Deutsches Arzteblatt international最新文献

{"title":"Allopurinol Can Cause Severe Skin Reactions and Multi-Organ Involvement.","authors":"Susan Smakovic, Maren Paulmann, Maja Mockenhaupt","doi":"10.3238/arztebl.m2024.0238","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0238","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"122 4","pages":"111-112"},"PeriodicalIF":6.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526817","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":"Acute-on-Chronic Liver Failure.","authors":"Jonel Trebicka, Michael Praktiknjo, Kai-Henrik Peiffer, Andreas Pascher, Martin Sebastian Schulz, Frank Erhard Uschner","doi":"10.3238/arztebl.m2024.0255","DOIUrl":"10.3238/arztebl.m2024.0255","url":null,"abstract":"<p><strong>Background: </strong>Cirrhosis is the end stage of chronic liver disease. Cirrhosis causes portal hypertension, which, in turn, can lead to acute on chronic liver failure (ACLF), which is defined as acute decompensation combined with failure of the liver, coagulation system, kidneys, lungs, and/or circulatory system, or hepatic encephalopathy.</p><p><strong>Methods: </strong>This review is based on a selective literature search for international publications in the NCBI database using the keywords \"liver cirrhosis\" and \"ACLF.\" Valid guidelines (up to June 2024) were also included.</p><p><strong>Results: </strong>Cirrhosis is present in approximately 1% of all hospital admissions in Germany, and complications of cirrhosis cause an estimated 1 million deaths worldwide each year. ACLF, the most severe form of decompensated liver cirrhosis, bears a 28-day mortality of 45% and affects 35% of all patients hospitalized for decompensated cirrhosis. Its precipitating factors are infection, alcohol overuse, bleeding, and drug-induced enceph alopathy (benzodiazepines or opioids). No drugs or other treatments for ACLF have been approved; only its etiology and precipitating factors are amenable to treatment.</p><p><strong>Conclusion: </strong>Liver transplantation is currently the only curative option for ACLF but is not suitable for all patients because of the narrow therapeutic window and the common presence of contraindications. Prospective data are lacking that would aid in the selection of patients for liver transplantation so that post-transplantation survival rates can be improved.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"96-102"},"PeriodicalIF":6.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946373","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":"Traumatic Anterior Shoulder Dislocation: Epidemiology, Diagnosis, and Treatment.","authors":"Anna Patricia Goth, Alexander Klug, Georg Gosheger, Mirkka Lynn Hiort, Doruk Akgün, Kristian Nikolaus Schneider","doi":"10.3238/arztebl.m2024.0254","DOIUrl":"10.3238/arztebl.m2024.0254","url":null,"abstract":"<p><strong>Background: </strong>Traumatic anterior shoulder dislocation is the most common type of joint dislocation, with an incidence of 11 to 29 per 100 000 persons per year. Controversy still surrounds the recommendations for treatment and the available procedures for surgical stabilization.</p><p><strong>Methods: </strong>This review is based on pertinent publications (2014-2024) that were retrieved by a selective search in the PubMed and Google Scholar databases. Meta-analyses and ran - domized controlled trials (RCTs) with evidence levels I and II were included.</p><p><strong>Results: </strong>The typical injury mechanism is forcible external rotation and abduction of the arm. The diagnosis is established by x-ray, which may be supplemented by magnetic resonance imaging (MRI) for the assessment of soft-tissue structures. The indication and type of surgical treatment depends on the patient's age, sex, activity level, and concomitant injuries. For purely soft-tissue injuries, arthroscopic Bankart repair is an established treatment, with reported significant reduction in the rate of recurrent instability after follow-up periods of up to 12 years. An accompanying bony injury of the dorsal humeral head (Hill-Sachs lesion), depending on its extent, may be an indication for the arthroscopic Remplissage procedure: this can lower the rate of recurrence, but it can also cause a postoperative restriction of external rotation. In cases of chronic instability, an arthroscopic or open Latarjet procedure and bone grafting can be per formed to augment the ventral glenoid articular surface. These procedures have likewise been reported to yield low rates of recurrent instability, but also higher complication rates.</p><p><strong>Conclusion: </strong>The treatment of shoulder dislocation should be individually tailored. Although the reported results are promising, the evidence base remains weak. Prospective studies with larger case numbers are needed so that clear treatment algorithms can be established.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"89-95"},"PeriodicalIF":6.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001849","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":"Myocardial Revascularization in Heart Failure With Reduced Ejection Fraction.","authors":"Bernhard Haring, Johann Bauersachs, Norbert Frey, Uta C Hoppe, Torsten Doenst, Michael Böhm","doi":"10.3238/arztebl.m2024.0249","DOIUrl":"10.3238/arztebl.m2024.0249","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) patients with reduced ejection fraction (HFrEF) now more commonly die of non-cardiovascular causes than they did in the past. In patients with both HFrEF and ischemic cardiomyopathy (as the cause of HFrEF or as an accompanying condition), the effect of myocardial revascularization-i.e. percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)-on long-term outcome is unclear.