Deutsche medizinische Wochenschrift (1946)最新文献

{"title":"[Secondary hemophagocytic lymphohistiocytosis due to icteric leptospirosis with acute renal failure].","authors":"Marvin Dumke, Nadine Wilsdorf, Iris Barndt","doi":"10.1055/a-2455-6902","DOIUrl":"https://doi.org/10.1055/a-2455-6902","url":null,"abstract":"<p><p>A 51-year-old patient presented himself with fever, upper abdominal pain and exertional dyspnea. Hemodynamic instability accompanied by generalized icterus, hepatosplenomegaly, a morbilliform rash with petechia and bilateral conjunctivitis revealed in clinical examination.Laboratory results revealed elevated C-reactive protein and procalcitonin as well as pancytopenia and hyperbilirubinemia. Furthermore hypertriglyceridemia, hyperferritinemia and elevated soluble IL-2-receptor were found. Testing for infectious diseases detected IgM-antibodies to leptospires. Bone marrow cytology featured hemophagocytosis.Secondary hemophagocytic lymphohistiocytosis due to icteric leptospirosis (Weil's disease) was diagnosed.Immediate antibiotic therapy and circulatory support by fluid and vasopressors was initiated and non-invasive ventilation and hemodialysis stabilized the patient. With steroids and polyvalent immunoglobulins the organ functions recovered.Hemophagocytic lymphohistiocytosis is an important differential or concomitant diagnosis in sepsis and can be induced by rarely diagnosed infectious triggers like leptospirosis.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 8","pages":"434-437"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756778","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":"[Update on diagnostics and therapies in inflammatory bowel diseases].","authors":"Raja Atreya","doi":"10.1055/a-2335-6154","DOIUrl":"https://doi.org/10.1055/a-2335-6154","url":null,"abstract":"","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 8","pages":"391"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756780","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":"[Lupus nephritis - does a lot help a lot?]","authors":"Cornelia Elisabeth Eckert, Bruno Reible, Zoran Popovic, Bernhard Hellmich, Christian Löffler","doi":"10.1055/a-2375-2634","DOIUrl":"https://doi.org/10.1055/a-2375-2634","url":null,"abstract":"<p><p>Lupus nephritis (LN) is a frequent and often serious manifestation of systemic lupus erythematosus, which can lead to the need for renal replacement therapy. Its timely diagnosis and treatment is therefore of crucial importance. The use of targeted immunomodulating therapies and the consistent use of nephroprotective measures in the treatment of LN can now significantly improve the renal prognosis and reduce glucocorticoid-associated toxicity. Recent study data have shown that the combination of different immunomodulating therapies including calcineurin inhibitors or belimumab is superior to therapy with single agents in terms of clinically relevant renal endpoints. This multi-target therapy has now also been included in several recently updated international guidelines. In the future, CAR-T cell therapy could be a promising prospect for patients with refractory lupus nephritis.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 8","pages":"451-460"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756773","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":"[Update on drug therapy for ulcerative colitis].","authors":"Elena Sonnenberg, Britta Siegmund, Carl Weidinger","doi":"10.1055/a-2368-7090","DOIUrl":"https://doi.org/10.1055/a-2368-7090","url":null,"abstract":"<p><p>Ulcerative colitis (UC) is classified as a chronic inflammatory bowel disease (IBD) and can present in various degrees of severity. In addition to mild courses of the disease, such as uncomplicated proctitis, which can often be successfully treated with topical 5-ASA formulations, complicated courses can be observed, which can sometimes be life-threatening. Affected patients are often considerably burdened and often severely restricted in their quality of life, as they suffer from numerous, often bloody bowel movements, which are accompanied by abdominal cramps, urgency and sometimes even incontinence. In addition, many UC patients suffer from concomitant extraintestinal inflammatory manifestations including skin manifestations like psoriasis, erythema nodosum or joint involvement such as spondylarthritis. For many years, steroids and conventional immunosuppressants such as azathioprine were the only treatment options available. Twenty years ago, the approval of the first anti-TNF antibody, Infliximab, marked a significant turning point in IBD therapy. Despite the continuous progress in drug therapy, the rates of primary and/or secondary treatment failure are still considerable. With this in mind, a large number of additional substances have been developed and approved for the treatment of UC in the recent years. In addition to TNF antibodies and their biosimilars, the anti-integrin vedolizumab, various Janus kinase (JAK) inhibitors, an interleukin (IL)-12/-23p40 antibody, various IL-23p19 antibodies and sphingosine-1-phosphate receptor (S1PR) modulators have broadened the therapeutic landscape and found their way into the clinical treatment of UC patients. In this article we will discuss case-based decision paths for the selection of fitting anti-inflammatory treatments in UC patients and summarize the principles of the different therapeutic strategies for UC.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 8","pages":"412-418"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756782","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":"[Pneumococcal sepsis 2015-2022: considerations on vaccination strategies].","authors":"Herbert Hof, Sabine Singer, Ika Steiner, Daniela Bertsch, Maria Kirstahler, Klaus Oberdorfer, Matthias Imöhl, Mark van der Linden","doi":"10.1055/a-2506-4928","DOIUrl":"10.1055/a-2506-4928","url":null,"abstract":"<p><p>In spite of available vaccines the frequency of sepsis caused by <i>Streptococcus pneumoniae</i> still remains rather high.In the years 2015-2022 <i>Streptococcus pneumoniae</i> could be isolated from 925 blood cultures in our laboratory. Serotyping was performed from 754 strains. In addition, their in vitro susceptibility to some antibiotics was assessed.In this period 925 blood cultures were positive, predominantly from aged patients (older than 60 years) and more frequently from men than from women. In the years 2020 and 2021 less positive blood cultures were found, which could be interpreted as a result from non-pharmaceutical interventions preventing aerogenically transmitted diseases such as coronavirus infections during the epidemic. Children were also relatively susceptible in their first year of life. 653 strains were serotyped, with serotypes 3 and 8 predominating. 