Deutsche medizinische Wochenschrift (1946)最新文献

The Hippocratic Oath is one of the most known medical texts. Despite its importance, it was rarely used in art and music. There exist only two complex musical settings of the Hippocratic Oath: "SERMENT-ΟΡΚΟΣ pour chœur mixte" ("Oath for mixed chorus") by Iannis Xenakis (1922-2001) and "Der Eid des Hippokrates für Klavier zu 3 Händen" ("The Hippocratic Oath for piano three hands") by Mauricio Kagel (1931-2008). Both being among the most important composers of the 20^th century: Xenakis attempted to apply stochastic processes to his compositional techniques and Kagel is considered a pioneer of instrumental theatre. Both musical settings of the Hippocratic Oath were commissioned by medical institutions: Xenakis composed the work "Serment" in 1981 as a commission for the 15^th World Congress of the "International Society of Cardiovascular Surgery" in Athens. "Der Eid des Hippokrates" was composed by Kagel in 1984 on behalf of the German medical journal "Deutsches Ärzteblatt". Both works are therefore intended for medical practitioners and both are influenced by the pathography of the two composers. This article will present results of the analysis and interpretation from a medical-historical perspective.

The 1960s saw a fundamental shift in everyday nursing care, from an understanding of nursing that encompassed the body and soul of the sick to a biomedical understanding of illness. Due to economic constraints and a shortage of nursing staff, nursing work became more intense - as a result of rationalization and the resulting acceleration of work. This led to a reduction in contact between nurses and patients. Nurses responded by developing concepts of patient-oriented care or holistic care. The research for this article is based on the evaluation of nursing textbooks and the review of nursing journals.

Despite its cultural association with peace and joy, the Christmas season can act as a psychosocial stressor, triggering or exacerbating various fears or anxiety-related disorders. This article reviews the psychological and somatic dimensions of anxiety in the context of the holiday period, drawing from literature, art, and clinical observations. Specific phobias (e.g., santaclausophobia, decidophobia, dendrophobia), social anxiety disorder, and generalized anxiety disorder are discussed related to seasonal triggers. From a pathophysiological perspective, anxiety can induce dyspnea, tachycardia, palpitations, gastrointestinal symptoms, sweating and dizziness. Mechanisms such as sympathetic overactivity, hyperventilation-induced hypocapnia, corticotropin-releasing hormone effects and the function of the enteric nervous system with respect to anxiety are reviewed. Finally, the article discusses current therapeutic approaches for anxiety symptoms and anxiety- or fear-related disorders including cognitive behavioral therapy (CBT) with exposure exercises, pharmacological options (SSRIs, SNRIs), and complementary interventions such as breath-based relaxation techniques as well as spiritual approaches. In sum, the present article highlights the clinical importance of recognizing anxiety as a transdisciplinary phenomenon frequently encountered not only in psychiatry and psychotherapy, but also across cardiology, gastroenterology, pulmonology, neurology, and dermatology - particularly during periods of psychosocial vulnerability such as the holiday season.

Christian Albert Theodor Billroth (1829-1894) is primarily known as a pioneer of modern surgery among medical professionals today. During his entire life, however, he was also very musically inclined and was at the center of musical life wherever he worked. As a student, he was an active member of Göttingen University's musical circles, later he wrote concert reviews and organized private concerts in his home. In late 1865, he invited the composer and pianist Johannes Brahms (1833-1897) to such a soiree in Zurich. Henceforth, Brahms appreciated the surgeon as a correspondent on an equal footing - several letters to Brahms are proof of Billroth's effusive enthusiasm for new works by Brahms, and primarily also of his musical expertise. Billroth's soirees in Vienna often focused on Brahms, when luminaries such as the Hellmesberger String Quartet or Joseph Joachim played his newest works for Brahms, so that he could make final amendments before printing them. The present article sheds a light on the fascinating friendship of two central 19th-century figures.

Heart failure is the leading single cause of hospitalisation in Germany and places a heavy clinical and psychosocial burden on patients, families, and caregivers. Since 2021, evidence‑based management of heart failure with reduced ejection fraction (HFrEF) has centred on four pharmacological "pillars": β‑blockers, sacubitril/valsartan (or an ACE inhibitor), mineralocorticoid‑receptor antagonists, and sodium-glucose co‑transporter‑2 (SGLT‑2) inhibitors. While these agents improve survival and quality of life, they also predispose to adverse effects - most notably electrolyte disturbances. Hypo‑ or hyperkalaemia can precipitate malignant arrhythmias and therefore demands vigilant monitoring. Iron deficiency is equally prevalent in the heart‑failure population; randomised trials have primarily tested intravenous iron(III)‑carboxymaltose and iron(III)‑derisomaltose to correct this deficit. This review summarises the most recent epidemiological data for heart failure in Germany and Europe, outlines current guideline‑directed therapies, and highlights key treatment‑related complications clinicians must anticipate and manage.

