Deutsche medizinische Wochenschrift
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Hepatocellular carcinoma (HCC) is the fifth most common cause of cancer with an increasing incidence. The major HCC risk factor in 80 % of all patients is liver cirrhosis followed by chronic hepatitis B infection or non-alcoholic steatohepatitis (NASH) in non-cirrhotic HCC patients. In early BCLC stages curative treatment applying liver resection, liver transplantation or local ablation is feasible, but, despite increased usage of surveillance programmes two-thirds of HCC patients are diagnosed in advanced BCLC stages. ⋯ In fact, major advances in HCC therapy concern medical treatment with the implementation of immunotherapy. The combination of atezolizumab with bevacizumab comprises the new first-line treatment in BCLC stage C. Tyrosine kinase inhibitors (TKI) are indicated in case of contraindications or as second line therapy.
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Dtsch. Med. Wochenschr. · Oct 2021
[The impact of immunosuppression and chronic kidney disease on immunogenicity of COVID-19 vaccines].
HOW EFFECTIVE ARE THE APPROVED VACCINES IN KIDNEY DISEASES AND THOSE RECEIVING IMMUNOSUPPRESSION?: Several observational studies indicated that immunosuppression is associated with a weakened or absent humoral response. Patients with chronic kidney diseases or undergoing maintenance dialysis without immunosuppression have a reduced humoral response to COVID-19 vaccines. I HAD COVID-19. ⋯ AFTER THE FIRST SERIES OF VACCINATION, NO OR ONLY A MARGINAL AMOUNT OF ANTIBODIES WERE DETECTABLE. ARE THERE STRATEGIES TO IMPROVE VACCINE RESPONSE?: Many countries recommend the application of a third dose for vulnerable patient cohorts, especially because of a weakened response and their risk to develop a severe disease course of COVID-19. Prospective clinical trials are ongoing to test the ideal strategy to improve vaccine response in these cohorts.
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Dtsch. Med. Wochenschr. · Oct 2021
[Functional characterization of patients with isolated post-capillary or combined post-capillary and pre-capillary pulmonary hypertension].
The World Conference on PH recommended differentiation of isolated postcapillary (Ipc) and combined post- and precapillary (Cpc) PH according to pulmonary vascular resistance alone. The aim of this study was the haemodynamic and functional characterization of patients diagnosed IpcPH and CpcPH according to the current recommendation of the latest World Symposium on Pulmonary Hypertension (PH) with an exploratory data analysis. ⋯ Although CpcPH patients showed higher values of mPAP and PVR functional capacity was not worse than in patients with IpcPH. In patients with PH due to left heart disease an elevated RA/LA ratio may indicate CpcPH and invasive diagnostic work-up should be considered.
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A 59-year-old woman presented for an endocrinological evaluation of recurrent spontaneous hypoglycemia. The complaints always regressed after carbohydrate intake. Due to classic congenital adrenal hyperplasia, the patient received substitution therapy with hydrocortisone for decades. ⋯ In addition to endogenous hyperinsulinism, a disturbance of the contrainsulinergic hormones can also be responsible for spontaneous hypoglycemia.The MMTT and the 72-hour fast test should be used for diagnosis. It is important to ensure that hormone analysis is carried out immediately in hypoglycemia. The ratio of insulin, C-peptide and proinsulin to blood glucose and the constellation of counter-regulatory hormones such as cortisol, ACTH, growth hormone, Insulin-like growth factor 1 (IGF-1) and catecholamines can provide information about the etiology of hypoglycemia.
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The recently published guidelines "Sports cardiology and exercise in patients with cardiovascular disease" (2020) are the first of a kind by the European Society of Cardiology (ESC). The guidelines provide comprehensive training recommendations for patients with cardiovascular diseases or risk factors, covering the entire spectrum of cardiovascular diseases with case-specific recommendations for recreational and competitive sports. The ESC recognizes exercise as an essential part of both prevention and therapy of cardiovascular diseases, that - comparable to drug therapies - requires correct prescription. ⋯ COVID-19 can lead to cardiovascular complications even in asymptomatic and mild disease courses. Before resuming intense sporting activities, different return-to-sports protocols have been introduced. The current consensus is that the extent of these examinations should be based on symptoms, severity and duration of COVID-19 and that individual return-to-training recommendations should be given.