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Knop S.,Medizinische Klinik und Poliklinik II
Medizinische Monatsschrift fur Pharmazeuten | Year: 2014

The multiple myeloma (MM) is still an incurable malignant plasma cell disease. Therapy is necessary, once symptoms of end organ damage occur. Numerous "new substances" (proteasome inhibitors, immunomodulatory substances) were introduced in the past decade, resulting in improved treatment results. Polychemotherapy, alternating drug applications and the principle of "continuous therapy" are used to achieve a high response rate (with the aim of a long-lasting disease control). Among all patients those with extramedullary disease (EMD) are currently the most difficult treatable patients. It remains to be seen whether and when genomic analyses by next generation sequencing will yield to an understanding of the ups and downs of various tumor subclones. Maybe such technologies result in the development of real targeted therapies for myeloma in the future. To date, such therapies are not available. © Deutscher Apotheker Verlag. Source

Scheurlen M.,Medizinische Klinik und Poliklinik II
Medizinische Klinik - Intensivmedizin und Notfallmedizin | Year: 2015

Background: Acute vascular occlusion within the mesenteric circulation leads to ischemic damage of the corresponding bowel segment, which starts on the mucosal level and progresses transmurally. Objectives: Report on pathogenesis, clinical picture and treatment of various forms of intestinal ischemia. Materials and methods: Analysis of the available literature taking into consideration our own experience. Results: Frequently, predisposing diseases and risk factors are present (e.g., cardiac diseases, hypercoagulability, status post cardiac surgery, circulatory failure, or administration of vasoconstrictive drugs). Acute small bowel ischemia—caused by either mesenteric embolism, mesenteric artery thrombosis, nonocclusive mesenteric ischemia (NOMI) or mesenteric venous thrombosis—represents an acute emergency. If this condition is suspected clinically, the diagnosis must be established immediately by computed tomography of the abdomen with intravenous administration of contrast medium in order to prevent irreversible damage to the small bowel. Medical treatment is supportive. If possible, occluded vessels may be re-opened either by radiologic intervention or surgically. Irreversibly damaged bowel segments must be surgically removed. Ischemic colitis has a benign course in most cases if limited to reversible mucosal damage. The diagnosis is based mainly on colonoscopy and computed tomography findings, and treatment is symptom oriented. Rarely, severe manifestations with a worse prognosis due to considerable comorbidities occur. In such cases, surgical removal of the ischemic bowel is frequently required. Conclusion: Even today, acute mesenteric ischemia is associated with a poor prognosis. To improve survival and to reduce long-term morbidity, a rapid and systematic diagnostic workup is mandatory. © 2015, Springer-Verlag Berlin Heidelberg. Source

Gobel T.,Klinik fur Innere Medizin II Gastroenterologie | Blondin D.,Heinrich Heine University Dusseldorf | Kolligs F.,Medizinische Klinik und Poliklinik II | Bolke E.,Heinrich Heine University Dusseldorf | Erhardt A.,Klinik fur Innere Medizin II Gastroenterologie
Deutsche Medizinische Wochenschrift | Year: 2013

The incidence of hepatocellular carcinoma (HCC) is increasing worldwide due to the growing number of hepatitis C related HCCs. In more than 80 % of the patients, HCC arises in a cirrhotic liver. Furthermore, more than half of the patients have an advanced Child-Pugh score or an inoperable tumor stage at the initial diagnosis. Recommendations for the treatment of HCC by national and international guidelines rely on the BCLC ("Barcelona Clinic for Liver Cancer") algorithm. Depending on the stage of liver function and tumor disease it recommends resection, liver transplantation, radiofrequency thermal ablation (RFA), transarterial chemoembolisation (TACE), systemic therapy with sorafenib or best supportive care, but does neither take into consideration combination of therapies nor new therapy modalities. However, there is increasing evidence that combinations i. e. sorafenib with TACE or combination of locoregional techniques enhance effectivity and tumor control compared to monotherapies. TACE with drug-eluting beads, selective internal radiotherapy (SIRT) and new locoregional therapy procedures like microwave ablation (MWA) are further promising therapeutic approaches. Patients with HCC should be discussed in a local tumor board in order to provide the optimal and most individual way of treatment. © Georg Thieme Verlag KG · Stuttgart · New York. Source

Schardt F.W.,Medizinische Klinik und Poliklinik II | Schmausser B.,University of Wurzburg | Bachmann E.,University of Wurzburg
Histology and Histopathology | Year: 2013

The progression of a tumor from benign to malign and localized to invasive and metastatic growth is the major cause of poor outcome of therapy in cancer patients. The deposition of fibrin along with other procoagulant molecules into the extracellular matrix obviously serves as a scaffold to support proliferation, migration and tumor cell growth as well as protection against the immune system. The use of antibodies as agents for the immunodetection of fibrin deposits in vivo has been hampered by anti-fibrin cross-reactivities with fibrinogen. For the immunohistochemical detection of fibrin we used highly specific monoclonal antibodies to a synthetic fibrinunique peptide, because the fibrin molecule shares many epitopes with fibrinogen. The monoclonal antibody was applied to adenocarcinoma of colon, mamma, pancreas, sarcoma and acute myeloic leukemia. In all tissue sections and cytospin preparations fibrin was identified in a direct apposition to the surface membranes of carcinoma and sarcoma cells, predominantly at the host-tumor interface and also in regions directly adjacent to zones of angiogenesis, whereas normal cells and tissue showed no deposits of fibrin. The findings will be supported by investigations that factors and components of the coagulation system could be detected in the tumor stroma and tumor cells. These factors are obviously produced and secreted by the malignant cells and deposited together with fibrinogen into the extracellular matrix. Our results show that basically all malignant cells examined, independently of ectodermal or mesenchymal derivation, themselves are the origin of hypercoagulability and fibrinolytic system inhibition. Source

Proton pump inhibitors (PPI) are among the most frequently prescribed drugs worldwide. Recently, several side effects of chronic PPI therapy have been identified. Reduced intestinal absorption of vitamin B12 or calcium, an increased rate of bone fractures, an interference with the metabolism of other drugs (e.g., clopidogrel), and an increased incidence of Clostridium difficile-associated colitis are discussed. So far, data on such side effects of PPI are mainly supported by retrospective and/or uncontrolled studies. Therefore, a definitive estimation of the real risk of long-term PPI medication is not yet possible. However, since chronic treatment with PPI may lead to severe side effects, it is necessary to keep the established indications for these drugs (peptic ulcer therapy, gastro-esophageal reflux disease, prophylaxis of mucosal lesions by potentially ulcerogenic drugs) in mind. PPI therapy as stress ulcer prophylaxis should be confined to risk groups and risk situations. Long-term treatment with PPI requires repeated confirmation of a persisting indication, choice of the lowest effective dose, and - if applicable - an interval or "on demand" treatment. © 2013 Springer-Verlag Berlin Heidelberg. Source

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