RESUMEN
Hidradenitis suppurativa (HS) is a chronic inflammatory disease, characterized by abscess formation and mutilating scar formation in the body folds. The burden of disease is high for both patient and treating physician. In dermatological daily practice, proper patient education and formation of a trustful physician-patient relationship are of highest importance. HS patients are treated both conservatively and surgically mostly by dermatologists, which requires extensive knowledge of the pathogenesis, trigger factors, comorbidities and treatment options. Interdisciplinary collaboration with other disciplines is still underdeveloped. New physical treatments (laser, radiofrequency, intense pulsed light [IPL]), topical and systemic therapies enable good ambulatory long-term management for all HS stages.
Asunto(s)
Hidradenitis Supurativa , Enfermedad Crónica , Cicatriz , Comorbilidad , Hidradenitis Supurativa/diagnóstico , Hidradenitis Supurativa/terapia , Humanos , LuzRESUMEN
BACKGROUND: The introduction of biologics has revolutionized the treatment of moderate to severe plaque psoriasis. Due to the continuous expansion of biological therapies for psoriasis, it is particularly important to acknowledge efficacy and safety of the compounds not only in clinical trials but also in long-term registry-based observational studies. AIM: Typical side effects and significant risks of antipsoriatic biologic therapies considering psoriatic control groups are presented. MATERIALS AND METHODS: A selective literature search was conducted in PubMed and long-term safety studies of the psoriasis registries PsoBest, PSOLAR and BADBIR were evaluated. RESULTS AND DISCUSSION: To assess the long-term safety of biologics, the evaluation of the course of large patient cohorts in long-term registries is of particular medical importance. Newer biologic drugs seem to exhibit a better safety profile than older ones.
Asunto(s)
Productos Biológicos , Fármacos Dermatológicos , Psoriasis , Productos Biológicos/efectos adversos , Terapia Biológica , Fármacos Dermatológicos/efectos adversos , Humanos , Psoriasis/tratamiento farmacológico , Sistema de RegistrosRESUMEN
Because of the high variability of seasonal influenza viruses and the eminent threat of influenza viruses with pandemic potential, there is great interest in the development of vaccines that induce broadly protective immunity. Most probably, broadly protective influenza vaccines are based on conserved proteins, such as nucleoprotein (NP). NP is a vaccine target of interest as it has been shown to induce cross-reactive antibody and T cell responses. Here we tested and compared various NP-based vaccine preparations for their capacity to induce humoral and cellular immune responses to influenza virus NP. The immunogenicity of protein-based vaccine preparations with Matrix-M™ adjuvant as well as recombinant viral vaccine vector modified Vaccinia virus Ankara (MVA) expressing the influenza virus NP gene, with or without modifications that aim at optimization of CD8+ T cell responses, was addressed in BALB/c mice. Addition of Matrix-M™ adjuvant to NP wild-type protein-based vaccines significantly improved T cell responses. Furthermore, recombinant MVA expressing the influenza virus NP induced strong antibody and CD8+ T cell responses, which could not be improved further by modifications of NP to increase antigen processing and presentation.
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Linfocitos T CD8-positivos/inmunología , Vacunas contra la Influenza/inmunología , Gripe Humana/inmunología , Infecciones por Orthomyxoviridae/inmunología , Orthomyxoviridae/inmunología , Proteínas de Unión al ARN/metabolismo , Proteínas del Núcleo Viral/metabolismo , Animales , Anticuerpos Neutralizantes/metabolismo , Células Cultivadas , Reacciones Cruzadas , Femenino , Vectores Genéticos/genética , Humanos , Ratones , Ratones Endogámicos BALB C , Proteínas de la Nucleocápside , Proteínas de Unión al ARN/genética , Proteínas de Unión al ARN/inmunología , Vacunas de ADN , Vacunas de Subunidad , Virus Vaccinia/genética , Proteínas del Núcleo Viral/genética , Proteínas del Núcleo Viral/inmunologíaRESUMEN
In venous disease, acute thromboses and chronic venous insufficiency have the highest health economics relevance. Duplex sonography is the first line diagnostic assessment tool, while cross-sectional imaging is employed as a supplementary method. Due to the availability and examination times computed tomography is preferred in the emergency setting and is supplemented by magnetic resonance imaging (MRI) for specific questions. Endovascular treatment procedures are increasingly becoming available in addition to classical conservative treatment methods.