</p><p><strong>Methods: </strong>This review is based on publications that were retrieved by a selective search of the literature for pertinent clinical studies and current guidelines.</p><p><strong>Results: </strong>Drug treatment for HFrEF has markedly prolonged these patients' survival. In a comparative study, HF pharmacotherapy was found to add an average of 8.3 years to the lifespan of a 55-yearold patient with HFrEF. Three of the four randomized controlled trials on revascularization procedures were conducted prior to the major pharmacotherapy improvements leading to better outcomes in HF patients over the past decade. These trial data indicate a long-term benefit from CABG compared to medical treatment alone in patients with HFrEF and severe coronary heart disease. For example, in the STICH trial, the hazard ratio for death from any cause after a follow-up time of nearly 10 years was 0.84 (95% confidence interval, [0.73; 0.97]). The role of pre-procedural myocardial viability and ischemia testing remains to be fully determined. The choice of method for myocardial revascularization should be discussed within an interdisciplinary cardiac team in consideration of the patient's symptoms and ischemic burden, the complexity of the coronary findings, as well as the patient's perioperative risk and current medical HF therapy. No RCTs comparing CABG to PCI are yet available.</p><p><strong>Conclusion: </strong>Optimal guideline-directed medical therapy is a key determinant of long-term survival in patients with HFrEF.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"103-108"},"PeriodicalIF":6.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001895","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":"Online Radiotherapy: The Paradigm Shift to Real-Time Adaptive Radiotherapy.","authors":"Goda Kalinauskaite, Konstantin Nikolaou, Andrea Wittig, Daniel Zips, Klaus Zöphel, Carolin Senger","doi":"10.3238/arztebl.m2024.0242","DOIUrl":"10.3238/arztebl.m2024.0242","url":null,"abstract":"<p><strong>Background: </strong>Adaptive radiotherapy (ART) involves the continuous adaptation of the radiation plan according to patient- and tumorspecific feedback. In online ART, the plan is optimized in real time during the treatment; in offline ART, the plan is recalculated between treatment sessions. Hybrid linear accelerators with integrated CT, MRI, or PET are required to perform online ART.</p><p><strong>Methods: </strong>This review is based on clinically relevant studies on online ART (January 2019 - May 2024) that were retrieved by a selective search in PubMed.</p><p><strong>Results: </strong>Online ART is a new technique for which no phase 3 trials have been published; in contrast, multiple randomized trials are already available for offline ART. The initial findings of a random - ized phase 2 trial of online ART for head and neck cancer showed lower rates of G2 or higher radiation-induced dermatitis (8% vs. 31%, p = 0.05) and a lower dose to the parotid gland (mean dose: 11.5 Gy vs. 16.0 Gy, p = 0.02) with online ART compared to standard radiochemotherapy. Moreover, observational studies show that online ART is feasible and spares organs at risk in patients with esophageal, pancreatic, rectal, and prostatic cancer. Additionally, online ART can enable simulation-free treatment planning and faster initiation of radiotherapy. It is, however, more demanding of time and resources and more costly than standard radiotherapy, and no studies with long-term clinical endpoints are available to date.</p><p><strong>Conclusion: </strong>Initial studies confirm the feasibility of online ART and arouse the hope that it will enable more precise radiotherapy with less damage to surrounding structures. Phase 3 trials are needed so that the patient groups who stand to benefit most from online ART can be identified.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"59-64"},"PeriodicalIF":6.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869410","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":"Age-Adapted Diagnostic Evaluation and Treatment of Patients With Type 1 Neurofibromatosis in Germany.","authors":"Said Farschtschi, Pia Vaassen, Lan Kluwe, Tabea Hartung, Johannes Salamon, Thorsten Rosenbaum","doi":"10.3238/arztebl.m2024.0257","DOIUrl":"10.3238/arztebl.m2024.0257","url":null,"abstract":"<p><strong>Background: </strong>Neurofibromatosis type 1 (NF1) is a rare genetic disorder affecting multiple bodily systems that predisposes to the development of tumors. It affects approximately 1 in 3000 newborns in Germany. Its clinical manifestations are diverse and complex, and its diagnostic and therapeutic management call for specialized knowledge and experience. The lack of nationwide guidelines and recommendations further increases the difficulty of establishing an appropriate standardized and interdisciplinary approach.</p><p><strong>Methods: </strong>The suggestions presented here are based on a selective literature review, international guidelines, and our own clinical experience over many years.</p><p><strong>Results: </strong>We propose an age-adapted diagnostic and therapeutic approach to patients with NF1, subdivided into four main areas. We suggest follow-up examinations every one to two years to address typical course of the disease as well as administrative aspects, such as care by pediatricians. Whole-body magnetic resonance imaging (MRI) should be performed when the diagnosis is made. MRI and ultrasonography of particular body regions should be performed where appropriate. The NF1 gene should be sequenced to determine the causative pathogenic variant and as an aid to genetic counseling. If this fails to reveal a pathogenic variant, the NF1 gene should also be sequenced in tumor tissue. The vitamin D3 and sex hormone status are also relevant, as are serum metanephrines. Further specialist consultations may be necessary, and their findings should be discussed in an interdisciplinary framework.