Emergency physicians must be familiar with the basics of treating pregnant women and pregnancy-related emergencies. Pregnant women who present at an emergency department are usually victims of accidents. Others suffer fr...Emergency physicians must be familiar with the basics of treating pregnant women and pregnancy-related emergencies. Pregnant women who present at an emergency department are usually victims of accidents. Others suffer from illnesses that are not directly related to pregnancy. Quite a few women of childbearing age are surprised to learn that they are pregnant during the diagnostic process.
Pregnant patients rarely constitute emergencies in the prehospital setting; however, they pose a particular challenge for emergency medical services personnel, as the physiological characteristics of pregnancy must be un...Pregnant patients rarely constitute emergencies in the prehospital setting; however, they pose a particular challenge for emergency medical services personnel, as the physiological characteristics of pregnancy must be understood, pregnancy-related conditions must be included in the differential diagnosis, and specific trauma consequences must be considered. This article is based on the xABCDE and SAMPLER standard care protocols.
Dtsch Med Wochenschr
· 2026 Mar · PMID 41871550
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Organ donation is a rare occurrence in intensive care units. At most, 3% of all intensive care patients die of irreversible loss of brain function 1 - and only certain patients can be potential organ donors. The followin...Organ donation is a rare occurrence in intensive care units. At most, 3% of all intensive care patients die of irreversible loss of brain function 1 - and only certain patients can be potential organ donors. The following "step-by-step" article outlines the conditions and procedures for postmortem organ donation.
Dtsch Med Wochenschr
· 2026 Mar · PMID 41871549
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Genetic kidney diseases are diverse. Autosomal dominant polycystic kidney disease and the Alport spectrum, together with many rarer genetic forms, cause chronic kidney disease (CKD) to a significant extent. Genetic diagn...Genetic kidney diseases are diverse. Autosomal dominant polycystic kidney disease and the Alport spectrum, together with many rarer genetic forms, cause chronic kidney disease (CKD) to a significant extent. Genetic diagnostics are increasingly being used, but genetically confirmed diagnoses are still often overlooked - even though a confirmed diagnosis often has a decisive influence on disease management.
Smaxwil C, Valina U, Senne M
… +5 more, Aschoff P, Rischpler C, Winter-Emden J, Klasen C, Zielke A
Dtsch Med Wochenschr
· 2026 Mar · PMID 41871548
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A 75-year-old female patient presented with persistent cough and exertional dyspnea. Initial CT imaging revealed extensive mediastinal lymphadenopathy associated with a suspicious right-sided thyroid nodule and bilateral...A 75-year-old female patient presented with persistent cough and exertional dyspnea. Initial CT imaging revealed extensive mediastinal lymphadenopathy associated with a suspicious right-sided thyroid nodule and bilateral cervical lymph nodes.Fine-needle aspiration confirmed follicular thyroid carcinoma with cervical lymphogenous metastases. Molecular analysis detected no actionable mutations. FDG-PET-CT demonstrated multiple mediastinal and bihilar lymph node metastases and a small osseous metastasis in the left iliac bone.Advanced follicular thyroid carcinoma with extensive mediastinal lymphatic metastases and no curative treatment option.Following multidisciplinary tumor board discussion, palliative therapy with the tyrosine kinase inhibitor (TKI) lenvatinib was initiated. After eight months of treatment, a marked reduction in mediastinal tumor mass enabled total thyroidectomy with lymphadenectomy. Subsequently, adjuvant radioiodine therapy (5.5 GBq I-131) was performed. Histology revealed an anaplastic thyroid carcinoma with partial squamous differentiation. Six months postoperatively, due to metastatic progression, systemic combination therapy with lenvatinib and pembrolizumab was started. The patient remains in stable general condition under this regimen.In selected cases, initially palliative TKI therapy can lead to a neoadjuvant effect and enable a curative approach. Continuous multidisciplinary management and close follow-up are essential for successful outcomes.
