Praxis最新文献

Introduction: Cardiovascular diseases rank among the leading causes of death worldwide. Patients with cardiovascular diseases often require lifelong follow-ups and medication. Psychological symptoms are prevalent in this population, and early recognition of such symptoms is crucial for improving the course of the cardiovascular disease. This case report presents the story of a patient with an aortic dissection whose diagnosis and necessary treatment were delayed. Subsequently, the patient experienced flashbacks, which consisted of negative experiences related to the cardiovascular disease and earlier traumatic life events. Successful treatment involved a combination of cardiac intervention, including aortic arch replacement, cardiac rehabilitation, and psychocardiological care during the rehabilitation phase.

Introduction: We describe a 34-year-old female patient with recurrent thromboembolic events, most recently with occlusion of the superior mesenteric vein - despite regular intake of oral anticoagulation with Apixaban at the dosage recommended by the manufacturer. The underlying cause was enteral malabsorption with protein loss syndrome due to active Crohn's disease, limited to the small intestine, with an atypical clinical presentation. We discuss the topic of anticoagulation in the presence of an enteral barrier disorder.

Introduction: The landscape of diagnosis and treatment of locally advanced and metastatic prostate cancer has seen an unprecedented evolution in recent years. Incorporation of results from pivotal studies is crucial for state-of-the-art counselling of patients and to inform treatment recommendations. However, in daily practice ambiguous situations may occur or various options may seem adequate. Furthermore, specific national regulations, e.g. availability of diagnostic tools and drug approvals, may influence treatment choices. This paper presents the voting results of a Swiss expert panel that convened in August 2024 and discussed selected questions addressed by an international panel of experts during the Advanced Prostate Cancer Conference held in Lugano in April 2024. The objective is to facilitate national harmonization of diagnosis and treatment of locally advanced and metastatic prostate cancer and thereby providing a basis for discussion with individuals with prostate cancer.

Introduction: Background: Extrasystole is a common reason for visits to general practitioners. In cardiological literature, supraventricular extrasystole in particular tends to play a minor role. This article discusses the current state of knowledge and common practice for this frequently encountered clinical problem. Question: Due to increasing health awareness among the population and the use of new diagnostic technologies (e.g. smartwatches), there has been an increase in GP consultations among young and healthy patients with symptomatic or asymptomatic extrasystole. Comorbidities play a decisive role in this clinical picture. This review provides an overview of supraventricular and ventricular extrasystoles and explicitly addresses the question of diagnostic and therapeutic approaches in the context of extrasystoles in healthy young people. Methodology: A targeted literature search was conducted in the PubMed, EMBASE, Cochrane and Library databases using the search terms: Extrasystole, supraventricular extrasystoles, ventricular extrasystoles, arrhythmia, tachycardia, ambulatory ECG monitoring, premature ventricular complex (PVC), premature atrial complex (PAC), heart rate variability, Holter ECG monitoring, taking into account the current guidelines of the European Society of Cardiology (ESC). Results: 54 publications were identified, the results of which were evaluated in line with the research question. From these, the key conclusions for general practitioners dealing with this issue were drawn. Conclusion: In principle, technological improvements and wider accessibility among the population lead to increased use of diagnostic procedures. According to the latest findings, it is important for primary care providers to note that even asymptomatic SVES - although in principle harmless when isolated - should not be ignored. Early detection and monitoring of individuals with frequent SVES in combination with cardiovascular risk factors could help reduce the risk of cardiovascular events, including strokes and other complications associated with atrial fibrillation. With regard to ventricular extrasystoles, it should be noted that asymptomatic individuals with a low VES burden of  5 % do not require further investigation. Antiarrhythmic therapy plays a purely symptomatic role in the treatment of extrasystoles and has no prognostic benefit. Catheter ablation has become increasingly important in recent years and is the first-line treatment for symptomatic, idiopathic ventricular extrasystoles from the RVOT and left bundle branch in the current ESC guidelines from 2022.

Introduction: We report on a 29-year-old patient with highly intense, acute abdominal pain of idiopathic origin (out of proportion), admitted to the emergency department with suspected appendicitis. An ultrasound revealed signs of bowel obstruction, and due to persistent pain despite intravenous morphine analgesia, a computed tomography was performed, revealing a closed-loop obstruction. The patient underwent laparoscopy, where an omental adhesion was identified and surgically resolved. The postoperative course was uneventful. This potentially dangerous diagnosis should be considered even in healthy patients without prior surgeries. Keywords: Acute abdomen, abdominal pain, intestinal obstruction, ileus, closed loop obstruction, emergency medicine.

Introduction:

Introduction: This medical case report describes the diagnosis and treatment of a 24-year-old man with a germ cell tumor. The patient presented to the emergency practice with a palpable mass in the left upper abdomen that had been present for three weeks, without any additional symptoms. Bedside ultrasonography revealed an inhomogeneous tumor in the retroperitoneum. Further ultrasound examination of the abdomen and testicle identified a possible primary tumor in the left testicle, which was classified as a tumor with non-seminoma parts based on laboratory findings with markedly elevated Beta-HCG and AFP levels. Additionally a primary orchidectomy followed for definitive diagnosis. The patient underwent chemotherapy with four cycles of cisplatin, etoposide, and bleomycin, which was well-tolerated. After the removal of the remaining retroperitoneal mass, complete remission was achieved. This case highlights the importance of comprehensive diagnostics and interdisciplinary collaboration in the treatment of germ cell tumors, as well as the critical role of ultrasound in both emergency and primary care settings. With early diagnosis and appropriate therapy, patients with these tumors have a very high survival rate despite the metastasis. Keywords: Germ cell tumour, retroperitoneal mass, beta-HCG and AFP, orchiectomy, chemotherapy.

Introduction: Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are associated conditions that typically affect older patients, usually over the age of 50. Their clinical presentations often overlap, and the two can even transition into one another. Increasingly, they are viewed not as distinct diseases but as manifestations of a single disease spectrum. Common symptoms include shoulder pain, headaches, and visual disturbances. Diagnosis relies on imaging and inflammatory markers. Both conditions are initially treated with glucocorticoids, increasingly complemented by IL-6 inhibitors or methotrexate. New therapeutic approaches such as JAK inhibitors are currently in development.

Introduction: Acute rhinosinusitis (ARS) is one of the most common infectious diseases found the in the outpatient clinics. In order to avoid overuse of diagnostic tools and over-treatment, knowledge of its etiology is key. The objective of this paper is to present the current classification of ARS, its management recommendation and indications for antibiotic treatment as well as to identify potential complications. A review of the current literature for ARS was performed, especially of the two most significant position papers (EPOS 2020, ICARS-RS-2021, AAO-HNSF, AWMF-S2k-Leitlinie). The past years, a differentiated view on ARS and its classification has evolved. ARS is mainly an inflammatory disease triggered by viral infection while a minority develops into a bacterial infection. The diagnosis is mainly clinical and most cases are self-resolving with symptomatic treatment.

Introduction: About 30 % of the Swiss population regularly takes dietary supplements, whereas only 22 % of them have a medical reason to do so. We describe a case of a woman with multiple sclerosis and her partner, who has a rare metabolic disorder. Due to a lack of conventional treatment options perceived by the patient, they started a high-dose vitamin D supplementation. While the man only developed a subclinical vitamin D intoxication, the woman was hospitalized due to a severe vitamin-D-induced hypercalcemia.