The treatment of intramedullary tumors is based on case series, retrospective analyses, and case reports, as randomized trials are lacking.Conclusion: Patients with intramedullary tumors should be cared for, as much as possible, in the setting of prospective, uniform studies of their spontaneous course and the outcomes after treatment. This will yield better evidence on the treatment of these tumors in the future.","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"840-846"},"PeriodicalIF":6.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767212","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}

引用次数: 0

The Administrative Prevalence and Pharmacotherapy of Chronic Inflammatory Bowel Diseases, 2012–2020.

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-12-13 DOI: 10.3238/arztebl.m2024.0138

Karsten H Weylandt, Astrid Wiese, Adelheid Jung, Christoph Schmöcker, Daniel C Baumgart, Felicia Turowski, Claudia Kohring, Kerstin Klimke, Manas K Akmatov, Jörg Bätzing, Dawid Pieper, Jakob Holstiege

引用次数: 0

Pneumatosis Intestinalis in Metastatic Colon Cancer During Cetuximab Treatment.

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-11-29 DOI: 10.3238/arztebl.m2024.0148

Till Orlemann, Sebastian Zundler, Teresa Graetz

引用次数: 0

The Diagnosis and Treatment of Hypertrophic Cardiomyopathy. 肥厚型心肌病的诊断与治疗》。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-11-29 DOI: 10.3238/arztebl.m2024.0196

Maximilian N Möbius-Winkler, Ulrich Laufs, Karsten Lenk

{"title":"The Diagnosis and Treatment of Hypertrophic Cardiomyopathy.","authors":"Maximilian N Möbius-Winkler, Ulrich Laufs, Karsten Lenk","doi":"10.3238/arztebl.m2024.0196","DOIUrl":"10.3238/arztebl.m2024.0196","url":null,"abstract":"Background: Hypertrophic cardiomyopathy (HCM) with or without left ventricular outflow tract (LVOT) obstruction is a common primary myocardial disease, with a prevalence of 1:500. It is characterized by thickening of the myocardium. Its diagnostic evaluation includes history-taking and physical examination, genetic studies, transthoracic echocardiography, and cardiac MRI. When optimally treated, it carries a mortality of less than 1% per year.Methods: This review is based on pertinent publications retrieved by a selective literature search, including the current guidelines.Results: In symptomatic patients with high LVOT gradients (≥ 50 mm Hg), the treatment of first choice is pharmacotherapy with nonvasodilating beta-blockers or non-dihydropyridine-type calcium channel antagonists. Common side effects include bradycardia and hypotension, and there is a risk of AV nodal blockade. Both substance classes lower the LVOT gradient. Beta-blockers alleviate dyspnea and improve patients' quality of life. Verapamil can increase physical resilience. A further option is mavacamten, a myosin inhibitor that gained approval in Germany in mid-2023: it, too, lowers the LVOT gradient and improves quality of life. In 7-10% of patients, there is a reversible reduction of the left ventricular ejection fraction to less than 50%. Septal reduction treatments can be considered if drug therapy fails. Attention must also be paid to the management of sequelae such as atrial fibrillation, malignant arrhythmias, and mitral valve insufficiency.Conclusion: Patients with HCM have a near-normal life expectancy if the disease is diagnosed early and treated according to the guidelines. The treatment of HCM and HOCM (hypertrophic obstructive cardiomyopathy) have been studied in no more than a few clinical trials, and randomized studies with clinical endpoints are needed.","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"805-811"},"PeriodicalIF":6.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388835","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}

引用次数: 0

Onconephrology: The Significance of Renal Function for the Development, Diagnosis, and Treatment of Cancer. 肿瘤肾脏病学：肾功能对癌症发展、诊断和治疗的重要意义。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-11-29 DOI: 10.3238/arztebl.m2024.0193

Susanne Delecluse, Fridtjof Harder, Frieder Keller, Martin Zeier, Stefanie Zschäbitz

