Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Dec 2019
Historical Article["Medicine is a social science" - the 200th birthday of Salomon Neumann].
Salomon Neumann (1819-1908) is one of the outstanding representatives of 19th century social medicine. As a medical reformer, statistician and city councilor, he made a significant contribution to improving social and hygienic conditions in Berlin. His most famous work was published in 1847 under the title "Die oeffentliche Gesundheitspflege und das Eigenthum" [Public Health and Property]. ⋯ Not only was Neumann exposed to anti-Semitic reprisals during his lifetime, a foundation he founded to promote the science of Judaism was dissolved by the National Socialists in 1940. On the occasion of his 200th birthday, this article commemorates the life and work of the democratically minded and socially committed doctor and health politician. Salomon Neumann has rendered great services to social medicine in Germany.
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IgG4-related disease (IgG4-RD) is an entity first described less than 20 years ago, characterized by tumorous swelling of affected organs. Differentiation from malignant disease, systemic infections and other systemic autoimmune diseases can be challenging. Typical histopathologic findings facilitate a diagnosis in a compatible clinical context. ⋯ Medical treatment usually consists of glucocorticoids, which may be combined with other immunosuppressives. Surgical or interventional treatment may be necessary if complications arise. Since high-quality evidence is lacking for most aspects of the management of IgG4-RD, international collaborative studies are urgently needed.
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Vascular malformations can appear at any age and in every region of the body. Due to their rare appearance and differences in clinical manifestations the appropriate diagnosis and subsequent classification remains challenging. Once the diagnosis is established, various treatment options exist, requiring an interdisciplinary approach. This review provides an overview over state-of-the-art interventional therapies of vascular malformations.
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Dtsch. Med. Wochenschr. · Dec 2019
Historical Article[Maurice Raynaud (1834-1881) and the Mystery of "Raynaud's Phanomenon"].
Maurice Raynaud first described color changes and symptoms of the fingers due to cold-induced vasospasm and restricted blood flow in his medical school thesis in 1862. Raynaud's phenomenon is common and exists as an uncomplicated primary Raynaud phenomenon and a Raynaud phenomenon secondary to underlying diseases and medication. Mechanisms contributing to altered vasoconstrictor activity are endothelial and not-endothelial. Cold-induced vasospasm is probably a thermoregulatory problem and effects are mediated by sympathetic activity and selective stimulation of alpha2c-adrenoreceptors.
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Pregnancy has a profound impact on the thyroid gland and its function. This has to be considered in the assessment of thyroid function tests on the basis of trimester-specific reference intervals during pregnancy and in the decision making when to start therapy. The adverse impact of overt thyroid disorders in pregnancy is well understood, while the relevance of subclinical thyroid disorders and presence of thyroid antibodies remains a bit controversial. ⋯ The most common cause of hyperthyroidism is transient gestational thyrotoxicosis mediated by human chorionic gonadotropin (hCG), which leads to a reduction or suppression of TSH in the first trimester that does not require antithyroid medication. In other causes of overt hyperthyroidism antithyroid drugs (propylthiouracil or thionamides) need to be considered carefully and require interdisciplinary management. The presented recommendations are based on the current guideline of the American Thyroid Association (ATA) and the European Thyroid Association (ETA) as well as recently published literature.