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Enfermedades Vasculares/diagnóstico por imagen , Enfermedades Vasculares/terapia , Procedimientos Endovasculares , Humanos , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos XAsunto(s)
Síndrome de Behçet , Interleucina-18 , Síndrome de Behçet/diagnóstico , Biomarcadores , HumanosRESUMEN
More than 1.5 million people were diagnosed with skin cancer in 2012 in Germany-of which 318,000 were malignant melanoma. The number of malignant skin tumours has increased by 60% since 2005. Epithelial skin cancers are even more common. Since 2012, 1.3 million diagnoses have been documented. This incidence represents an increase of 79% within 7 years. The number of skin cancer patients treated in German hospitals has also increased. In 2014, 99,613 patients were treated as inpatients with the diagnosis of skin cancer; in 2000 there were 57,147 patients. This was the largest growth rate among all cancer treatments in hospitalised patients. The continuously changing age pyramid leads to an expected further growth of the incidence of skin tumours. In parallel the development of molecular knowledge in tumorigenesis is also rapid. A series of cell-specific mutations have been described in recent years for various skin tumours. Mutations are found mainly in genes engaging their translation products at key positions in regulatory cell metabolism or cell division. These include oncogenes, which have greatly increased activity due to targeted mutations or tumor suppressor genes and act under physiological conditions as negative regulators that are inactivated by mutations. These findings have led to the development of a series of new promising compounds for the treatment of skin tumours.
Asunto(s)
Biomarcadores de Tumor/genética , Carcinogénesis/genética , Predisposición Genética a la Enfermedad/epidemiología , Predisposición Genética a la Enfermedad/genética , Neoplasias Cutáneas/genética , Neoplasias Cutáneas/mortalidad , Distribución por Edad , Anciano , Anciano de 80 o más Años , Marcadores Genéticos/genética , Humanos , Incidencia , Persona de Mediana Edad , Modelos Genéticos , Polimorfismo de Nucleótido Simple/genética , Factores de Riesgo , Tasa de SupervivenciaRESUMEN
PURPOSE: Clinical pathways are used to organize complex care processes by providing structure and standardization. The multidisciplinary approach of oral appliance (OA) therapy for sleep-disordered breathing (SDB) is a complex and dynamic process suitable for such a structured pathway approach. METHODS: A clinical pathway for patients referred for OA therapy was developed and implemented. The aim of this study was to evaluate the impact of this clinical pathway on the time to delivery of the OA and the organization of the multidisciplinary dental sleep clinic (MDSC). The latter was achieved using the care process self-evaluation tool (CPSET). RESULTS: First, development and implementation of the clinical pathway gave structure and shortened the mean time to delivery by 102 days (240 ± 70 vs. 138 ± 33 days) (Mann-Whitney U: P < 0.001). Second, the CPSET scores were obtained in a cohort of 49 healthcare professionals involved in the pathway. Overall, patient-focused organization received the highest scores (80.5 ± 9.0%), whereas cooperation with primary care received the lowest score (66.7 ± 12.4%). CONCLUSIONS: This is the first project on clinical pathways in OA therapy for SDB. The implementation of the pathway in our MDSC has created a significant shortening of the time to delivery. A first evaluation of the clinical pathway using the CPSET scores indicates that all disciplines involved should be thoroughly informed in an ongoing approach.