A decline in glomerular filtration rate (GFR) is considered a physiological change in older age. Accurate estimation of the eGFR is essential not only for establishing a diagnosis but also for selecting appropriate medications and determining correct dosages, in order to avoid both under- and overdosing, as well as associated adverse drug reactions. In patients with signs of sarcopenia, relying solely on serum creatinine or creatinine-based eGFR may lead to an overestimation of kidney function. In older adults, the most accurate estimation of eGFR is achieved by using equations that combine creatinine and cystatin C. The currently recommended EKFC equation has been well validated in a large cohort of older European individuals. In cases of suspected kidney disease, a spot urine test for albumin and creatinine - with calculation of the albumin-to-creatinine ratio (UACR) - should also be performed in older adults.

For the first time, German recommendations for diagnosis and treatment of gout on an interdisciplinary S3 guideline level are available. For the diagnosis of a typical gout attack in a primary care setting, the typical clinical picture, medical history, and an elevated serum uric acid level are usually sufficient; gout might be diagnosed with the aid of the so-called gout calculator. For acute joint inflammations not typical of gout, specialist medical professionals may utilize additional diagnostic procedures such as joint sonography, joint aspiration with microscopic crystal detection, and dual-energy computed tomography. Once the diagnosis is confirmed, there are 2 pillars of gout treatment: short-term acute treatment of the attack; and target-oriented, causal uric acid-lowering therapy. Since patients with gout usually suffer from other cardio-metabolic-renal diseases, treatment of these conditions should also be optimized. In addition to recurrent gout inflammation, these diseases ultimately cause a higher rate of cardiovascular events and mortality. Although not primarily approved for gout, the group of SGLT2 inhibitors, due to their uricosuric side effect, represents a possible treatment option for patients with gout and corresponding comorbidities.

Thromboangiitis obliterans (TAO) is a rare cause of peripheral circulatory disorders and is fundamentally linked to nicotine consumption. Presumably due to the global decline in tobacco consumption, TAO is now rarely encountered even in vascular medicine practice. TAO has a fluctuating course and can present initially with acral necrosis. The application of clinical criteria according to Shionoya and the adequate interpretation of imaging with segmental occlusions and periarterial collaterals are essential for the diagnosis of TAO. Vasculitis, which occurs predominantly in younger men under the age of 45, is undergoing a clinical change and now more frequently affects women, more frequently occurs in patients over the age of 45, less frequently affects multiple extremities, and less frequently presents with thrombophlebitis. Early-onset peripheral artery disease (PAD) should be ruled out in the differential diagnosis. It can be difficult to distinguish cannabis arteritis in cases of simultaneous consumption. The therapeutic pillar of TAO, the etiology of which remains unclear to this day, is the immediate and complete cessation of tobacco use. To avoid amputations, escalating strategies involving systemic administration of prostaglandins, sympathectomy, and endovascular recanalization are often necessary. The prognosis for amputation-free survival is good under these circumstances.

Antineutrophil Cytoplasmic Antibody (ANCA)-associated Vasculitis (AAV) is a life-threatening systemic autoimmune disease. Break of tolerance against either proteinase 3 or myeloperoxidase is key to the disease etiology. Innate and adaptive immune cells cooperate and contribute to the inflammatory necrotizing small-vessel vasculitis. AAV can affect every organ and frequently affects the kidneys. Necrotizing crescentic glomerulonephritis is associated with worse patient outcome. Anti-inflammatory and immunosuppressive treatments are effective in inducing acute vasculitis remission but are associated with treatment-related morbidity and mortality. In 2024, Kidney Disease: Improving Global Outcomes (KDIGO) provided an update of the Clinical Practice Guideline for the Management of AAV patients with kidney manifestation. A major aspect of the update is the consequent reduction of glucocorticoid exposure to diminish glucocorticoid toxicity. The C5a receptor blocker avacopan allows significant reduction of the cumulative glucocorticoids during AAV induction treatment, while increasing sustained remission and improving the glomerular filtration rate. Therefore, avacopan is now considered in the guideline as an alternative to glucocorticoids. Other topics covered by the KDIGO experts are the use of cyclophosphamide and rituximab or combinations thereof in patients with severe kidney involvement for inducing AAV remission. Moreover, considerations for the use of plasma exchange are provided.