Zentrum fur Innere Medizin

Garmisch-Partenkirchen, Germany

Zentrum fur Innere Medizin

Garmisch-Partenkirchen, Germany
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Wastl D.,Zentrum fur Innere Medizin | Helwig K.,Medizinische Klinik III | Dietrich C.F.,Zentrum fur Innere Medizin
Medizinische Klinik - Intensivmedizin und Notfallmedizin | Year: 2015

As a point-of-care tool, emergency sonography has the potential to rule out or to confirm a diagnosis in the context to the leading symptom of critically ill persons. Extended focused assessment with sonography for trauma (E-FAST) and focused echo entry level (FEEL) are examples of algorithms that have been developed for this purpose. Echoscopy is another form of point-of-care sonography that is used at the bedside. It helps to answer simple questions (yes/no) and allows follow-up examinations to be made with little effort. Point-of-care sonography does not compete with normal standardized sonography because it is not able to answer medical questions in a sophisticated manner. © 2015, Springer-Verlag Berlin Heidelberg.

Mayet W.-J.,Zentrum fur Innere Medizin | Lohse A.W.,Universitatsklinikum Hamburg Eppendorf
Zeitschrift fur Rheumatologie | Year: 2013

The correlation between rheumatic diseases and liver diseases is complex and often not given sufficient attention. There are, however, consequences for diagnosis and therapy. Rheumatic diseases can present with hepatic symptoms while liver diseases can exhibit rheumatic symptoms. Examples of liver diseases as a cause of rheumatic symptoms are viral hepatitis B and C, autoimmune hepatitis and hemochromatosis. As a result of rheumatic diseases, such as adult onset Still's disease and systemic lupus erythematosus, liver dysfunction can occur. Autoimmune hepatitis, primary biliary cirrhosis and primary sclerosing cholangitis are directly associated with rheumatic diseases and have to be distinguished by way of differential diagnosis. During antirheumatic therapy, serious hepatotoxic side effects have to be expected. © 2013 Springer-Verlag Berlin Heidelberg.

In the course of several gastroenterological diseases rheumatological symptoms can occur which in some cases are even the main symptoms. Important examples are Crohn's disease, ulcerative colitis, Whipple's disease and gluten-sensitive enteropathy. Arthralgia and also arthritis with or without joint destruction are possible in the context of chronic inflammatory bowel diseases. Pathogenetically, the bowels are of central importance. The interrelation of hepatological and rheumatological diseases is also complex. Viral hepatitis can present a clinical picture resembling classical rheumatoid arthritis but also show symptoms of collagenosis and vasculitis. In addition to the differential diagnostic demarcation, in most cases therapy of the underlying gastroenterological disease is the determining factor regarding the development of rheumatological symptoms. © 2011 Springer-Verlag.

The increase in prevalence of diabetes mellitus and in life expectancy cause the growing number of diabetic patients with peripheral artery disease (PAD). Patients with long standing diabetes suffer frequently (about 70%) from peripheral sensory neuropathy. Therefore these patients miss the symptoms of claudication. Patients with silent ischemia will be classified to Stadium I (Fontaine) instead to stadium II or III or their diagnosis will be missed at all. The clinical investigation of the food pulses should be done at least once per year in all patients with diabetes mellitus. When one or more pulses are not detectable the further diagnostic procedures should start with the measurement of the ABI (Ancle Brachial Index). In patients with mediasclerosis the measurement will give false high numbers. After early diagnosis conventional treatment may be effective. With late diagnosis in the stadium IV (Fontaine) always and especially before any amputation revascularisation should be done. Guidelines give the right choise of katheter-based or open vascular-surgical procedures. © Springer-Verlag 2011.

Paraneoplastic syndromes, as syndromes associated with malignancy, can present unrelated to tumor invasion or metastases. They can occur with varying clinical appearance and are often indistinguishable from idiopathic rheumatic symptoms. Some musculoskeletal disorders are more associated with malignancies. The therapy of rheumatic syndromes can itself have an effect on the tumorigenic process. The clinical severity of paraneoplastic rheumatic symptoms can in many cases aid in the assessment of tumor activity and the response to therapy. While generally an extensive search for occult malignancies in every older rheumatoid patient in cases with no indications of malignancy is not advisable, knowledge of rheumatic symptoms associated with malignancies aids in the important early detection of tumors, while avoiding unnecessary examinations. © Springer-Verlag 2011.

