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Mitteilungen der SPS. 来自 SPS 的通信。
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-02-01 DOI: 10.1007/s00482-024-00794-1
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引用次数: 0
[Diagnosis and treatment of Dunbar syndrome]. [邓巴综合症的诊断与治疗]。
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-02-01 Epub Date: 2023-11-21 DOI: 10.1007/s00482-023-00766-x
Anna Woestemeier, Alexander Semaan, Jörg C Kalff, Philipp Lingohr

The rare Dunbar syndrome or medial arcuate ligament syndrome (MALS) is defined as compression of the celiac trunk and/or ganglion by the medial arcuate ligament. It is often diagnosed after patients have suffered for a long time and is characterized by intermittent food-related pain, nausea, and unexplained weight loss. After exclusion of other causes of the above symptoms by gastroscopy, colonoscopy, CT, or MRI, the gold standard for diagnosis is dynamic color-coded duplex sonography, which may be supplemented by CT or MR angiography. The treatment of choice is a laparoscopic division of the arcuate ligament at the celiac trunk, although percutaneous transluminal angioplasty (PTA) with stent implantation may be performed in cases of postoperative persistence of symptoms or recurrent stenosis. Since symptoms persist postoperatively in up to 50% of cases, strict indication and complete diagnosis in designated centers are of great importance for successful treatment.

罕见的邓巴综合征或内侧弓状韧带综合征(MALS)被定义为内侧弓状韧带压迫腹腔干和/或神经节。它通常在患者长期遭受痛苦后被诊断出来,其特征是间歇性的食物相关疼痛,恶心和无法解释的体重减轻。在胃镜、结肠镜、CT或MRI排除上述症状的其他原因后,诊断的金标准是动态彩色编码双超声,可辅以CT或MR血管造影。首选的治疗方法是腹腔镜下切开腹腔干弓形韧带,尽管在术后症状持续或复发性狭窄的情况下可以进行经皮腔内血管成形术(PTA)和支架植入。由于高达50%的病例术后症状持续存在,因此在指定的中心严格适应证和完全诊断对成功治疗至关重要。
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引用次数: 0
[Evidence-based CRPS treatment: currently still wishful thinking]. [基于证据的 CRPS 治疗:目前仍是一厢情愿]。
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-02-01 Epub Date: 2023-12-06 DOI: 10.1007/s00482-023-00773-y
T Gabriel, P Klose
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引用次数: 0
[Short paths to diagnosis with artificial intelligence: systematic literature review on diagnostic decision support systems]. [人工智能诊断的捷径:关于诊断决策支持系统的系统文献综述]。
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-02-01 Epub Date: 2024-01-02 DOI: 10.1007/s00482-023-00777-8
Julia Sellin, Jean Tori Pantel, Natalie Börsch, Rupert Conrad, Martin Mücke

Background: Rare diseases are often recognized late. Their diagnosis is particularly challenging due to the diversity, complexity and heterogeneity of clinical symptoms. Computer-aided diagnostic aids, often referred to as diagnostic decision support systems (DDSS), are promising tools for shortening the time to diagnosis. Despite initial positive evaluations, DDSS are not yet widely used, partly due to a lack of integration with existing clinical or practice information systems.

Objective: This article provides an insight into currently existing diagnostic support systems that function without access to electronic patient records and only require information that is easily obtainable.

Materials and methods: A systematic literature search identified eight articles on DDSS that can assist in the diagnosis of rare diseases with no need for access to electronic patient records or other information systems in practices and hospitals. The main advantages and disadvantages of the identified rare disease diagnostic support systems were extracted and summarized.

Results: Symptom checkers and DDSS based on portrait photos and pain drawings already exist. The degree of maturity of these applications varies.

Conclusion: DDSS currently still face a number of challenges, such as concerns about data protection and accuracy, and acceptance and awareness continue to be rather low. On the other hand, there is great potential for faster diagnosis, especially for rare diseases, which are easily overlooked due to their large number and the low awareness of them. The use of DDSS should therefore be carefully considered by doctors on a case-by-case basis.