Asunto(s)
Conducta Cooperativa , Vías Clínicas/organización & administración , Clínicas Odontológicas/organización & administración , Comunicación Interdisciplinaria , Avance Mandibular/instrumentación , Aparatos Ortodóncicos , Grupo de Atención al Paciente/organización & administración , Atención Dirigida al Paciente/organización & administración , Apnea Obstructiva del Sueño/terapia , Adulto , Anciano , Bélgica , Atención a la Salud/organización & administración , Femenino , Humanos , Masculino , Persona de Mediana Edad , Calidad de la Atención de Salud/organización & administración , Apnea Obstructiva del Sueño/diagnóstico , Adulto JovenRESUMEN
Recurrent aphthous ulcers are the most common inflammatory lesions of the oral mucosa, occurring in up to 10% of the population and even more common in children. The history, morphological characteristics, predilection sides and typical stages of aphthae help to distinguish them from other diseases that may exhibit aphthous-like lesions. Underlying diseases should be excluded. The main goals of therapy are to minimize pain and functional disabilities as well as decrease frequency and severity of recurrences. Topical symptomatic relief is the standard of care for simple cases of recurrent aphthosis. In cases of major aphthosis or systemic involvement, topical therapies are still useful but should be combined with systemic therapy, such as colchicine, pentoxifylline or prednisolone. In case of Adamantiades-Behçet disease, systemic immunomodulatory drugs can inhibit the development of new lesions. This overview summarizes morphological and presentation forms of aphthae, differential diagnoses and evidence-based therapeutic possibilities.
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Medicina Basada en la Evidencia , Factores Inmunológicos/administración & dosificación , Inmunosupresores/administración & dosificación , Estomatitis Aftosa/tratamiento farmacológico , Estomatitis Aftosa/prevención & control , Humanos , Prevención Secundaria , Estomatitis Aftosa/diagnósticoRESUMEN
Venous thrombosis is one of the most common vascular diseases. Without treatment, pulmonary embolism is a potentially life-threatening complication. Long-term complications are chronic venous insufficiency and post-thrombotic syndrome. Medical anticoagulation is currently the standard therapy, since it prevents appositional thrombus growth although it usually can not prevent the development of post-thrombotic syndrome. The structure of the thrombotic material often leads to partial recanalisation with residual stenosis. Early and sufficient systemic thrombolysis with adequate concentration may achieve disintegration of the thrombus and preservation of venous valve function. Supplementary to conservative therapy, local catheter thrombolysis is possible even in cases with contraindications for a systemic thrombolysis therapy. Additional interventional techniques reduce the required concentration of the thrombolytic. Venous stenosis can be treated by balloon angioplasty and stent implantation. This article reviews the different percutaneous treatment options as well as their application and usefulness in thrombosis of the lower torso.
Asunto(s)
Angioplastia de Balón/métodos , Vena Femoral , Fibrinolíticos/administración & dosificación , Vena Ilíaca , Embolia Pulmonar/terapia , Stents , Trombectomía , Terapia Trombolítica/métodos , Filtros de Vena Cava , Vena Cava Inferior , Trombosis de la Vena/terapia , Administración Tópica , Angiografía , Vena Femoral/diagnóstico por imagen , Fibrinolíticos/efectos adversos , Humanos , Vena Ilíaca/diagnóstico por imagen , Infusiones Intravenosas , Flebografía , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/prevención & control , Terapia Trombolítica/efectos adversos , Tomografía Computarizada por Rayos X , Vena Cava Inferior/diagnóstico por imagen , Trombosis de la Vena/diagnóstico por imagenRESUMEN
This article focuses on the percutaneous treatment options of venous thromboses and occlusions. Interventional therapy modalities for mediastinal, brachial, axillar, cerebral, and mesenteric thromboses are reviewed. Stenoses of the superior vena cava are most often caused by mediastinal malignomas. Balloon angioplasty together with stent implantation is an effective method for revascularisation in cases of upper venous congestion. Benign central venous stenoses are common in dialysis patients for whom interventional therapy using balloon angioplasty has proven excellent results. In the treatment of insufficient dialysis access, percutaneous techniques represent the first-choice option. Regarding cerebral and mesenteric thrombosis, interventional therapy is restricted to selected individual cases.
