Deutsche medizinische Wochenschrift (1946)最新文献

{"title":"[Multimorbidity and the Kidney].","authors":"Anna Maria Affeldt, Lena Pickert, Thomas Benzing, Ute Hoffmann","doi":"10.1055/a-2360-2837","DOIUrl":"https://doi.org/10.1055/a-2360-2837","url":null,"abstract":"<p><p>Multimorbidity, i.e. the simultaneous presence of 2 or more diseases, is common in patients with chronic kidney disease (CKD). Cardiovascular diseases such as coronary heart disease, heart failure, stroke or vascular dementia are of particular importance. CKD and comorbidities influence each other, which is why the current KDIGO guidelines emphasize the need for personalized treatment approaches. This applies in particular to older patients, who are especially frequently affected by CKD. The diagnosis of CKD patients should not only include typical comorbidities, but also a comprehensive risk assessment and an evaluation to avoid polypharmacy.Recognising CKD is of particular importance for patients with chronic diseases in old age, as kidney disease can have a profound effect on or worsen the course of other diseases and the limitation of kidney function has a significant influence on the treatment approach. Particular attention must be paid to the correct assessment of kidney function in older people in terms of determining the estimated glomerular filtration rate (eGFR). Here, a measurement of serum creatinine is not always sufficient due to lower muscle mass and may need to be supplemented by additional parameters to estimate the glomerular filtration rate, such as cystatin C.Depending on the eGFR, kidney disease is categorized into the stages CKD G1-G5. In addition, if kidney disease is suspected, a test for proteinuria should also be performed, preferably as a measurement of albumin excretion in spontaneous urine (albumin-to-creatinine ratio, ACR). Geriatric screening and assessment are also crucial to recognize the multimorbidity, frailty and psychosocial aspects of older patients.The treatment of multimorbidity in CKD patients focusses on progression reduction and secondary and tertiary prevention, whereby a healthy lifestyle, regular exercise and a balanced diet are also important. The prevention of cardiovascular disease, particularly in the case of high blood pressure and diabetes mellitus, requires individualized therapy, in which the choice and dosage of medication must also be taken into account, particularly in the case of advanced renal impairment. If heart failure and/or atrial fibrillation are also present, close interdisciplinary collaboration between nephrologists, cardiologists and GPs is helpful in order to optimize treatment. In addition, CKD patients with dementia face particular challenges in terms of medication and the avoidance of delirium and mental symptoms.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 9","pages":"487-495"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813114","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":"[Advanced therapies: Un update on medical treamtent options in Crohn`s disease].","authors":"Agnieszka Kafel, Clara Rodriguez de Castro Zalona, Chiara Seiz, Elisabeth Schnoy","doi":"10.1055/a-2368-7173","DOIUrl":"10.1055/a-2368-7173","url":null,"abstract":"<p><p>Crohn's disease is a chronic inflammatory bowel disease (IBD) that can manifest throughout the entire gastrointestinal tract from mouth to anus. It is characterized by so-called \"skip lesions\", which are affected sections of the intestine interspersed with healthy sections. In recent years, there have been significant progress and an expansion of medical treatment options for Crohn's disease with the approval of many new substances. Treatment goals have also become more ambitious, going beyond clinical symptom control to mucosal healing and, according to the STRIDE II criteria, to transmural healing in Crohn's disease in the future. If these goals are achieved, patients with Crohn's disease have a good chance of remaining in long-term remission and can expect fewer complications such as disease progression, hospitalization, anemia, fistulas, strictures, or surgeries. Despite having access to a variety of different substance classes in the treatment of Crohn's disease, in everyday practice we can see that these medications are not effective for some patients in the long-term. There is a so-called \"therapeutic ceiling\" in IBD, meaning that only about 40-50% of those affected are successfully managed long-term with one substance. Therefore, new medical treatment options for Crohn's disease always represent an opportunity to treat patients even better.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 8","pages":"405-411"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756719","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":"[Anti-inflammatory therapeutic advances in nephrology: can we learn from cardiology?]","authors":"Laura Katharina Sievers, Roland Schmitt","doi":"10.1055/a-2376-0783","DOIUrl":"10.1055/a-2376-0783","url":null,"abstract":"<p><p>Pathophysiology of kidney diseases frequently implies sterile inflammation, e.g. during glomerulonephritis or after renal transplantation. Recently, the relevance of systemic low-grade inflammation for chronic kidney disease (CKD) progression and complications of CKD have come into focus. In this review article, the etiology, and consequences of low-grade inflammation in CKD patients are discussed. Further, the potential of anti-inflammatory approaches to slow down CKD progression is addressed. Recent advances have resulted in FDA approval of colchicine for patients with preserved renal function and atherosclerosis. Thus, lastly, anti-inflammatory therapy of atherosclerosis in patients with or without CKD is outlined.Taken together, anti-inflammatory therapy offers novel opportunities to improve CKD progression, inhibit transition from acute to chronic kidney disease and reduce the risk of fatal long-term complications such as cardiovascular disease.