Deutsche medizinische Wochenschrift
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Several inflammatory rheumatic diseases can severely affect any organ system and require immediate intervention and intensive care admission. The early detection of impending organ failure and the underlying rheumatic disease is of paramount importance for the prognosis and outcome of affected patients. ⋯ The presentation of the relevant systemic rheumatic diseases is structured according to the most important organ systems, i. e. the respiratory system, the kidney and the cardiovascular system. Furthermore, there is a focus in this paper on macrophage activation syndrome (MAS) as a potentially lethal complication of several rheumatic diseases and the catastrophic antiphospholipid syndrome (CAPS) as a rare cause of multi organ failure.
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A majority of patients with newly diagnosed malignant disease are 70 years old or older. Frailty - i. e. increased vulnerability towards stressors at older age - is a major challenge during the oncological work-up and treatment in the elderly. Therefore, older cancer patients should receive a systematic assessment of frailty by use of standard tools. ⋯ However, patients with such characteristics are at increased risk of complications compared to younger subjects. Physicians and medical staff involved in treatment must therefore co-operate well. This article provides an overview of the current evidence and highlights key aspects of diagnosis and treatment of malignant diseases in the elderly.
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Dtsch. Med. Wochenschr. · Sep 2021
Review[A decade of checkpoint inhibitors: current standard of care and future trends].
Therapy with checkpoint inhibitors still revolutionizes the therapeutical landscape in oncology. Since the first approval of a checkpoint inhibitor for the therapy of malignant melanoma 2011, many other approvals in the field of hematology and oncology followed. ⋯ Here we review the different treatment strategies of mono- and combination-therapies. Additionally, important biomarkers for the treatment with checkpoint inhibitors are discussed.
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Dtsch. Med. Wochenschr. · Sep 2021
Review[Dilemma situation: Acute mental illness during pregnancy].
Acute mental illness during pregnancy is an emergency medical situation requiring immediate intervention. A variety of medical, pharmacologic, legal, and ethical dilemmas must be resolved to simultaneously ensure the well-being of the mother and unborn child. This article provides an overview of the management of common psychiatric emergency situations in pregnancy.
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Dtsch. Med. Wochenschr. · Sep 2021
Review[Practical aspects of the application of CAR T cells and management of their toxicities].
CD19 CAR T cells induce - in part long-lasting - remissions in heavily pretreated patients with relapsed/refractory B-cell malignancies. However, they are associated with unique toxicities, and patient management therefore requires specific expertise. ⋯ We discuss practical aspects of CAR T cell therapy from the patient's initial presentation, over leukapheresis, to CAR T cell transfusion. Additionally, we highlight the pathophysiology and principles of the management of the most common toxicities (cytokine release syndrome [CRS], immune cell associated neurotoxicity syndrome [ICANS] and cytopenias).