Asunto(s)
Venas Mesentéricas/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/cirugía , HumanosRESUMEN
The treatment of recurrent aphthous stomatitis (RAS) still remains nonspecific and is based primarily on empirical data. The goals of therapy include the management of pain and functional impairment by suppressing inflammatory responses, as well as reducing the frequency of recurrences or avoiding the onset of new aphthae. For common forms of RAS, standard topical treatment options that provide symptomatic relief include analgesics, anesthetics, antiseptics, anti-inflammatory agents, steroids, sucralfate, tetracycline suspension, and silver nitrate. Dietary modifications may also support therapeutic measures. In resistant cases of benign aphthosis or aphthosis with systemic involvement, appropriate systemic treatment can be selected from a wide spectrum of immunomodulators that include colchicine, prednisolone, cyclosporine A, interferon-a, tumor necrosis factor-a antagonists, antimetabolites, and alkylating agents.
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Estomatitis Aftosa/tratamiento farmacológico , Adulto , Niño , Ensayos Clínicos Controlados como Asunto , Humanos , Pomadas , Recurrencia , Estomatitis Aftosa/diagnóstico , Estomatitis Aftosa/dietoterapia , Estomatitis Aftosa/prevención & controlRESUMEN
In the last decades, the percutaneous interventional approach for the treatment of central venous obstructions (CVO) has become increasingly popular as the treatment of first choice because of its minimal invasiveness and reported success rates. CVOs are caused by a diverse spectrum of diseases which can be broadly categorized into two principal eliciting genera, either benign or malignant obstructions. The large group of benign venous obstructions includes the increasing number of end-stage renal disease patients with vascular access related complications. Due to the invasiveness and complexity of thoracic surgery for benign CVOs, the less invasive percutaneous interventional therapy can generally be considered the preferred treatment option. Initially, the radiological intervention consisted of balloon angioplasty alone, subsequently additional stent placement was applied. This was advocated as either primary placement or secondary in cases of elastic recoil or residual stenosis after percutaneous transluminal angioplasty (PTA). The efficacy of angioplasty of CVO in patients with vascular accesses, either with or without stenting, has been addressed by various studies. Overall, reports indicate an initial technical and clinical success rate above 95% and satisfactory patency rates. However, systematic follow-up and frequent re-interventions are necessary to maintain vascular patency to achieve long-term success.
Asunto(s)
Cateterismo Venoso Central/efectos adversos , Oclusión de Injerto Vascular/terapia , Imagen por Resonancia Magnética Intervencional , Radiología Intervencionista , Ultrasonografía Intervencional , Angiografía de Substracción Digital , Angioplastia de Balón , Oclusión de Injerto Vascular/diagnóstico por imagen , Humanos , Diálisis Renal , Stents , Tomografía Computarizada por Rayos X , Grado de Desobstrucción VascularRESUMEN
BACKGROUND: Cervical carcinoma cells including those infected with the oncogenic human papilloma virus (HPV) and several cervical carcinoma cell lines show a strong expression of the CD40 receptor, unlike benign cervical epithelial cells infected with HPV. The functional relevance of this up-regulated expression in the tumor is not fully understood. Nevertheless, it might offer a unique possibility to target those malignant cells due to the antiviral and antitumoral effects of the CD40/CD40 ligand (CD40L) interactions. AIM: In vitro assessment of the effect of CD40L on HPV 18-P105 promoter activity and the subsequent release of IL-6 by the promoter transfected HeLa(CD40) cells, which express CD40 constitutively. MATERIAL AND METHODS: Transfection of HeLa(CD40) cells was achieved by electroporation after optimizing the parameters by the pCMV-ß-Gal vector and ß-Gal stain. Transfected HeLa(CD40) cells were challenged with BHK(CD40L) and TNFα, in addition to BHK(wt) and medium alone as controls. HPV18-P105 promoter activity was demonstrated by luciferase reporter gene assay while IL-6 was assessed by ELISA. RESULTS: CD40/CD40L interactions and TNFα treatment significantly reduced HPV18-P105 promoter activity (56.0 ± 10.2% and 64.1 ± 9.1% vs. control, respectively; p < 0.001). Likewise, IL-6, which is a sensitive cytokine of CD40 activation, was significantly increased in HeLa(CD40) cells in the same experiments (2.7 fold after stimulation with BHK(CD40L) and 5.2 fold after stimulation with TNFα vs. control; p < 0.01 and p < 0.001, respectively). CONCLUSION: It is likely that the CD40/CD40L interactions and TNFα are effective against cervical carcinomas by repressing transcriptional activity of HPV promoter. This can result in new adjuvant treatments.
