Dtsch Med Wochenschr
· 2026 Jun · PMID 42330968
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INTRODUCTION: Tularemia is a rare zoonotic disease caused by Francisella tularensis, whose pulmonary manifestations occur only sporadically in Central Europe and can be particularly challenging to diagnose. MEDICAL HISTO...INTRODUCTION: Tularemia is a rare zoonotic disease caused by Francisella tularensis, whose pulmonary manifestations occur only sporadically in Central Europe and can be particularly challenging to diagnose. MEDICAL HISTORY: We report on a 58-year-old patient presenting with B-symptoms in whom a thoracic mass was detected on computed tomography. INVESTIGATIONS AND DIAGNOSIS: Further imaging studies revealed a metabolically active mediastinal mass with lymphadenopathy, suggestive of bronchial carcinoma. Only surgical mediastinoscopy with evidence of granulomatous-histiocytic inflammation, as well as further infectious disease diagnostics, led to the diagnosis of pulmonary tularemia. TREATMENT AND COURSE: Following a 20-day course of doxycycline, there was rapid clinical improvement and complete laboratory and radiological regression of the lymphadenopathy. CONCLUSION: This case underscores that pulmonary tularemia can resemble malignant processes morphologically and metabolically. Early consideration of infectious disease differential diagnoses, as well as the combination of histology, serology, and molecular biological methods, are crucial to avoid misdiagnoses and unnecessary invasive procedures.
Dtsch Med Wochenschr
· 2026 Jun · PMID 42330967
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Adult patients with sickle cell disease may present to the emergency department with a broad spectrum of acute clinical manifestations. These acute complications can be life-threatening and require a structured, time-sen...Adult patients with sickle cell disease may present to the emergency department with a broad spectrum of acute clinical manifestations. These acute complications can be life-threatening and require a structured, time-sensitive emergency management approach. Although vaso-occlusive pain crises represent the most frequent cause of presentation, other severe complications-including cerebrovascular events, acute chest syndrome, priapism, and hepatobiliary disorders-may also require immediate medical evaluation. Prompt diagnostic assessment and initiation of appropriate therapy are essential to prevent clinical deterioration and the development of secondary complications.
Dtsch Med Wochenschr
· 2026 Jun · PMID 42330966
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Hereditary stomatocytosis comprises a group of disorders of the erythrocyte membrane that lead to impaired membrane permeability for Na and K ions. The most common form, dehydrated stomatocytosis, has long been underesti...Hereditary stomatocytosis comprises a group of disorders of the erythrocyte membrane that lead to impaired membrane permeability for Na and K ions. The most common form, dehydrated stomatocytosis, has long been underestimated in terms of its incidence and significance. It is associated with hemolysis, usually anemia of varying severity, and a combination of primary and secondary resorptive hemochromatosis. In the perinatal period, some patients develop edema and effusions of varying severity, which usually regress spontaneously but can progress to life-threatening hydrops fetalis. Splenectomy is not only ineffective in this disease but also contraindicated due to the associated risk of thrombosis.
Dtsch Med Wochenschr
· 2026 Jun · PMID 42330965
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Hereditary hemolytic anemias (HHAs) are a heterogeneous group of genetic disorders characterized by the premature destruction of red blood cells due to intrinsic defects within these cells. In contrast to acquired forms,...Hereditary hemolytic anemias (HHAs) are a heterogeneous group of genetic disorders characterized by the premature destruction of red blood cells due to intrinsic defects within these cells. In contrast to acquired forms, HHAs are caused by genetic variants affecting erythrocyte structure, function, or metabolism, leading to chronic hemolysis. Hemoglobinopathies, including thalassemias and sickle cell disease, represent the most prevalent HHAs worldwide and require combined analysis of hemoglobin fractions and genetic variants. Membranopathies, particularly hereditary spherocytosis, the most common form in Europe, are primarily identified using assays such as eosin-5-maleimide (EMA) binding and osmotic fragility testing. Enzymopathies, most notably pyruvate kinase and glucose-6-phosphate dehydrogenase deficiencies, necessitate a combination of enzymatic activity assays and confirmatory genetic testing. Advances in molecular diagnostics, especially next-generation sequencing, have substantially increased diagnostic yield by enabling parallel analysis of multiple genes and facilitating the identification of causative variants. This has important implications for establishing definitive diagnoses, guiding therapy, refining prognostic assessment, and enabling genetic counseling. Despite these advances, a subset of cases remains genetically unresolved, underscoring the need for continued research and expanded diagnostic strategies. Overall, this review highlights the central role of integrating specialized laboratory diagnostics with molecular genetic testing and supports an early, genetics-informed approach to optimize the diagnosis and management of HHAs in adult patients.