Nemeth A, Friedel G, Groß T
… +5 more, Spengler W, Hahn J, Wolfer H, Schlensak C, Steger V
Dtsch Med Wochenschr
· 2026 Mar · PMID 41871547
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Primary lung cancer is the most common cause of death from malignant tumors in industrialized countries worldwide. Non-small cell lung cancer (NSCLC) is the most commonly diagnosed form of this disease, accounting for ap...Primary lung cancer is the most common cause of death from malignant tumors in industrialized countries worldwide. Non-small cell lung cancer (NSCLC) is the most commonly diagnosed form of this disease, accounting for approximately 85% of cases 1. The aim of this paper is to present an analysis of surgical treatment options in the early stages of NSCLC, including the indications for surgical intervention and the various surgical techniques.
Dtsch Med Wochenschr
· 2026 Mar · PMID 41871546
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Lung cancer remains one of the most prognostically unfavourable malignancies and is the leading cause of cancer-related mortality worldwide. The most significant risk factor is active smoking, which accounts for over 85%...Lung cancer remains one of the most prognostically unfavourable malignancies and is the leading cause of cancer-related mortality worldwide. The most significant risk factor is active smoking, which accounts for over 85% of lung cancer deaths. Approximately 8 million people die annually from tobacco-related causes - the primary driver of lung cancer - exceeding the combined mortality from HIV, malaria, and tuberculosis. Although substantial advances have been made in recent years regarding treatment options for lung cancer, rapid diagnosis remains of paramount importance. The often late diagnosis, due to absent early symptoms and nonspecific clinical presentation, significantly worsens patient outcomes. This underscores the need for heightened diagnostic vigilance, particularly in high-risk populations, along with rapid and systematic diagnostic procedures. The patient's general clinical condition and ability to tolerate therapy form the basis of the initial diagnostic workup. Accurate staging is critical for treatment planning and prognostic assessment. The following overview summarizes the key diagnostic steps for early detection and effective therapy planning in lung cancer.
Dtsch Med Wochenschr
· 2026 May · PMID 41862211
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Amiodarone, a potent antiarrhythmic drug, may cause thyroid dysfunction due to its high iodine content. Both hypo- and hyperthyroidism can occur. Early diagnosis, differentiation of subtypes, and individualized therapy a...Amiodarone, a potent antiarrhythmic drug, may cause thyroid dysfunction due to its high iodine content. Both hypo- and hyperthyroidism can occur. Early diagnosis, differentiation of subtypes, and individualized therapy are essential to prevent severe complications and improve patient outcomes.
Latus J, Peschel K, Eitel I
… +4 more, Handtke C, King AV, Seemann I, Knebel F
Dtsch Med Wochenschr
· 2026 May · PMID 41839213
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BACKGROUND: Patients with cardiovascular, renal, and metabolic diseases are at increased risk of hyperkalemia, particularly when treated with RAASi. However, data on the management of hyperkalemia in German primary care...BACKGROUND: Patients with cardiovascular, renal, and metabolic diseases are at increased risk of hyperkalemia, particularly when treated with RAASi. However, data on the management of hyperkalemia in German primary care practices are limited. METHODS: The retrospective, cross-sectional study WATCH-K included 411202 patients from primary care practices with documented chronic kidney disease (CKD), heart failure (HF), hypertension, and/or diabetes mellitus, all at elevated risk for hyperkalemia. Patients were observed for ≥1 year. The study analyzed the frequency of serum potassium measurements, the prevalence and diagnosis of hyperkalemia, and its treatment with potassium binders. RESULTS: In the overall population 70.8% of patients received RAASi therapy, and 35.2% had their serum potassium levels measured at least once during the year, most frequently among patients with CKD (44.8%) and HF (42.8%). Among all patients tested, 24.5% (n=35368) showed hyperkalemic values, but only 2.0% (n=696) had a recorded diagnosis. Only 10.9% (n=76) of them were treated with potassium binders, and only 15.8% (n=12) of them received modern agents such as sodium zirconium cyclosilicate or patiromer. CONCLUSION: The management of hyperkalemia in high-risk patients in German primary care should be significantly improved through more frequent potassium monitoring and guideline-directed use of potassium binders to enhance patient outcomes. Furthermore, exploring the reasons behind the cautious use of medication to treat hyperkalemia may provide valuable insights.
