Deutsche Medizinische Wochenschrift Research Articles

Co-Morbidities and Treatment Decisions in Newly Diagnosed CLL Patients Cross All Disease Stages in Kurdistan Region-Iraq

Co-Morbidities and Treatment Decisions in Newly Diagnosed CLL Patients Cross All Disease Stages in Kurdistan Region-Iraq

Kurt Huldschinsky: A pioneer in the struggle against rickets

Kurt Huldschinsky (1883-1940) was a German pediatrician who was one of the international leaders in the field of rickets research between the two world wars. After his medical studies, he served at the Kaiserin-Auguste-Victoria-Haus in Berlin and at the University Children's Hospital in Vienna, among other places. After World War I, he worked with the famous orthopedist Konrad Biesalski at the Oskar-Helene-Heim for the healing and education of frail children in Berlin. Here he was the first to prove that exposure to ultraviolet (UV) radiation from mercury vapor lamps ("artificial sunlight") could cure rickets in young children, which is mostly caused by vitamin D deficiency. He published his discovery in this journal - the Deutsche Medizinische Wochenschrift [German Medical Weekly] - in 1919. For this groundbreaking scientific achievement and his further research into the prevention and treatment of rickets, Huldschinsky was awarded the Otto Heubner Prize of the German Association of Pediatrics in 1926. He was even nominated for the Nobel Prize in Medicine. As a Jew, however, he had to flee Germany from the National Socialists in 1933/34. Together with his wife and daughter, he emigrated to Egypt, where he died in Alexandria on October 31, 1940. As Huldschinsky was for many decades almost forgotten, this article recalls the life and work of a meritorious physician and scientist.

THE COMPANY YOU KEEP: A CASE OF REFRACTORY HYPOXEMIC RESPIRATORY FAILURE, THYROID STORM, AND SYSTOLIC HEART FAILURE IN THE POSTPARTUM PERIOD

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: We present a case of acute hypoxemic respiratory failure from flash pulmonary edema in a new mother with Graves’ disease. CASE PRESENTATION: A 36 year old woman, four days postpartum with history of Graves’ disease and pre-eclampsia presented in acute respiratory distress. On admission, she had a systolic BP > 200 mmHg, sinus tachycardia to 150 BPM, bilateral patchy pulmonary infiltrates, and profound hypoxemia requiring intubation. Severe hypoxemia persisted despite paralysis and lung recruitment maneuvers, therefore airway pressure release ventilation (APRV) was used as a rescue strategy. Thyroid studies suggested evidence of thyroid storm (low TSH, high free T3, normal free T4 and a Burch-Wartofsky score of 70). Intravenous esmolol was initiated to achieve peripheral beta blockade but was complicated by PEA arrest. Return of spontaneous circulation was achieved after five minutes of CPR. An echocardiogram showed biventricular failure and ejection fraction of 30%. Hydrocortisone, propylthiouracil, and iodine were initiated for thyroid storm and eventually she was extubated. Repeat echocardiogram revealed recovered ejection fraction of 60%. She was discharged in stable condition on methimazole with close follow-up. DISCUSSION: Therapies invariably consist of both positive and negative effects. The role of an intensivist is to weigh these risks and benefits, make sound judgement, and adapt to unintended consequences. This patient presented in extremis with hypoxemic respiratory failure from flash pulmonary edema. Her history of Graves’ disease combined with laboratory and clinical data pointed strongly to thyroid storm. The best evidence suggests that early treatment of thyroid storm is crucial and mortality rates rise to 75% with delays in therapy. While beta-blockade is considered first line therapy to treat the effects of uncontrolled thyroid hormone, in this case it undoubtedly led to cardiac arrest. Following the successful resuscitation, it was clear that RV dysfunction paired with high intrathoracic pressures generated by APRV mode should be seen as a death knell if paired with beta blockade. Opposing the sympathetic surge and tachycardia required to maintain cardiac output, our patient quickly decompensated, with loss of chronotropy and RV failure leading to cardiac arrest. Rapid removal of the short-acting agent esmolol, along with resuscitative efforts were able to quickly correct the untoward effects and the patient made a full recovery. CONCLUSIONS: This case offers a unique presentation of thyroid storm and highlights the duality of therapies. A high level of suspicion is required for timely diagnosis of thyroid storm and early treatment is critical. Despite this, the benefits of therapy cannot be seen in a vacuum and we must strive to understand the potential negative consequences in our quest to provide exceptional critical care. Reference #1: Chiha M, Samarasinghe S, Kabaker AS. Thyroid Storm: An Updated Review. Journal of Intensive Care Medicine. August 5, 2013. Volume: 30 issue: 3, page(s): 131-140. Reference #2: Karger S, Führer D. Thyroid storm--thyrotoxic crisis: an update. Dtsch Med Wochenschr. 2008;133(10):479-484. doi:10.1055/s-2008-1046737 DISCLOSURES: No relevant relationships by Paul Cooper, source=Web Response No relevant relationships by Dustin Fraidenburg, source=Web Response No relevant relationships by Janae Gonzales, source=Web Response No relevant relationships by Malvika Kaul, source=Web Response No relevant relationships by Shuvani Sanyal, source=Web Response No relevant relationships by Christen Vagts, source=Web Response