Dtsch Med Wochenschr
· 2026 Jun · PMID 42214365
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Systemic sclerosis is one of the most challenging autoimmune connective tissue diseases. 2024 new treatment recommendations were published by EULAR which now are amended by German recommendations for diagnostic and thera...Systemic sclerosis is one of the most challenging autoimmune connective tissue diseases. 2024 new treatment recommendations were published by EULAR which now are amended by German recommendations for diagnostic and therapy. This overview article focuses on these new advices to help referring physicians to identify patients with typical clinical features earlier and thus to improve early diagnosis and future treatment options. Here, especially (but not solely) B-cell targeting therapies are in the scope.
Dtsch Med Wochenschr
· 2026 Jun · PMID 42214364
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Chronic kidney disease (CKD) has been increasingly recognized as a major global health burden, prompting the WHO and UN in 2025 to call for strengthened prevention, early detection, and improved care. CKD accounted for a...Chronic kidney disease (CKD) has been increasingly recognized as a major global health burden, prompting the WHO and UN in 2025 to call for strengthened prevention, early detection, and improved care. CKD accounted for approximately 1.5 million deaths in 2023, with age standardized mortality continuing to rise. Metabolic risk factors, especially hypertension, diabetes, and obesity, are the primary drivers of CKD burden in adults, while environmental and occupational exposures play an additional role in low resource settings. Congenital anomalies, hereditary nephropathies, and early life kidney injury are the main risk determinants in children. CKD of unknown cause (CKDu) represents a distinct public health challenge in agricultural regions of low-income countries, affecting mainly younger adults without traditional risk factors, with heat stress, dehydration, and environmental toxins considered potential contributors.
Dtsch Med Wochenschr
· 2026 Jun · PMID 42214363
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The current guidelines of the European Society of Cardiology recommend the use of cardiac glycosides/digitalis in patients with heart failure and sinus rhythm only if the LVEF is ≤40% and if heart failure symptoms persis...The current guidelines of the European Society of Cardiology recommend the use of cardiac glycosides/digitalis in patients with heart failure and sinus rhythm only if the LVEF is ≤40% and if heart failure symptoms persist despite therapy with Betablockers, ACE inhibitors (or angiotensin receptor-neprilysin inhibitors), and mineralocorticoid receptor antagonists, in order to reduce the risk of further hospitalizations. Therapy with cardiac glycosides is not recommended in heart failure with an LVEF >40% and sinus rhythm. In patients with atrial fibrillation, therapy with cardiac glycosides may be used primarily for rate control in heart failure with an LVEF >40%, and in those with an LVEF ≤40% if heart rate control under Betablocker therapy is insufficient or not possible. In the recently published DIGIT-HF study, digitoxin at low serum concentrations reduced all-cause mortality and heart-failure-related hospitalizations in patients with heart failure and reduced ejection fraction, in addition to very good guideline-recommended pharmacological and device therapy. Both patients with sinus rhythm and those with atrial fibrillation benefited. Important new study data from the DECISION study on the use of digoxin in heart failure are expected in 2026. Other studies provide indications of favorable effects of cardiac glycosides on pulmonary arterial pressure values in heart failure and on heart-failure surrogate marker in atrial fibrillation. Digitoxin can be used safely at low serum concentrations in symptomatic heart failure with reduced ejection fraction to improve prognosis and prevent heart-failure hospitalizations. In particular, patients with atrial fibrillation, advanced heart-failure symptoms, low blood pressure, and higher heart rates should be treated with digitoxin, as well as patients in whom the use of currently recommended prognosis-improving pharmacotherapy is limited. Cardiac glycosides are an important and safe therapeutic option for rate control in patients with atrial fibrillation and heart failure. The study data on digoxin expected in 2026 are important for the final assessment of the use of cardiac glycosides in heart failure.
