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Lange U.,Justus Liebig University | Muller-Ladner U.,Justus Liebig University | Pfeilschifter J.,Klinik fur Innere Medizin III
Internist | Year: 2011

Osteoporotic fractures are a frequent cause of functional disabilities and loss of quality of life. Preventive measurements need to focus on training of muscle function and coordination, and adequate daily calcium and vitamin D supplementation; furthermore a regular check up for drugs associated with falls and osteoporosis. The German guideline recommends that a specific osteoporosis medication should be initiated in individuals with a 10-year risk for hip and vertebral fractures of 30%. This article presents the current guideline for osteoporosis including the actual updates. © 2011 Springer-Verlag. Source

Braun J.,Rheumazentrum Ruhrgebiet | Pfeilschifter J.,Klinik fur Innere Medizin III
Zeitschrift fur Rheumatologie | Year: 2010

Osteoporotic fractures are a frequent cause of disability and loss of quality of life in old age. Maintaining muscle function and balance, a daily calcium intake of 1000 mg, sufficient vitamin D and prudent use of drugs associated with falls and osteoporosis are key components to fracture prevention. The German guideline recommends that a specific long-term osteoporosis medication be initiated in individuals with a 30% 10-year risk for hip fractures and vertebral fractures. © Springer-Verlag 2010. Source

The median age at first diagnosis of NSCLC is approximately 70 years. The data on chemotherapy in the increasing group of elderly NSCLC patients is rather scarce; however, it suggests that age alone is not an adequate prognostic factor for an individual patient with advanced NSCLC. The outcome in elderly patients in PS 0 - 1 can be identical to that in younger patients. Therefore, the application of an effective chemotherapy should always be considered as a therapeutic option in elderly patients with NSCLC in PS < 2. In patients who are in good general condition, a platinum-containing Doublet therapy is effective and feasible and should be considered as the results are clearly superior to monotherapy. In general, the full spectrum of therapy should also be applied in elderly NSCLC patients, but individual characteristics should be taken into account. This holds also true for molecular tests and targeted therapies. In the future, the individual therapy risk should be assessed wherever possible using a multidimensional geriatric oncology assessment (CGA) in order to be able to adequately adapt the therapy decision to each patient's situation, in particular if they are partially impaired elderly patients, and in order to avoid toxicity. However, an ideal and generally accepted CGA tool for this purpose has yet to be established. Due to the demographic development, geriatric oncology research in general has to be intensified in a sustainable way soon. The limiting factor in this context is the high financial and logistic effort necessary to carry out a clinical study in a collective of elderly or very old patients so that it seems questionable whether, apart from publically funded projects, sustainable results can be achieved. © 2015 Dustri-Verlag Dr. Karl Feistle. Source

Druml W.,Klinik fur Innere Medizin III
Medizinische Klinik - Intensivmedizin und Notfallmedizin | Year: 2013

Renal failure patients in the intensive care unit comprise a heterogeneous group of subjects with widely differing metabolic patterns and nutritional requirements. This group includes patients with acute kidney injury (AKI), acute-on-chronic renal failure, chronic kidney disease, and those on regular hemodialysis therapy. Renal failure is associated with a broad spectrum of specific metabolic alterations. In addition to these alterations and the often underrated impact of renal replacement therapy, the metabolism is also affected by the underlying disease process as well as associated organ failures and complications, especially infections. Nutritional support for renal failure is not fundamentally different from other disease processes, but in designing a nutrition regimen the variations in metabolism and nutrient requirements should be considered. Nutritional needs can differ widely between patients but also in the same patient during the course of disease. Thus, patients with renal failure require an individualized approach to nutritional support. Moreover, because of the altered metabolism of many nutrients and the intolerance of fluids and electrolytes, close monitoring of the nutritional therapy is mandatory in patients with renal failure. © 2013 Springer-Verlag Berlin Heidelberg. Source

Rittger H.,Friedrich - Alexander - University, Erlangen - Nuremberg | Hochadel M.,University of Heidelberg | Behrens S.,Klinik fur Kardiologie und Kons. Intensivmedizin | Hauptmann K.-E.,Klinik fur Innere Medizin III | And 5 more authors.
EuroIntervention | Year: 2012

Aims: The elderly constitute an increasing proportion of all patients with acute coronary syndromes (ACS). However, increased age has been identified as an important risk factor for adverse events and complications of ACS and treatment. The purpose of this study was to investigate age-related differences in presentation and diagnostics, as well as contemporary treatment and outcome in a large series of elderly patients receiving an invasive strategy for ACS. Methods and results: The present study is an analysis of all patients, who were enrolled in the German Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK) registry in 2008. To assess age-related differences, subjects were divided into three groups: (<75 yrs, 75 to 85 yrs and >85 yrs). Out of 19,708 consecutive patients who were admitted for the treatment of ACS and enrolled in the ALKK registry, 14,174 (71.9%) were <75 yrs, 4,685 (23.8%) were between 75 and 84 yrs and 849 (4.3%) patients were >85 yrs. Therapy recommendation after diagnostic angiography was conservative in 24.6% of the youngest, in 25.1% of the elderly, and in 25.3% of the very elderly patients. Interventional success rates were 95.2% in the youngest vs. 93.1% in the elderly and very elderly patient group (p<0.001). Overall in-hospital event rate increased significantly with age (3.4% vs. 7.4% vs. 8.3%, respectively; p<0.001). Conclusions: Our analysis shows that there is a high success rate among the large proportion of elderly patients who are treated for ACS by an intervention. Complication rates increased significantly, however, with age. © Europa Edition 2012. All rights reserved. Source

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