Thrombectomy and Thrombolysis by Catheter Through Right Gastroepiploic Vein of Acute Superior Mesenteric Venous Thrombosis with Peritoneal Signs

Thrombectomy and Thrombolysis by Catheter Through Right Gastroepiploic Vein of Acute Superior Mesenteric Venous Thrombosis with Peritoneal Signs

The Pandemic Influenza 1918

The pandemic influenza 1918 was the greatest pandemic of the 20th century with a high death toll worldwide. Due to the wartime, the public reaction in Germany to the pandemic was subdued. The international scientific debate in Europe began with the first publications by the Deutsche Medizinische Wochenschrift in July 1918. One of the many open questions was the search for the infectious agent causing influenza which was not solved until 1930. The historical publications and additional later research clearly point to the prominent role of bacterial coinfections for the high rate of complications and deaths during the pandemic. This article lines out the scientific debate from 1918 until now.

39-year-old man with 15 years lasting pain in both hands

In the article "39-year-old patient with years of pain in both hands" (Dtsch Med Wochenschr 2015; 140: 1231) have called the names of the authors Klaus Muehlenberg, Claudia Metzler and Oliver Pech.

The effect of a conflict of interest disclosure form using closed questions on the number of positive conflicts of interest declared – a controlled study

Objective. While declarations of conflicts of interest (COI) have become an integral part of medical articles, COIs are often not declared completely and accurately. One of several possible reasons for deficient COI declarations is the lack of standardized and comprehensive COI forms. In 2010, the International Committee of Medical Journal Editors (ICMJE) introduced a COI form using clear definitions and closed questions. Deutsches Ärzteblatt (DA), the journal of the German Medical Association, adapted this form and implemented it in early 2011. However, it is unclear whether changing COI forms leads to more positive COI statements.Material and Methods. In a controlled pre-post design, positive COI statements were analyzed at three German medical journals: one had changed its COI form (DA), two had not: Deutsche Medizinische Wochenschrift (DMW) and Nervenarzt (Ner), both of whom used open questions in their forms. At the levels of both authors and articles, respectively, the proportion of positive COI declarations in orignal and review articles was recorded for volumes 2010 (before implementation of the new COI form at DA) and 2012 (after). The change in positive COI disclosures at the journals was compared. Chi-square tests were used to compare the figures by journal in 2010 versus 2012 and among DA, DMW, and Ner.Results and Discussion. While positive COI statements more than doubled at DA, there was no meaningful change in either of the control journals: In 2010, 19.1% [95% CI: 15.4–23.2] of all DA-authors submitted positive COI declarations, relative to 39.6% [35.0–44.5] in 2012, a factor of 2.1. At the level of articles, positive COI statements increased from 32.3% [23.7–42.0] to 70.1% [60.5–78.6] (factor 2.2). At DMW, positive declarations rose by a factor of 1.3 to 12.1% [9.7–14.8] in 2012 at author level and by a factor of 1.3 to 19.4 [14.2–25.7] for articles. At Ner, figures fell: to 19.9% for authors [16.9–23.4] and 30.7% for articles [24.0–38.1] (both by a factor of 0.8). P-values for the comparison of positive COI statements between 2010 and 2012 were low at DA (p for both author and article level comparisons <0.00001) and considerably higher at DMW and Ner (all >0.05). Although this is not a randomized controlled study, the findings support the hypothesis that the steep increase in positive COI statements at DA from 2010 to 2012 is the result of its new COI form: Relative to two journals that had not modified their COI forms the effect size of the change was considerably higher at DA. Also, in contrast to DMW and Ner, p-values indicate that chance is unlikely to have played a major role in the change of positive COI statements at DA.Conclusions. COI forms employing closed questions based on clear definitions of conflicts of interests, such as those recommended by ICMJE and now used by Deutsches Ärzteblatt, seem to be superior to less structured forms. These results require confirmation with other COI forms and at other journals.