Ploenes N, Karagiannidis C, Straßmann SE
… +1 more, Windisch W
Dtsch Med Wochenschr
· 2026 Jun · PMID 42214362
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Patient self-inflicted lung injury (P-SILI) describes a pathophysiological concept in which patients with acute hypoxemic respiratory failure (AHRF) may exacerbate lung injury through excessive respiratory drive and vigo...Patient self-inflicted lung injury (P-SILI) describes a pathophysiological concept in which patients with acute hypoxemic respiratory failure (AHRF) may exacerbate lung injury through excessive respiratory drive and vigorous spontaneous breathing efforts, thereby perpetuating respiratory failure. Spontaneous breathing-related lung injury is thought to be mediated by 4 main mechanisms: 1. increased mechanical stress on lung tissue, 2. heterogeneous ventilation with intrapulmonary gas redistribution (pendelluft), 3. augmented pulmonary blood flow leading to microvascular injury, and 4. Patient-ventilator asynchrony (PVA) in the setting of non-invasive ventilation (NIV). All of these mechanisms are closely linked to an elevated respiratory drive, which primarily arises from the underlying lung pathology, particularly alveolar flooding due to plasma leakage. Clinical monitoring of respiratory effort and neural respiratory drive is possible using techniques such as esophageal pressure measurement. However, these methods are often invasive, not fully validated, time- and resource-intensive, costly, and may be associated with reduced patient comfort.In the management of acute respiratory failure, including acute respiratory distress syndrome (ARDS) and AHRF, prevention of P-SILI is essential. Recent evidence suggests that late failure of NIV followed by delayed intubation is associated with the highest mortality rates. Consequently, the choice of ventilatory support must be individualized and continuously reassessed, taking into account the risk of both P-SILI and ventilator-induced lung injury. Non-invasive ventilation, high-flow nasal cannula therapy, pharmacological interventions, and prone positioning during spontaneous breathing all have therapeutic limits that require continuous, round-the-clock evaluation. To date, robust evidence from large clinical trials regarding their impact on the prevention and treatment of P-SILI, as well as the optimal timing of intubation, remains lacking.
Scheffzük C, Fleischmann-Struzek C, Kumpf O
… +4 more, Paul N, Renner CIE, Wiegele M, Denke C
Dtsch Med Wochenschr
· 2026 Jun · PMID 42214361
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RECENT DEVELOPMENTS: More than half of the intensive care unit (ICU) survivors develop persistent cognitive, physical, and psychological impairments, summarized as post-intensive care syndrome (PICS), accompanied by redu...RECENT DEVELOPMENTS: More than half of the intensive care unit (ICU) survivors develop persistent cognitive, physical, and psychological impairments, summarized as post-intensive care syndrome (PICS), accompanied by reduced quality of life and restricted social participation. In this context, digital interventions are gaining attention as an adjunct to existing care. They facilitate the transfer of relevant patient information and direct communication with clinicians, improve access to PICS-related information, and support the access to therapeutic services. However, prior studies have largely addressed single PICS domains and focused mainly on feasibility. NEW STUDIES: In 2024/2025, three randomized controlled trials (IMPROVE, ENCOMPASS, m-CCRP) were published. They provide the first systematic evaluation of digital follow-up programs for ICU survivors and show that telemedicine-based approaches are feasible and acceptable to patients; still, greater standardization of assessments and outcome measures is essential to improve comparability across future studies. CHALLENGES AND BARRIERS: The implementation of digital PICS follow-up care is associated with several challenges. On the patient side, barriers include PICS-related impairments, limited digital literacy, and data privacy concerns. On the provider side, implementation is hindered by insufficient technical infrastructure, poor integration into existing care processes, and reimbursement barriers. OUTLOOK AND POTENTIAL: Digital and telemedicine-based approaches have the potential to bridge gaps in care, complement follow-up services, and improve access for vulnerable patient groups in particular. They are not a replacement, but a core component of a modern, cross-sectoral PICS follow-up care framework.
