Deutsches Ärzteblatt International

BACKGROUND: Chronic primary pelvic pain syndrome in men (CPPPSm) can be associated with urogenital pain, urinary symptoms, sexual dysfunction, and emotional disturbance. Its clinical heterogeneity and incompletely understood pathogenesis make it more difficult to treat. This article is intended to familiarize the reader with basic aspects of the manifestations, pathophysiology, diagnostic evaluation, differential diagnosis, and treatment of this condition. METHODS: This article is based on relevant publications retrieved by a selective search of the literature, including the current guidelines of the European Association of Urology...

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is the third most common cause of death around the world. The affected patients suffer not only from impaired lung function, but also from a wide variety of comorbidities. Their cardiac comorbidities, in particular, lead to increased mortality. METHODS: This review is based on pertinent publications retrieved by a selective search in PubMed, including guidelines from Germany and abroad. RESULTS: The usual diagnostic criteria for COPD are a post-bronchodilator FEV1/FVC quotient below the fixed threshold of 0...

BACKGROUND: Opacification of the lens of the eye (cataract) is usually due to aging. It is a painless, progressive condition that affects contrast and color perception and alters refraction, leading to visual loss that may be total. In cataract surgery, the turbid lens is replaced by an artificial lens. An estimated 600 000 to 800 000 such procedures are performed in Germany each year. METHODS: This review is based on pertinent publications retrieved by a selective search in PubMed, including meta-analyses, Cochrane reviews, and randomized controlled clinical trials (RCTs)...

BACKGROUND: Medial sclerosis (MeS) is a chronic systemic vascular disease that mainly affects the arteries of the lower limb. Its prevalence in the general population is approximately 2.5% (range: 1.6% to 10.0%). It is more common in men than in women. METHODS: This review is based on pertinent publications retrieved by a selective search in PubMed. RESULTS: MeS is the final common pathway of a wide variety of diseases; its pathogenesis is not fully understood...

BACKGROUND: The acute effects of traumatic brain injury (TBI) are well documented, but there is no systematic quantification of its long-term sequelae in German-language literature. The purpose of this article is to compare the frequency of conditions linked to prior TBI with their frequency in the non-brain-injured population. METHODS: A matched cohort study was carried out on the basis of routine data from the BARMER statutory health insurance carrier. The exposure group consisted of patients treated over the period 2006-2009 for TBI at a variety of treatment intensities, including persons with multiple organ trauma...

BACKGROUND: Acute chest pain (aCP) can be a symptom of life-threatening diseases such as acute coronary or aortic syndrome; however, aCP often is not of cardiac origin. The current recommendations for pre-hospital drug treatment in patients with aCP are unclear. METHODS: We conducted a retrospective cohort study of 822 patients with aCP who were treated by emergency physicians (EP). The causes of aCP were classified as follows: non-ST-segment elevation acute coronary syndrome (NSTE-ACS), acute aortic syndrome, hypertensive crisis, cardiac arrhythmia, musculoskeletal causes, and other causes...

BACKGROUND: Diffuse large B-cell lymphoma (DLBCL) is the most common malignant B-cell neoplasm, with an incidence of 5.6 per 100 000 persons per year and a mean age of onset of approximately 65 years. It is an aggressive type of non-Hodgkin's lymphoma requiring urgent treatment with curative intent. Evidence-based guidelines have not been available to date. METHODS: For this first international evidence-based DLBCL-specific guideline, various systematic literature searches were performed...

BACKGROUND: Lung cancer is the most common cause of death among all types of cancer in Germany, with an annual death rate of 45 000 patients. Over the past 15 years, innovations in diagnosis and treatment have prolonged the survival of patients with non-small-cell lung cancer in all tumor stages. METHODS: This review of the diagnosis and treatment of lung cancer is based on current national and international guidelines, and on prospective trials with the highest possible level of evidence that were retrieved by a selective search of the literature...

BACKGROUND: Recent studies have shown that the incidence of colorectal cancer among younger persons is rising. We investigated incidence trends and survival in the German federal state of North Rhine-Westphalia. METHODS: Cancer registry data from the period 2008-2019 were classified into two age groups (15-54 and 55-99). In each age group, the standardized incidence, average annual percent change (AAPC), and relative 5-year survival (RS) were calculated and stratified according to the site, histology, size, and grade of the colorectal tumor...

BACKGROUND: The appropriate provision of sedation as a last resort for the relief of suffering in palliative care is dealt with variably in actual practice. This article is intended as an overview of practically relevant information found in treatment recommendations and guidelines. METHODS: A systematic literature search was conducted in the PubMed, Scopus, and Google Scholar databases, and a manual search was carried out online. Recommendations that were not available in either German or English, or that were specific to pediatric practice, were excluded...

