Deutsche medizinische Wochenschrift (1946)最新文献

{"title":"[Rare side effect in the treatment of bacterial endocarditis].","authors":"Carola Andrea George, Fabian Gisler, Ursula Flückiger","doi":"10.1055/a-2505-8860","DOIUrl":"10.1055/a-2505-8860","url":null,"abstract":"<p><p>A patient went to the hospital due to persistent febrile temperatures. Positive blood cultures for Enterococcus faecalis as well as a vegetation on the mitral valve in the echocardiography were detected. Therefore the diagnosis of E. faecalis endocarditis was made. An appropriate antimicrobial combination therapy with amoxicillin and gentamicin was initiated. During the course of treatment, gentamicin was switched to ceftriaxone because of an acute kidney injury KDIGO stadium AKI 1. Furthermore a mechanical mitral valve replacement was performed. After a continuous 5-week antimicrobial therapy, the patient was urgently transferred back from cardiological rehabilitation to the hospital due to acute flank pain with emesis.Clinically, the 64-year-old patient presented with tenderness in the right abdomen. Laboratory tests revealed acute kidney injury AKI 3 with microhematuria in the urine analysis. Sonographically, there was evidence of hydronephrosis in the right kidney. An abdominal CT revealed a calculus in the urinary bladder.The calculus, measuring 7 × 3 × 2 mm, was expelled through micturition and consisted 100% of amoxicillin. Therefore, the diagnosis of amoxicillin-induced urolithiasis was made.The antimicrobial therapy with amoxicillin was adjusted according to kidney function. Due to an initially unclear inflammatory condition associated with Dressler syndrome, the combination therapy was completed after 8 weeks instead of 6 weeks. At this time, the creatinine level was slightly elevated. After two weeks, it was back within the normal range. Two years later, the patient is free from recurrence of endocarditis.In the case of intrarenal precipitation of crystals, crystal nephropathy occurs, which presents a rare side effect of amoxicillin. As in this case, massive precipitation of macroscopic crystals in the renal pelvis can even lead to urolithiasis with obstructive nephropathy. This case demonstrates the importance of regular monitoring of renal function during treatment with amoxicillin, particularly in high-dose therapy with prolonged treatment duration.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 11","pages":"628-631"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Healthcare landscape in internal medicine in Germany: A trend analysis over 10 years for the German Society of Internal Medicine (DGIM)].","authors":"Dirk Müller-Wieland, Elke Berger, Phillip Hengel, Reinhard Busse, Georg Ertl, Norbert Suttorp","doi":"10.1055/a-2328-6929","DOIUrl":"10.1055/a-2328-6929","url":null,"abstract":"<p><p>The aim of the project is to analyse the status of the inpatient and outpatient care landscape with regard to medical staff, care structures and performance developments for internal medicine and its specialities.Various data sources were used, including the German Medical Association, the National Association of Statutory Health Insurance Physicians, the Federal Statistical Office and structured hospital quality reports.According to the German Medical Association, 58000 internists were registered in 2020, 45% (n=26,400) of whom worked in the inpatient sector and 48% (n=28,000) in the outpatient sector. The proportion of female, younger, part-time and salaried employees is increasing. The proportion of internists among all general practitioners rose from around 25% or 25,200 in 2013 to over 30% or 29,300 in 2020.According to the structured quality reports, 34% (n=166000) of the 494000 hospital beds in 2019 were allocated to internal medicine and 33% of these (n= 54500) to the various specialties. The number of beds per population remained almost unchanged from 2010 to 2017, both for internal medicine as a whole and across all specialities.In 2019, a good 7.2 million (36%) of the almost 20 million inpatient cases were treated in internal medicine departments. Of these, 69% or 5.0 million were in general internal medicine with an average length of stay of 6.9 days. In relation to general and specialized internal medicine, number of hospital beds, medical staff and cases differed from region to region.The proportion of younger, female, part-time and salaried doctors in internal medicine is increasing. The development of internal medicine varies regionally, which should be taken into account when reforming the healthcare system.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":" ","pages":"e28-e40"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Conservative Management of Chronic Coronary Syndrome].","authors":"Alexander Asmussen, Ingo Hilgendorf","doi":"10.1055/a-2442-7841","DOIUrl":"https://doi.org/10.1055/a-2442-7841","url":null,"abstract":"<p><p>CCS management, based on the 2024 ESC Guidelines, a cornerstone of contemporary cardiology, aims to prevent cardiovascular events, alleviate symptoms, and enhance quality of life through conservative and invasive strategies. Non-invasive approaches, encompassing patient education, lifestyle interventions, and optimized pharmacological treatments, have demonstrated significant benefits in prognosis and quality of life. The guidelines advocate for a patient-centered approach, tailoring therapies to pathophysiological mechanisms, comorbidities, and individual needs. Pharmacological strategies integrate antithrombotic, lipid-lowering, RAAS-blocking, anti-inflammatory, and antidiabetic agents for event prevention, alongside antianginal medications for symptom relief. Invasive interventions remain essential for high-risk patients with obstructive coronary artery disease (e.g., left main disease, three-vessel disease, or proximal LAD involvement) or refractory angina despite optimal medical therapy. However, the growing efficacy of medical management increasingly challenges the incremental benefits of early revascularization. The guidelines also highlight underdiagnosed conditions such as ANOCA (Angina with Non-Obstructive Coronary Arteries) and INOCA (Ischemia with Non-Obstructive Coronary Arteries). Recognizing diverse endotypes, including microvascular dysfunction and vasospastic angina, enables precise and individualized therapeutic approaches. Conservative therapy remains the foundation of CCS management, demanding a holistic, multidisciplinary, and patient-centered approach to optimize outcomes and improve quality of life.