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ZusammenfassungImmunmediierte inflammatorische Erkrankungen (IMID) sind eine klinisch heterogene Gruppe von Erkrankungen, die genetische, ätiologische und auch klinische Überschneidungen aufweisen. Nach dem heutigen Stand der Forschung liegen den sog. primären IMID gemeinsame pathogene Mechanismen und zytokinassoziierte Signaltransduktionswege zugrunde. Zu den primären IMID zählen unter anderem chronisch-entzündliche Darm‑, Haut- und Augenerkrankungen sowie rheumatische Erkrankungen. Patienten, die an einer primären IMID erkrankt sind, weisen ein erhöhtes Risiko für die Entwicklung einer sekundären IMID auf. Die vorliegende Arbeit skizziert die Abgrenzung zwischen primären und sekundären IMID unter Berücksichtigung von Komplikationen und Komorbiditäten. Ausgehend von den Fächern Gastroenterologie, Dermatologie, Rheumatologie und Ophthalmologie wird ein möglicher optimaler interdisziplinärer Umgang mit IMID-Patienten diskutiert. Im speziellen werden Leitsymptome, die auf eine IMID hinweisen, und diagnostische Maßnahmen beschrieben, die vor Überweisung eines Patienten zum entsprechenden Spezialisten durchgeführt werden sollten. Da einzelne Patienten, die unter mehreren IMID leiden, eine therapeutische Herausforderung darstellen, können hierfür interdisziplinäre Sprechstunden bzw. sog. Immunoboards in der klinischen Praxis hilfreich sein.

The objective was to compare retinal morphology and function following intravitreal injections of bevacizumab (Avastin) or triamcinolone (Volon A) in patients with early diabetic macular edema (DME). The study was planned as a randomized, prospective, interventional clinical trial. A total of 30 diabetic patients with treatment-naive, clinically significant macular edema were included in this study and randomized to two equal groups. One group initially received three injections of 2.5 mg bevacizumab in monthly intervals. The second group received a single injection of 8 mg triamcinolone, followed by two sham interventions. Functional and anatomic results were evaluated monthly using ETDRS vision charts and spectral-domain optical coherence tomography. According to the study protocol, retreatment after 3 months was dependent on functional and anatomic outcome in a PRN regimen. Baseline best corrected visual acuity (BCVA) was 0.30 logMAR and central retinal subfield thickness (CSRT) was 505 μm in the bevacizumab group and 0.32 logMAR and 490 μm CSRT in the triamcinolone group. After 3 months, BCVA improved to 0.23 logMAR (bevacizumab) and 358 μm CRST and 0.26 logMAR (triamcinolone) and 308 μm CSRT. After 12 months, BCVA further recovered in the bevacizumab group (0.18 logMAR) but slightly decreased in the triamcinolone group (0.36 logMAR). Intravitreal bevacizumab and triamcinolone are both equally effective in reducing CSRT in early DME. After 6 months, rehabilitation of vision was comparable in both treatment arms, whereas at the final follow-up at month 12, BCVA was superior in the bevacizumab than in the triamcinolone sample. This may be related to cataract development following steroid treatment, as well as to substance-specific mechanisms within the angiogenic versus the inflammatory cascade.

Increasing evidence suggests that the visual analysis of other people's actions depends upon the observer's own body representation or schema. This raises the question of how differences in observers' body structure and schema impact their perception of human movement. We investigated the visual experiences of two persons born without arms, one with and the other without phantom sensations. These participants, plus six normally-limbed control observers, viewed depictions of upper limb movement under conditions of apparent motion. Consistent with previous results (Shiffrar M, Freyd JJ (1990) Psychol Sci 1:257), normally-limbed observers perceived rate-dependent paths of apparent human movement. Specifically, biologically impossible motion trajectories were reported at rapid display rates while biologically possible trajectories were reported at slow display rates. The aplasic individual with phantom experiences showed the same perceptual pattern as control participants, while the aplasic individual without phantom sensations did not. These preliminary results suggest that phantom experiences may constrain the visual analysis of the human body. These results further suggest that it may be time to move beyond the question of whether aplasic phantoms exist and instead focus on the question of why some people with limb aplasia experience phantom sensations while others do not. In this light, the current results suggest that somesthetic representations are not sufficient to define body schema. Instead, neural systems matching action observation, action execution and motor imagery likely contribute to the definition of body schema in profound ways. Additional research with aplasic individuals, having and lacking phantom sensations, is needed to resolve this issue.