Dtsch Med Wochenschr
· 2026 Jun · PMID 42214360
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With the global rise in cancer incidence, the number of critically ill oncology patients with potential need for intensive care unit (ICU) admission is also increasing. This trend is not solely attributable to disease pr...With the global rise in cancer incidence, the number of critically ill oncology patients with potential need for intensive care unit (ICU) admission is also increasing. This trend is not solely attributable to disease progression, but also to the aging of the cancer population, often accompanied by significant comorbidities, and to complications arising from modern oncologic therapies. In particular, adverse effects related to chemotherapy, hematopoietic stem cell transplantation, and immunotherapies increasingly require intensive medical intervention. Although the marked heterogeneity of this patient population makes generalizations difficult, studies have shown that critically ill patients with hematologic malignancies can demonstrate favorable survival and recovery rates despite the severity of their illness. Acute respiratory failure (ARF) is among the most frequent indications for ICU admission in cancer patients. Therapeutic management is often complex and not standardized, especially in the context of treatment limitations. Non-invasive respiratory support strategies, such as high-flow oxygen therapy or non-invasive ventilation (NIV), may offer clinical benefit in carefully selected patients, provided that close monitoring and readiness to escalate therapy are ensured. Innovative immuno-oncologic treatment strategies have substantially broadened the therapeutic spectrum in oncology and often provide severely ill patients with curative options. However, these therapies are associated with specific and sometimes life-threatening adverse effects. Among the most significant are the cytokine release syndrome (CRS), triggered for example by CAR-T cells or T-cell engagers, and the immune effector cell-associated neurotoxicity syndrome (ICANS). In addition, other immune-related adverse events (irAEs) may occur in association with checkpoint inhibitor (ICI) therapies. These potentially life-threatening complications require structured diagnostic approaches, close interdisciplinary management, and early initiation of immunomodulatory therapy.
Dtsch Med Wochenschr
· 2026 Jun · PMID 42214359
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The rising prevalence of dementia, driven by demographic aging, underscores the urgent need for effective therapeutic strategies. This update reviews recent advances in anti-dementia treatments, focusing on pharmacologic...The rising prevalence of dementia, driven by demographic aging, underscores the urgent need for effective therapeutic strategies. This update reviews recent advances in anti-dementia treatments, focusing on pharmacological and non-pharmacological interventions. Acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine) and the NMDA receptor agonist memantine, traditionally used for Alzheimer's disease, are now recommended off-label for vascular dementia, offering modest cognitive benefits with manageable side effects. The approval of amyloid-targeting monoclonal antibodies - lecanemab and donanemab - marks a paradigm shift, as these agents demonstrate disease-modifying potential in mild cognitive impairment (MCI) and early Alzheimer's disease by reducing amyloid plaques and slowing cognitive decline. However, their use is complicated by amyloid-related imaging abnormalities (ARIA), necessitating careful patient selection and monitoring, particularly in APOE4 homozygotes. Non-pharmacological approaches, including cognitive and physical training, have gained prominence. Regular moderate exercise (150 minutes/week) improves cognitive function in MCI and dementia, while multimodal interventions (e.g., FINGER, POINTER) target risk reduction through lifestyle modifications. Digital health applications, such as "Neuronation" and "Memodio", offer promising adjuncts, though evidence remains limited. The failure of GLP-1 analogs (e.g., semaglutide) in recent trials highlights the challenges in repurposing metabolic agents for neurodegeneration. The introduction of disease-modifying therapies emphasizes the importance of early diagnosis and comprehensive geriatric assessment to balance efficacy, safety, and patient-centered outcomes. Ongoing research and real-world data will further clarify the long-term benefits and risks of these innovations, shaping future dementia care.
