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Cui X.-W.,Med. Klinik 2 | Jenssen C.,Klinik fur Innere Medizin | Saftoiu A.,University of Medicine and Pharmacy of Craiova | Ignee A.,Med. Klinik 2 | Dietrich C.F.,Med. Klinik 2
World Journal of Gastroenterology | Year: 2013

Conventional ultrasound (US) is the recommended imaging method for lymph node (LN) diseases with the advantages of high resolution, real time evaluation and relative low costs. Current indications of transcutaneous ultrasound and endoscopic ultrasound include the detection and characterization of lymph nodes and the guidance for LN biopsy. Recent advances in US technology, such as contrast enhanced ultrasound (CEUS), contrast enhanced endoscopic ultrasound (CE-EUS), and real time elastography show potential to improve the accuracy of US for the differential diagnosis of benign and malignant lymph nodes. In addition, CEUS and CE-EUS have been also used for the guidance of fine needle aspiration and assessment of treatment response. Complementary to size criteria, CEUS could also be used to evaluate response of tumor angiogenesis to anti-angiogenic therapies. In this paper we review current literature regarding evaluation of lymphadenopathy by new and innovative US techniques. © 2013 Baishideng. All rights reserved.


Avouac J.,University of Paris Descartes | Huscher D.,Leibniz Institute | Furst D.E.,University of California at Los Angeles | Opitz C.F.,Klinik fur Innere Medizin | And 2 more authors.
Annals of the Rheumatic Diseases | Year: 2014

Objective To establish an expert consensus on which criteria are the most appropriate in clinical practice to refer patients with systemic sclerosis (SSc) for right heart catheterisation (RHC) when pulmonary hypertension (PH) is suspected. Methods A three stage internet based Delphi consensus exercise involving worldwide PH experts was designed. In the first stage, a comprehensive list of domains and items combining evidence based indications and expert opinions were obtained. In the second and third stages, experts were asked to rate each item selected in the list. After each of stages 2 and 3, the number of items and criteria were reduced according to a cluster analysis. Results A literature search and the opinions of 47 experts participating in Delphi stage 1 provided a list of seven domains containing 142 criteria. After stages 2 and 3, these domains and tools were reduced to three domains containing eight tools: clinical ( progressive dyspnoea over the past 3 months, unexplained dyspnoea, worsening of WHO dyspnoea functional class, any finding on physical examination suggestive of elevated right heart pressures and any sign of right heart failure), echocardiography (systolic pulmonary artery pressure >45 mm Hg and right ventricle dilation) and pulmonary function tests (diffusion lung capacity for carbon monoxide <50% without pulmonary fibrosis). Conclusions Among experts in pulmonary arterial hypertension-SSc, a core set of criteria for clinical practice to refer SSc patients for RHC has been defined by Delphi consensus methods. Although these indications are recommended by this expert group to be used as an interim tool, it will be necessary to formally validate the present tools in further studies.


Klein-Weigel P.,Klinik fur Innere Medizin | Opitz C.,Klinik fur Innere Medizin | Riemekasten G.,Charité - Medical University of Berlin
Vasa - Journal of Vascular Diseases | Year: 2011

Due to its high association with Raynaud's phenomenon systemic sclerosis (SSc) is probably the most common connective tissue disease seen by vascular specialists. In part 1 of our systematic overview we summarize classification concepts of scleroderma disorders, the epidemiologic and genetic burden, the complex pathophysiologic background, and the clinical features and the stage-dependent capillary microscopic features of SSc. Furthermore, we address the diagnostic recommendations propagated by the German Network for Systemic Sclerosis and the Task Force for Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology, the European Respiratory Society, and the International Society of Heart and Lung Transplantation. © 2011 by Verlag Hans Huber, Hogrefe AG.


Opitz C.,Klinik fur Innere Medizin | Klein-Weigel P.F.,Klinik fur Innere Medizin | Riemekasten G.,Charité - Medical University of Berlin
Vasa - Journal of Vascular Diseases | Year: 2011

Here we give an overview over treatment recommendations propagated by the European League Against Rheumatism (EULAR), EULAR Scleroderma Trials and Research Group, the German Network for Systemic Sclerosis, the European Respiratory Society, and the International Society of Heart and Lung Transplantation. As response to immunosuppressant (IS) therapy is usually weaker in systematic sclerosis (SSc) compared to other connective tissue disorders IS should be considered with caution. To prevent scleroderma renal crisis steroid doses should not exceed 15 mg/d. The definitive role of a number of new immunosuppressant drugs and the effects of autologous stem cell transplantation in systemic clerosis (SSc) have to be elucidated. Prostanoids, especially iloprost, are widely used as intravenous formulas for the treatment of severe Raynaud's phenomenon (RP) and digital ulcers (DU). Calcium antagonists are of limited therapeutic value. Bosentan, an oral endothelin receptor antagonists (ETRA), was shown to prevent new DU, but failed to heal existing DU, while the oral phopshodiesterase inhibitor (PDI) Sildenafil reduces the occurrence of RP and might be effective in ulcer healing. Combination therapies of PDI with ETRA are currently evaluated. Therapy of pulmonary arterial hypertension (PAH) is usually started as oral monotherapy, frequently using an ETRA. When this first-line therapy is not tolerated ETRA is substituted by PDI. If treatment goals are not reached with monotherapy combinationtherapy is started, for example by adding a PDI to an existing ETRA. In general, treatment of PAH in patients with connective tissue disease follows the same algorithms as in idiopathic PAH. © 2011 by Verlag Hans Huber, Hogrefe AG.


