Dietrich C.F.,University of Würzburg |
Hocke M.,Medizinische Klinik 2 |
Jenssen C.,Innere Medizin
Deutsche Medizinische Wochenschrift | Year: 2013
This CME-review is about the clinical importance of the abdominal lymph node diagnostic with special attention to various ultrasound techniques. This includes innovative techniques like contrast enhanced ultrasound and elastography. The clinical importance of ultrasound in relation to cross sectional imaging will be the target of the article as well as anatomic- topographic aspects. The article deals as well with endosonographic techniques because of the upmost importance of the technique for diagnosing mediastinal and abdominal lymphnode swellings. In conclusion of the article different clinical scenarios and clinical algorithms are presented to help the reader to diagnose abdominal lymphadenopathy correctly in an efficient way. © Georg Thieme Verlag KG Stuttgart , New York.
Lollgen H.,Innere Medizin
Herzschrittmachertherapie und Elektrophysiologie | Year: 2015
Introduction: There has been a long standing controversy on the role of a resting electrocardiogram (ECG) in the preparticipation examination of athletes, as well as in children and adolescents, in leisure time and competitive athletes. Besides other arguments, this was due to the limited validity, which led to false positive and false negative findings. Methods: Recent studies from different research groups yielded a significant improvement in establishing ECG criteria in athletes to discriminate normal from abnormal or pathological findings in athletes. This is additionally supported and improved by a software-based ECG device considering the new Seattle criteria. These new criteria from the Seattle conference reliably discriminate normal from abnormal findings. Frequent ECG findings in athletes, especially in those engaged in endurance sports are sinus bradycardia, atrioventricular (AV) block and signs of left ventricular hypertrophy. Results: Abnormal findings are related to structural left ventricular alterations due to cardiomyopathy, mainly hypertrophic with or without outflow tract obstruction, arrhythmogenic right ventricular cardiomyopathy (ARVC) and dilated cardiomyopathy. The ECG findings suggestive of electrical conductance disorders are observed in channelopathies, Wolff-Parkinson-White (WPW) syndrome supraventricular arrhythmias or disturbances of cardiac conduction. The main diseases are long or short QT syndrome, Brugada syndrome and catecholaminergic polymorphic ventricular tachycardia. Atrial fibrillation, mostly paroxysmal, is also now more frequently observed especially in middle aged endurance athletes. Conclusion: Interpretation of ECG in young and older athletes requires in-depth knowledge in cardiology and sports medicine. The interpretation can only be carried out by considering medical history, clinical examination and ethnicity. Profound and long-term experience of athlete’s ECG interpretation is required to protect athletes and to prevent cardiac emergencies. © 2015, Springer-Verlag Berlin Heidelberg.
Endoscopic submucosal excavation (ESE) is a safe and useful technique for endoscopic removal of submucosal tumors of the stomach and the esophagus in selected cases [Die Endoskopische Submukosaexkavation (ESE) ist für ausgesuchte Fälle eine sichere und praktikable Technik zur endoskopischen Entfernung submuköser Tumoren von Magen und Speiseröhre]
Reinehr R.,Innere Medizin
Zeitschrift fur Gastroenterologie | Year: 2015
Submucosal tumors of stomach and esophagus are often detected incidentally during endoscopy and further characterized by endoscopic ultrasonography. After risk estimation such submucosal tumors are either controlled by watchful waiting or surgically resected. Nevertheless, symptomatic submucosal tumors should be treated. Endoscopic submucosal excavation (ESE) and submucosal tunneling endoscopic resection (STER) may represent an alternative non-surgical therapeutic option. Two cases of complete endoscopic resection of symptomatic submucosal tumors are reported: a small gastrointestinal stroma tumor (GIST) of the antrum and a 12 cm long esophageal lipoma. For selected cases, ESE of symptomatic submucosal tumors of stomach and esophagus represents a useful alternative compared to surgical removal particularly if mass is located in antrum or corpus, sized < 20 mm and clearly defined by endoscopic ultrasonography. © Georg Thieme Verlag KG Stuttgart · New York.
Gabel A.,Innere Medizin
Notfall und Rettungsmedizin | Year: 2011
The incidence of in-flight medical emergencies (IMEs) on board commercial aircraft is increasing annually due to the rising numbers of passengers, increasing average age, and development of ul tra-high capacity aircraft. Since systematic studies are not available, the number of IMEs in com mercial air traffic is difficult to estimate. In general one should expect 0.25-1 IMEs per 10,000 pas sengers transported. The majority of events turn out to be of a relatively harmless nature. A possi ble life-threatening situation may be present in 10% of cases. The vast majority of IMEs consists of syncopal episodes while a true cardiologic condition is found in 6% of cases. For enhanced under standing of the pathophysiologic fundamentals and adapted strategies for treatment in the aviation setting, this article describes the determining factors of altitude physiology, organizational and le gal circumstances of in-flight medical response, organizational preventive measures, as well as ap propriate medical emergency equipment of selected airlines. This information may be used to de velop optimal strategies for treatment of selected cardiologic conditions in airliners. © Springer-Verlag 2011.
