Internist最新文献

The acute porphyrias are a group of four metabolic defects in which the heme synthesis in the liver is disrupted. They are characterized by massively painful acute attacks, which can be life-threatening if not diagnosed. To raise the awareness for these rare disorders, a heme molecule in cartoon style is introduced, which accurately explains the basic biochemical processes in the body and mediates important information on the acute hepatic porphyrias in a simplified and attractive way. The article is complemented by a case report.

Adverse reactions to food affect approximately one third of the population. They are based on very different mechanisms and are divided into food intolerances, which manifest mainly in the gastrointestinal tract, and food allergies, which can also cause extraintestinal symptoms and have an immunological genesis. The most common food allergies in adults are pollen-associated allergies to cereals or pome and stone fruits, while allergies to peanut, milk and egg are particularly common in children. The diagnostics of food allergies are complex and therapy is primarily based on targeted elimination diets. This advanced education article focuses on food allergies with gastrointestinal symptoms.

Background: In addition to conventional anti-inflammatory treatment for chronic inflammatory bowel disease (IBD), there has been an evolution of new treatment options over the past 20 years. Already approved biologics provide multiple treatment alternatives but also make the treatment algorithms more complex. This development results in a substantial improvement in patient care. The ambitious treatment targets are associated with a higher quality of life and the reduction of long-term disability and morbidity.

Objective: The aim of this article is to give an overview of how biologics can currently be implemented in IBD. In particular, the current clinical management is presented and an outlook on future treatment options with biologics for IBD is provided.

Material and methods: A search was carried out in PubMed and ClinicalTrials.gov and the current German and European guidelines and expert recommendations were evaluated.

Results: Since the late 1990s there have been a continuously increasing number of treatment options for IBD. All substances have proven safety and efficacy in large randomized clinical studies and enable increasingly more individualized treatment for patients with IBD. Biologics are currently the standard treatment of choice for moderate to severe inflammatory activity as well as for steroid-refractory or steroid-dependent courses of disease after failure of conventional treatment.

Conclusion: The diversity of IBD treatment offers increasing treatment options and thus improved patient care; however, as the number of new substances increases treatment becomes more complex. This article summarizes the current and future treatment options for IBD and their integration into current treatment algorithms.

Background: Patients with atrial fibrillation are at a significantly increased risk of thromboembolic events, especially ischemic strokes. Oral anticoagulation reduces this risk, but cannot be used in some patients for various reasons and is associated with a relevantly increased risk of bleeding. As an alternative for prophylaxis of thromboembolic events in patients with atrial fibrillation, there are different options of left atrial appendage closure.

Aim: This article explains the possibilities of interventional atrial occlusion as well as the suitable patient clientele using an overview of the currently available systems for atrial occlusion, a guideline for patient selection and a summary of the current scientific data.

Conclusion and available scientific data: In carefully selected patients suffering from atrial fibrillation with relative or absolute contraindications for oral anticoagulation, interventional closure of the atrial appendage is a safe alternative for prophylaxis against thromboembolic events. The currently available scientific evidence from randomized controlled trials is sparse. Nevertheless, extensive amounts of registry study data suggest a benefit, while the results of several large randomized controlled trials are expected in the coming years.