Mesenchymal stem cells and cardiac regeneration: a sophisticated approach depends on trophic effects—what's left over? Focus on “Activation of Toll-like receptor 3 amplifies mesenchymal stem cell trophic factors and enhances therapeutic potency”

application of stem cells for tissue, in particular cardiac, regeneration represents a promising field of investigation but has not achieved clinical utility ([Fig. 1][1]). From the latter point of view, Strauer and colleagues ([7][2]) in 2001 achieved an important milestone by their administration

Takotsubo cardiomyopathy resembling acute high lateral myocardial infarction

A 65-year-old female patient admitted to the emergency department was diagnosed with acute high lateral myocardial infarction, but later Takotsubo cardiomyopathy (TC) was discovered. She had squeezing chest pain that started shortly after an emotional stress. The electrocardiogram revealed a loss of R wave voltage in leads V1 to V4 and an ST-segment elevation in I and aVL. After an urgent coronary angiography and ventriculography, TC was considered, and supportive anti-ischemic treatment was started. The severe left ventricular systolic dysfunction improved and normalized during the follow-up. She was discharged without any complications. TC is a new entity of acute cardiac events, and patients usually recover completely without sequelae with proper diagnosis and management. An exact diagnosis may also prevent an inappropriate application in the setting of recurrences.

Asterixis (Flapping Tremors) As an Outcome of Complex Psychotropic Drug Interaction

Asterixis (Flapping Tremors) As an Outcome of Complex Psychotropic Drug Interaction

The role of endoscopy in the management of choledocholithiasis

The role of endoscopy in the management of choledocholithiasis

Who Discovered the Erythrocyte Sedimentation Rate?: Figure 1.

To the Editor: Recently, an interesting discussion concerning the application of erythrocyte sedimentation rate (ESR) and C-reactive protein appeared in The Journal , with inaccurate information about the history of the discovery of the ESR. Crowson and colleagues in the article1 and later2 suggested that discovery of the ESR occurred in the 1920s. However, the discovery was not made at that time, but at the end of the 19th century. For the sake of the highest standards of discussion, we would remind readers that the discoverer of ESR was a Polish physician, Edmund Faustyn Biernacki (1866–1911; Figure 1)3,4,5,6,7. Figure 1. Edmund Faustyn Biernacki (1866–1911). Reproduced from Biernacki E. Drukarnia Granowskiego i Sikorskiego, 189911. Biernacki announced the discovery in 1897 in 2 articles simultaneously: one in Polish in Gazeta Lekarska 4, the second in German in the Deutsche Medizinische Wochenschrift 5. It is also possible to identify the … Address correspondence to Dr. Grzybowski; E-mail: ae.grzybowski{at}gmail.com

An Alternative Technique for Genioglossus Muscle Advancement in Phase I Surgery in the Treatment of Obstructive Sleep Apnea

Surgery continues to be a mainstay in the management of patients with obstructive sleep apnea. The only 100% cure for upper airway obstruction is the tracheostomy, first described for this use by Kuhlo et al 1 Kuhlo W. Doll E. Franck M.D. Erfolgreiche behandlungeines Pickwick syndromes durh eine dauertrachealkanule. Dtsch Med Wochenschr. 1969; 94: 1268 Crossref Scopus (122) Google Scholar in 1969. Because of the numerous comorbidities associated with tracheostomy, most patients are reluctant to undergo this procedure. The standard of care currently follows a 2-stage surgical approach, as put forth by the Riley-Powell Stanford protocol. 2 Riley R. Powell N. Guilleminault C. Inferior mandibular osteotomy and hyoid myotomy suspension for obstructive sleep apnea: A review of 55 patients. J Oral Maxillofac Surg. 1989; 47: 159 Abstract Full Text PDF PubMed Scopus (126) Google Scholar Stage I involves a combinations of procedures including uvulopalatopharyngoplasty, nasal surgery, surgery of the base of the tongue, hyoid suspension, and anterior mandibular osteotomy with genioglossus muscle (GG) advancement. Stage II is used in those patients in whom Stage I fails, as evidenced by lack of improvement on polysomnography. Stage II surgery involves maxillomandibular advancement and has been shown to be highly successful.