Rothe T.,Innere Medizin
Allergologie | Year: 2010
This paper intends to open up a discussion on the clinical usefulness of an allergen-avoidance intervention as a diagnostic tool. In atopic asthma the relevance of skin sensitizations is not always obvious. Constant allergen contact and anti-inflammatory treatment may obscure the relationship between symptoms and offending allergen. Apart from an allergen challenge, a sojourn at high altitude avoiding allergen contact may be an important diagnostic tool to judge if the disease is IgE-driven or not, especially prior to an allergen immunotherapy and a treatment with anti-IgE. The proposed proportional Venn diagram could help to differentiate between specific asthma phenotypes in daily allergy practice. © 2010 Dustri-Verlag Dr. Karl Feistle.
Laxative use and satisfaction of chronically constipated women - A survey of female patients and gastroenterologists in Germany [Laxanziengebrauch und Zufriedenheit chronisch obstipierter Frauen - eine Umfrage bei Patientinnen und Gastroenterologen in Deutschland]
Muller-Lissner S.,Innere Medizin |
Pehl C.,Medizinische Klinik
Zeitschrift fur Gastroenterologie | Year: 2012
Objective: Data were collected concerning the patient satisfaction in the treatment of chronic constipation with laxatives. Method: An internet-based survey of female patients with chronic constipation and an online enquiry addressed to gastroenterologists in Germany were carried out. Results: 492 female patients and 104 physicians participated in the survey. Only 20 % of the patients were currently consuming laxatives. Around one-third of those not using laxatives have had unsatisfactory experiences. Only 32 % of the participants currently taking laxatives were totally satisfied with their drugs. As a general rule several different preparations were tried. The laxatives most closely associated with satisfied patients were bisacodyl and sodium picosulfate, followed by macrogol. The main reasons for dissatisfaction were an insufficient relief of the constipation and a bloated feeling. The majority of the participants expressed an interest in new drugs for the treatment of constipation. The participating physicians stated that they saw several female patients per week who were not satisfied with their constipation treatment, but probably overestimate the proportion. Conclusion: The present survey shows that the majority of women suffering from constipation do not take laxatives and also that about half of them were not satisfied with the agents tried. Only about one-third of the chronic users were totally satisfied. Thus, there is a clear need for new laxatives. © Georg Thieme Verlag KG Stuttgart · New York.
Schmidt W.A.,Innere Medizin
Aktuelle Rheumatologie | Year: 2014
In polymyalgia rheumatica imaging techniques show inflammation in shoulders and hips as well as in paravertebral regions. Positron emission tomography and magnetic resonance imaging provide a good overview. However, in clinical practice ultrasound is more commonly used because of availability and cost issues. New classification criteria are more specific when including an algorithm with ultrasound. In addition, ultrasound of temporal and axillary arteries, if necessary with other imaging modalities, should be performed for diagnosing or excluding concomitant giant cell arteritis. © Georg Thieme Verlag KG Stuttgart · New York.
Huegle U.,Innere Medizin |
Muller-Gerbes D.,Innere Medizin |
Dormann A.J.,Innere Medizin
Zeitschrift fur Gastroenterologie | Year: 2013
Chronic radiation proctitis can develop after radiation therapy of pelvic malignancies. Symptoms include haematochezia, diarrhoea, tenesmus, urgency, faecal incontinence, and rectal pain. Various therapies have been attempted with argon plasma coagulation (APC) currently being the treatment of choice, but complications such as ulceration and stricture are commonly encountered. There are limited data suggesting that radiofrequency ablation (RFA) may be an effective alternative to APC, in particular in transfusion-dependent patients. Here we report two cases of chronic radiation proctitis, one of whom was transfusion-dependent, who were safely and successfully treated with focal RFA. Haematochezia decreased significantly the day subsequent to treatment, and transfusion independence was achieved after a single session. Three to four sessions were required to eradicate the neovascular lesions. Post-therapeutic rectal re-epithelialisation occurred, and no bleeding was encountered during up to nine months of follow-up.
Herrlinger K.R.,Innere Medizin
Digestive Diseases | Year: 2013
When looking at different treatment guidelines the topics most debated for Crohn's disease are the following: (a) the use of mesalamine for remission induction and maintenance in mild to moderate Crohn's disease; (b) the early use of anti-TNF antibodies in Crohn's disease with or without classical immunomodulators for remission induction, and (c) remission induction in steroid-refractory disease with anti-TNF antibodies or calcineurin inhibitors. The topics mentioned above will be discussed with regard to the statements of the German Gastroenterology Association (DGVS) on the basis of the underlying evidence. © 2013 S. Karger AG, Basel.
Labenz J.,Innere Medizin
Internist | Year: 2016
Barrett’s esophagus is an endoscopically visible metaplasia of the columnar epithelium in the esophagus with histological detection of a specialized intestinal metaplasia. The circumferential and longitudinal extent are described endoscopically using the Prague classification. Barrett’s esophagus mostly occurs as the result of gastroesophageal reflux disease. The risk of developing esophageal adenocarcinoma is increased but the absolute risk is low with 0.10–0.15 % per year. According to guideline recommendations, screening for Barrett’s esophagus as well as endoscopic and biopsy surveillance should be limited to high risk groups. On detection of intraepithelial neoplasia (IEN) endoscopic therapy is indicated, whereby a second opinion must be obtained from a specialized pathologist for low-grade IEN. The influence of proton pump inhibitors on the progression to carcinoma is controversially discussed and a preventive anti-reflux operation is not indicated. © 2016, Springer-Verlag Berlin Heidelberg.