Medizinische Klinik最新文献

Case report: In a 45 year old patient pulmonary, renal and ocular manifestations of ANCA-associated vasculitis is reported that required immunosuppressive therapy. On admission the patient complained about enduring lower abdominal pain. A CT scan revealed free intraabdominal fluid and dilated small intestine filled with fluid. Laparotomy was performed with the working diagnosis of paralytic ileus. Intraoperatively, hemorrhagic-necrotic alterations of the small intestinal wall were conspicuous and resected. Microscopic examination revealed transmural ischemic necrosis of the resected intestinal tissue with prominent granulomatous vasculitis of arteries. CD20-antibody rituximab was applied due to the life-threatening condition and as ultima ratio therapy. Subsequently the disease activity was controlled, renal function improved and abdominal discomfort subsided.

Conclusion: Gastrointestinal involvement with necrotizing vasculitis is an uncommon but serious complication. Most patients respond to established therapy protocols encompassing cyclophosphamide and glucocorticoids. Administration of rituximab may be a promising alternative in refractory cases.

Case report: We report on a 36-year old patient with a chronic leg ulcer at the right malleolus lateralis which persists since nine month and causes distinct pain. Furthermore telengiectatic erythema in terms of a naevus flammeus could be found at the right leg and foot as well as genital and gluteal. By birth the right leg of the patient was longer than the other one. In spite of initiation of several therapies the ulcer was refractory to different therapies. The clinical diagnosis of a chronic venous insufficiency of the right leg was clearly proven by apparative diagnostic. In consequence of all findings we diagnosed a Klippel-Trenaunnay syndrome consisting of the typical trias of naevus flammeus, hemihypertrophie of bone and soft tissue as well as angiodysplasies with a distinct chronic venous insufficiency.

Conclusion: The presented case describes a patient with a Klippel-Trenaunnay syndrome as a seldom cause of a chronic leg ulcer. Although it is a very rare cause for a chronic wound it should be known by physicians to be considered in the differential diagnosis process.

Background: Due to improvements in long-term survival in cancer patients, emphasis is increasingly placed on chronic symptoms such as cancer-related fatigue in patients after completion of cancer treatment. Fatigue prevalence in these patients ranges from 17% to 56%. However, there is a lack of complex treatments that take the multifactorial character of fatigue causation into account.

Patients and methods: Based on a needs analysis, a patient education program was developed and evaluated. The study aimed at cancer patients after completion of the cancer treatment who suffer from chronic fatigue. The self-management program FIBS consists of six modules. Information about fatigue and behavioural therapy orientated strategies and exercises are included. Patients who attended the program were highly satisfied. They were satisfied with the selected topics at an average of 84.0%, and with the conditions at 84.25%. 95.8% of the patients achieved a subjectively perceived personal benefit, on average 8.14 of 12 possible points. The overall patient education satisfaction scored 78.72%.

Conclusion: The newly developed self-management program closes a gap in health care of cancer patients with chronic fatigue for whom there are hardly any intervention options to date. The program is characterised by target group-specific contents and methods and a high satisfaction of the patients.

Background and purpose: Costs for diabetes treatment burden statutory health care systems. Aim of the LIVE-COM study (Long Acting Insulin Glargine versus Insulin Detemir Cost Evaluation Comparison) was to assess resource utilization and costs of diabetes care as well as patient reported outcomes in a random sample of type 2 diabetes patients treated with either insulin glargine (GLA) or detemir (DET) as part of a basal-bolus regimen in a primary care setting.

Patients and methods: LIVE-COM is a non-interventional, cross-sectional study performed between April and September 2008 in 138 randomly selected centers of primary care physicians in Germany. From 1731 type 2 diabetes patients (GLA: n = 1150; DET: n = 581) with statutory health insurance status and pretreatment with either GLA or DET for at least 6 months as part of a basal-bolus therapy, total direct costs of diabetes care (for insulins, oral antidiabetic drugs, test strips, needles, lancets, Hypokits®) were calculated from total recorded expenditures, for a period of six months, from the perspective of statutory health insurance. Patient-reported outcomes were assessed using validated questionnaires (SF-12, DTSQs, ITEQ).