BACKGROUND: In Germany, each year over 3000 patients with malignant and non-malignant hematologic and systemic diseases are treated by allogeneic hematopoietic cell transplantation (HCT). Genetic donor-recipient disparities, especially those concerning variable human leukocyte antigens (HLA), mediate both an immunotherapeutic effect and the risk of damage to healthy tissues ("graft-versus-host disease"). The adoption of evidence-based strategies for donor selection has been crucial for the continuous improvement of survival rates after allogeneic HCT, with over 50% of patients transplanted for standard indications-such as early-stage acute myeloid leukemia-alive at three years post-transplant...

BACKGROUND: An increasing number of persons around the world are receiving the diagnosis of gender incongruence, and most of them are in their reproductive years. Safe contraception and fertility preservation are important issues for counseling. METHODS: This review is based on pertinent publications retrieved by a systematic search in the PubMed and Web of Science databases, employing the search terms "fertility," "contraception," "transgender," "gender-affirming hormone therapy" (GAHT), "ovarian reserve," and "testicular tissue...

BACKGROUND: Atopic dermatitis is a common, chronically recurring inflammatory skin disease. It gives rise to a high disease burden and is of major importance in social medicine. METHODS: This review is based on pertinent publications retrieved by a selective search in PubMed, including the current German and European guidelines. RESULTS: Basic therapy with drug-free topical agents markedly improves the barrier function of the skin. Adults should apply at least 250 g per week...

BACKGROUND: Congenital heart anomalies are the most common type of organ malformation, affecting approximately 1% of all newborn infants. More than 90% of these children now survive into adulthood. They need to be cared for by specialists for adults with congenital heart disease (ACHD), as well as by family physicians, internists, and cardiologists who are adequately versed in the basic management of persons with this lifelong condition. METHODS: This review is based on pertinent publications retrieved by a selective literature search, including guidelines and consensus statements from Germany and abroad...

BACKGROUND: Myelodysplastic syndromes (MDS) are malignant diseases arising from hematopoietic stem cells. Their overall incidence is 4 cases per 100 000 persons per year, and they are usually diagnosed when evaluating cytopenia. The median survival time is three years. Myelodysplastic syndromes take a variable course; one-quarter of patients go on to develop acute leukemia. METHODS: This review is based on publications retrieved by a selective search of the literature from 2013 to 2022, including relevant guidelines, in the PubMed database...

BACKGROUND: There are no data on recent trends in the incidence rate of type 2 diabetes (T2D) in Germany. The aim of this study was to determine the sex-, age-, and region-specific trends in the T2D incidence rate between 2014 and 2019. METHODS: Based on nationwide data from statutorily insured persons in Germany, negative binomial regression models were used to analyze age- and sex-specific trends in the T2D incidence rate. Ageand sex-adjusted trends were calculated for 401 administrative districts using a Bayesian spatiotemporal regression model...

BACKGROUND: The choice of imaging modality-the use of whole-body computed tomography (WB-CT) versus a step-wise diagnostic procedure-in injured children is controversial. In this study we availed ourselves of data from the TR-DGU, the trauma registry of the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie), to investigate whether the use of WB-CT improves the outcome. METHODS: The TR-DGU data from the period 2012-2021 were evaluated...

BACKGROUND: Consumption of medication to alleviate pain is widespread in Germany. Around 1.9 million men and women take analgesics every day; some 1.6 million persons are addicted to painkillers. Analgesic use is thought also to be common in sports, even in the absence of pain. The aim of this study was to assess the extent of painkiller use among athletes. METHODS: In line with the PRISMA criteria and the modified PICO(S) criteria, a systematic literature review was registered (Openscienceframework, https://doi...

BACKGROUND: Metastases are the most common malignant tumors affecting the central nervous system and occur in 20-40 percent of patients with solid systemic tumors. The aim of this review is to discuss the role of neurosurgical procedures in a modern, multidisciplinary treatment approach. METHODS: An expert panel of neurosurgeons, neurologists, and radio-oncologists conducted a selective literature review on neurosurgical interventions for the diagnosis and treatment of cerebral metastases...

BACKGROUND: Disorders of the sense of smell have received greater attention because of the frequency with which they occur as a symptom of SARS-CoV-2 infection. Olfactory dysfunction can lead to profound reduction in quality of life and may arise from many different causes. METHODS: A selective literature review was conducted with consideration of the current version of the guideline issued by the Association of the Scientific Medical Societies in Germany. RESULTS: The cornerstones of diagnosis are the relevant medical history and psychophysical testing of olfactory function using standardized validated tests...