Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Aug 2020
[Transsexualism and transgender medicine - what every internal specialist should know about].
The authors present current findings on transsexualism and its treatment. According to the ICD-10, transsexualism is defined as the "desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex, and a wish to have surgery and hormonal treatment to make one's body as congruent as possible with one's preferred sex." Synonyms of transsexualism are terms such as gender dysphoria reflecting the distress that persons feel due to a mismatch between their gender identity and their sex assigned at birth. ⋯ The diagnosis of transsexualism is made by psychiatrists, but at least five more medical specialties (endocrinologist, surgeon, ear, nose and throat specialist, speech therapist and dermatologist) are involved when treating transsexual persons. Hormonal therapy is a very important element of the treatment process; due to the complexity of transsexualism it should be undertaken by endocrinologists with experience and expertise in this field.
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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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The management of differentiated thyroid carcinoma has shown considerable changes in recent years, moving away from a fixed therapy regimen towards individual treatment strategies. The aim of our work (literature research) is to present current developments in the follow-up of differentiated thyroid cancer. For the management of individual follow-up, an initial evaluation and, at later time points, the re-evaluation of the risk of recurrence is crucial. ⋯ FDG-PET/CT has also shown an excellent performance in this setting. The previously fixed therapy regimen has been realigned towards an individual treatment management. Current studies and guidelines lead to a repetitive recurrence risk evaluation and the adjustment of the aftercare planning to the individual risks with appropriately selected examination methods and personalized intervals of assessment.
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CKD-MBD (chronic kidney disease - mineral and bone disorder) describes a complex syndrome of renal osteodystrophy, mineral disturbances and cardiovascular disease in patients with chronic kidney disease. The present articles intends to provide an up-to-date summary of recent clinically important developments in the field of CKD-MBD. ⋯ The summary also comments on which grade of evidence novel aspects and innovative developments in CKD-BMD are based. The author concludes that nephrologists should strive after more high-quality, large-scale randomized-controlled interventional trials in order to optimize the evidence behind CKD-MBD therapy.
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Dtsch. Med. Wochenschr. · Aug 2020
Review[Current diagnosis and treatment of chronic lymphocytic leukaemia].
Two major advances were made in the treatment of chronic lymphocytic leukaemia (CLL): the addition of the antibody rituximab to chemotherapy two decades ago and the introduction of the targeted agents during the last few years. Four targeted drugs with different mechanisms of action were added to the armamentarium of CLL treatment: the anti-CD20 antibody obinutuzumab, the two kinase inhibitors ibrutinib and idelalisib, which target the Bruton tyrosine kinase (BTK) and Phosphatidylinositiol-3-Kinase (PI3K) respectively in the B-cell receptor signalling pathway, as well as the Bcl2-antagonist venetoclax. Recently, the combination of venetoclax/obinutuzumab was approved for the first-line treatment of all CLL patients based on a phase-III trial in elderly unfit patients. ⋯ Patients with the high-risk parameters deletion 17p or TP53mutation are known to poorly respond to chemo(immuno)therapy and should receive either ibrutinib or venetoclax/obinutuzumab. Thus, a choice has to be made between a continuous monotherapy with ibrutinib or a time-limited combination with either venetoclax/obinutuzumab (12 months) or chemoimmunotherapy (usually 6 months). In addition to disease-related factors (e. g. presence of deletion 17p/TP53 mutation, IgHV mutational status, prior therapies), comorbidities, co-medication and the specific side effects of the CLL therapies (myelosuppression, infections and secondary malignancies for chemoimmunotherapy; cardiac toxicity, bleeding and autoimmune disease for ibrutinib; tumour-lysis syndromes and infections for venetoclax) the patient's expectations need to be considered.