Herth F, Schreiber J, Mokros I
… +2 more, Schwitalla JC, Vetter C
Dtsch Med Wochenschr
· 2026 Apr · PMID 41825462
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OBJECTIVE: Description of treatment and prescription patterns among asthma patients in the regions of Magdeburg (MD) and Mannheim (MA) compared nationwide. METHODS: We analyzed IQVIATM LRx data 1 from the period of July...OBJECTIVE: Description of treatment and prescription patterns among asthma patients in the regions of Magdeburg (MD) and Mannheim (MA) compared nationwide. METHODS: We analyzed IQVIATM LRx data 1 from the period of July 2022 to June 2023. The prescription database LRx covers about 80% of prescriptions for patients in the statutory health insurance in Germany. A machine learning model was used to assign the indication of asthma to patients with ≥ 1 redeemed GKV prescription for respiratory diseases. RESULTS: In this analysis, 2992487 patients with asthma were identified in Germany ( MD 20692; MA 55302), of which 30% were assigned to GINA stage 4 (MD 33%; MA 30%) and 4% to GINA stage 5 (MD 5%; MA 5%) (GINA: Global Initiative for Asthma 2). Only 27% of the patients had ≥ 1 prescription from pulmonologists (MD 37%; MA 28%). Among all patients, 13% showed signs of uncontrolled asthma (MD 12%; MA 13%). Of these, 21% were eligible for biologics (Bx) (MD 22%; MA 20%), of which 16% received ≥ 1 Bx prescription (MD 18%; MA 18%). Only 11% of patients with uncontrolled asthma had no acute oral corticosteroid (OCS) prescriptions (MD 10%; MA 9%), whereas among patients continuously treated with biologics, 58% had no OCS prescriptions (MD 68%; MA 75%). Nationwide nearly 24% of continuously with Bx treated patients (MD 24%; MA 31%) redeemed prescription of low to medium dose inhaled corticosteroids (ICS). CONCLUSION: Patients with severe asthma or signs of uncontrolled asthma require additional care from pulmonologists. Despite all observed regional differences in care, identifying patients with uncontrolled asthma and promptly referring them to pulmonologists is an important approach for improvement. In real-world care, treatment of severe uncontrolled asthma with biologics has the potential to reduce the use of oral and inhaled corticosteroids.
Dtsch Med Wochenschr
· 2026 Mar · PMID 41802427
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Recent advances in progressive pulmonary fibrosis treatment include three major developments: Nerandomilast, a selective PDE4B inhibitor, demonstrated significant reduction in FVC decline in Phase III trials for both IPF...Recent advances in progressive pulmonary fibrosis treatment include three major developments: Nerandomilast, a selective PDE4B inhibitor, demonstrated significant reduction in FVC decline in Phase III trials for both IPF and PPF, with improved tolerability compared to current antifibrotics and expected EMA approval in 2026. Inhaled treprostinil received FDA approval in May 2025 as the first specific therapy for PH-ILD in the US, based on the INCREASE study showing improved exercise capacity, with ongoing TETON studies investigating its antifibrotic potential in IPF/PPF. Additionally, German guidelines propose expanded PPF progression criteria beyond international definitions to include more clinical parameters and prevent therapy exclusion of relevant patient groups. These developments mark the first potential new antifibrotic options in over a decade and promise multimodal treatment approaches combining systemic and inhaled therapies.
Dtsch Med Wochenschr
· 2026 Mar · PMID 41802426
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Iron deficiency in patients with heart failure is frequently underdiagnosed or inadequately treated. This may be largely attributable to differences in the diagnostic criteria compared to those applied in individuals wit...Iron deficiency in patients with heart failure is frequently underdiagnosed or inadequately treated. This may be largely attributable to differences in the diagnostic criteria compared to those applied in individuals without chronic disease. Nonetheless, the clinical relevance of identifying and treating iron deficiency in this population is substantial. Numerous studies have demonstrated that intravenous iron therapy not only alleviates symptoms and improves quality of life and exercise capacity, but also reduces the combined endpoint of morbidity and mortality. This review discusses current and emerging definitions of iron deficiency in the context of heart failure, emphasizing their implications for diagnosis. Furthermore, it summarizes the available evidence on clinical outcomes and provides an overview of established and evolving therapeutic strategies.
