Search

Cytoreductive therapy can ameliorate symptoms in chronic myeloid leukemia (CML) but only treatment beyond hematologic remission aiming to affect the leukemic clone can improve prognosis, Up to now bone marrow transplantation is the only established therapy with the potential to completely eliminate the BCR-ABL positive cell population. Interferon-alpha (IFN-α) as well as cytosine arabinosider (ARA-C), particularly in combination, have been shown to be effective in achieving cytogenetic remission in some patients. With Glivec (STI-571) there is now a drug available which can induce major cytogenetic response in more than half of the patients who have failed IFN-α treatment and thus possibly delay or prevent blast crisis. Recent reports, however, have shown that primitive, quiescent, Philadelphia-positive stem cells are insensitive to STI-571 in vitro. Such cells could be the basis of relapse after termination of Glivec-therapy. [ABSTRACT FROM AUTHOR]

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

What is right? Tonsillotomy or tonsillectomy? Moreover, when and what has to be preferred? Is the discussion never ending? No, and this is good. Tonsil surgery is and will remain a frequent surgical procedure for the otolaryngologist. Especially, because many children are operated, and because - also rare - significant complications can occur, a quality-controlled benefit-risk-analysis is important. Part of this is systematic analysis of the evidence of the benefits and risks of tonsillotomy and tonsillectomy, as it was performed recently by the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG) by order of the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA). One result was the implementation of the tonsillotomy as a regular service paid by the insurance companies. Nevertheless, the discussion is not yet concluded. Actually, a randomized controlled trial is in preparation sponsored by the G-BA to proof the non-inferiority of tonsillotomy against tonsillectomy for the treatment of patients with recurrent acute tonsillitis. The present article on ENT specialist knowledge should put the reader, especially ENT residents, in a position to advice patients and their relatives on the pros and cons of tonsil surgery., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Idiopathic pulmonary fibrosis (IPF) is a severe and often fatal disease. Diagnosis of IPF requires considerable expertise and experience. Since publication of the international IPF guideline in the year 2011 and Update 2018 several studies and technical advances occurred, which made a new assessment of the diagnostic process mandatory. In view of the antifibrotic drugs which have been approved for the treatment of IPF patients, the goal of this guideline is to foster early, confident and effective diagnosis of IPF. The guideline focusses on the typical clinical setting of an IPF patient and provides tools to exclude known causes of interstitial lung disease including standardised questionnaires, serologic testing and cellular analysis of bronchoalveolar lavage. High resolution computed tomography remains crucial in the diagnostic work-up. If it is necessary to obtain specimen for histology transbronchial lung cryobiopsy is the primary approach, while surgical lung biopsy is reserved for patients who are fit for it and in whom bronchoscopic diagnosis did not provide the information needed. Despite considerable progress, IPF remains a diagnosis of exclusion and multidisciplinary discussion remains the golden standard of diagnosis., Competing Interests: Eine Übersicht der Interessenkonflikte findet sich im Internet unter http://awmf.org; AWMF-Registriernummer 020-016., (© Georg Thieme Verlag KG Stuttgart · New York.)

Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht.

Objective: Continuous positive airway pressure (CPAP) therapy is the reference therapy for moderate and severe obstructive sleep apnea syndrome (OSAS). However, CPAP adherence is dissatisfying. We analyzed influencing factors on CPAP adherence and we evaluated if a structured follow-up enhances its adherence., Material and Methods: In this study all patients (n = 237) with a newly adjusted CPAP therapy due to the diagnosis of mild to severe OSAS between 2011 and 2013 were investigated. Follow-up took place every 1593.7 ± 77.4 CPAP operation hours., Results: AHI (Apnea-hypopnea index) decreased significantly during therapy (5.6 ± 8.5/h; p < 0.001). 79 % fulfilled the criteria of CPAP adherence (at least 4 operation hours at 7 days a week). There were no significant influences on CPAP adherence seen in patients' demographic, clinical and pharmacological characteristics. The most common problems of patients receiving a CPAP therapy were dryness of the mucous membranes (43.7 %) and pressure marks (22.4 %). Considering the changes in Epworth Sleepiness Scale there were no significant relations to CPAP adherence. Satisfaction with our follow-up significantly correlated with CPAP adherence (r = 0.185; p = 0.032), whereas therapy pressure did not have any significant influence on CPAP adherence (r = -0.072; p = 0.383)., Conclusion: A structured and individually adapted follow-up is important. In future, apart from control of therapy success, greater attention in the follow-up of CPAP therapy should be given to aspects of problem solution, feedback, education, and motivation., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht.

Competing Interests: The authors report no conflicts of interest in this work.