Citations Count

Citations rule the world—at least the world of academic medicine. Because of the importance of the impact factor, medical journals are dependent on being cited as often as possible in other medical journals. This is also true of Deutsches Arzteblatt International, which, after its inclusion in the Science Citation Index in 2009, is expecting its first impact factor in 2011 (1). In this situation, it is easy to forget that citations in the lay press too are important for medical journals. Being mentioned in the general media may not enhance the impact factor, but is a sign of how important the public deems a journal. By studying the German lay press one can gain an impression as to whether the prejudice that medicine is completely anglicized is correct. Is it really true that only English language journals are important in the work of a German medical journalist? We have analyzed how often leading German lay media mentioned German and English language medical journals in the course of the preceding eight years. The analysis was based on six medical journals, which are comparable, as they all appear weekly and all cover a variety of medical subjects: the New England Journal of Medicine, JAMA, the British Medical Journal, Deutsche Medizinische Wochenschrift, Munchener Medizinische Wochenschrift, and Deutsches Arzteblatt (for details of the methods, see the Box). Box The frequency was examined of the citations of the scientific content of the following weekly medical journals: the New England Journal of Medicine, the Journal of the American Medical Association (JAMA), the British Medical Journal (BMJ), Deutsche Medizinische Wochenschrift, Munchener Medizinische Wochenschrift—Fortschritte der Medizin, and Deutsches Arzteblatt. The journals selected were all clinically orientated magazines for general medicine (rather than specialized journals). The survey was based on the results of a search in the online search machines of FAZ, Welt, SZ, Spiegel, and Zeit. The search only covered central printed products, so that, for example, the Frankfurter Allgemeinen Sonntagszeitung (Sunday Newspaper), the SZ Magazin and Spiegel Online were excluded. For reasons of capacity, we could only consider five of the important and serious printed media in Germany. All journal names were searched for under their complete titles (e.g. New England Journal of Medicine, Munchener Medizinische or Munchener Medizinische Wochenschrift—Fortschritte der Medizin) and their conventional abbreviations (NEJM, N Engl J Med, or MMW or MMW Fortschr Med). Different cases (e.g. Deutsche/r Medizinische/n Wochenschrift) or other close variants (e.g. Munchener/Munchner Medizinische Wochenschrift) were considered. A citation was only counted if it was a direct reference to the scientific content of one of the six medical journals. Thus, a reference to the appointments section of Deutsches Arzteblatt or the announcements of its publishers were not counted as scientific citations. The English edition of Deutsches Arzteblatt, Deutsches Arzteblatt International, was excluded from the evaluation. On the other hand, in a subanalysis, the citations for Deutsches Arzteblatt which related to its political reporting were counted seperately. To ensure a reliable check of the citation of a scientific journal, the full text of the lay journal or newspaper was always searched for. The search took place between November 2008 and March 2009.

Patientenzufriedenheit – Ein potentieller Eckpfeiler des Krankenhausmanagements

Dieser Artikel wurde fur den Gebrauch von Christian Schmidt bereitgestellt. Vervielfaltigung nur mit Zustimmung des Verlages. 1156 Originalarbeit | Original article Dtsch Med Wochenschr 2009; 134: 1151–1156 · C. Schmidt et al., Patientenzufriedenheit – Ein ... Results: 18 711 completed questionnaires were collected from a population of 71 000 treated patients (rate of return: 26%; males 50,6%; females 49,4%). Two-thirds of admissions were elective whereas the remainder were emergencies. The quarterly evaluation revealed quality of food and cleanliness as the main areas of complaint. Patients' dissatisfactions was the greater the longer the stay in hospital. Other differences between patients on statutory or private health insurance, respectively, were voiced regarding „respectful treatment“ and „professional ability“ (especially by private patients). Furthermore, patient satisfaction related to the duration of doctors' rotation (i.e. how long they were on duty), satisfaction being greater the longer the period of rotation. Conclusion: The study has provided information on patient satisfaction as a measure of effective hospital management.

János Veres und die „Veres-Nadel“

Die operative Frauenheilkunde empfing zahlreiche Anregungen aus anderen operativen und nichtoperativen Fachgebieten. Für die gynäkologische Laparoskopie gehört bis heute die Veres-Nadel (nicht „Veress“-Nadel), die Erfindung des ungarischen Pulmonologen János Veres (1903 - 1979), zu den wichtigsten Instumenten. Veres publizierte seine Erfahrungen mit der neuen Nadel, die er für Pleurapunktionen entwickelte, zunächst in ungarisch und 1938 in der „Deutschen Medizinischen Wochenschrift“.