</p><p><strong>Conclusion: </strong>These recommendations are intended to serve as a guide to a standardized interdisciplinary approach to the management of patients with NF1 in Germany, based on an up-to-date scientific understanding of the disease. This approach should improve care overall, both by enabling better care and by eliminating unnecessary diagnostic studies.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"71-76"},"PeriodicalIF":6.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946375","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":"Delayed Gastric Emptying Under Treatment with GLP-1 Agonists.","authors":"Monika Rau, Alexander Meining","doi":"10.3238/arztebl.m2024.0233","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0233","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"122 3","pages":"70"},"PeriodicalIF":6.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794576","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":"Geographic Atrophy in Age-Related Macular Degeneration.","authors":"Sandra Liakopoulos, Leon von der Emde, Marvin L Biller, Thomas Ach, Frank G Holz","doi":"10.3238/arztebl.m2025.0003","DOIUrl":"10.3238/arztebl.m2025.0003","url":null,"abstract":"<p><strong>Background: </strong>Age-related macular degeneration (AMD), a condition of multifactorial origin, is a major cause of irreversible vision loss in industrialized countries. The dry late stage of the disease, known as geographic atrophy (GA), is characterized by progressive loss of photoreceptor cells and retinal pigment epithelial cells in the central retina. An estimated 300 000 to 550 000 people in Germany suffer from GA.</p><p><strong>Methods: </strong>This review is based on pertinent literature retrieved by a selective search in the PubMed and Web of Science databases.</p><p><strong>Results: </strong>In 2023, the complement inhibitors pegcetacoplan and avacincaptad pegol were approved in the USA for repeated intravitreal injections and thereby became the first drugs ever approved for the treatment of GA. In Europe, the marketing authorization application for both drugs was withdrawn by the manufacturers after a negative judgment was expressed by the European Medicines Agency (EMA) Committee for Medicinal Products for Human Use (CHMP). The EMA stated that the significant slowing of atrophy progression that had been achieved in the approval trials did not lead to any clinically relevant functional benefit for the patients. Further treatment approaches, including gene therapy, are now being studied in clinical trials. There is evidence that micronutrients may slow the progression of atrophy.</p><p><strong>Conclusion: </strong>In Europe at present, there is no approved treatment for GA due to AMD. There is thus a continuing need for preventive and rehabilitative measures such as smoking cessation, a balanced diet, and magnifying visual aids for patients in the advanced stages of the disease.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"82-88"},"PeriodicalIF":6.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001892","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":"Thoracic Aortic Aneurysm 40 Years After Tube Graft Repair.","authors":"Julie Cleuziou, Julia Hoffmann, Maria von Stumm","doi":"10.3238/arztebl.m2024.0216","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0216","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"122 3","pages":"81"},"PeriodicalIF":6.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794594","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":"The Effect of Parental Weight and Genetics on the Body Mass Index of Very Low Birth Weight Infants as They Reach School Age.","authors":"Wolfgang Göpel, Carla Lüders, Katharina Heinze, Tanja K Rausch, Ingmar Fortmann, Silke Szymczak, Inke R König, Egbert Herting, Kathrin Hanke","doi":"10.3238/arztebl.m2024.0253","DOIUrl":"10.3238/arztebl.m2024.0253","url":null,"abstract":"<p><strong>Background: </strong>Prematurely born individuals are usually of low or normal weight in childhood; in adulthood, however, their probability of being overweight is twice that of persons born at full term. There is not yet any way to predict the weight development of premature babies.</p><p><strong>Methods: </strong>A polygenic BMI score (BMI = body-mass index), calculated from the often very small individual effects of more than 2 million genetic variants, was recently described for adults. We studied the possible association of this score with the course of BMI in premature babies over time, from infancy up to the age of 10-14 years.</p><p><strong>Results: </strong>508 individuals were included in the study. At the age of 5-7 years, their mean body weight was 18.8 ± 3.3 kg. The difference between the highest and lowest deciles of the polygenic score was 3.3 kg. At age 10-14, the average body weight was 41.3 ± 11.3 kg, and the difference between the highest and lowest deciles had increased to 9.2 kg. In persons with birth weight under the 10th percentile (n = 68), the difference was 19.2 kg (30.9 kg vs. 50.1 kg). The polygenic BMI score was significantly associated with the BMI z-scores of the overall group and the subgroup of growth-retarded children.</p><p><strong>Conclusion: </strong>Extreme values of a polygenic BMI score are strongly associated with the weight development of preterm infants as they develop into children aged 10-14. The large effect size implies that this score may aid in the counseling of prematurely born children and their parents.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"65-70"},"PeriodicalIF":6.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946378","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}