67% of the serotypes found were covered by the 20-valent conjugate vaccine whereas the polysaccharide vaccine (PPV23) included 75%. The vast majority of isolates was susceptible to penicillin, erythromycin as well as to doxycycline. Multi-drug resistant strains were not detected.A large part of the infections might have been prevented by vaccination assuming a high vaccine effectiveness. However, 27% of <i>S. pneumoniae</i> serotypes detected were not covered by any of the vaccines currently available.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":" ","pages":"e11-e17"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Endoscopy in Inflammatory Bowel Diseases: From Proven to New].","authors":"Timo Rath, Markus F Neurath","doi":"10.1055/a-2344-7995","DOIUrl":"https://doi.org/10.1055/a-2344-7995","url":null,"abstract":"<p><p>Inflammatory bowel diseases with the 2 main forms - ulcerative colitis and Crohn's disease - are chronic relapsing diseases of the gastrointestinal tract in which dysregulation of the intestinal immune system against commensal components of the microbiome leads to perpetuated intestinal inflammation based on a genetic predisposition. While in the past symptom control was the focus of therapy, more recent data show that achieving endoscopic remission is superior to sole clinical symptom control for the further course and prognosis of the diseases. In this review article, we will present the significance of endoscopy for inflammatory bowel diseases, describe established scoring systems for endoscopic graduation of inflammatory activity and, last but not least, also present and review new endoscopic developments.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 8","pages":"419-426"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756768","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":"[70-year-old male patient with Polycythaemia vera and chronic leg ulcer].","authors":"Daniel Craus, Valentina Laura Müller, Alexander Kreuter","doi":"10.1055/a-2432-7259","DOIUrl":"https://doi.org/10.1055/a-2432-7259","url":null,"abstract":"","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 8","pages":"403-404"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756716","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":"[New and current therapeutic goals of chronic inflammatory bowel disease].","authors":"Raul Lande, Irina Blumenstein","doi":"10.1055/a-2335-5901","DOIUrl":"https://doi.org/10.1055/a-2335-5901","url":null,"abstract":"<p><p>Chronic inflammatory bowel diseases (IBD), such as Crohn's disease (MC) and ulcerative colitis (CU), are serious immune-mediated diseases that affect the gastrointestinal tract and represent a considerable burden for patients. In recent decades, the treatment of IBD has shifted from symptomatic control to more precise, long-term goals. Advances in IBD research have led to therapy goals having been redefined and expanded in order to achieve complete inflammation control and prevent complications in the long term.An important component of modern therapeutic approaches is the definition of specific markers that serve as indicators for the achievement of these therapeutic goals. These markers enable objective monitoring of the success of treatment and thus offer a clear approach for controlling the therapy. The present article focuses on the new therapeutic goals in IBD treatment and discusses the role of therapeutic target markers in clinical practice.A central goal in modern IBD therapy is endoscopic healing, i.e. the complete macroscopic healing of the intestinal mucosa. In clinical practice this includes in particular an ulcer-free mucosa. In contrast to clinical remission alone, endoscopic healing provides an objective assessment of the inflammatory state and correlates strongly with an improved long-term prognosis.The histologic remission goes beyond endoscopic healing and aims to endoscopic healing to no longer detect signs of inflammation at the microscopic level. This is particularly relevant as the results show that patients who achieve a complete histological remission have an even lower recurrence rate and better long-term results than those who only achieve a clinical or endoscopic remission.Even though no curative therapy for IBD currently exists, the complete cure remains the ultimate goal of research. In current practice, this goal is still unattainable in current practice, but progress in genetic and immunological research offers hope. In the long term, the aim is to innovative approaches such as gene editing or immunotherapy to cure the disease. This could mean that patients are not only free of symptoms, but also freed from the burden of the disease in the long term.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 8","pages":"427-432"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756776","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":"[Advanced therapies: Un update on medical treamtent options in Crohn`s disease].","authors":"Agnieszka Kafel, Clara Rodriguez de Castro Zalona, Chiara Seiz, Elisabeth Schnoy","doi":"10.1055/a-2368-7173","DOIUrl":"https://doi.org/10.1055/a-2368-7173","url":null,"abstract":"<p><p>Crohn's disease is a chronic inflammatory bowel disease (IBD) that can manifest throughout the entire gastrointestinal tract from mouth to anus. It is characterized by so-called \"skip lesions\", which are affected sections of the intestine interspersed with healthy sections. In recent years, there have been significant progress and an expansion of medical treatment options for Crohn's disease with the approval of many new substances. Treatment goals have also become more ambitious, going beyond clinical symptom control to mucosal healing and, according to the STRIDE II criteria, to transmural healing in Crohn's disease in the future. If these goals are achieved, patients with Crohn's disease have a good chance of remaining in long-term remission and can expect fewer complications such as disease progression, hospitalization, anemia, fistulas, strictures, or surgeries. Despite having access to a variety of different substance classes in the treatment of Crohn's disease, in everyday practice we can see that these medications are not effective for some patients in the long-term. There is a so-called \"therapeutic ceiling\" in IBD, meaning that only about 40-50% of those affected are successfully managed long-term with one substance. Therefore, new medical treatment options for Crohn's disease always represent an opportunity to treat patients even better.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 8","pages":"405-411"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756719","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":"Demedikalisierung – weniger ist oft mehr.","authors":"Hans-Michael Mühlenfeld","doi":"10.1055/a-2492-9679","DOIUrl":"https://doi.org/10.1055/a-2492-9679","url":null,"abstract":"","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 8","pages":"438-450"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756784","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}