English or German? The language of medicine based on the bibliographic data appearing in the Deutsche Medizinische Wochenscrift (1920 to 1995)

To describe and analyse the frequency of English and German in the bibliographical references from the original articles published in "Deutsche Medizinische Wochenschrift" during the past 75 years (1920-1995). The language of publication of 16,001 references from 800 original papers, at the rate of 50 articles per year at intervals of 5 years, was determined. The percentage of references in German has been decreasing during the whole studied period: 90.1% in 1920, 85.9% in 1935, 75.8% in 1950, 44.1% in 1965, 31.0% in 1980, and 16.4% in 1995. The percentage of references in English, on the contrary, has continued to increase: 3.2% in 1920, 10.6% in 1935, 21.5% in 1950, 50.0% in 1965, 66.2% in 1980, and 82.8% in 1995. Even though the importance of English has been increasing during the entire considered period, it did not clearly supplant German as the main language of medicine in Germany until 1975.

The 100th anniversary of Wassermann-Neisser-Bruck reaction

August Paul von Wassermann (1866-1925), German bacteriologist, together with Albert Neisser (1855-1916), German dermatologist and venereologist, and Carl Bruck (1879-1944), German dermatologist and venereologist, developed the first serologic test for the diagnosis of syphilis. They published their first article about it on May 10, 1906 (Dtsch Med Wochenschr 1906;32:745). They made use of the idea of the complement fixation test of Jules Bordet (1870-1961) and Octave Gengou (1875-1957), so the Wassermann reaction is sometimes called Bordet-Wassermann reaction. The study was done at the Berlin Institute of Infectious Diseases ( Berliner Institut für Infektionskrankheiten) and at the Breslau (Wroclaw) Department of Dermatology. The Wassermann reaction was used in the diagnosis of syphilis. The antigen used in it was prepared empirically. Originally, the so-called antigens were extracts of human or monkey tissue rich in Treponema pallidum. The most active one was a liver extract of a syphilitic fetus. Later on, the active substance, referred to as cardiolipin, was found in normal nonsyphilitic tissues, including the heart (usually bovine heart). Karl Landsteiner (1868-1943) identified the antigen involved in the Wassermann reaction as a lipoid substance, which finally was identified as diphosphatidylglycerol. Wassermann antibodies, produced in the course of syphilis infection, are reactive with cardiolipin in the presence of lecithin and cholesterol. The antigen-antibody reaction produces immune complexes, which results in complement fixation via the classic pathway; this may be used to determine the serum level of antibodies (if <1 μg/mL). In the final step, indicator cells (erythrocytes) together with a subagglutinating amount of antibodies (antierythrocyte antibodies) are added to the mixture. If there remains any complement left, these cells will be lysed; if it has been consumed by immune complexes, the amount of the remaining complement will be insufficient to produce the lysis of the red cells. In the first experiment of Wassermann et al, the reaction was positive exclusively with the sera of patients with syphilis, but it was soon discovered that some other diseases gave positive results in nonsyphilitic individuals. First such cases were reported in 1909. With the discovery of new and more specific tests for syphilis, the complement fixation tests of Wassermann type gradually went into oblivion. A new era in venereology was started with the discovery of T pallidum by Fritz Schaudinn (1871-1906) and Erich Hoffmann (1868-1954) in 1905, and the development of serology of syphilis by Wassermann, Neisser, and Bruck in 1906. Although the Wassermann reaction is no longer in use now, it should be emphasized that it was one of the very first serodiagnostic tests ever used in medical practice. Carl Bruck said in the 1920s: “This fortunate and unique mistake constituted the basis of a very important discovery, whose significance was both theoretical and practical.”

What’s going on in LDL apheresis

Low-density lipoprotein (LDL) apheresis is a safe and very effective extracorporeal treatment for refractory hypercholesterolemia in order to prevent or to reduce coronary heart disease [ [1] Schettler V. Wieland E. Effects of LDL-apheresis – more than reduction of cholesterol?. Dtsch Med Wochenschr. 2007; 132 (March 16): 575-578 Crossref PubMed Scopus (7) Google Scholar ]. It is an invasive procedure that selectively removes LDL cholesterol and other lipoproteins from the plasma.

Depression in outpatients with diabetes mellitus

Depression in outpatients with diabetes mellitus