Dtsch Med Wochenschr
· 2026 Mar · PMID 41802425
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The increasing incidence of infections fueled by novel host factors and the rising prevalence of drug-resistant isolates are growing global concerns. Outbreaks of and fluconazole-resistant are reported globally, posi...The increasing incidence of infections fueled by novel host factors and the rising prevalence of drug-resistant isolates are growing global concerns. Outbreaks of and fluconazole-resistant are reported globally, posing a major threat to immunocompromised and critically ill patients. The rising resistance to azoles and echinocandins among presents additional challenges. In May 2025, the European Confederation of Medical Mycology (ECMM) published a new global guideline on the diagnosis and management of infections. Notable updates include the use of a revised taxonomy, an increased focus on non-albicans species, and recommendations on newly approved antifungal agents. New breakpoints have been published by EUCAST for . The newly licensed echinocandin Rezafungin broadens the therapeutic options available for invasive candidiasis. Ibrexafungerp and Fosmanogepix are promising alternative treatment options for systemic infections in late-stage clinical development.
Dtsch Med Wochenschr
· 2026 Mar · PMID 41802424
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Molecular diagnostics now also plays an essential role in treatment planning in the early and late stages of non-small cell lung cancer (NSCLC). Following surgical resection or chemoradiotherapy, two targeted substances,...Molecular diagnostics now also plays an essential role in treatment planning in the early and late stages of non-small cell lung cancer (NSCLC). Following surgical resection or chemoradiotherapy, two targeted substances, osimertinib and alectinib, are now approved for adjuvant treatment. In resectable NSCLC, treatment with checkpoint inhibitors can be administered in an adjuvant, neoadjuvant, or perioperative setting. In metastatic stages, chemotherapy, immunotherapy, and targeted therapies are the therapeutic cornerstones with multiple drugs being tested in clinical studies. Immunotherapy has also become an established treatment option in the early stages of NSCLC and small cell lung cancer (SCLC). Based on the ADRIATIC study (durvalumab after simultaneous radiochemotherapy), this therapy was approved for SCLC, as it was for NSCLC.
Dtsch Med Wochenschr
· 2026 Mar · PMID 41802423
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Obesity is currently considered as adiposity based chronic disease with BMI as therapeutic target for prevention of obesity associated complications. For treatment of obesity, a stepwise approach is recommended including...Obesity is currently considered as adiposity based chronic disease with BMI as therapeutic target for prevention of obesity associated complications. For treatment of obesity, a stepwise approach is recommended including multifactorial basal therapy with nutrition counseling, exercise training and behavior modification. Further steps comprise adjuvant pharmacological treatment and bariatric surgery. With the development of incretin based medications that activate GLP-1 and GIP receptors for increase in satiety, an impressive improvement in effectivity of obesity medications is observed. Licensed substances in Germany include the GLP-1 receptor agonists liraglutide and semaglutide, and the GLP-1/GIP receptor coagonist tirzepatide. Trial data reveal weight losses of on average 7.5 kg after 160 weeks for liraglutide, up to 17.4 kg after 68 weeks for semaglutide, and up to 22.5 kg after 72 weeks for tirzepatide. In addition, semaglutide demonstrated positive results in cardiovascular outcome trials. The weight reducing effects of incretin based substances are close to those achieved by bariatric interventions, therefore closing the gap between lifestyle intervention and bariatric surgery.
Dtsch Med Wochenschr
· 2026 Mar · PMID 41802422
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Vascular malformations often impair patients' quality of life for many years, frequently following a prolonged period of misdiagnoses and unsuccessful treatments. Advances in genetic diagnostics have fundamentally reshap...Vascular malformations often impair patients' quality of life for many years, frequently following a prolonged period of misdiagnoses and unsuccessful treatments. Advances in genetic diagnostics have fundamentally reshaped classification and opened the door to individualized therapeutic approaches. In addition to established modalities such as sclerotherapy, embolization, and surgery, targeted pharmacologic therapies - including mTOR and MEK inhibitors - are expanding the treatment spectrum. Increasing emphasis is also placed on a patient-centered perspective, with systematic assessment of symptoms, functional limitations, and psychosocial burden. For clinical practice, this means recognizing red flags early, referring patients promptly to specialized centers, and ensuring interdisciplinary care focused on quality of life.