Med Klin
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To date, the problem of infectious risks in the domestic environment has not been focused as intensively as that in the clinical environment. Due to increasing costs in health care, there are considerations to intensify outpatient treatment models, e.g., for hematology-oncology patients, enhancing the importance of this problem. ⋯ The scope of these recommendations is to support the attending physician when advising the immunocompromised patient and to give suggestions for possible control measures to the patient.
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Fever in travellers returning from the tropics may be caused not only by tropical infection but also by travel associated non-specific infections and cosmopolitan infective diseases. ⋯ Plasmodium falciparum infection has to be excluded first because of vital damage. Following malaria (30%) respiratory infections (11%) are common. Fever as a symptom of non-infective disease occurred in 9%. Other diseases (typhus, Dengue fever, tuberculosis) are rare but have to be considered.
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Case Reports
[Coexistence of hereditary coproporphyria and porphyria cutanea tarda: a new form of dual porphyria].
Dual porphyrias are characterized by two independent disturbances of porphyrin metabolism. ⋯ The hereditary coproporphyria is caused by a new mutation in the coproporphyrinogen oxidase gene in the case of a dual porphyria with co-existence of porphyria cutanea tarda and hereditary coproporphyria. The sporadic, hepatic porphyria cutanea tarda Type I is induced by estrogens. The large excretory variations reflect the influence of hormonal factors on the porphyria process of hereditary coproporphyria and porphyria cutanea tarda.
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Bcr-Abl, a constitutively activated tyrosine kinase, is a product of the Philadelphia chromosome (Ph) translocation t(9;22), present in nearly all cases of chronic myeloid leukemia (CML) and in about 20% of cases with acute lymphoblastic leukemia. CML, a myeloproliferative disorder, progresses through three phases--chronic phase, accelerated phase and blast crisis. Current therapies include drug regimens such as interferon alpha, hydroxyurea, busulfan or allogeneic bone marrow transplantation, the only curative treatment for CML, which is, however, limited to younger patients with a suitable donor. INHIBITION OF BCR-ABL AS EFFECTIVE AND SELECTIVE TREATMENT IN CML: In vitro studies and studies in animal models have shown, that Bcr-Abl is the molecular cause CML. Therefore inhibition of the Bcr-Abl tyrosine kinase is expected to be an effective and selective treatment modality for CML. STI571 was shown to be a competitive inhibitor at the ATP-binding site of the Bcr-Abl tyrosine kinase, the platelet-derived growth factor receptor and c-kit tyrosine kinases. It shows effects on proliferation and survival of Bcr-Abl-expressing cells without affecting normal cells or Ph-negative leukemic cells. DRUG RESISTANCE TO STI571: Several mechanisms of resistance have been identified from in vitro studies with Bcr-Abl-positive cell lines. Mechanisms include amplification or overexpression of Bcr-Abl or an increased expression of P-gly-coprotein. In a mouse model the binding of STI571 to acidic alpha 1 glycoprotein (AAG) has been proposed to be involved in the development of STI571 resistance. Recent studies with clinical samples from resistant patients have shown that point mutations in the kinase domain of Bcr-Abl play a role in the development of resistance to STI571. ⋯ STI571 is a promising example of a moleculary targeted therapy directed towards the molecular cause of CML. To maximize the therapeutic value and to avoid the induction of resistance, a combination of the drug with other chemotherapies should be considered. According to its pharmacological profile, STI571 could also be useful in the treatment of tumors with deregulated PDGF receptor or c-kit signaling, e.g., in chronic myelomonocytic leukemia with a t(5;12) chromosomal translocation or in cases with gastrointestinal stromal tumors (GIST). STI571 shows a new paradigm in the development of new targeted therapies for the treatment of malignant diseases.
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Aortic valve replacement is recommended in case of symptomatic severe aortic stenosis. This decision is difficult for patients with low-gradient aortic stenosis and severely impaired left ventricular function because of high perioperative mortality in this group. Although aortic valve replacement is usually justified if severe aortic stenosis is proved, patients with primary myocardial dysfunction and subsequent reduced aortic valve opening do not benefit from aortic valve replacement. Distinguishing these two groups of patients is necessary but not possible with echocardiography at rest. Positive inotropic stimulation with dobutamine stress echocardiography enables a more reliable graduation of aortic stenosis under these circumstances. ⋯ We report on a symptomatic 58-year-old man with aortic stenosis and severely impaired left ventricular function. Using echocardiography at rest, there was a severely reduced aortic valve area of 0.6 cm2 and a mean pressure gradient of 24 mm Hg. Determined by cardiac catheterization, the peak-to-peak gradient was 20 mm Hg and the aortic valve area calculated by the Gorlin formula was 0.6 cm2. After positive inotropic stimulation using dobutamine stress echocardiography, the aortic valve area increased to 1.5 cm2 indicating an only moderate aortic stenosis. Thus aortic valve replacement was not performed and myocardial failure was medically treated. After 1.5 years of follow-up, the patient is in good condition and without complaints.