Innere Medizin (Heidelberg, Germany)最新文献

Prophylactic replacement therapy for hemophilia A (hereditary factor VIII deficiency) is a success story of the production of coagulation factor concentrates from donor plasma. Recombinant factor concentrates, which are also produced with modified gene constructs for coagulation factor VIII in order to improve pharmacological properties, have since proven their worth. This successful development over many years of factor concentrates for the successful treatment of hemophilia patients has now been followed by the innovation of a factor VIII mimetic in the form of a monoclonal antibody, which was developed in Japan already some years back. Emicizumab is a humanized, bispecific monoclonal antibody for therapeutic use in hemophilia A. With this therapeutic agent, the treatment of the hereditary coagulation defect is based, for the first time, on a completely new active principle. The specific antibody simulates the properties of coagulation factor VIII as a cofactor for the formation of the tenase complex with the coagulation factors IX and X. As a result under steady state conditions almost normal thrombin and thus fibrin formation can be achieved.

Background: Socio-structural and socio-cultural change in Western societies is increasingly challenging healthcare institutions to take good care of people's health and dignity. Further and sustainable progress in health care is increasingly influenced by socio-cultural conditions. If these conditions are insufficiently taken into account, further medical progress is jeopardized.

Aim of the paper: The aim of this paper is to elucidate the significance of social conditions of health over the life course and thus to shed more light on one of the four ethical principles in medicine, namely equity.

Material: The question is addressed by a literature review, whereby the literature was reviewed from a structural theory perspective.

Results: If people feel discriminated against in terms of their age, gender, or migration background, this not only has an impact on their self-esteem, but also on their health and recovery from illness. Unfavorable economic living conditions have a negative impact on health behavior. Experiences of discrimination in the healthcare system can reduce satisfaction with treatment and contribute to non-compliance with treatment instructions.

Discussion: The socio-cultural effects mentioned above can be influenced not only by individual changes in behavior but in particular by structural and institutional change processes. There is a need for "habitus sensitivity" in both clinical and private practice, i.e., it is also part of the responsibility of doctors in the healthcare system to eliminate discrimination.

Sexually transmitted infections (STI) or sexually transmitted diseases (STD) can be caused by bacteria, viruses, fungi, protozoa and arthropods. The most frequent bacterial STIs include Chlamydia infections, syphilis and gonorrhea; viral STIs include herpes genitalis (herpes simplex virus 1 and 2), human papillomavirus (HPV) and human immunodeficiency virus (HIV). An empathetic medical history taking in cases of a clinical suspicion can provide important information for adequate diagnostics. When an STI is detected, a complete screening for other STIs should be carried out. The STIs result in a wide variety of symptoms and it is often difficult to make a clear diagnosis to a certain pathogen based on the clinical symptoms. To avoid reinfections, it is recommended to also test recent sexual partners. For certain pathogens highly effective postexposure prophylaxis or preventive vaccinations are available.

The label "precision medicine" appears to have the status of a "moral high-value word". Moral high-value words possess an ambivalent dialectic of light and dark. On the one hand, precision medicine promises an individual diagnosis and treatment of severe diseases focussed on the ill person with reduction of undesired side effects as far as possible. On the other hand, the label "precision medicine" rapidly leads to a gradual devaluation of everything that only seems "not precise", "vague" or simply "generally just unspecific". Precision medicine therefore nearly automatically promotes their prioritization and preference in the distribution of scarce resources, which is simultaneously associated with a deprioritization or inferiority in the distribution of scarce resources for the "not so valuable". As a further communicative weak point the limited understanding of "precision" catches the eye: precision medicine is often associated with technological high-performance medicine, which often reacts to a clear (severe) disease picture; however, many courses of diseases are still in an unclear stage or in a situation where there are clearly no (longer) perspectives for recovery and curative measures are no longer medically indicated. This article takes up on three ethical aspects, which should play an essential role in the debate on precision medicine: the uppermost criterion in the distribution of scarce resources, the relevance for patients as the uppermost aim of medical treatment and that of the patient-relevant inner understanding of the quality of life or well-being of patients.

The case of a 33-year-old male with recurrent icterus and hemolysis since childhood that was long mistaken for Gilbert disease is presented. Subsequently, the patient also developed splenomegaly and gallstones together with iron overload. Genetic testing revealed the diagnosis of hereditary xerocytosis, which is an erythrocyte membrane disorder causing recurrent hemolysis. Xerocytosis is often challenging to diagnose and the frequency of the condition might be underestimated as there are often no typical findings in the microscopic differential blood count, and Eosin-5-maleimide dye (EMA) test, which is used to diagnose other erythrocyte membrane disorders, is normal. In cases of splenomegaly, iron overload and recurrent hemolysis, or in the case of a clinical diagnosis of Gilbert disease together with one of the above-mentioned symptoms, further investigations and possibly also genetic testing should be considered.

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.

Streptococcus pyogenes is a human pathogenic, gram positive bacterium that primarily leads to pharyngitis or soft tissue infections. Primary peritonitis caused by S. pyogenes infection is rare and there are only a few published cases worldwide. Primary peritonitis due to other pathogens occurs in immunosuppressed conditions such as HIV or other chronic diseases. However, younger, healthy women are more likely to be affected by S. pyogenes peritonitis. At present, the underlying molecular mechanisms can only be speculated on. One possibility is that, similar to the clinical picture of streptococcal toxic shock syndrome (STSS), a specific serotype of the M protein in combination with inhibition of the cell response of neutrophil granulocytes could play a role. In addition to peritonitis, the clinical picture may include other organ manifestations such as acute kidney damage or circulatory dysregulation. In terms of treatment, rapid pathogen-directed empirical antibiotic therapy is the treatment of choice. If there is no indication of secondary peritonitis, diagnostic laparoscopy can be dispensed with in the further diagnostic work-up.

Background: Pulmonary embolism is the third most common cardiovascular disease. Interventional treatment options as an alternative to systemic lysis therapy of hemodynamically stable, submassive pulmonary embolisms have received an unprecedented boost in innovation in recent years. The treatment options are heterogeneous and can be roughly divided into local thrombolysis and local thrombectomy. For years in our center we have been carrying out catheter-assisted, locoregional lysis therapy with side-hole lysis catheters and a cumulative dose per pulmonary branch of 10 mg alteplase over 15 h for hemodynamically stable, submassive pulmonary emboli.

Aim: The aim of this retrospective study was to review this therapeutic concept and to collect data on clinical endpoints and possible complications.

Methods: The study included data from 01/2018-03/2023. For this purpose, the patients were selected based on the OPS codes (8.838.60 and 1‑276.0), and the data was collected using the medical records. Biometric data, data on previous illnesses and vital parameters, laboratory chemistry data, CT diagnostic data, echocardiographic data, data on drug treatment and data on complications were collected anonymously.

Results: There was a significant reduction in the strain on the right heart. Peripheral oxygen saturation also improved significantly and heart rate decreased significantly. The complication rate remained low and was almost exclusively limited to access-related problems.

Conclusion: Catheter-assisted, locoregional lysis therapy is a safe and effective treatment method for submassive pulmonary embolism.