背景:罕见疾病往往很晚才被发现。由于临床症状的多样性、复杂性和异质性,这些疾病的诊断尤其具有挑战性。计算机辅助诊断辅助工具,通常被称为诊断决策支持系统(DDSS),是缩短诊断时间的有效工具。尽管诊断决策支持系统得到了初步的积极评价,但尚未得到广泛应用,部分原因是该系统与现有的临床或实践信息系统缺乏整合:这篇文章对目前现有的诊断支持系统进行了深入分析,这些系统无需访问电子病历,只需要容易获取的信息即可运行:通过系统性文献检索,我们找到了 8 篇关于 DDSS 的文章,这些系统可协助诊断罕见病,且无需访问电子病历或诊疗机构和医院的其他信息系统。对已发现的罕见病诊断支持系统的主要优缺点进行了提取和总结:结果:基于肖像照片和疼痛图纸的症状检查器和罕见疾病诊断支持系统已经存在。这些应用的成熟程度各不相同:目前,DDSS 仍面临着许多挑战,如数据保护和准确性方面的担忧,接受度和认知度仍然较低。另一方面,它在加快诊断速度方面具有巨大潜力,尤其是对罕见疾病的诊断。因此,医生应根据具体情况慎重考虑是否使用数据收集和分析系统。
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引用次数: 0
Mitteilungen der SPS. 来自 SPS 的通信。
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-02-01 DOI: 10.1007/s00482-024-00791-4
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引用次数: 0
[Neuropathic pain as a symptom in autonomic neuropathies and other rare diseases : Small fiber neuropathy: its recognition, diagnosis, and treatment]. [作为自律神经病和其他罕见疾病症状的神经性疼痛:小纤维神经病:其识别、诊断和治疗]。
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-02-01 Epub Date: 2024-01-10 DOI: 10.1007/s00482-023-00783-w
Fiona Fischer, Maike F Dohrn, Romina Kapfenberger, Denver Igharo, Diana Seeber, Elena de Moya Rubio, Kalliopi Pitarokoili, Natalie Börsch, Martin Mücke, Roman Rolke, Jörg B Schulz, Andrea Maier

Background: Neuropathic pain is difficult to diagnose and treat. Small fiber neuropathy (SFN) flies under the radar of nerve conduction studies.

Objectives: The importance of a structured patient history and physical examination in the context of neuropathic pain is emphasized. Describing SFN as an important cause, the authors consider rare but partially treatable differential diagnoses. They conclude that autonomic symptoms are frequently associated, often presenting with diverse symptoms.

Methods: A selective literature research to present SFN symptoms as well as differential diagnostic and therapeutic steps in the context of SFN and rare diseases focusing on the autonomic nervous system.

Results: Neuropathic pain significantly reduces quality of life. To shorten the time until diagnosis and to initiate therapy, the authors recommend a structured patient history including sensory plus and minus symptoms and non-specific autonomic signs. If the initial search for the cause is not successful, rare causes such as treatable transthyretin (ATTR) amyloidosis and Fabry's disease or autoimmune causes should be considered, particularly in the case of progressive and/or autonomic symptoms.

Conclusion: The diagnosis and therapy of rare SFN requires interdisciplinary collaboration and, in many cases, a referral to specialized centers to achieve the best patient care.

背景:神经病理性疼痛难以诊断和治疗。小纤维神经病变(SFN)在神经传导研究中被忽视:作者强调了结构化病史和体格检查在神经病理性疼痛中的重要性。作者将 SFN 描述为一个重要病因,并考虑了罕见但可部分治疗的鉴别诊断。他们的结论是,自律神经症状经常与多种症状相关联:方法:通过选择性文献研究,介绍 SFN 症状以及在 SFN 和罕见疾病背景下的鉴别诊断和治疗步骤,重点关注自律神经系统:神经病理性疼痛大大降低了生活质量。为了缩短诊断和开始治疗的时间,作者建议对患者病史进行结构化分析,包括感觉症状和非特异性自律神经体征。如果最初寻找病因未果,应考虑可治疗的转甲状腺素(ATTR)淀粉样变性和法布里病等罕见病因或自身免疫性病因,尤其是在出现进行性和/或自主神经症状的情况下:罕见 SFN 的诊断和治疗需要跨学科合作,在许多情况下还需要转诊到专业中心,以获得最佳的患者护理。
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引用次数: 0
[Think about child protection also in chronic pain]. [想想在慢性疼痛中也要保护儿童]。
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-02-01 Epub Date: 2024-01-09 DOI: 10.1007/s00482-023-00786-7
Melanie Anheyer
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引用次数: 0
Treating pain in patients with Ehlers-Danlos syndrome : Multidisciplinary management of a multisystemic disease. 治疗 Ehlers-Danlos 综合征患者的疼痛:多系统疾病的多学科管理。
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-02-01 Epub Date: 2024-01-08 DOI: 10.1007/s00482-023-00778-7
Natalie Börsch, Martin Mücke, Andrea Maier, Rupert Conrad, Jean Tori Pantel, Julia Sellin, Kyros Mani, Pradeep Chopra

Background: The clinical picture of people with Ehlers-Danlos syndromes (EDS) is complex and involves a variety of potential causes of pain. This poses major challenges to patients and healthcare professionals alike in terms of diagnosis and management of the condition.

