Time filter

Source Type

Mainz, Germany

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. Source

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. Source

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. Source

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. Source

Janssens U.,Klinik fur Innere Medizin
Medizinische Klinik - Intensivmedizin und Notfallmedizin | Year: 2014

Backgound: The treatment of patients with severe sepsis and septic shock continues to evolve. Recent studies have enunciated the benefit of early goal-directed therapy (EGDT) during the first 6 h after recognition of the condition. With EGDT a reduction in mortality of over 16 % was shown over standard care. Thereafter the components of the EGDT were consequently implemented in the international Surviving Sepsis Campaign as well as the German sepsis guidelines. Nevertheless the medical community’s enthusiasm for EGDT has remained indecisive. There remains a profound skepticism about treatment targets such as central venous pressure or mean arterial pressure as well as central venous oxygen saturation. Moreover multiple barriers such as critical shortage of nursing staff, problems in obtaining central venous pressure monitoring or lack of agreement with the EGDT resuscitation protocol may lead to non-adherence to EGDT early in the course of sepsis.Recent study results: In a recent multicenter trial, protocol-based resuscitation of patients in whom septic shock was diagnosed in the emergency department did not improve outcomes.Recommendation: The Severe Sepsis 3-Hour Resuscitation Bundle and the 6-Hour Septic Shock Bundle represent a distillation of the concepts and recommendations found in the practice guidelines published by the Surviving Sepsis Campaign. The bundles are designed to allow teams to follow the timing, sequence, and goals of the individual elements of care. Early recognition, early mobilization of resources, and multidisciplinary collaboration are imperative to enhance the prognosis of patients with sepsis. © 2014, Springer-Verlag Berlin Heidelberg. Source

Discover hidden collaborations