Dtsch Med Wochenschr
· 2026 Jun · PMID 42214358
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This review summarizes recent developments in the genetics of Wilson's disease, highlights major diagnostic innovations, discusses novel aspects of therapeutic strategies, and outlines advances in treatment monitoring th...This review summarizes recent developments in the genetics of Wilson's disease, highlights major diagnostic innovations, discusses novel aspects of therapeutic strategies, and outlines advances in treatment monitoring that are of particular relevance for clinical practice. Recent genetic population studies based on carrier frequencies of ATP7B mutations suggest that the prevalence of Wilson's disease is higher than estimates derived from clinical patient registries. Current evidence indicates that some ATP7B mutations are associated with milder disease phenotypes and reduced penetrance, supporting the concept of genotype-phenotype associations. A major advance in the diagnosis of Wilson's disease is the introduction of Relative Exchangeable Copper (REC). An additional diagnostic improvement is metallothionein immunohistochemistry in liver biopsy specimens. In cases of Wilson's disease-related acute liver failure, immediate listing for liver transplantation is generally recommended. Based on recent studies, bridging plasma exchange therapy should be considered in all patients and particularly in patients without advanced hepatic encephalopathy, and in selected cases with early treatment and mild encephalopathy transplantation may be avoided.
Dtsch Med Wochenschr
· 2026 Jun · PMID 42214357
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Vascular-specific sports and exercise therapy should be offered as first-line therapy to all patients with intermittent claudication, provided that the patient is able to perform this therapy. The results should be evalu...Vascular-specific sports and exercise therapy should be offered as first-line therapy to all patients with intermittent claudication, provided that the patient is able to perform this therapy. The results should be evaluated after 3-6 months in terms of quality of life, and the vascular team should then discuss the next steps on an individual basis. Supervised walking training in a vascular sports group with a trained vascular trainer is the basic therapy. Home exercise training with targets and goal-oriented monitoring is equivalent to a structured training program in terms of the walking distance achieved and should be considered if supervised walking training is not possible. The current data situation is reflected in the S3 guideline of the DGA, according to which consensus recommendations are made for the implementation of vascular-specific sports and exercise therapy. Vascular trainer training has been standardized in a 16-hour curriculum and coordinated with the vascular medicine professional associations DGA and DGG as well as the professional associations DGPR and DVGS. The corresponding courses are offered regularly with mutual recognition. Rehabilitation clinics can specialize in the treatment of patients with PAD and have this recognized by a certificate from the DGA, DGG, and DGPR as a "rehabilitation clinic with vascular expertise." The implementation of rehabilitation measures for patients with intermittent claudication at the beginning of the diagnosis could support and promote the sustainability of vascular medicine sports and exercise therapy. Training patients as part of rehabilitation measures can increase patient adherence to secondary prevention medication.
Dtsch Med Wochenschr
· 2026 May · PMID 42150543
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Nutrition forms the basis in the treatment of type 2 diabetes mellitus (T2DM). An individually adapted, balanced diet can help reduce obesity, stabilize blood sugar levels and minimize the risk of secondary diseases. The...Nutrition forms the basis in the treatment of type 2 diabetes mellitus (T2DM). An individually adapted, balanced diet can help reduce obesity, stabilize blood sugar levels and minimize the risk of secondary diseases. The main focus is on the selection of low-energy-dense, high-fiber foods, the avoidance of highly processed carbohydrates and a moderate calorie intake.
