Deutsche medizinische Wochenschrift (1946)最新文献

A 54-year-old man presented with increasing arthralgia and swelling of the metacarpophalangeal (MCP) joints II and III for approximately 2 years. He also reported morning stiffness and joint pain in both knees and feet.Both MCP joints II and III and the proximal interphalangeal joints II and III were tender without visible swelling. X-rays of the hands showed symmetrical osteoarthritic changes of the MCP joints I-III on both sides. Joint ultrasound revealed symmetrical osteophyte formation without inflammatory signs. Laboratory tests showed elevated ferritin (1436µg/l), iron (252µg/dl), and transferrin saturation (79%). Genetic testing confirmed a homozygous C282Y mutation, and FibroScan elastography indicated advanced fibrosis.Hemochromatosis-associated arthropathy.A symptom-oriented analgesic treatment with Metamizole was initiated. During the hospital stay, the patient received physical and occupational therapy. Hepatology specialists will manage further treatment at a university center, and the outcome remains to be seen.Symmetrical involvement of the MCP joints II and III should raise suspicion of hemochromatosis.

An important prerequisite for ascertaining rational antibiotic prescribing is the availability and evaluation of antibiotic use data. In this study we report evolving trends of antibiotic use in German hospitals during the last decade.Using drug dispensing data from acute care hospital pharmacies, we calculated yearly antibiotic use density values for the period from 2012/13 through to 2021/22. Use density was expressed as daily doses per 100 patient days, using both hospital adapted doses of antibiotics ("recommended daily dose", RDD) as well as WHO-"defined daily doses" (DDD). The 2021/22 data were extrapolated to estimate the hospital consumption in DDD per 1000 population and day.The overall antibiotic use density remained stable during the observation period. It was 41.9 RDD/100 patient days (median, n=169 hospitals, interquartile range 35-48 RDD/100) in the year 2012/13 and 42.1 RDD/100 (median, n=329, interquartile range 35-48 RDD/100) in the year 2021/22, respectively. The estimated national use per population in 2021/22 was 1.85 DDD per 1000 inhabitants and day. The antibiotic use levels in university hospitals (54.0 RDD/100) were higher than in non-university hospitals that showed a similar use density across different hospital size categories (medians between 39.8 and 44.0 RDD/100). Overall, penicillin use increased over time (change in proportion +63%), while fluoroquinolones (- 54%) and first and second generation cephalosporins (- 41%) were prescribed less frequently. Antibiotic use density in intensive care units was approximately twice as high as in normal wards. High levels of antibiotic use were also observed in haematology-oncology divisions at teaching hospitals (median 96.8 RDD/100), in urology (medians between 65.1 and 70.5 RDD/100) and oto-rhino-laryngology (medians between 49.1 and 60.9 RDD/100) and urology divisions.During the last decade, there was no increasing use of antibiotics in German acute care hospitals. We observed shifts in selected drug classes, in particular an increasing use of penicillins. The estimated hospital antibiotic consumption per population was slightly above the European average.

As the survival prognosis of cancer patients continues to improve, the improvement in quality of life during and after cancer treatment is becoming increasingly important 1. Exercise therapy has a positive effect on so-called "patient-reported outcomes" 2. The combination of endurance training and individualized strength training plays a particularly important role here. There is therefore a need for consistent and comprehensive implementation of quality-assured exercise therapy in everyday clinical practice.

Secondary malignancies (secondary cancers) are malignant diseases that occur at a certain time after cancer treatment. The malignant neoplasms can occur anywhere from 2 months to decades after cancer treatment. In addition, multiple tumor diseases can also develop due to a hereditary tendency to tumors. This article provides an overview of the causes, early detection and individual treatment.

The number of people living with or after cancer is steadily increasing due to an ageing society and improved cancer treatment. However, once treatment has been completed, the consequences of the disease are often felt for a long time. These affect many different areas of life and often lead to a high level of suffering and need for care. Psycho-oncological support offers effective support for many of those affected.

In Germany, around 80000 people are currently dependent on permanent renal replacement therapy (RRT). Due to demographic developments and improvements in life expectancy, the prevalence will continue to increase even if the effects of newer pharmacological substances such as SGLT2 inhibitors and GLP1 agonists are promising in inhibiting progression. There are basically three different methods of renal replacement therapy and their variants: Kidney transplantation (KTX), peritoneal dialysis (PD), hemodialysis (HD)/hemodiafiltration (HDF). The life expectancy of dialysis patients is reduced by around 67% compared to the normal population, particularly due to cardiovascular and infection-related complications. PD and HD are considered to be equivalent in terms of mortality. Currently, HDF is increasingly coming back into focus after the last randomized controlled trial (CONVINCE trial) proved its superiority over conventional HD. Kidney transplantation is clearly superior to dialysis therapy in terms of life expectancy; according to a meta-analysis, the risk of death is reduced by around 55% in comparison.