Der Internist
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The major goal of cancer screening programs is the reduction of disease-specific mortality by detecting malignant tumors in an early and still curable stage. Sensitive screening tests are used in apparently healthy people and conspicuous findings are referred for further investigations. ⋯ This information, together with personal preferences, is the basis for a well-informed decision for or against participation in a screening program. This article imparts essential knowledge that is needed for individual medical counseling on screening for colorectal, skin, breast and prostate cancer.
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Rheumatoid factor and antinuclear antibodies are detectable in many different conditions and are ordered by various specialities. The interpretation of results, however, is quite complex. The objective of this article is to help apply these tests correctly and enable an accurate interpretation of the test results. Furthermore, we describe the steps in the differential diagnostics for selecting those patients who need to be referred to a rheumatologist.
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The use of thyroid-stimulating hormone (TSH) testing in routine laboratory screening and testing of TSH before administration of contrast medium, resulted in an increased number of incidentally detected elevated TSH levels. In the case of slightly increased values in asymptomatic patients, repeated measurement of TSH is recommended for confirmation. ⋯ In subclinical hypothyroidism it remains unclear at which TSH levels the initiation of substitution therapy makes sense. In the case of simultaneously elevated peripheral thyroid hormones rare diseases, such as secondary hyperthyroidism and thyroid hormone resistance should be considered.
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How physicians within the specialty of internal medicine perceive their stress-related working conditions, especially due to a changing health system with an impact on workflows and working hours, is examined in this study. ⋯ This study should be a cause for concern, since current data suggest a future shortage of qualified employers in the specialty of internal medicine. Taking this into account, working conditions in hospitals should be improved in order to bind current employees and attract new employees.
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Recent years have seen dramatic changes in the biological understanding and treatment of solid tumors. Based on the tumor biology, targeting agents have been developed which directly affect the underlying genetic or immunological changes found in specific tumor entities. Significant increases in survival have delivered the functional proof of the concept of targeted and immunological tumor therapy. ⋯ Such agents include hormone therapy with enzalutamide and abiraterone, radiotherapy with cabazitaxel and xofigo (radium 223), metastatic breast cancer (eribulin and everolimus), renal cell carcinoma (sunitinib, sorafenib, axitinib, everolimus and temsirolimus), non-small cell lung cancer (crizotinib and afatinib), colorectal cancer and gastrointestinal stromal tumor (regorafenib) and melanoma (ipilimumab and vemurafenib). The treatment of rarer tumors, such as pancreatic and hepatocellular cancer and soft tissue sarcoma has entered the stage of targeted therapy with the approval of nanoparticle albumin-bound (nab)-paclitaxel, sorafenib, and eribulin/pazopanib. Current clinical trials are focusing on the best time point and sequence of therapy and also improvement in the management of these promising agents.