Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Feb 2020
[Sepsis: Sequelae for Affected Patients and The Health Care System].
The number of patients who survive sepsis is growing. However, two of three sepsis survivors suffer from new physical or mental sequelae. Cognitive deficits, depression or limitations of the activities of daily living can seriously impair quality of life and working ability. ⋯ An interdisciplinary approach is necessary to evaluate and treat sepsis sequelae. Survivors and their relatives should be informed about sepsis and possible sequelae as early as possible. Further studies are needed to improve the understanding of pathomechanisms and effectivity of treatment interventions for sepsis sequelae.
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Membranoproliferative glomerulonephritis (MPGN) and glomerulopathy with dominant C3 deposits are very rare autoimmune disorders of the kidney that had been classified in its current form in 2010 due to a better understanding of the underlying pathophysiology. Today, the immune complex-associated membranoproliferative glomerulonephritis (IC-MPGN) and C3 glomerulopathy (C3G) represent a disease spectrum which is heterogeneous in terms of pathophysiology and the clinical time course. ⋯ Therefore, following histologic diagnosis a comprehensive complement analysis, accompanied by antibody screening and human genetics should be carried out consistently. The published evidence provides a robust basis for the use of available therapeutic approaches for these often rapidly progressive and relapsing diseases.
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Dtsch. Med. Wochenschr. · Feb 2020
[Current diagnostic and therapeutic standards in aggressive B-cell lymphomas].
In this review, we focus on new advances regarding diagnostic and therapeutic standards of aggressive B-cell lymphomas. This includes the introduction of the so-called "cell of origin" classification which differentiates diffuse large B-cell lymphomas (DLBCL) into the ABC and GCB subtypes and became part of the revised WHO classification of 2017. While 6-8 cycles of R-CHOP remain the standard of first-line treatment in DLBCL, for young patients up to 60 years of age with an international prognostic index (IPI) of 0 the treatment can be shortened to 4 cycles of R-CHOP plus 2 cycles of rituximab. ⋯ For patients with relapse or refractory disease, salvage treatment followed by autologous or allogeneic transplantation remains the standard. After failure of 2 lines of treatment, 2 different CAR-T-cell products are licensed offering a potentially curative treatment options even for patients not eligible for transplantation strategies. New treatment modalities as antibody-drug conjugates and bispecific antibodies show promising results in clinical studies and will presumably broaden the spectrum of treatment options for patients with DLBCL.
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While monitoring and symptomatic care is sufficient for most intoxicated patients, some develop life threatening symptoms. We present recent changes in the recommendations of the treatment in patients with calcium channel blocker, beta blocker and high dose paracetamol intoxications. Additionally, new insights in the efficacy and safety of the use of physostigmine in anticholinergic patients and beta blockers in cocaine intoxication are discussed as well as the specific considerations in the resuscitation of intoxicated patients.
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Dtsch. Med. Wochenschr. · Feb 2020
[Secondary causes of fatty liver disease - an update on pathogenesis, diagnosis and treatment strategies].
Secondary causes of fatty liver disease are important to recognize since specific therapy options are available for some of these causes. Common causes of secondary fatty liver disease comprise hepatitis C virus infection (HCV), endocrinological diseases, nutritional and intestinal diseases as well as genetic liver and metabolic diseases. Certain drugs may also predispose to the development of fatty liver disease. ⋯ The risk variants in these genes have additive effects on steatosis development and diseases progression towards fibrosis and cirrhosis. The diagnosis of secondary causes of fatty liver disease may allow for therapeutic intervention and prevent disease progression. Accordingly, secondary causes of fatty liver disease should be considered during the diagnostic workup of NAFLD patients.