Innere Medizin (Heidelberg, Germany)最新文献

From a psychological point of view resilience is closely related to aspects of stress. As a further development of the classical stress model, the skills of individuals are described in the context of psychological resource models which enable an appropriate coping with situations that trigger stress. These differential aspects of the stress reaction are frequently highlighted in the literature on psychology. Based on a sophisticated description of stressors (i.e., environmental stimuli which are able to induce stress) characters of a person, such as personality, age, gender and strategies of coping are responsible for the expression of the stress response. The individual "translation" of the effects of stressors into a (stress) response is mediated by various somatic systems and aspects of emotionality. At the different levels of the stress reaction restoration processes occur which are helpful in modifying the potentially harmful effects of stressors and a homeostasis is restored. These restoration processes can be systematically described as a buffer function for the extent of a stress reaction and can be influenced in a targeted way. Therefore, the term resilience which has been used for some time appears to be a type of metaphor for psychological processes which have been known for a long time in the context of psychological research on stress and recovery.

A 22-year-old male patient with a clinical picture similar to that of sepsis was diagnosed with macrophage activation syndrome in adult Still's disease on the basis of clinical and laboratory criteria. The diagnostic work-up included the differentiated clarification of a persistent fever syndrome and the differential diagnosis of hemophagocytic lymphohistiocytosis. Immunosuppressive therapy with dexamethasone, immunoglobulins and anakinra was initiated and a sustained clinical remission was achieved.

The group of systemic fibrosing connective tissue diseases is remarkably diverse, comprising a wide spectrum of distinct entities. Central to their pathogenesis is the fibroblast, which, when activated by exogenous or endogenous triggers, can pathologically overproduce components of the extracellular matrix or exhibit uncontrolled proliferation. Systemic sclerosis, recognized as the prototype of systemic fibrosing diseases, belongs to the connective tissue diseases. Despite considerable advancements in the understanding of its pathogenesis, diagnosis, and treatment over recent years, systemic sclerosis remains one of the most fatal conditions among inflammatory rheumatic diseases. Its hallmark features include vasculopathy, systemic fibrosis, and autoimmunity, with common organ involvement affecting the skin, lungs, heart, gastrointestinal tract, kidneys, and musculoskeletal system. Therapeutic strategies focus on improving perfusion, controlling inflammation, and implementing antifibrotic measures. Key differential diagnoses include eosinophilic fasciitis, mixed connective tissue disease, and other overlap syndromes, which often require immunomodulatory treatment. Innovative developments in the field suggest a potential paradigm shift in the treatment of inflammatory rheumatic diseases, with cell-based therapies like CD19-depleting chimeric antigen receptor (CAR) T cell therapy showing promising early outcomes. Other systemic fibrosing diseases include scleromyxedema and scleroedema adultorum Buschke, both of which belong to the mucinoses and contribute further to the complexity of this disease group.

Chronic liver damage, such as metabolic dysfunction-associated steatotic liver disease (MASLD), viral hepatitis B or C, cholestatic hepatitis (PBC, PSC), toxic damage (alcohol) or genetic alterations (hemochromatosis, Wilson's disease, etc.) usually cause a chronic inflammatory response in liver cells or bile duct epithelial cells. In the long term this chronic inflammatory response can lead to scarring of the liver, a condition known as fibrosis. The development of liver fibrosis is largely independent of the causative agent, although the pattern of initial fibrosis (periportal, pericentral or sinusoidal) can vary. Untreated and progressive fibrosis can sometimes lead to complete architectural deconstruction and deposition of connective tissue in the liver, intestines and other parenchymal organs, with a gradual loss of function. In the end stage of liver cirrhosis, portal hypertension, encephalopathy, bleeding or carcinomas, e.g., hepatocellular carcinoma (HCC) and intrahepatic cholangiocellular carcinoma (iCCCa), can occur. Intestinal fibrosis is one of the most devastating complications of Crohn's disease. With novel and consistent therapeutic interventions, fibrotic processes can be stopped and reversed. New research technologies have substantially improved our knowledge of liver fibrogenesis and intestinal fibrosis. The focus of this review article is on MASLD and Crohn's disease, chronic inflammatory diseases of the liver and intestines with increasing prevalence and a major impact on the general population. The current principles and potential possibilities of preventive and therapeutic antifibrotic interventions are illustrated.