Plauth M.,Klinik fur Innere Medizin | Schutz T.,Charité - Medical University of Berlin
Current Opinion in Clinical Nutrition and Metabolic Care | Year: 2011

Purpose of review: To provide an overview of findings on the role of branched-chain amino acids (BCAAs) in the pathophysiology, pathobiochemistry, and treatment of liver cirrhosis and its complications that have been published since or were not included in the last review on this topic in 2007 in this journal. Recent findings: There has been continued interest in the potential of oral BCAA supplements in improving energy metabolism, nitrogen metabolism, carbohydrate metabolism, insulin resistance, severity of liver disease, serum albumin levels, quality of serum albumin, or postoperative complication rates. Unfortunately, many trials suffer from lacking or inadequate controls or small sample size. In a fine example of scientific perseverance, Dutch researchers uncovered the long-known phenomenon of ingested blood being highly comagenic in patients with cirrhosis to be due to the low biologic value of blood protein. The absence of isoleucine and the abundance of leucine in the hemoglobin molecule by way of BCAA antagonism leads to impaired protein synthesis and azotemia paving the way for hepatic encephalopathy. Summary: Recognizing hypoisoleucinemia and BCAA antagonism following gastrointestinal bleeding, and its successful treatment by isoleucine infusion has advanced our understanding of the role of BCAA in liver cirrhosis. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Dietrich C.F.,Med. Klinik 2 | Jenssen C.,Klinik fur Innere Medizin
Deutsche Medizinische Wochenschrift | Year: 2012

The differential diagnosis of incidentally found Focal Liver Lesions (FLL) is complex. Screening procedures so far are only defined for patients with liver cirrhosis. Characterization of a FLL begins as soon as it is detected. Taking patients history and thorough clinical examination are essential. An imaging procedure that is used to detect liver masses should also allow the examiner to determine whether the lesion is benign or malignant. Conventional B-mode US and colour Doppler imaging are effective at detecting and characterizing typical liver cysts and calcifications. Laboratory data, computed tomography, magnetic resonance imaging and imaging guided liver biopsy are complementary methods. Contrast Enhanced Ultrasound (CEUS) is a well established diagnostic imaging technique for a variety of indications and applications. One of the most important applications is in the liver where it is frequently a first-line technique for the detection and diagnosis (characterization) of focal liver lesions (FLL). In this setting the accurate differentiation of benign from malignant lesions is critical to ensure the patient undergoes the appropriate therapeutic option. This has been documented in recently published guidelines, in particular in terms of the enhancement patterns of the most common FLL hemangioma, focal nodular hyperplasia hepatocellular adenoma and their differentiation from malignant lesions. In this article the role of CEUS in the characterization of incidentally found FLL is described. © Georg Thieme Verlag KG Stuttgart.


Wiedemann G.J.,Klinik fur Innere Medizin
Deutsche Medizinische Wochenschrift | Year: 2013

The question of when a certain concentration of a serum biomarker turns into a tumor marker, i.e. an objectively verifiable criterion for tumor diagnosis, leads to the analysis of the specificity (a measure of the proportion of correctly identified healthy individuals), sensitivity (a measure of the proportion of correctly recognized cancer patients), and precision (positive predictive value). Or in short: a tumor marker is specific if no healthy individual has one. This constitutes the problem: The serum concentrations of biomarkers of cancer patients and healthy subjects overlap. Healthy individuals occasionally have "tumor markers" and cancer patients in turn sometimes express inconspicuous biomarkers. © 2013 Georg Thieme Verlag KG · Stuttgart · New York.


Introduction: Residents in Germany with a migrant background represent a large and diverse group.?In 2012, their population in the Federal Republic of Germany was about 20?%. Diseases occur in different forms and their prevalence and treatment is often inadequate when compared to residents without an immigrant background. Aim: The aim of this retrospective, single-center follow-up is the illustration of differences between patients with and without a migrant background suffering from diabetic foot ulcers in inpatient care. Method: The study’s main focus will be patients treated at St. Martinus Hospital in Düsseldorf within the diabetic foot treatment center in 2013. Their numbers, age, sex and disease severity (Wagner grade and amputation rate) will be observed. The allotment of the migration status was made retrospectively based on the characteristics name, respectively maiden name, place of birth and nationality. Results: A total of 132 inpatients (n?=?102 without a migration background, n?=?30 with a migration background) with a diabetic foot syndrome were treated. The findings illustrate a significant difference in the mean age (70.21 years without a migrant background; with migrant background 74.80 years, p?=?0.0397 (significance level p?


Plauth M.,Klinik fur Innere Medizin
Medizinische Klinik - Intensivmedizin und Notfallmedizin | Year: 2013

In the critically ill liver patient, nutrition support is not very different from that given for other illnesses. In hyperacute liver failure, nutrition support is of less importance than in the other subtypes of acute liver failure that take a more protracted course. Nasoenteral tube feeding using a polymeric standard formula should be the first-line approach, while parenteral nutrition giving glucose, fat, amino acids, vitamins, and trace elements is initiated when enteral nutrition is insufficient or impracticable. In chronic liver disease, notably cirrhosis, there is frequently protein malnutrition indicating a poor prognosis and requiring immediate initiation of nutrition support. Enteral nutrition ensuring an adequate provision of energy and protein should be preferred. Particular care should be taken to avoid refeeding syndrome and to treat vitamin and trace element deficiency. © 2013 Springer-Verlag Berlin Heidelberg.


Horsch D.,Klinik fur Innere Medizin
Verdauungskrankheiten | Year: 2016

Only few registered medications are available for the relatively rare neuroendocrine tumors. In fall 2015, 3 studies were presented changing therapeutic algorithms for neuroendocrine tumors. © 2016 Dustri-Verlag Dr. Karl Feistle.

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