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 6","pages":"293-297"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473309","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":"[89-year-old patient with epigastric pain and hematin vomiting].","authors":"Janine Hus, Aliriza Celik, Nele Thießen","doi":"10.1055/a-2432-8704","DOIUrl":"https://doi.org/10.1055/a-2432-8704","url":null,"abstract":"","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 6","pages":"251-252"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473305","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":"[Hypovolaemic and haemorrhagic shock].","authors":"Stephan Braune, Martin Rieck, Angela Ginski","doi":"10.1055/a-2295-1929","DOIUrl":"10.1055/a-2295-1929","url":null,"abstract":"<p><p>Hypovolemic and hemorrhagic shock are life-threatening conditions that, if untreated, rapidly lead to multi-organ failure and death. These conditions result from significant intravascular fluid or blood loss, causing critical organ hypoperfusion. The underlying pathophysiology involves complex hemodynamic, inflammatory, and coagulation disturbances that may progress to irreversible organ dysfunction. Rapid diagnosis, early hemorrhage control, and targeted hemodynamic and hemostatic therapy are crucial to improve patient outcomes. Diagnosis is based on clinical symptoms, laboratory parameters, and imaging or endoscopic assessments. The primary therapeutic approach focuses on addressing the underlying cause while implementing fluid resuscitation and vasopressor support. In hemorrhagic shock, coagulation management is of paramount importance. Essential treatment principles include maintaining normothermia, a pH above 7.2, and normocalcemia. If no contraindications exist, permissive hypotension should be applied to limit ongoing bleeding. Early goal directed administration of tranexamic acid and fibrinogen is recommended to stabilize coagulation. For patients experiencing severe hemorrhagic shock, transfusion strategies must be optimized. A hemoglobin target of 7-9g/dL is generally recommended, and in cases requiring massive transfusion, a ratio of red blood cells, plasma, and pooled platelets of 4:4:1 should be used. Additionally, patients receiving effective anticoagulation require specific reversal agents to restore hemostasis. In summary, the successful management of hypovolemic and hemorrhagic shock depends on early recognition, rapid hemorrhage control, and individualized goal directed resuscitation and hemostatic strategies.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 7","pages":"347-358"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631067","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":"[Septic shock].","authors":"Ulrike Olgemöller, Christian Becker","doi":"10.1055/a-2288-2366","DOIUrl":"10.1055/a-2288-2366","url":null,"abstract":"<p><p>Due to a large number of nosocomial, but also hospital-associated infections, sepsis and therefore septic shock occur frequently in everyday clinical practice. Considering the high prevalence and mortality rate of the disease and its complexity, precise knowledge of pathophysiology, diagnostics and therapy is essential for every clinical doctor.Because time in this case is such a critical factor, patients in septic shock in particular require a standardized approach and targeted, swift diagnostics to start adequate treatment as soon as possible. In addition to hemodynamic stabilization, the treatment of the infection's origin is particularly important.This article is intended to provide an overview of the most important diagnostic tools, treatment strategies and concepts, as well as practical assistance for everyday clinical practice.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 7","pages":"333-341"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631069","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 COPD and cardiovascular events].","authors":"Maximilian Leitner, Anna Maria Blum, Robert Bals","doi":"10.1055/a-2326-7636","DOIUrl":"10.1055/a-2326-7636","url":null,"abstract":"<p><p>Chronic Obstructive Pulmonary Disease (COPD) is closely linked to cardiovascular disease (CVD), with up to 70% of COPD patients experiencing cardiovascular comorbidities. The coexistence of COPD and CVD significantly increases hospitalization rates, symptom burden, and mortality, particularly during acute exacerbations of COPD (AECOPD), which impose an increased risk of cardiovascular events - both during and shortly after these episodes. Mechanistic links between COPD and CVD include systemic inflammation, oxidative stress, endothelial dysfunction, and hypoxemia, all of