Der Internist
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Review Comparative Study
[Status and current strategies of HIV vaccine development].
Despite intensive research efforts a vaccine against HIV has not yet been developed twenty years even after the onset of the HIV-epidemic. The problems in the development of an HIV-vaccine as well as former and current strategies to overcome these problems are presented here. The current status of human studies of different candidate vaccines is outlined.
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Mortality of pneumonia is low in the outside setting (1%) but rises up to 20% in hospital admitted patients. Early diagnosis and standardized therapy improve patient's prognosis. For community acquired pneumonia age, comorbidity and the setting of therapy (outside department, normal ward or intensive care unit) are the most important variables to choose an adequate antibiotic treatment. ⋯ Antibiotic resistance due to mistakes in antibiotic therapy is an increasing problem in the intensive care unit. Therefore, pneumonia preventive measures like influenza and pneumococcal vaccination become more important. Standardized hygienical procedures help to reduce nosocomial, mainly ventilator associated pneumonia.
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Acute biliary pain represents the main symptom of gallbladder stones, less frequently of common bile duct stones or functional disorders of the biliary tract. The pain lasts at least 15 minutes, is typically localized to the epigastrium or the right upper quadrant of the abdomen and my radiate to the right shoulder. Diagnosis of biliary pain is primarily based on clinical criteria, ultrasound allows detection of causative gallstones with high sensitivity and specificity. Analgesics and laparoscopic cholecystectomy are widely accepted as standard therapy for the majority of patients.
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Multiple myeloma is one of the 20 most frequent malignancies in Germany. Initial symptoms are usually non-specific. Assessment of bone marrow and laboratory data as well as imaging techniques are essential for diagnosis and prognostic evaluation. ⋯ High-dose therapy followed by transplantation of autologous hematopoietic stem cells improves prognosis for patients up to the age of 70. Currently, modifications of allogeneic hematopoietic stem cell transplantation, anti-angiogeneic and immunomodulatory drugs as well as proteasome inhibitors are evaluated in clinical trials. Supportive care has derived benefit from the introduction of new bisphosphonates.
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Biography Historical Article
[Genius and madness. On the 150th birthday of Vincent van Gogh (1853-1890)].