Hartmann B.,Zentrum fur Innere Medizin
Clinica Chimica Acta | Year: 2012

Inhibitors of the mammalian target of rapamycin (mTOR) are administered as immunosuppressant as well as antineoplastic agents. Because of the narrow therapeutic index of mTOR inhibitors, drug monitoring is required, and this is usually done by measuring blood drug levels. Increasing knowledge of the signaling pathways of the mTOR protein kinase provides an opportunity for pharmacodynamic drug monitoring.With the different laboratory methods it is becoming possible to measure new biomarkers to control the influence of mTOR activity. One of these biomarkers is phospho-S6 kinase, with its isoform p70S6K. © 2012.

Allescher H.D.,Zentrum fur Innere Medizin
Gastroenterologe | Year: 2012

Aging causes typical changes in several regions of the human body which lead to altered function. These changes can also be observed in the gastrointestinal tract, despite the fact that food and fluid intake is a well preserved function of the human body and changes are less prominent than those in the skeletal regions. In general a clear distinction has to be made between primary "physiological" aging changes of the laryngo-pharynx, esophagus or stomach and changes of swallowing function which are due to secondary effects of other diseases which have an increased incidence with rising age. The latter include cerebro-vascular and neurodegenerative disorders and malignant disease of the oropharynx, esophagus and cardia. © Springer-Verlag 2012.

During laboratory monitoring of patients with rheumatic diseases it is not uncommon to notice elevated liver transaminase levels. From a rheumatological perspective there are multiple causes for this. Liver dysfunction can be the result of certain rheumatological diseases, such as systemic lupus erythematosus. Primary biliary cirrhosis and primary sclerosing cholangitis are associated with rheumatic diseases. On the other hand, hepatological diseases, such as hepatitis C and autoimmune hepatitis show rheumatological symptoms. The most common cause of elevation of liver transaminase levels in rheumatic patients is without doubt the anti-rheumatic therapy. © 2015, Springer-Verlag Berlin Heidelberg.

Oesophageal motility disorders are associated with typical changes in bolus transport, with dysphagia and retrosternal pain. Depending on the underlying pathophysiology, disorders with hyper- and hypomotility can be distinguished. Hypermotile and spastic motility can be reduced with nitrates, calcium antagonists, antimuscarinic agents, phosphodiesterase inhibitors and other spasmolytics like peppermint oil; however, the clinical symptomatic effect is sparse or lacking. Using intramuscular injection of botulinum toxin, which causes selective inhibition of acetylcholine release, a targeted reduction or blockade of striated and smooth oesophageal muscle can be achieved and used for clinical treatment, e.g. for classical achalasia and diffuse oesophageal spasm. Besides pneumatic dilatation of the cardia, peroral endoscopic myotomy (POEM) offers a new interventional endoscopic therapy, which can be successfully applied in patients with achalasia and spastic oesophageal motility disorders. As some disorders are linked to altered pain perception, modification of hypersensitive states in the oesophagus with tricyclic antidepressants and selective serotonin reuptake inhibitors offer new therapeutic possibilities. In contrast to the hypermotile disorders, treatment alternatives for hypomotile disorders are limited. Systemic direct and indirect muscarinic agents show limited efficacy and the use of prokinetics is hampered by side effects and interactions. © 2016, Springer-Verlag Berlin Heidelberg.

Hepatocellular carcinoma (HCC) in Europe generally develops in over 80% of the cases on the basis of liver cirrhosis. The simultaneous presence of tumor disease and cirrhosis makes therapy particularly challenging and complicated. As an especially severe complication of liver cirrhosis HCC is now considered worldwide to be the fifth most frequent cause of tumor-associated death. In particular, the large number of patients with HCV-associated liver cirrhosis will lead to a further increase in the incidence of this tumor in the next few years. In spite of solid evidence for a regular screening of patients with liver cirrhosis, unfortunately it is only possible in about one-fifth of the patients to detect the tumor in such an early stage that curative therapy is possible. Once the diagnosis has been made it is of decisive importance for the patient that initially an appropriate and correct therapy be chosen. For this an interdisciplinary assessment under consideration of the potentially curative (resection, liver transplantation, local ablation) and palliative (transarterial procedures, sorafenib) therapeutic options is a central significance. In order to improve the management of HCC in the future a more comprehensive and broader usage of primary prevention will be necessary - including among others, generalized vaccination against HBV. The consequent screening of patients with liver cirrhosis as well as, after a positive diagnosis, multimodal therapeutic options should be readily and easily available for all such patients. © Georg Thieme Verlag KG Stuttgart - New York.

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