Results: Mean total costs per patient over six months were lower with GLA based therapy compared with DET based therapy (972 euro ± 374 euro vs. 1135 euro ± 477 euro, p < 0.001). Adjusted by ANCOVA: 932 euro (95% CI: 905, 957 euro) vs. 1.061 euro (95% CI: 1025, 1099 euro, p < 0.001). The adjusted mean single costs for basal insulin (223 euro vs. 246 euro), bolus insulin (241 euro vs. 289 euro), test strips (347 euro vs. 393 euro) and needles (67 euro vs. 80 euro) were significantly lower in the GLA group (p < 0.001, each), whereas costs of OAD (36 euro vs. 35 euro), lancets (14 euro vs. 15 euro) and Hypokits® (1.9 euro vs. 1.0 euro) did not differ significantly. Glycemic parameters (HbA1c, fasting blood glucose) were better on GLA based therapy (p < 0.01) and associated with lower daily total insulin doses (68 U vs. 79 U). Furthermore, slightly better results in patient-reported outcomes were found in GLA patients.

Conclusion: In a head-to-head comparison over six months a glargine vs. detemir based basal-bolus therapy in type 2 diabetes patients was associated with lower total costs of diabetes care Δ: -128 euro/patient) mainly caused by savings of consumables. Further health services research with larger sample sizes should be conducted to obtain a more comprehensive analysis of economic aspects of insulin analogs or other innovative drugs in routine practice.

Background: Schistosomiasis and hepatitis B are both tropical diseases with more than 200 and 350 million people infected worldwide respectively, but are rare in western countries. Worldwide a high rate of coinfections can be expected.

Case report: A 34-year-old African patient was referred to our clinic with known hepatitis B/D-coinfection for evaluation of antiviral treatment.

Results: Surprisingly, liver biopsy showed a granuloma with the egg of Schistosoma in addition to virus induced alterations. Subsequent examination of the stool allowed to classify the parasite as Schistosoma mansoni. Thus, before initiation of an antiviral treatment, an antischistosomal therapy with praziquantel leading to elimination of schistosomiasis was started.

Conclusion: Patients from tropical countries suffering from chronic viral hepatitis may present with additional coinfections which can be earily overlooked in daily clinical routine. Screening of African patients from endemic areas for schistosomiasis should include examinations for tropical diseases by specialists.

The proto-oncogene src encodes a nonreceptor tyrosine kinase whose expression and activity are correlated with advanced malignancy and poor prognosis in a variety of human cancers. Nine additional enzymes with homology to src have been identified and collectively are referred to as src family kinases (SFKs). SFKs represent the largest family of nonreceptor tyrosine kinases and interact directly with receptor tyrosine kinases, G-protein-coupled receptors, steroid receptors, signal transducers and activators of transcription, and molecules involved in cell adhesion and migration. These interactions lead to a diverse array of biological functions including proliferation, cell growth, differentiation, cell shape, motility, migration, angiogenesis, and survival. Studies investigating mutational activation of src in human cancers suggest that this may be a rare event and that wild-type src is weakly oncogenic. Thus, the role of src in the development and progression of human cancer remains unclear; however, it has been suggested that SFK activity may be linked to cancer progression and metastatic disease by facilitating the action of other signaling proteins. SFKs may therefore represent a promising therapeutic target. As a consequence, src-targeting therapies are a recent development. Although numerous agents have been discovered, few have reached clinical development. Amongst them, dasatinib, bosutinib and saracatinib are already in phase II testing and data from these trials suggest that these agents are well tolerated, however, they possessed little clinical activity as monotherapy. Future clinical development will therefore include trials of combination therapy.