Deutsche medizinische Wochenschrift (1946)最新文献

Early Warning Systems (EWS) enable timely detection of clinical deterioration in hospitalized patients by systematically assessing vital signs. Tools like NEWS2, MEWS, and qSOFA help identify risk and trigger interventions, including activating Medical Emergency Teams (MET). Common causes of decline include infections, cardiovascular, respiratory, neurologic, or metabolic events. Regular monitoring - especially in high-risk or elderly patients - is essential. EWS improve patient safety and are increasingly part of quality measures, such as mandatory sepsis screening in Germany from 2026. Integration into digital records and staff training are key for effective implementation and outcome improvement.

The prevalence of overweight and obesity in children and adolescents constitutes a significant health issue associated with a range of comorbidities. In Germany, the care provided to these young patients is often insufficient. The introduction of a disease management programme (DMP) for obesity in children and adolescents aims to improve interdisciplinary and guideline-based care. This study examines the perceptions and evaluations of paediatricians regarding the current state of obesity care.An online survey was conducted among 9662 paediatricians in Germany. 802 participants delivered complete responses which were included in the study. They provided information on the frequency of obesity-related consultations, their decisions on addressing the issue, and the availability of treatment options.The majority of respondents (82,0%) rated the quality of care as poor or very poor. Time constraints and limited infrastructure were cited as the main barriers to effective obesity management. Only a small proportion of respondents reported access to a sufficient network of nutritional, exercise, and psychotherapeutic services.The findings highlight the urgent need for structured and comprehensive care options for children and adolescents with obesity, including improved infrastructure and the development of interdisciplinary services. The recent implementation of the DMP could play a pivotal role in sustainably improving the care landscape.

Status epilepticus is a common neurological emergency. Despite significant advances in emergency and intensive care medicine in recent years, status epilepticus continues to be associated with high mortality. In addition to knowledge and implementation of guideline-based treatment algorithms, an important factor for successful treatment of status epilepticus is, above all, the administration adequately high dose of benzodiazepines in the initial phase.

A 56-year-old man presented with low back pain radiating to the left leg.CT of the lumbar spine revealed reduced disc height and a vacuum phenomenon. MRI demonstrated a left-sided disc herniation at L3-L4, considered the cause of symptoms. Intraoperatively, however, the disc material appeared unusually dark and pigmented.Histological analysis confirmed ochronotic pigment deposits, leading to the diagnosis of alkaptonuria (AKU).The surgical procedure was completed as planned. Postoperatively, the patient was referred for further internal medicine evaluation and genetic counselling.When encountering atypically pigmented tissue, surgeons should consider rare metabolic disorders such as AKU, allowing early diagnosis and appropriate long-term management.

Antiaggregation with platelet function inhibitors (PFI) is an integral part of secondary prevention in patients with clinically manifest atherosclerotic vascular disease. The role of PFI in primary prevention is controversial. The current guidelines on peripheral arterial disease (PAD) and carotid stenosis recommend that patients who are clinically asymptomatic regarding vascular disease should not take PFI. However, the data on which this decision is based has a low level of evidence, and other international guidelines recommend antiaggregation in any case of plaques in the carotid.The present analysis of the literature shows that the blanket statement that patients with asymptomatic carotid atherosclerosis (stenosis degree <50%) and PAD do not require prophylactic PFI neither considers the extent nor the morphology of the underlying atherosclerosis. The indication for PFI in patients with asymptomatic atherosclerosis should always be determined individually, considering both the extent of the atherosclerosis and the personal risk of bleeding and ischemia.

In 1875, two German neurologists simultaneously described a previously unknown phenomenon in the same medical journal: Carl Westphal (1833-1890) referred to it as the "phenomenon of the lower leg", while Wilhelm Erb (1840-1921) called it the "patellar tendon reflex".This novel observation quickly attracted significant attention from the international medical community. Yet many questions remained unanswered: Was this truly a reflex transmitted via the tendons? Nothing comparable had been described before. Where in the spinal cord could its neural circuitry be localized? And how might this phenomenon be clinically useful?Further complicating its classification was the observation that the reflex could occur in both patients and healthy individuals - but inconsistently, and at times not at all.Moreover, critical voices from neighboring France repeatedly claimed that Erb and Westphal had merely repackaged previously known findings as their own.Drawing on extensive research of 19^th-century medical literature, this account traces the initial descriptions of the reflex, the subsequent scientific investigations, and its eventual incorporation into clinical neurological practice.

The fate of dementia patients often causes deep emotional crises for those living with the disease as well as their relatives. The inevitable loss of personal memories, identity and ultimately of basic bodily functions is deeply frightening and thus makes the neurodegenerative condition a predestined pathology for dramatic roles in film tragedies. Since the 1980s, the subject of dementia - in correlation with its increasing prevalence - has frequently been incorporated into feature films, however initially in minor productions and TV movies. This began to change in the 1990s and the new millennium was the beginning of a genuine boom for this subgenre, leading to overwhelming public, box office and critical success. Dementia has arrived in the repertoire of filmmakers and recent productions such as Robert and Frank (2012), Falling (2020) or The Father (2020) have reached millions of viewers and shaped their perception of the disease. Therefore the taboo surrounding dementia is gradually broken, reducing fears, misconceptions and prejudices in the population. While this trend should be viewed positively, it nevertheless has its downsides: dementia films tend to equate the progress of the disease with a regression into the infantile, to portray love as a potent antagonist of the condition and to glorify the (vegetative) final stage as a mystical-pantheistic state. Such trivialization by mass media may lead to an underestimation of both the patients' suffering as well as the Herculean task of caring for dementia patients. This can create new challenges in the healthcare of patients, issues that physicians should be aware of in the future whenever advising patients affected or their relatives.

Lemuel Gulliver's travelogues were published 300 years ago. Gulliver's fame is well-founded: only a limited number of sailors endured one long sea voyage, while he survived four, experiencing numerous strange and challenging adventures. Some of his encounters raise medical questions or have found their way into medical terminology; others relate to long forgotten diseases or reflect the travel literature and fantastic tales of his era; still others make direct reference to scientific experiments entirely new in those days; and ultimately, all of them question the seemingly obvious values of humanity and medicine.

Friedrich Theodor von Frerichs (1819-1885) was born in the rural northern German region of East Frisia and rose to fame as one of the most influential physicians and medical scientists in 19^th-century Europe. His work paved the way for the 19^th-century transition of medicine from a practice largely based on doctrines and traditions to an empirical science. As an internist, he was a pioneer in the fields of hepatology, gastroenterology, nephrology, and diabetology. His approach to academia and teaching set an example for medical schools around the world. In 1882, he founded the German Society of Internal Medicine and the Congress of Internal Medicine, the 132^nd edition of which will take place in its inaugural city of Wiesbaden in 2026.