Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Feb 2020
[Current diagnostic and therapeutic standards in aggressive B-cell lymphomas].
In this review, we focus on new advances regarding diagnostic and therapeutic standards of aggressive B-cell lymphomas. This includes the introduction of the so-called "cell of origin" classification which differentiates diffuse large B-cell lymphomas (DLBCL) into the ABC and GCB subtypes and became part of the revised WHO classification of 2017. While 6-8 cycles of R-CHOP remain the standard of first-line treatment in DLBCL, for young patients up to 60 years of age with an international prognostic index (IPI) of 0 the treatment can be shortened to 4 cycles of R-CHOP plus 2 cycles of rituximab. ⋯ For patients with relapse or refractory disease, salvage treatment followed by autologous or allogeneic transplantation remains the standard. After failure of 2 lines of treatment, 2 different CAR-T-cell products are licensed offering a potentially curative treatment options even for patients not eligible for transplantation strategies. New treatment modalities as antibody-drug conjugates and bispecific antibodies show promising results in clinical studies and will presumably broaden the spectrum of treatment options for patients with DLBCL.
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Sarcoidosis is a systemic granulomatous disease whose etiology has not yet been clarified. Generally, sarcoidosis is a benign disease, but recent studies have shown that the number of chronic progressive diseases is greater than previously thought. ⋯ Furthermore, the indication for immunosuppressive treatment must be determined individually for each patient and depends on the severity of the symptoms and organ disorders. In addition to corticosteroids as the first choice, other immunosuppressants such as methotrexate and TNFalpha blockers have been established as stepwise approach.
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Calcium is pivotal for neuromuscular function, coagulation, and signal transduction. An imbalance of enteral calcium uptake, deposition in and resorption from bones, and renal calcium elimination causes hypercalcemia. ⋯ Knowing the actions of the CaSR is important for diagnosing and treating patients with hyperparathyroidism. Diuretics can cause hypercalcemia, but also provide a clinical tool to lower serum calcium.
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Glomerulonephritis, secondary to bacterial, or, more rarely, viral or parasitic infections, is called infection-associated. The epidemiology of infection-associated glomerulonephritis has changed in recent decades. ⋯ The clinical manifestations of APGN and SAGN are different: APGN typically presents with a glomerulonephritis after an infectious latency period (post-infectious), while SAGN typically shows an immune complex glomerulonephritis concomitant with infection (para-infectious). SAGN often presents with an occult infections in older patients with multiple comorbidities.
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Thyroid disorders are among the most common endocrine alterations. Ultrasound examination of the thyroid gland is a rapid and radiation-free method, adding important information to a patient's medical history, physical examination, and laboratory results. This article describes a practical approach to an ultrasound examination in a step by step manner. The most important findings and most common causes of thyroid disorders are discussed on the basis of typical images.