A long and winding road led to the discovery of immunoglobulin E (IgE) in 1966 and 1967. We are currently on a long and winding road to understand the immunologic basis of the clinical effects of the anti-IgE antibody omalizumab in asthma. It is possible that patients with asthma (as patients with chronic spontaneous urticaria) benefit in different immunologic ways from omalizumab treatment. This article reviews the history of IgE discovery and current concepts of anti-IgE therapy in asthma., Competing Interests: Interessenkonflikt: M. Lommatzsch erhielt Honorare für Beratungen und Vorträge von den Firmen ALK Abelló, Allergopharma, AstraZeneca, Bencard, Berlin-Chemie, Boehringer-Ingelheim, Boston Scientific, Chiesi, GSK, Janssen-Cilag, MSD, Mundipharma, Novartis, Nycomed/Takeda, Sanofi, TEVA, UCB. ML erhielt Forschungsförderung von der Deutschen Forschungsgemeinschaft (DFG), dem Land Mecklenburg-Vorpommern, GSK, AstraZeneca. K. Geißler hat Vortragshonorare von den Firmen AstraZeneca, Novartis und Teva erhalten. KG hat Forschungsförderung von den Firmen AstraZeneca und Teva erhalten. K.-C. Bergmann hat Vortrags- und Beraterhonorare von den Firmen AstraZeneca, ALK, Bencard, HAL, Lofarma, Novartis, Stallergenes und Teva erhalten. J. C. Virchow hat Vorträge gehalten und Honoraria erhalten von: AstraZeneca, Avontec, Bayer, Bencard, Bionorica, Boehringer-Ingelheim, Chiesi, Essex/Schering-Plough, GSK, Janssen-Cilag, Leti, MEDA, Merck, MSD, Mundipharma, Novartis, Nycomed/Altana, Pfizer, Revotar, Sanofi/Regeneron, Sandoz-Hexal, Stallergens, TEVA, UCB/Schwarz-Pharma, Zydus/Cadila und als Berater fungiert für: Avontec, Boehringer-Ingelheim, Chiesi, Essex/Schering-Plough, GSK, Janssen-Cilag, MEDA, MSD, Mundipharma, Novartis, Regeneron, Revotar, Roche, Sanofi-Aventis, Sanofi/Regeneron, Sandoz-Hexal, TEVA, UCB/Schwarz-Pharma. JCV hat Forschungsförderung erhalten von der Deutschen Forschungsgemeinschaft (DFG), dem Land Mecklenburg-Vorpommern, GSK, MSD., (© Georg Thieme Verlag KG Stuttgart · New York.)

Surgery in the pharynx belongs to the most frequent otorhinolaryngological procedures. Adenoidectomy and tonsillectomy are amongst the most frequent surgeries at all and belong to the first procedures which are performed by otorhinolaryngology residents during their specialist training. Therefore, it is essential to study early during the specialist training the most frequent pharyngeal procedures, surgical techniques, complications and outcome. A series of excellent clinical trials and meta-analyses have been published in the recent year demonstrating that adenoidectomy is an important therapy element in pediatric otorhinolaryngology. In particular due to the developments in the field of laser surgery, tonsillotomy could experience a revival in the recent years. The indication spectrum is still widening. There are many fields where clinical trials are needed to proof if tonsillotomy is as effective as tonsillectomy but with the advantage of lower morbidity. There are manifold pharyngeal surgical procedures to treat patients with obstructive sleep apnea. These surgical techniques have proved valuable especially as alternative to conservative therapy and in case of treatment failure under airway pressure therapy. As the obstruction during this type of sleep-related respiratory disorder is often not located at one anatomical site, an individual combination of several pharyngeal and other surgeries are needed for an effective treatment of the patient. The present article gives an overview of the most important pharyngeal surgeries for future otorhinolaryngologists under specialist training., (© Georg Thieme Verlag KG Stuttgart · New York.)

Tonsillectomy is one of the most painful surgical procedures. Unfortunately, it is not unusual that the patient hear statement like: "There is no way around" or "You receive already enough pain killers". Asking the anesthetist or the otorhinolaryngologist, one may get to hear: "Pain after tonsillectomy is not a real problem. We have a reliable pain management protocol". In contradiction, many clinical studies are showing that many patients have persistent and even severe pain after tonsillectomy despite postoperative pain therapy. Considering the results of many controlled clinical trials analyzing manifold varieties of pain management regimes it becomes obvious that there is no standard pain therapy after tonsillectomy with reliable proof of sufficient pain suppression. This review wants to give an overview on the current status of clinical research on pain measurement methods and pain management after tonsillectomy., (© Georg Thieme Verlag KG Stuttgart · New York.)

Chronic Rhinosinusitis is one of the most frequent chronic diseases. A major cause is allergic rhinitis. Both illnesses and the combination of both, which is the topic of this educational article, as well as the clarification and therapy of differential diagnoses are belonging in the hands of the otorhinolaryngologist. Finally, it is not completely understood which mechanisms of the allergic inflammation in the nose lead or predispose in the individual patient to the development of a chronic sinus disease. A series of excellent national and international guidelines have been published supporting the otorhinolaryngologist in diagnostics and treatment of patients with allergic rhinosinusitis. This article presents the most important and actual diagnostic and therapeutic procedures for the treatment of this important chronic disease in children and adults., (© Georg Thieme Verlag KG Stuttgart · New York.)