Deutsche medizinische Wochenschrift
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Behçet's syndrome (BS, synonym: Behçet's disease, or Adamantiades-Behçet's disease, ABD) is classified as a vasculitis of variable vessel size and can manifest itself in both arterial and venous vessels. Its extensive and at the same time interindividually very different clinical picture is not uncommon a challenge, both with regard to the diagnosis of this rheumatic systemic disease, which is rather rare in our latitudes, and its therapeutic options. In addition to the four cardinal symptoms of recurrent oral aphthae, genital aphthae, skin and eye lesions, the clinical picture offers numerous other manifestations which often require interdisciplinary cooperation. ⋯ The drug is recommended for the treatment of recurrent oral aphthae in adult Behçet's patients requiring systemic therapy. Nevertheless, there is a further need for new drugs. This article aims to highlight recent findings in the areas of epidemiology, immunopathogenesis & genetics, clinical findings, and therapy, with an emphasis on clinical relevance.
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The spread of multidrug-resistant Mycobacterium tuberculosis bacteria jeopardizes tuberculosis control, especially in the WHO Europe region. Following the availability of novel drugs and treatment regimens the World Health Organization has updated management recommendations for patients affected by drug-resistant tuberculosis. These novel recommendations include a significant reduction in the duration of therapy. This review presents the epidemiology and diagnostics of antibiotic-resistant tuberculosis as well as up-to-date treatment recommendations.
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Actively avoiding fever is the only possibility to improve neurological outcome after cardiac arrest. It is uncertain if and which patients benefit from a lower target temperature. The ERC Guidelines in 2021 recommended targeted temperature management (TTM) for all patients after in- and out-of-hospital cardiac arrest with a target temperature of 32-36 °C for at least 24 hours. ⋯ The large TTM2 Trial in 2021 did not show a benefit neither in survival nor in neurological outcome in the group of hypothermia at 33°C compared to normothermia. Although leading to the updated guidelines, applying these study results to the German population is restricted as the rate of bystander cardiopulmonary resuscitation (CPR) or shockable rhythms is much lower in Germany. Further studies are needed to allow a better differentiation of subpopulations and to implement a more individual classification und therapy.
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Acute severe alcoholic hepatitis is a serious disease with poor prognosis. As a result of an improved understanding of the underlying pathomechanisms, a variety of new, innovative therapeutic modalities are currently being investigated that may help to improve prognosis. New approaches include the application of anti-inflammatory agents (e.g., interleukin-1 inhibitors), modifications of the gut-liver axis via fecal microbiome transfer or the administration of non-absorbable antibiotics (e.g., rifaximin), and drugs to enhance hepatocellular regeneration (e.g., interleukin-22 agonists). This article describes current management concepts of alcoholic hepatitis and provides an overview of new potential treatment approaches.
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Dtsch. Med. Wochenschr. · Sep 2023
[Advanced non-small cell lung cancer - pioneer in personalized oncology].
In no other cancer is clinical practice as close to the ideals of personalized oncology as in the treatment of non-small cell lung cancer (NSCLC). Here, we briefly outline the basic principles of molecular analysis. The focus of the article is on the clinical utility of targeted therapy. Finally, we highlight the challenges for medical staff and structural solutions reflecting the situation in Germany.