Objectives: The aim of the article was to provide an overview of the specific pain management needs of patients with EDS and address their background.

Material and methods: A selective literature search was performed to highlight the current state of research on pain management in EDS patients.

Results: Affected patients require multimodal pain management considering their individual needs, disease-specific features, and comorbidities.

Conclusion: Medical awareness and evidence need to be further improved to enhance the medical care situation of these patients with complex needs.

背景:埃勒斯-丹洛斯综合征(EDS)患者的临床表现十分复杂,引起疼痛的潜在原因多种多样。这给患者和医护人员的诊断和病情管理带来了巨大挑战:本文旨在概述 EDS 患者的特殊疼痛治疗需求,并介绍其背景情况:材料和方法:对文献进行了选择性检索,以突出EDS患者疼痛治疗的研究现状:结果:考虑到患者的个体需求、疾病的特异性特征和合并症,受影响的患者需要多模式疼痛治疗:结论:医学意识和证据需要进一步提高,以改善这些具有复杂需求的患者的医疗护理状况。
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引用次数: 0
[Pain and cervical dystonia]. [疼痛与颈肌张力障碍]。
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-02-01 Epub Date: 2024-01-24 DOI: 10.1007/s00482-024-00790-5
Feline Hamami, Tobias Bäumer

Background: Dystonia is a hyperkinetic movement disorder that results in twisting, cramps and tremors due to sustained or intermittent muscle contractions. Cervical dystonia is the most common form of dystonia, in which the head, neck and/or shoulder areas are affected. In addition to these motor symptoms, pain and psychiatric symptoms are frequent in (cervical) dystonia.

Objective: Description of the incidence and evaluation of pain in cervical dystonia, summary and discussion of treatment options and effects.

Material and methods: In this review article the results in the scientific literature on pain in dystonia are summarized and discussed.

Results: Compared to other forms of dystonia, pain occurs most frequently in patients with cervical dystonia. A large proportion of patients with cervical dystonia suffer from pain, which contributes most to impairment of the patient. The motor symptoms of dystonia are usually treated with botulinum toxin injections. These have a muscle relaxing effect and also relieve pain. The study situation on the occurrence and treatment of pain in other forms of dystonia is so far very limited. Pain can dominate the clinical picture in patients with cervical dystonia. Evaluation of pain in cervical dystonia can be performed using standardized questionnaires.

Conclusion: It is important to ask patients with cervical dystonia about pain and to consider it in treatment planning and evaluation. Vice versa, if pain is present the possibility of a causative dystonia should also be considered. For pain assessment there are some newly developed questionnaires to assess pain in a standardized way in patients with dystonia. Further research is needed to better understand the pathomechanisms of pain in dystonia.

背景:肌张力障碍是一种运动功能亢进性疾病,由于肌肉持续或间歇性收缩而导致扭曲、痉挛和震颤。颈肌张力障碍是肌张力障碍中最常见的一种,患者的头部、颈部和/或肩部都会受到影响。除了这些运动症状外,(颈型)肌张力障碍患者还经常出现疼痛和精神症状:描述颈性肌张力障碍中疼痛的发生率和评估,总结和讨论治疗方案和效果:在这篇综述文章中,对有关肌张力障碍疼痛的科学文献结果进行了总结和讨论:与其他形式的肌张力障碍相比,颈性肌张力障碍患者的疼痛发生率最高。大部分颈肌张力障碍患者都患有疼痛,这也是导致患者功能受损的主要原因。肌张力障碍的运动症状通常通过注射肉毒杆菌毒素来治疗。肉毒毒素具有肌肉松弛作用,还能缓解疼痛。迄今为止,关于其他形式肌张力障碍的疼痛发生和治疗的研究还非常有限。疼痛在颈肌张力障碍患者的临床表现中占主导地位。对颈性肌张力障碍患者疼痛的评估可以使用标准化的问卷:结论:询问颈肌张力障碍患者的疼痛情况,并在治疗计划和评估中加以考虑非常重要。反之亦然,如果存在疼痛,也应考虑肌张力障碍致病的可能性。在疼痛评估方面,有一些新开发的问卷可以对肌张力障碍患者的疼痛进行标准化评估。要更好地了解肌张力障碍患者疼痛的病理机制,还需要进一步的研究。
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引用次数: 0
[Chronic pain in children - is it an alarm signal?] [儿童慢性疼痛--是警报信号吗?]
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-02-01 Epub Date: 2024-01-11 DOI: 10.1007/s00482-023-00785-8
Elfriede Kastenberger
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引用次数: 0
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Schmerz
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