Isolierte Zungenschwellung nach Penizillin und negative Allergieabklärung – alles in Butter?

2022 ◽  
Author(s):  
Kathrin Scherer Hofmeier ◽  
Andreas J. Bircher
Keyword(s):  
Work Up

ZusammenfassungPenizilline können alle Arten spezifischer Immunreaktionen nach der erweiterten Coombs- und Gell-Klassifikation auslösen und zählen zu den häufigsten Ursachen unerwünschter Arzneimittelreaktionen. Das diagnostische Armamentarium umfasst neben den verschiedenen Hauttesten den Nachweis spezifischer IgE gegen allergene Determinanten am Betalaktam-Molekül und ggf. zelluläre Aktivierungsteste. Im Fall negativer Ergebnisse bei den genannten Testen kann ggf. noch die Toleranz im Rahmen eines Provokationstestes nachgewiesen werden. Die Sensitivität der diagnostischen Teste ist – mit Ausnahme des Provokationstests – aber limitiert, und falsch negative Teste sind möglich. Wir präsentieren zwei Fälle mit einer isolierten Zungenschwellung nach Gabe von Amoxicillin bei vollständig negativem, wiederholtem allergologischen Work-up. Bei beiden Patienten konnte die Überempfindlichkeit nur mit einer Reexposition nachgewiesen werden.

Thorough Work-Up Crucial in Sarcoidosis Cases

2012 ◽  
Vol 43 (6) ◽  
pp. 26
Author(s):  
DOUG BRUNK
Keyword(s):  
Work Up

Neuropsychiatric Work-Up Same for SLE Patient

2011 ◽  
Vol 44 (1) ◽  
pp. 30
Author(s):  
DIANA MAHONEY
Keyword(s):  
Work Up

Bedeutung der allergologischen Abklärung bei Asthma und COPD

2014 ◽  
Vol 71 (5) ◽  
pp. 267-274
Author(s):  
Judith A. Schneider Spence ◽  
Andreas J. Bircher ◽  
Kathrin Scherer Hofmeier
Keyword(s):  
Respiratory Disease ◽  
Asthma Bronchiale ◽  
Aspirin Exacerbated Respiratory Disease ◽  
Work Up

Während eine allergologische Abklärung im Work-Up eines Asthma bronchiale inbegriffen sein sollte, wird die chronisch obstruktive Pneumopathie nicht spontan mit einer atopischen Diathese in Zusammenhang gebracht. Anamnese, Klinik, das Vorhandensein weiterer atopischer Krankheiten sowie Prickteste und die serologische Messung von spezifischen IgE-Antikörpern geben Hinweise auf eine allergische Genese einer akuten oder chronischen Lungenkrankheit. Der Stickoxidwert in der Ausatemluft (FeNO-Messung) kann durch die Infiltration von Eosinophilen in die Bronchialwand beim allergischen Phänotyp des Asthma bronchiale erhöht sein (TH2-gewichteter Phänotyp). Eine Abhängigkeit der Beschwerden vom Arbeitsplatz muss evaluiert werden. Neben dem allergischen Typ des Asthma bronchiale soll auch an eine Aspirin-exacerbated-respiratory disease (AERD) gedacht werden. Aufgrund der überlappenden pathophysiologischen Grundlagen und der Symptomatik zwischen Asthma bronchiale und der chronisch obstruktiven Pneumopathie ist die Zuweisung zum Allergologen allenfalls auch bei einem COPD-Patienten indiziert.

Extensive Work-Up for IBS Rarely Needed

2010 ◽  
Vol 38 (3) ◽  
pp. 42
Author(s):  
NANCY WALSH
Keyword(s):  
Work Up

Guideline for radioimmunotherapy of rituximab relapsed or refractory CD20+ follicular B-cell nonHodgkin´s lymphoma

2004 ◽  
Vol 43 (05) ◽  
pp. 171-176 ◽  
Author(s):  
T. Behr ◽  
F. Grünwald ◽  
W. H. Knapp ◽  
L. Trümper ◽  
C. von Schilling ◽  
...  
Keyword(s):  
Quality Control ◽  
Quality Management ◽  
Medical Physics ◽  
Essential Elements ◽  
Background Information ◽  
After Care ◽  
Complete Treatment ◽  
Close Cooperation ◽  
Work Up

