Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Dec 2019
[Batten down the hatches: CAR T-cells - immuno-oncology meets intensive care medicine].
CAR T-cell treatment has brought a significant benefit for patients with relapsed and refractory lymphoma and even long lasting remissions seem to be possible. Despite the good results CAR T-cell treatment is associated with severe and potentially life-threatening adverse effects. Patients regularly develop Cytokine Release Syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) after the transfusion of CAR T-cells. ⋯ The management of these patients requires an extensive diagnostic workup and complex treatment. An interdisciplinary team of hematologist, intensivist and others like neurologist and palliative medicine consultants is crucial for the best treatment of these patients. Together with the increasing number of patients this can lead to logistical issues for the intensive care departments of centers offering CAR T-cell therapies.
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Dtsch. Med. Wochenschr. · Dec 2019
[Current Standard of Care in Squamous Cell Carcinoma of the Head and Neck (SCCHN) - Prevention, diagnostics, prognostication and therapy].
The standard of care in squamous cell carcinoma of the head and neck (SCCHN) has recently undergone some major shifts in prevention, diagnostics, staging, prognostication and therapy. Prevention: Subtypes of the human papilloma virus (HPV) have been identified as causative agent for HPV-driven oropharyngeal carcinomas nearly two decades ago. Vaccination against HPV is now recommended for all girls and boys at the age of 9 to 14 years by the Standing Committee on Vaccination at the Robert Koch Institute (STIKO). ⋯ Therefore, de-intensification should not be practiced in current standard of care. Palliative systemic therapy: Checkpoint inhibitors nivolumab and pembrolizumab are the new standard of care after progression on platinum based therapies. In the Keynote-048 trial, treatment with either pembrolizumab alone (CPS > 1) or its combination with platin+ 5-flourouracil was superior to the current first line standard PFC.
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Dtsch. Med. Wochenschr. · Dec 2019
Historical Article[The Discovery of the Cardiac Atrioventricular Node by Sunao Tawara and Ludwig Aschoff].
Already in 1664, the Danish anatomist and naturalist Niels Stensen proved that the heart is a muscle. But for a long time it remained unclear what triggered the heart contractions. The Dutch physiologist Willem Einthoven registered the electrical processes in the contraction of the heart muscle and thus provided the first electrophysiological basis of cardiac muscle activity. ⋯ Thus the old dispute between myogenic and neurogenic arousal of the heart was decided in favor of the myogenic excitation conduction. The atrioventricular node described by Tawara was given the eponym "Aschoff-Tawara node". Tawara's groundbreaking work on the conduction system was the basis for the discovery of the sinus node and the interpretation of the heart's electrophysiology.
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Dtsch. Med. Wochenschr. · Dec 2019
Historical Article[Politicians' Personal Physicians: careers and complications from King David until today].
Court physicians need to deal with a clientele posing particular personality problems (e. g. rex inutilis) in a difficult environment characterized by specific health issues (morbi aulici) and they may have to avoid serious risks or want to seek great opportunities (medicus politicus). Very few have been successful as King David, a former music therapist without a medical degree, or the dentist and president Gurbanguly Berdimuhamedow. ⋯ Not all could resist temptation of questionable literary fame at the expense of confidentiality. All told, a career close to high profile leaders needs to be considered carefully as risks may outweigh benefits.
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Dtsch. Med. Wochenschr. · Dec 2019
Historical Article[Allowing, accepting, releasing: A philosophical-psychological approach to an active concept of suffering].
Pain or misery strike us - but it is up to us how to deal with them. Suffering is a verb; this underlines the active nature of suffering. ⋯ It suggests that suffering, if allowed and accepted, has the potential to facilitate transformation and, subsequently, to release from pain. The text ends with reflections on how a transformative understanding of suffering can be opened up in the accompaniment of suffering or dying.