Dtsch Med Wochenschr
· 2026 May · PMID 42150542
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The therapeutic goal describes the desired outcome of (intensive) treatment. A therapeutic goal may only be pursued if it is (still) achievable according to professional assessment. There is often disagreement within the...The therapeutic goal describes the desired outcome of (intensive) treatment. A therapeutic goal may only be pursued if it is (still) achievable according to professional assessment. There is often disagreement within the multi-professional treatment team about whether a goal is achievable or not. This article analyzes the individual steps involved in reflecting on, discussing, and setting therapeutic goals and, if necessary, changing them.
Dtsch Med Wochenschr
· 2026 May · PMID 42150541
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Giant cell arteritis (GCA) and Takayasu arteritis (TAK) are the predominant types of large-vessel vasculitis, sharing IL-6-mediated immunopathology but differing in age profile and clinical phenotype. Glucocorticoids (GC...Giant cell arteritis (GCA) and Takayasu arteritis (TAK) are the predominant types of large-vessel vasculitis, sharing IL-6-mediated immunopathology but differing in age profile and clinical phenotype. Glucocorticoids (GC) remain standard for induction therapy, although relapse rates and treatment-associated toxicity on GC monotherapy are high. Therefore, current guidelines support early tapering and the use of GC-sparing agents in relapsing or high-risk patients. Tocilizumab is now established as standard therapy in GCA, while methotrexate remains an alternative option. Recently, the janus kinase (JAK) inhibitor upadacitinib has gained regulatory approval for GCA, supported by results of a phase 3 trial. In TAK, conventional immunosuppressants are used in new-onset disease, while TNF-alpha or IL-6-blockade can be considered in relapsing or refractory disease. Optimal duration of treatment is not yet well defined.
Dtsch Med Wochenschr
· 2026 May · PMID 42150540
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Giant cell arteritis (GCA) is the most common primary systemic vasculitis and can present with a cranial, large-vessel, or mixed phenotype. Rapid and secure diagnosis is essential to prevent irreversible visual loss. Ima...Giant cell arteritis (GCA) is the most common primary systemic vasculitis and can present with a cranial, large-vessel, or mixed phenotype. Rapid and secure diagnosis is essential to prevent irreversible visual loss. Imaging has fundamentally transformed the diagnostic pathway. Vascular ultrasound is the first-line modality, enabling high-resolution assessment of both cranial and extracranial vessels, detecting pathological findings such as the halo sign, compression sign, and increased intima-media thickness. Magnetic resonance imaging (MRI) serves as an important complementary modality without radiation exposure. However, persistent mural signal abnormalities in large vessels limit activity assessment. Imaging with [F]FDG positron emission tomography-computed tomography (PET/CT) enables whole-body assessment and identification of extracranial involvement but is constrained by limited specificity for inflammation and frequent persistent uptake in remission. Emerging tracers such as [F]FAPI and [Ga]Ga-DOTA-Siglec-9 may further improve imaging of inflammation in GCA. Similarly, novel ocular imaging modalities, including transorbital ultrasound and optical coherence tomography angiography, offer promising tools for detecting macro- and microvascular ophthalmologic involvement. Takayasu arteritis (TAK), the second major large-vessel vasculitis, is predominantly affecting young women, involving only the aorta and its major branches. Early diagnosis is crucial, as ongoing inflammation leads to stenosis, occlusion, aneurysm formation, and ischemic complications. Imaging with MRI is the diagnostic gold standard, enabling detailed assessment of mural inflammation and luminal pathology without radiation exposure. Ultrasound supports rapid evaluation of accessible arteries, though it is limited for the thoracic aorta. Radiation-based imaging with [F]FDG PET/CT and CT-angiography may complement MRI, but their use is constrained by radiation exposure which is particularly relevant in this young patient population. Disease activity monitoring remains challenging, as persistent mural thickening, IMT elevation, and [F]FDG uptake may reflect vascular remodeling rather than active vasculitis.