Asunto(s)
Antígenos CD40/inmunología , Ligando de CD40/inmunología , Papillomavirus Humano 18/genética , Infecciones por Papillomavirus/inmunología , Factor de Necrosis Tumoral alfa/inmunología , Neoplasias del Cuello Uterino/inmunología , Cuello del Útero/inmunología , Cuello del Útero/virología , Femenino , Genes Reporteros , Células HeLa , Humanos , Interleucina-6/inmunología , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/virología , Regiones Promotoras Genéticas , Neoplasias del Cuello Uterino/complicaciones , Neoplasias del Cuello Uterino/virologíaRESUMEN
The extensive antigenic drift displayed by seasonal influenza viruses and the risk of pandemics caused by newly emerging antigenically distinct influenza A viruses of novel subtypes has raised considerable interest in the development of so-called universal influenza vaccines. We review options for the development of universal flu vaccines and discuss progress that has been made recently.
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Virus de la Influenza A/inmunología , Vacunas contra la Influenza/inmunología , Gripe Humana/prevención & control , Pandemias/prevención & control , Anticuerpos Antivirales , Humanos , Virus de la Influenza A/clasificación , Gripe Humana/epidemiología , Estaciones del AñoRESUMEN
Fifty-nine patients with occlusive disease of the aorto-iliac and femoro-popliteal arteries were investigated prospectively by intravenous (IV) or intraarterial (IA) digital subtraction angiography (DSA) and magnetic resonance angiography (MRA). This was accomplished using a two-dimensional (2D) Inflow- (59 patients) and a 2D Phase Contrast- (RSE--rapid sequential excitation) sequence (29 patients). The spectrum of pathology included stenoses < 50%, stenoses 50-89%, stenoses 90-99%, occlusions, aneurysms and status following reconstructive surgery. MRA- and DSA-examinations were evaluated by four radiologists. The diagnoses were made by consent decisions of a radiologist and a vascular surgeon based on clinical and radiological findings. Diagnostic performance of IA-DSA was superior to all other imaging modalities. Vascular delineation of 2D Inflow-MRA was comparable to that of IV-DSA. The image quality of RSE-MRA was not adequate for diagnosis. In conclusion, 2D Inflow-MRA is a promising method for evaluating abdominal and peripheral arteriosclerotic disease. Interpretation of MR-angiograms, however, requires profound knowledge of MRA-techniques, X-ray angiography and hemodynamics.
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Angiografía de Substracción Digital , Enfermedades de la Aorta/diagnóstico , Arteriopatías Oclusivas/diagnóstico , Arteria Femoral , Arteria Ilíaca , Angiografía por Resonancia Magnética , Arteria Poplítea , Adulto , Anciano , Aorta Abdominal , Constricción Patológica/diagnóstico , Estudios de Evaluación como Asunto , Humanos , Persona de Mediana Edad , Variaciones Dependientes del Observador , Estudios ProspectivosRESUMEN
MATERIAL AND METHODS: In 59 patients with arterial flow disturbances 2-D inflow sequence of the abdominal and lower leg arteries were prospectively obtained on a 1.5 T MR-imager and were compared with additional DSA examinations. Supplementary Phase Contraste RSE ("Rapid Sequential Excitation") sequences were carried out in 29 patients. MRA and DSA angiograms were evaluated in random order by 4 readers using a questionnaire. The assessment of image quality were evaluated by variance analysis. Diagnostic performance of MRA and DSA was assessed by comparison of the readers' diagnostic assessments with reference diagnoses established by a radiologist and a vascular surgeon with full knowledge of all data concerning a patient. Image quality of inflow MRA was considered inferior to i.a. DSA (p < 0.001) and comparable with i.v. DSA (p = 0.1361). Image quality of RSE-MRA was inadequate (p < 0.001). Correspondingly, i.a. DSA was the superior and RSE-MRA the inferior imaging technique. The accuracy of inflow MRA in determining stenosis grade was 66% and that of RSE-MRA 59%.