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 11","pages":"615-622"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Multimorbidity - only solvable together].","authors":"Maria Cristina Polidori, Michael Denkinger","doi":"10.1055/a-2360-2794","DOIUrl":"10.1055/a-2360-2794","url":null,"abstract":"","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 9","pages":"463-464"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Update on diagnostics and therapies in inflammatory bowel diseases].","authors":"Raja Atreya","doi":"10.1055/a-2335-6154","DOIUrl":"https://doi.org/10.1055/a-2335-6154","url":null,"abstract":"","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 8","pages":"391"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Secondary hemophagocytic lymphohistiocytosis due to icteric leptospirosis with acute renal failure].","authors":"Marvin Dumke, Nadine Wilsdorf, Iris Barndt","doi":"10.1055/a-2455-6902","DOIUrl":"10.1055/a-2455-6902","url":null,"abstract":"<p><p>A 51-year-old patient presented himself with fever, upper abdominal pain and exertional dyspnea. Hemodynamic instability accompanied by generalized icterus, hepatosplenomegaly, a morbilliform rash with petechia and bilateral conjunctivitis revealed in clinical examination.Laboratory results revealed elevated C-reactive protein and procalcitonin as well as pancytopenia and hyperbilirubinemia. Furthermore hypertriglyceridemia, hyperferritinemia and elevated soluble IL-2-receptor were found. Testing for infectious diseases detected IgM-antibodies to leptospires. Bone marrow cytology featured hemophagocytosis.Secondary hemophagocytic lymphohistiocytosis due to icteric leptospirosis (Weil's disease) was diagnosed.Immediate antibiotic therapy and circulatory support by fluid and vasopressors was initiated and non-invasive ventilation and hemodialysis stabilized the patient. With steroids and polyvalent immunoglobulins the organ functions recovered.Hemophagocytic lymphohistiocytosis is an important differential or concomitant diagnosis in sepsis and can be induced by rarely diagnosed infectious triggers like leptospirosis.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 8","pages":"434-437"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[43-year-old patient presenting with pulmonary masses following hysterectomy].","authors":"Patricia Walther, Sascha Bender, Michael Hainz","doi":"10.1055/a-2455-7831","DOIUrl":"https://doi.org/10.1055/a-2455-7831","url":null,"abstract":"","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 9","pages":"479-480"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Psyche in Climate Crisis? An Update on Ecological Psychiatry and Psychotherapy].","authors":"Eva-Lotta Brakemeier, Sebastian Karl, Sarah Stapel, Andreas Meyer-Lindenberg","doi":"10.1055/a-2447-2517","DOIUrl":"https://doi.org/10.1055/a-2447-2517","url":null,"abstract":"<p><p>The human-caused climate crisis is advancing relentlessly and poses a global threat. But to what extent is our psyche also in crisis due to climate change? This article explores the profound impacts of the climate crisis and environmental destruction on mental health, advocating for a comprehensive, ecologically-oriented approach to psychiatry and psychotherapy.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 9","pages":"521-532"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[New cases of botulism after intragastric injection of botulinum toxin].","authors":"Werner Beermann","doi":"10.1055/a-2506-6699","DOIUrl":"10.1055/a-2506-6699","url":null,"abstract":"<p><p>Two female patients presented to our clinic shortly after one another with visual disturbances, double vision, swallowing difficulties and shortness of breath, a few days after an intragastric injection of botulinum toxin in a clinic in Turkey.The physical examination was unremarkable except for signs of respiratory insufficiency with increased respiratory rate and shortness of breath, especially when lying down; no clear neurological symptoms were found. Imaging showed reduced diaphragmatic mobility. Blood gas analyses showed hypoxemic respiratory insufficiency.The patients were observed as inpatients for a few days without specific therapy and were discharged with regressing symptoms.In March 2023, the Robert Koch Institute, the European Centre for Disease Prevention and Control and the WHO published a report on 87 patients who had received intragastric injections of botulinum toxin in 2 Turkish hospitals with the aim of losing weight and subsequently have developed symptoms of botulism. The current cases presented here draw further attention to the problems of the procedure that is still being carried out and to the risks of botulism.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 9","pages":"504-507"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Lupus nephritis - does a lot help a lot?]","authors":"Cornelia Elisabeth Eckert, Bruno Reible, Zoran Popovic, Bernhard Hellmich, Christian Löffler","doi":"10.1055/a-2375-2634","DOIUrl":"10.1055/a-2375-2634","url":null,"abstract":"<p><p>Lupus nephritis (LN) is a frequent and often serious manifestation of systemic lupus erythematosus, which can lead to the need for renal replacement therapy. Its timely diagnosis and treatment is therefore of crucial importance. The use of targeted immunomodulating therapies and the consistent use of nephroprotective measures in the treatment of LN can now significantly improve the renal prognosis and reduce glucocorticoid-associated toxicity. Recent study data have shown that the combination of different immunomodulating therapies including calcineurin inhibitors or belimumab is superior to therapy with single agents in terms of clinically relevant renal endpoints. This multi-target therapy has now also been included in several recently updated international guidelines. In the future, CAR-T cell therapy could be a promising prospect for patients with refractory lupus nephritis.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 8","pages":"451-460"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}