Krankenhausfinanzierung 2014

As with others medical disciplines hospitals specialized in rheumatology again face heavy economic burdens in 2014. To meet the challenges knowledge of the new German diagnosis-related groups (G-DRG) system, the legislative framework and current jurisprudence can be helpful. The following article presents the major changes and discusses the consequences for hospitals specialized in rheumatology.     

Hypertonie-Update 2014

Background

Hypertension is still one of the most important diseases in Germany. More than 60% of patients over 60 years of age suffer from hypertension. The consequences of uncontrolled hypertension are stroke or ischemic heart disease. Many studies during the last decades investigated therapeutic options to lower hypertension with respect to morbidity and mortality.

Aim

In this review, a summary of recently published guidelines to diagnose and treat hypertension is given.

Material and methods

Several international hypertension societies and groups have revised their guidelines for rational and also resource sparing diagnostics and therapy of arterial hypertension during recent years. The target values and therapeutic approaches in particular were amended.

Results

Target values for treatment of hypertension were changed in current guidelines. The treatment goal for all hypertensive patients is now below 140/90 mmHg. Patients older than 80 years of age might have systolic blood pressure up to 150 mmHg without intensification of therapy. Early combination of blood pressure reducing agents is applicable in many patients. For first line antihypertension therapy special importance is given to angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, calcium antagonists and thiazide diuretics.

Discussion

In the new guidelines there is a special focus on blood pressure values which are not so ambitious as in the early phase of this century. Blood pressure goals are now more moderate. Combination therapy is now generally accepted for many patients in eary stages, to target the correct blood pressure control.     

Hypertriglyceridemia—Acute Pancreatitis—Ischemic Heart Disease

ABSTRACT Hyperlipoproteinemia type V, with serum triglyceride concentrations of about 20 mmol/1, was detected in a pair of monozygotic, 40-year-old twin brothers. One of them had had recurrent attacks of pancreatitis, the other not. The endocrine and exocrine pancreatic functions were apparently normal, supporting that the pancreatitis was secondary to the hypertriglyceridemia. After successful lipid-lowering therapy the attacks of abdominal pain disappeared and remained absent during a 13-year follow-up period. The other twin died of ischemic heart disease nine years after the discovery of his lipid abnormality. The reduction of his lipid levels had been much less successful. His average “atherogenic index” (the ratio of cholesterol in low density to that in high density lipoproteins) was normal but increased to a very high value if cholesterol in very low density lipoproteins was also included together with the low density ones in the numerator. Lipoprotein particles modified in composition may have contributed to an increased uptake through a scavenger pathway and promoted atherosclerosis.     

Hypophysitis in 2014

Hypophysitis is a rare pathology. As clinical symptoms and radiologic signs are non-specific, the diagnostic is difficult. Hypophysitis's pathogenesis remains obscure but new histological and etiological variants have recently been reported. Primary hypophysitis is the main form. For the first time, hypophysitis in ANCA-associated vasculitides has been reported. An entity of immunoglobulin G4 related plasmatic hypophysitis has been described and well-defined diagnostic criteria are proven. Monoclonal antibodies directed against the cytotoxic T-lymphocyte antigen-4 (CTLA-4), investigated in metastatic cancer, can induce hypophysitis. Hypophysitis's pathogenesis remains obscure but several candidate pituitary autoantigens have been described in the last decade, although none has proven useful as a diagnostic tool.     

Fultility—futilis—The Leaky Vessel

[Schmidt T. Futility—futilis —the leaky vessel. Ann Emerg Med . June 2000;35:615-617.]     

Almanac 2014: cardiomyopathies

Cardiomyopathies are myocardial disorders that are not explained by abnormal loading conditions and coronary artery disease. They are classified into a number of morphological and functional phenotypes that can be caused by genetic and non-genetic mechanisms. The dominant themes in papers published in 2012–2013 are similar to those reported in Almanac 2011, namely, the use (and interpretation) of genetic testing, development and application of novel non-invasive imaging techniques and use of serum biomarkers for diagnosis and prognosis. An important innovation since the last Almanac is the development of more sophisticated models for predicting adverse clinical events.