Der Internist
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Venous disorders affect a large proportion of the German population (varicose veins 13.3%, chronic venous insufficiency 40.8%). ⋯ Superficial vein thrombosis of the legs requires comprehensive duplex ultrasonography of the superficial and deep leg veins. Only superficial vein thrombosis less than 5 cm in length and more than 3 cm from the saphenofemoral or saphenopopliteal junction can be treated conservatively with compression, cooling, and relative immobilization. Superficial vein thrombosis greater than 5 cm in length with more than 3 cm distance to the deep venous system is treated pharmacologically with fondaparinux for 45 days (approved for 30-45 days). If the surface thrombus reaches the saphenofemoral or saphenopopliteal junction at a distance of less than 3 cm, therapy analogous to deep vein thrombosis is required for 3 months. The most effective therapy for varicose veins is invasive removal. In this regard, endovenous thermal ablation has become particularly important in recent years, given that its effectiveness is of a similar order of magnitude to that of crossectomy and stripping surgery, but the complication rates are significantly lower. Invasive removal of varicose veins not only improves patients' quality of life, but also significantly reduces the risk of deep vein thrombosis. Recent epidemiological data demonstrate an increased risk of cardiovascular disease in patients with chronic venous insufficiency. There is preliminary evidence that this risk of cardiovascular disease in varicose vein patients can be lowered by varicose vein therapy.
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Various factors affect the maturation of the infantile immune system both prenatally and postnatally, including risk and protective factors from the environment, nutrition, genetics and epigenetics. The microbiome seems to play a substantial role. The complex interaction and regulation of all these factors is ultimately decisive for whether a child develops an allergy during the course of development of the immune system. ⋯ Allergic rhinitis (AR) and bronchial asthma are nowadays no longer defined as separate diseases but as two forms of expression of an atopic entity with a similar pathology. Both diseases can be mediated by immunoglobulin E and be elicited by identical triggers. A bronchial hyperreactivity is detectable in the majority of patients with AR but without clinical asthma.
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A 61-year-old male patient underwent a colonoscopy for cramp-like upper abdominal pain of 3 weeks duration. An endoscopically irresectable ulcerated mass was seen in the transverse colon. ⋯ It is extremely rare for a tumor node to be shed in feces. If the benign nature of the entire lesion is doubtful, standard oncological procedures are advocated.
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The immune system is a human defense system that can be adapted to external conditions and is present ubiquitously throughout the organism. Its main purpose is to prevent damage caused by pathogens or toxins. In addition, it is capable of recognizing and destroying defective or degenerated endogenous cells. ⋯ The immune system is divided into the innate immune system and the acquired immune system. Pathological conditions, which may be short- or long-lasting, range from the congenital disorders of autoinflammation to the numerous autoimmune diseases, triggered by various stimuli. From a treatment perspective, nonspecific immunosuppressants or direct immune cell inhibitors or antibodies can be used for excessive reactions.