which contribute to the progression of both conditions.Current management guidelines stress the importance of early screening and risk factor control for cardiovascular comorbidities in COPD patients. Different COPD therapies can affect cardiovascular outcomes in distinct ways. Recent research suggests that inhaled corticosteroids (ICS), either alone or as part of triple therapy (long-acting muscarinic antagonist [LAMA], long-acting beta-agonist [LABA], and ICS), may help reduce mortality and morbidity, particularly for those at higher risk. Furthermore, beta-blockers and statins have shown potential benefits for COPD patients with CVD, although their exact role is not entirely clear. Newer antidiabetic agents, such as SGLT-2 inhibitors, have also demonstrated promise in reducing exacerbation rates.This review emphasizes the need for an integrated care approach, highlighting the importance of personalized, guideline-driven therapies to enhance quality of life and clinical outcomes for COPD patients with cardiovascular comorbidities.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 6","pages":"298-302"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473329","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":"[Lymphedema].","authors":"Katja Sibylle Mühlberg","doi":"10.1055/a-2361-0838","DOIUrl":"10.1055/a-2361-0838","url":null,"abstract":"<p><p>The 5 most important pillars of conservative lymphoedema therapy are (1) compression, (2) manual lymphatic drainage (MLD), (3) exercise, (4) skin and wound care, and (5) self-management. Without compression therapy the risk of cellulitis is increased and causes an elevated health/economic burden. The use of nocturnal compression shows advantages and a high degree of treatment adherence. The previous recommendation that compression should not be used for cellulitis has been cancelled. On the contrary, compression therapy is explicitly desirable for inflammatory dermatoses. The fact that lymphedema extremities show a 3-fold higher association with malignant skin tumours compared to unaffected extremities deserves attention. Using ICG lymphography, 4 different functional regions of lymphatic leg bundles were differentiated. The severity of the lymphoedema correlated with the kind of affected bundles. Vascularized lymph node transfer, which is a reconstructive lymphatic surgery procedure, was found to show evidence in terms of volume reduction, improved functionality, and better quality of life. The higher the BMI, the higher the risk of developing lymphoedema. Meta-analyses confirm the benefits of an active lifestyle with exercise and sporting activities in conjunction with patient education. Apparative systems for decongestion (intermittent pneumatic compression) usually force patients to remain immobile during application. Portable apparative compression systems are a promising alternative but are not yet available in Germany. Primary lymphoedema is not a uniform entity. The St. George's classification system shows the association of primary lymphoedema with systemic or syndromic diseases and vascular malformations as well. As a work-in-progress algorithm, it is a valuable aid in classifying primary lymphoedema, confirming the diagnosis and finding therapeutic approaches.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 6","pages":"253-259"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473323","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":"[Cardiogenic shock - State of the art pathophysiology, therapy and prognosis].","authors":"Alexander Kersten","doi":"10.1055/a-2288-2256","DOIUrl":"10.1055/a-2288-2256","url":null,"abstract":"<p><p>Cardiogenic shock is not a singular disease but rather a complex syndrome - characterized by systemic hypoperfusion, elevated intracardiac pressures, and insufficient cardiac output due to various possible underlying causes, leading to an acute, life-threatening, and critical condition.Significant advancements have been made in recent years in understanding the epidemiology, clinical course, phenotyping, hemodynamics, and the standardized classification of disease severity. However, progress in therapeutic interventions aimed at improving prognosis has been comparatively limited, with only a few therapies demonstrating significant evidence in randomized controlled trials. Among these, early revascularization in infarct-related cardiogenic shock (Acute Myocardial Infarction with Cardiogenic Shock - AMICS) has remained a key therapy for more than 20 years, and more recently, the use of percutaneous left ventricular assist devices in selected patients.Many questions remain unanswered, including the optimal pharmacotherapeutic regimen, the role of other mechanical support systems, the management of secondary organ dysfunction, and the best approach to supportive care.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 7","pages":"325-332"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631132","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":"Schock.","authors":"Uwe Janssens","doi":"10.1055/a-2519-4603","DOIUrl":"10.1055/a-2519-4603","url":null,"abstract":"","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 7","pages":"311-312"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631098","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}