Summary:This guideline is a prerequisite for the quality management in the treatment of non-Hodgkin-lymphomas using radioimmunotherapy. It is based on an interdisciplinary consensus and contains background information and definitions as well as specified indications and detailed contraindications of treatment. Essential topics are the requirements for institutions performing the therapy. For instance, presence of an expert for medical physics, intense cooperation with all colleagues committed to treatment of lymphomas, and a certificate of instruction in radiochemical labelling and quality control are required. Furthermore, it is specified which patient data have to be available prior to performance of therapy and how the treatment has to be carried out technically. Here, quality control and documentation of labelling are of greatest importance. After treatment, clinical quality control is mandatory (work-up of therapy data and follow-up of patients). Essential elements of follow-up are specified in detail. The complete treatment inclusive after-care has to be realised in close cooperation with those colleagues (haematology-oncology) who propose, in general, radioimmunotherapy under consideration of the development of the disease.

Surgery for Skull Base Malignancies-Preoperative Work-Up to Minimize Complications

Skull Base ◽  
2008 ◽  
Vol 18 (S 01) ◽  
Author(s):  
Andrew King ◽  
Stephen MacNally ◽  
Jarod Homer ◽  
Richard Ramsden ◽  
Shakeel Saeed ◽  
...  
Keyword(s):  
Skull Base ◽  
Preoperative Work Up ◽  
Work Up

Rapidly progressive glomerulonephritis as presenting feature of systemic lupus erythematosus in a Bangladeshi male patient: a rare case report

2020 ◽  
Vol 10 (2) ◽  
pp. 137-138
Author(s):  
Samiha Haque ◽  
Ishrat Jahan ◽  
Tufayel Ahmed Chowdhury ◽  
Muhammad Abdur Rahim ◽  
Mehruba Alam Ananna ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Venous Pressure ◽  
Rapidly Progressive Glomerulonephritis ◽  
Initial Response ◽  
Systemic Lupus ◽  
Renal Manifestation ◽  
Rare Case Report ◽  
Diagnostic Work ◽  
Work Up

Rapidly progressive glomerulonephritis is one of the most dramatic and tragic presentations of lupus nephritis (LN) or renal manifestation of systemic lupus erythematosus (SLE). A 35-year-old Bangladeshi gentleman presented with worsening oedema, scanty, high colored, frothy urine and deteriorating renal function. He had puffy face, anaemia, oedema, normal jugular venous pressure (JVP), high blood pressure (150/90 mm Hg), ascites and bilateral pleural effusions. Diagnostic work-up confirmed SLE with class IV LN. His initial response to specific therapy showed improvement Birdem Med J 2020; 10(2): 137-138

PHENOLIC METABOLITES OF DL-NORGESTREL: A METHOD FOR THE REMOVAL OF 1-HYDROXYLATED METABOLITES, POTENTIAL SOURCES OF PHENOLIC ARTIFACTS

1974 ◽  
Vol 76 (4) ◽  
pp. 789-800 ◽  
Author(s):  
Samuel F. Sisenwine ◽  
Ann L. Liu ◽  
Hazel B. Kimmel ◽  
Hans W. Ruelius
Keyword(s):  
Urinary Metabolites ◽  
Ion Exchange Resin ◽  
Gas Chromatography Mass Spectrometry ◽  
Phenolic Metabolites ◽  
Hydroxylated Metabolites ◽  
Analytical Work ◽  
Potential Sources ◽  
Alkaline Conditions ◽  
Artifact Formation ◽  
Work Up

ABSTRACT The identification of 1β-hydroxynorgestrel among the urinary metabolites of dl-norgestrel and the facile transformation of this compound under mild alkaline conditions to a potentially oestrogenic phenol provide an experimental basis for the conclusion advanced by others that the oestrogens present in the urine of subjects treated with synthetic progestens are artifacts formed during analytical work-up. A method has been devised which eliminates 1-hydroxylated metabolites as potential sources of phenolic artifacts. This method is based on the reduction by NaBH4 of the 1-hydroxy-4-en-3-one grouping in the A ring thereby excluding the possibility of aromatization during later fractionation on a basic ion exchange resin that separates neutral from phenolic metabolites. In the urines of women treated with 14C-dl-nogestrel, only 0.17–0.27% of the dose is found to have phenolic properties when this method is used. Two of the phenolic metabolites, 18-homoethynyloestradiol and 16β-hydroxy-18-homoethynyloestradiol, are present in amounts smaller than 0.01 % of the dose. Without the reduction steps the percentages are noticeably higher, indicating artifact formation under alkaline conditions. Similar results were obtained with urines from African Green Monkeys (Cercopithecus Aethiops) that had been dosed with 14C-dl-norgestrel. Radiolabelled 18-homoethynyloestradiol and 16β-hydroxy-18-homoethynyloestradiol were isolated from monkey urine and their identity confirmed by gas chromatography-mass spectrometry.