Background: Arterial occlusive disease of the central arteries involving the abdominal aorta and iliac arteries leads to multiple symptoms such as intermittent claudication, including of the gluteus muscle, and erectile dysfunction.

Objectives: A description of the indications, technique and clinical outcomes of the endovascular therapy of aorto-iliac artery occlusive disease.

Results: Due to new endovascular techniques and improved stents and stent grafts developed over the last two decades, the endovascular therapy of aorto-iliac obstructions has become the standard method for the treatment of intermittent claudication in experienced centers. Open surgical bypass revascularisation is mainly indicated after a failed endovascular attempt or in the case of unfavourable anatomy for endovascular therapy, including flush occlusions distal to the renal artery origins. A less frequently used revascularisation technique, the hybrid revascularisation, combines open surgical thromboendarterectomy of the common femoral artery and stent implantation of the ipsilateral iliac artery or aorta. Obstructions of the internal iliac artery resulting in, among other things, erectile dysfunction and hip claudication are ever more frequently treated with either drug-eluting stents or balloons.

Conclusion: In the case of appropriate operator experience and suitable anatomy, endovascular therapy has become the first-line revascularisation strategy for aorto-iliac occlusive disease involving the internal iliac artery.

There has been great progress in the field of endovascular therapy in recent years, particularly in the femoropopliteal vascular segment. Of particular importance here is lesion preparation, which has led to a significant reduction in restenosis and thus revascularisation rates. The use of mostly paclitaxel-based drug-coated balloons or stents has shown clear advantages over conventional balloon dilatation (POBA). This article will present and describe the various balloon and stent systems that can be used in endovascular therapy below the knee.

Vaccinations are an important preventive measure against viral diseases and have saved many lives since their introduction. Nowadays, any doctor can administer a vaccination. Patients with chronic diseases should be vaccinated according to indications. In general, it is advisable to carry out co-administration, which is usually possible without any problems with many vaccines, especially inactivated vaccines. Appropriate quality management can avoid complications. It is also important to inform patients about vaccinations and, if necessary, to remind them of their second appointment after the first vaccination in order to ensure maximum effectiveness.

The endovascular treatment of the femoropopliteal segment is the most frequent revascularization option in patients with peripheral arterial occlusive disease (PAOD); however, the plain old balloon angioplasty has limitations, especially in complex and calcified lesions, and can lead to dissections and recoil. In order to improve the technical success and the efficacy of the endovascular treatment in complex, sometimes severely calcified or thrombotic lesions or also in lesions in mobile segments, a lesion preparation strategy before the actual lesion treatment is frequently applied. Lesion preparation methods include atherectomy, thrombectomy or intravascular lithotripsy. Through lesion preparation plaques and/or organized thrombi can be minimally invasively removed or calcium deposits can be even fragmented with low threshold barotrauma, without damaging the vessel wall. Subsequently, the definitive treatment of the lesion can be carried out using drug-coated balloons (DCB), bare metal stents (BMS), drug-eluting stents (DES) or a combination of these. Due to the heterogeneity of patient and lesion characteristics, no 'one fits all' strategy is so far available; however, the choice of the appropriate instruments should be carried out based on the patient and lesion characteristics present, whereby for the lesion-specific parameters the extent of the morphology and underlying pathology plays an important role.

The case of 92-year-old male with a history of sepsis due to Clostridium septicum is described. Since the bacteria were also found at the site of joint aspiration, the patient underwent knee prosthesis removal. Due to the association between colorectal cancer and Clostridium septicum, a colonoscopy was performed. An adenocarcinoma was extracted in situ. At 5 months, the patient presented again with shortness of breath, acute retrosternal pain and fever. CT revealed a mycotic aneurysm of the descending aorta with Stanford B dissection and periaortic gas. Due to the fragility of the patient, conservative treatment was initiated.

Non-Hodgkin's lymphomas constitute a highly heterogeneous group of neoplasms. Their origin lies in the lymphatic cells of our immune system. Despite their biological variance, they can be clinically classified into indolent and aggressive lymphomas. This categorization has prognostic and therapeutic implications. The goal of treatment in aggressive lymphoma is full remission, which usually requires an intensive treatment regimen. In cases of indolent lymphoma, cure is not the therapeutic goal, but rather disease control. Recent developments have led to novel therapeutic options in addition to the classic well-known chemotherapies and anti-CD20 antibodies. The use of a variety of targeted therapies, including cellular therapies such as chimeric antigen receptor (CAR) T cells, has led to significantly improved outcomes.