Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Aug 2020
[Diagnostic work-up in central retinal artery occlusion and ischemic optic neuropathy - what is important?]
Ischemia of the retina in central retinal artery occlusion (CRAO) and of the optic nerve in ischemic optic neuropathy (ION) are common causes of irreversible vision loss in elderly patients and require a thorough diagnostic work-up. First and foremost, giant cell arteritis should be confirmed or ruled out. The further work-up of non-arteritic CRAO and non-arteritic ION (nAION) aims to determine the cardiovascular risk profile. ⋯ In non-arteritic CRAO, the search for embolic sources is the most important diagnostic task. A "white spot sign" seen on transorbital ultrasound confirms the diagnosis of embolic CRAO and rules out an arteritic etiology of CRAO.
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The publication of the new ACR/EULAR classification criteria for systemic lupus erythematosus (SLE) and the revision of the EULAR recommendations for the management of SLE last year include many important novelties that will change the classification and care of lupus patients. This refers to both general basic treatment principles and specific therapy recommendations. For example, SLE can only be classified as such if antinuclear antibodies (ANA) are present, independently of titer height and fluorescence pattern. ⋯ All patients should receive antimalarials in the absence of contraindications. If the response is inadequate or in case of moderate to severe organ manifestations, steroid pulses over a few days and the early use of immunosuppressive drugs (IM) are recommended. With the inclusion of biologicals, especially belimumab and rituximab, new substance classes made their way into the recommendations.
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Dtsch. Med. Wochenschr. · Aug 2020
[Medullary thyroid carcinoma and multiple endocrine neoplasia type 2].
Medullary thyroid carcinoma (MTC) is a rare malignancy and compromises only 3 % of all thyroid carcinomas. MTC cells secret calcitonin, which serves as a sensitive tumor marker for screening and follow-up of MTC. Calcitonin screening in patients with nodular goiter allows for early diagnosis of MTC and surgical curative treatment. ⋯ MTC is a slowly growing tumor with a good prognosis and 5 and 10 year survival rates up to 80 and 60 %. In the follow-up a dynamic risk stratification allows for a personalized disease management. In symptomatic and progressive metastasizing MTC tyrosine kinase inhibitors are an effective therapy.
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Dtsch. Med. Wochenschr. · Aug 2020
Case Reports[Polymyalgic complaint: is there a tumor behind it?]
A 61-year-old caucasian male presenting with pain in arms and thighs, weight loss of 10 kg in the last 3 months, and subfebrile temperatures, also had abdominal pain. In addition, he reported that his abdominal circumference had increased over the last two years. ⋯ The diagnostic work up of polymyalgic complaints should also include rare paraneoplastic diseases.