{"title":"Onconephrology: The Significance of Renal Function for the Development, Diagnosis, and Treatment of Cancer.","authors":"Susanne Delecluse, Fridtjof Harder, Frieder Keller, Martin Zeier, Stefanie Zschäbitz","doi":"10.3238/arztebl.m2024.0193","DOIUrl":"10.3238/arztebl.m2024.0193","url":null,"abstract":"Background: Modern treatment strategies have markedly improved the chances of survival for patients with cancer. As the population ages, cancer is becoming more common, as is chronic kidney disease (CKD). CKD increases the risk of cancer; conversely, cancer treatments can cause CKD.Methods: This review is based on publications retrieved by a selective literature search concerning the epidemiology and comorbidities of cancer and kidney diseases, the renal side effects of new anticancer drugs, and the need to consider renal function in cancer treatment.Results: The prevalence of severe CKD in Germany is 2.3%. Persons who have CKD, are on dialysis, or have undergone kidney transplantation are 1.2 to 3.5 times more likely to develop cancer than the general population. For patients who have CKD or are dialysis-dependent, the doses of approximately 67% of anticancer drugs need to be adjusted on the basis of their glomerular filtration rate and the renally excreted fraction of the drug. The optimal efficacy of therapeutic drugs, as well as of those used for diagnostic purposes, and the minimization of side effects, depend critically on adapted dosing and on proper timing of administration before or after dialysis. Modern anticancer drugs can also cause acute kidney damage (incidence with checkpoint inhibitors: 2-16%).Conclusion: Patients who have CKD, are on dialysis, or have undergone kidney transplantation make up a considerable fraction of persons being treated for cancer, and they need interdisciplinary treatment.","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"793-799"},"PeriodicalIF":6.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460397","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}

引用次数: 0

Clinical Practice Guideline: Condylar Hyperplasia of the Mandible—Diagnosis and Treatment. 临床实践指南：下颌骨髁状突增生--诊断与治疗》。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-11-29 DOI: 10.3238/arztebl.m2024.0210

Merle Riechmann, Nils-Claudius Gellrich, Bodo Kress, Christopher Schmidt, Cornelia Schröder, Andreas Neff

{"title":"Clinical Practice Guideline: Condylar Hyperplasia of the Mandible—Diagnosis and Treatment.","authors":"Merle Riechmann, Nils-Claudius Gellrich, Bodo Kress, Christopher Schmidt, Cornelia Schröder, Andreas Neff","doi":"10.3238/arztebl.m2024.0210","DOIUrl":"10.3238/arztebl.m2024.0210","url":null,"abstract":"Background: Condylar hyperplasia of the mandible is characterized by abnormal size and configuration of the condylar process. In Germany, the administrative prevalence of diagnosed and/or treated condylar hyperplasia is 2.4-9.6 cases per 100 000 persons. Misdiagnosis is common and can lead to severe esthetic and functional complications, including facial deformity that can progress into the patient's twenties, as well as dysfunctional speech and mastication.Methods: We conducted a systematic review of the literature and a structured consensus-finding process with the Delphi method.Results: The experts recommend timely diagnosis of condylar hyperplasia so that its progression can be prevented by appropriate treatment. The basic diagnostic evaluation consists of history taking, physical examination, and imaging with orthopantomography. If condylar hyperplasia is confirmed, three-dimensional imaging is performed, usually with SPECT. The treatment is mainly surgical: partial condylectomy techniques and orthognathic surgery are the most common methods. If left untreated, the disorder causes severe dysfunction of mastication as well as disfigurement. Most studies of treatments for condylar hyperplasia have been based on low case numbers and have yielded only level 4 or level 5 evidence.Conclusion: Condylar hyperplasia is a common, but not widely known problem. Its early diagnosis and treatment can prevent severe jaw asymmetry and further complications such as craniomandibular dysfunction and arthrosis of the temporomandibular joints.","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"816-823"},"PeriodicalIF":6.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460396","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}

引用次数: 0