Innere Medizin (Heidelberg, Germany)最新文献

{"title":"[Abdominal pain and severely impaired consciousness in a 19-year-old female patient].","authors":"Anton Kozlov, Cleo Mybes, Niklas Falk, Maximilian Franz Schulze-Hagen, Stephan Schlecker, Marc Ulrich Becher","doi":"10.1007/s00108-025-01939-9","DOIUrl":"https://doi.org/10.1007/s00108-025-01939-9","url":null,"abstract":"<p><p>A 19-year-old female patient presented to our clinic with abdominal pain, psychomotor agitation and disorientation. The laboratory analysis revealed severe hyponatremia. Cerebral magnetic resonance imaging (MRI) showed characteristic neuroradiological features of a posterior reversible encephalopathy syndrome (PRES). The detection of a significant increase in the serum concentration of porphyrins confirmed the clinical suspicion of acute intermittent porphyria (AIP). The likely trigger for the sudden AIP exacerbation was the use of levonorgestrel for postcoital contraception. Under treatment with high-dose glucose solution and haem arginate, the abdominal symptoms regressed rapidly. In contrast, neuropsychiatric symptoms improved only gradually, making neurological rehabilitation necessary.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[CAR T cell therapy in acute lymphoblastic leukemia].","authors":"Manik Chatterjee, Ralf C Bargou","doi":"10.1007/s00108-025-01949-7","DOIUrl":"https://doi.org/10.1007/s00108-025-01949-7","url":null,"abstract":"<p><p>Modern immunotherapy in the form of T‑cell-based CD19-targeted approaches, such as the approved bispecific T‑cell engager (BiTE antibody) blinatumomab and chimeric antigen receptor T cells (CAR T cells) with the approved products tisagenlecleucel and brexucabtagene autoleucel has revolutionized the treatment of B‑precursor acute lymphoblastic leukemia (ALL). The pivotal clinical trials for the approval, including follow-up studies as well as the now available real-world data outside of these trials, showed that CAR-T cell therapy provides an effective treatment option for patients with relapsed and refractory B‑precursor ALL after chemotherapy, improving an otherwise poor prognosis. In addition to the therapeutic response, side effects of CAR-T cell therapy and their clinical management are discussed. Furthermore, resistance mechanisms are discussed and an outlook on further development is given. The T‑precursor ALL remains a challenge due to its immunological complexity but new developments in CAR-T cell treatment approaches targeting CD5 and CD7 show that progress is also being made in this area.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Molecular autopsy: post-mortem genetic testing following sudden cardiac death].","authors":"Tina Jenewein, Britt-Maria Beckmann, Stefanie Scheiper-Welling, Silke Kauferstein","doi":"10.1007/s00108-025-01934-0","DOIUrl":"https://doi.org/10.1007/s00108-025-01934-0","url":null,"abstract":"<p><strong>Background: </strong>Sudden cardiac death (SCD) is an unexpected natural death with a suspected cardiac cause, accounting for approximately 20% of all cardiovascular deaths in Germany. A significant proportion of SCD in young people (< 50 years) are caused by hereditary arrhythmogenic diseases.</p><p><strong>Methods: </strong>The European Society of Cardiology (ESC) guidelines recommend autopsy in all cases of unexpected sudden death, especially in young people, and post-mortem genetic testing (molecular autopsy) if a hereditary heart disease is suspected. Several studies show that molecular autopsy reveals a clinically relevant sequence variant associated with an inherited arrhythmogenic disease in about 20% of cases. Clinical cardiological and genetic testing of biologically related relatives of the deceased can reduce the risk of further deaths within affected families.</p><p><strong>Results and conclusion: </strong>Based on molecular autopsy and clinical and genetic examination of relatives, therapeutic and preventive measures can be taken within families affected by SCD. This requires a structured approach to an SCD case by various medical disciplines within a financial and legal framework that has yet to be established in the German healthcare system.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Reply to the letter to the editor from Schalk E et al.: \"Respiratory syncytial virus-not only relevant for hygienic reasons\"].","authors":"L Reinke, R Worth, D Pape, J Heyckendorf, A Friedrichs","doi":"10.1007/s00108-025-01947-9","DOIUrl":"https://doi.org/10.1007/s00108-025-01947-9","url":null,"abstract":"","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[CAR T-cell therapy of mature B-cell neoplasms-Current use and practical considerations].","authors":"Theresa Weber, Andreas Burchert, Marion Subklewe","doi":"10.1007/s00108-025-01953-x","DOIUrl":"https://doi.org/10.1007/s00108-025-01953-x","url":null,"abstract":"<p><p>Chimeric antigen receptor (CAR) T‑cell therapy represents a novel and highly effective immunotherapeutic approach in the treatment of malignant B‑cell neoplasms. Although the term B‑cell non-Hodgkin's lymphoma (B-NHL) is still frequently used in clinical practice, the pathologically accurate designation according to the 2022 World Health Organization (WHO) classification is mature B‑cell neoplasms. The use of CAR T‑cell therapy is currently approved for several subtypes of these diseases, including large B‑cell lymphoma (LBCL), primary mediastinal B‑cell lymphoma (PMBL), mantle cell lymphoma (MCL) and follicular lymphoma (FL). The approach involves the ex vivo genetic modification of autologous T‑cells to express a CAR targeting the B‑cell surface antigen CD19, enabling the selective elimination of malignant CD19-positive cells. Clinical studies and register data have demonstrated a high overall response rate, significant improvements in progression-free survival (PFS) and sometimes also in overall survival (OS) in the varíous lymphoma entities. Despite these promising results, CAR T‑cell therapy remains complex and requires careful selection of the indications and specialized management of associated toxicities. Typical, but mostly manageable side effects of CAR T‑cell therapy include cytokine release syndrome (CRS), neurotoxicity (immune effector cell-associated neurotoxicity syndrome, ICANS), hematotoxicity (immune effector cell-associated hematotoxicity, ICAHT) and protracted immune reconstitution leading to increased susceptibility to infections. Close collaboration between CAR T‑cell centers and institutions that are not CAR T‑cell certified or practices is essential for the success of treatment. This affects not only the appropriate indications and the selection of an optimal bridging therapy prior to CAR T‑cell infusion but also particularly the structured management of potential complications during the postoperative course, in particular infectious complications, which frequently occur in the outpatient setting. Early communication, clear responsibilities and standardized follow-up protocols are decisive to ensure safe and successful care after CAR T‑cell therapy.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Tirzepatide for heart failure with preserved ejection fraction (HFpEF) and obesity-the cardiometabolic turnaround?]","authors":"Stefan Störk, Sirka Nitschmann","doi":"10.1007/s00108-025-01932-2","DOIUrl":"https://doi.org/10.1007/s00108-025-01932-2","url":null,"abstract":"","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Respiratory syncytial virus-not only relevant for hygienic reasons].","authors":"Enrico Schalk, Christina T Rieger, Oliver A Cornely, Sibylle C Mellinghoff, Nicola Giesen","doi":"10.1007/s00108-025-01942-0","DOIUrl":"https://doi.org/10.1007/s00108-025-01942-0","url":null,"abstract":"","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Management of side effects of CAR T cells].","authors":"Franziska Bach, Judit Grans-Seibel, Jorge Garcia-Borrega, Boris Böll","doi":"10.1007/s00108-025-01944-y","DOIUrl":"https://doi.org/10.1007/s00108-025-01944-y","url":null,"abstract":"<p><p>Chimeric antigen receptor (CAR) T cell therapy has significantly improved outcomes for patients with hematological neoplasms and the approval of six CAR T cell products has led to increasing routine use; however, CAR T cell therapy is associated with specific and sometimes severe side effects, which are summarized in this article. Cytokine release syndrome (CRS) is a frequent systemic inflammatory reaction triggered by the massive release of cytokines after CAR T cell activation. The symptoms range from mild fever to multiorgan failure. The management is stepwise using tocilizumab and corticosteroids depending on the severity, with recent data supporting the use of anakinra. Further targeted therapeutic agents appear to be promising. The immune effector cell-associated hemophagocytic lymphohistiocytosis-like syndrome (IEC-HS) is rare compared to CRS but life-threatening and is characterized by high ferritin levels, cytopenia and organ failure. Treatment includes anakinra, dexamethasone and other salvage medications, whereby recognition of the complication is essential. Immune effector cell-associated neurotoxicity syndrome (ICANS) is comparatively frequent, presenting with symptoms such as confusion, speech disturbances or seizures. The treatment depends on the severity and usually involves corticosteroids, anakinra and other immunosuppressants. Besides ICANS, a heterogeneous group of rarer neurological complications can also occur, which are often difficult to treat and not yet fully understood. Hematotoxicity with prolonged cytopenia (immune effector cell-associated hematotoxicity, ICAHT) is an increasingly recognized complication and its risk can be estimated before lymphocyte depletion using a simple score. Prolonged cytopenia substantially increases the risk of infections and explains why infections are the most frequent non-disease-related cause of death after CAR T cell treatment. In summary, since the first approval the management of CAR T cell-related side effects has markedly improved through a better understanding of the pathophysiology, identification of risk factors and especially early intervention strategies.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Purple urine bag syndrome].","authors":"Marco Franzoi, Florian Strasser, Hans Peter Gröchenig","doi":"10.1007/s00108-025-01882-9","DOIUrl":"10.1007/s00108-025-01882-9","url":null,"abstract":"","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":"762-764"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Fibrotic diseases].","authors":"Ulf Müller-Ladner, Claus F Vogelmeier","doi":"10.1007/s00108-025-01928-y","DOIUrl":"https://doi.org/10.1007/s00108-025-01928-y","url":null,"abstract":"","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":"66 7","pages":"657-658"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}