Deutsche medizinische Wochenschrift
-
Hematuria is a common clinical finding and has a wide spectrum of possible causes. Erythrocytes can originate from any part of the genitourinary tract. An urine dipstick test is the first step in diagnostic approach. ⋯ If an urological pathology is suspected, sonography should be complemented by a multi-phasic computed tomography. Based on the imaging results, a retrograde ureteroscopy should be considered. Repeated urinalysis on an annual basis for two consecutive years is recommended, if no diagnosis can be established.
-
Dtsch. Med. Wochenschr. · Jan 2020
Review[Anti B-cell-antibody treatment for maintenance of remission in granulomatosis with polyangiitis and microscopic polyangiitis].
Granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) are the most frequent primary necrotizing small vessel vasculitides. In these formerly fatal diseases remission can be induced by stage- and activity-adapted immunosuppressive regimens in the majority of patients. This does not lead to drug-free long-term remission or even cure. ⋯ Recent randomized controlled trials demonstrated that maintenance treatment with the anti-B-cell antibody Rituximab, administered 6-monthly as opposed to azathioprine leads to a significantly lower relapse rate but a similar profile of adverse events. These data enabled the extension of the approval of Rituximab for maintenance of remission treatment of GPA and MPA in Germany in 2018. Guidelines and expert recommendations concerning measures of infection prevention and vaccination of immunosuppressed patients as well as the management of hypogammaglobulinemia and cytopenia on Rituximab are presented in this review.
-
Dtsch. Med. Wochenschr. · Jan 2020
Case Reports[Complete remission of Loeffler's endocarditis with Imatinib in a myeloid and lymphoid neoplasm associated with eosinophilia].
A 53-year-old male presented with massive pruritus, whole-body exanthema, generalized muscle pain, and exercise dyspnoea NYHA II. ⋯ In summary, Loeffler's endocarditis caused by a myeloid and lymphoid neoplasm associated with eosinophilia and abnormalities of FIP1L1-PDGFRA rearrangement could be treated successfully with oral anticoagulation therapy and the tyrosine-kinase inhibitor imatinib.
-
Dtsch. Med. Wochenschr. · Jan 2020
[Lyme Borreliosis: Serological and Microbiological Diagnostics and Differential Diagnosis].
Lyme borreliosis caused by at least six Borrelia burgdorferi species, is the most important tick-borne disease in the northern hemisphere. With a wide spectrum of possible symptoms, the microbiological diagnosis of this disease is associated with a wide variety of ideas, divergent approaches and much uncertainty. ⋯ Most important messages include that (I) the suspected diagnosis of Lyme borreliosis is first based on anamnestic data and clinical symptoms (compare "case definitions") which is substantiated by microbiological examinations; (II) microbiological diagnostics - primarily antibody detection, downstream PCR and culture - are only indicated if there are indicative symptoms, with typical erythema migrans not requiring microbiological diagnostics; (III) keep in mind: The more unspecific the symptoms are the lower the positive and the higher the negative predictive value of microbiological testing; (IV) serological diagnosis should follow a two-step procedure: a sensitive ELISA as first step, if reactive followed by immunoblot (IgM and IgG). Detection rates are ca. 50 % in localized, 70- > 90 % in disseminated early and nearly 100 % (only IgG relevant) in late disease; (V) in the immunoblot early forms of disease show a narrow band spectrum, late forms show a broad spectrum; (VI) methods that are not recommended for diagnostic purposes include lymphocyte activation or transformation tests (LTT, MELISA, ELISPOT), PCR or antigen detection from urine or blood, lymphocyte subpopulations, or direct detection of borreliae from patient material using dark field- or focus floating microscopy.