Asunto(s)
Angiografía de Substracción Digital , Arteriopatías Oclusivas/diagnóstico por imagen , Angiografía por Resonancia Magnética , Anciano , Análisis de Varianza , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Distribución AleatoriaRESUMEN
We report on the case of a 22-year-old heroin-dependent diabetic woman. She presented with a gas-forming fungal infection of the kidney caused by Candida tropicalis. The patient was successfully treated by conservative means. Problems in the diagnosis and therapy of this rare disease are discussed.
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Candidiasis/diagnóstico , Diabetes Mellitus Tipo 1/diagnóstico , Nefropatías Diabéticas/diagnóstico , Pielonefritis/diagnóstico , Adulto , Candidiasis/tratamiento farmacológico , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Nefropatías Diabéticas/tratamiento farmacológico , Femenino , Fluconazol/administración & dosificación , Humanos , Sistemas de Infusión de Insulina , Pielonefritis/tratamiento farmacológico , Irrigación Terapéutica , Urodinámica/efectos de los fármacos , Urodinámica/fisiología , UrografíaRESUMEN
Epidemiological studies demonstrate a prevalence of Adamantiades-Behçets disease (MAB) in the range of 0.12-420 per 100,000 inhabitants with the highest rates in Istanbul, Turkey and the lowest rates in the USA. Ophthalmological data on the prevalence of ocular involvement are limited for MAB in Germany because most epidemiological studies are based on rheumatological or dermatological data. Berlin is the city with the highest number of non-native German inhabitants and its multiethnic character renders it uniquely appropriate for epidemiological studies on MAB. This article summarizes the most important epidemiological data of 140 patients (63 female and 77 male) with a mean follow-up of 6.4 years (range 0.5-22 years) which we have recently published. The mean age was 23 years at the first manifestation and 32 years when the fully developed disease was recorded. The mean age at onset of ocular involvement was 30 years, 56% of patients developed ocular involvement, which was the first manifestation in 8.6% and the second manifestation in 19.3%. More than half the patients developed ocular involvement. The calculated prevalence of ocular involvement in MAB is 1.77/100,000 inhabitants for the population of Berlin.
Asunto(s)
Síndrome de Behçet/epidemiología , Oftalmopatías/epidemiología , Adolescente , Niño , Preescolar , Comorbilidad , Femenino , Alemania/epidemiología , Humanos , Lactante , Recién Nacido , Masculino , Prevalencia , Factores de Riesgo , Adulto JovenRESUMEN
Of the 721 documented patients in the German Registry for Adamantiades-Behçet disease (registered charity), 258 were of German and 308 of Turkish descent, along with 30 other countries of origin. The prevalence in Germany is 0.9:100,000. Manifestation of the disease was predominantly in the third decade of life (median age: 26.5 years) and in 10.7% the disease onset was under 16 years of age. The full clinical picture developed on average in 2.9 years (median 3 months). Patients of Turkish descent showed androtopism in contrast to those of German descent (female:male 1.9:1), which was also detected in the whole collective in a ratio of 1.4:1. In 12.4% there was a family history with differences between German and Turkish patients (3.8% versus 14.6%) as well as in patients with disease onset in young and adult age (25.0% versus 7.3%). Most frequent features included oral aphthae (98.5%), cutaneous lesions (81%), genital ulcers (64.7%), ocular manifestations (51.6%), arthritis (52.4%) and positive pathergy test (30.8%). Turkish patients suffered significantly more often from eye manifestations compared with Germans, while in German patients prostatitis/epididymitis and gastrointestinal involvement were more frequently documented. As serious complications arose blindness 6.8%, meningoencephalitis 4.0%, severe arthritis 2.6%, fatal outcome 1.2%, hemoptysis 1.1% and gastrointestinal perforation 0.5%. The HLA-B5 antigen was positive in 58.1% and showed an association with eye manifestations. The relative risk of HLA-B5 positive individuals is high in both Germans (6.57) and Turks (5.81).