Contrast-Enhanced Ultrasound: a Simple and Effective Tool in Defining a Rapid Diagnostic Work-up for Small Nodules Detected in Cirrhotic Patients during Surveillance

2016 ◽  
Vol 25 (2) ◽  
pp. 205-211 ◽  
Author(s):  
Antonio Giorgio ◽  
Luca Montesarchio ◽  
Piero Gatti ◽  
Ferdinando Amendola ◽  
Paolo Matteucci ◽  
...  
Keyword(s):  
Predictive Value ◽  
Imaging Modality ◽  
Dynamic Imaging ◽  
Contrast Enhanced Ultrasound ◽  
Histologic Diagnosis ◽  
Therapeutic Work ◽  
Contrast Enhanced ◽  
Arterial Vascularization ◽  
Cirrhotic Patients ◽  
Work Up

  Background & Aims: Disappearance of portal blood flow and arterial vascularization is the hallmark of hepatocarcinogenesis. The capability of a dynamic imaging modality detecting arterial hypervascularization of small nodules is crucial to promote a rapid diagnostic and therapeutic work-up improving survival. We aimed to evaluate the capability of CEUS to detect arterial vascularization of ≤ 2 cm HCC nodules arising during surveillance so as to shorten the diagnostic and therapeutic work-up. Methods: From October 2009 to September 2014, among 1757 consecutive cirrhotic patients under surveillance with ultrasound (US), 243 patients had new single nodules 7-20 mm; 229/243 had a conclusive histologic diagnosis and comprised the study group. All patients underwent CEUS followed by enhanced MRI and US guided percutaneous 18G needle core biopsy of the nodules. Of the 229 nodules, 27 were hyperechoic, 171 hypoechoic and 31 isoechoic lesions. Results: The histology results revealed that 199/229 nodules were HCC and 30 were benign. Of 199 HCC, CEUS evidenced arterial hypervascularity in 190 nodules (95.5%) (sensitivity 94.48 %, specificity 100%, PPV 100%, NPV 76.92 %). Of the 39 CEUS arterial-unenhanced nodules, 30 were benign and 9 (23%) were well-differentiated HCC. eMRI showed arterial hypervascularity in 199 nodules (86,9%). Of these, only 193 (97%) were histologically HCCs while 6 were benign (sensitivity: 97%, specificity: 80%, PPV: 97%, NPV: 80%). Conclusions: CEUS has a great capability to detect arterial hypervascularity of small HCC. Because only 4.5% of new nodules escape the demonstration of arterial hyervascularity, CEUS must be performed immediately after conventional US to contrast the malignant fate of small lesions arising in a cirrhotic liver.. Abbreviations: CEUS: contrast-enhanced ultrasound; CT: computed tomography; HCC: hepatocellular carcinoma;MRI: magnetic resonance; NPV: negative predictive value; PPV: positive predictive value; US: ultrasonography.

Autoimmune Pancreatitis – Diagnosis, Management and Longterm Follow-up

2014 ◽  
Vol 23 (2) ◽  
pp. 179-185 ◽  
Author(s):  
Suvadip Chatterjee ◽  
Kofi W. Oppong ◽  
John S. Scott ◽  
Dave E. Jones ◽  
Richard M. Charnley ◽  
...  
Keyword(s):  
Autoimmune Pancreatitis ◽  
Rare Condition ◽  
Team Approach ◽  
Diagnostic Challenge ◽  
Multisystem Disorder ◽  
North East ◽  
The North ◽  
Work Up ◽  
Igg4 Level

Background & Aims: Autoimmune pancreatitis (AIP) is a fibroinflammatory condition affecting the pancreas and could present as a multisystem disorder. Diagnosis and management can pose a diagnostic challenge in certain groups of patients. We report our experience of managing this condition in a tertiary pancreaticobiliary centre in the North East of England.Methods: Patients were identified from a prospectively maintained database of patients diagnosed with AIP between 2005 and 2013. Diagnosis of definite/probable AIP was based on the revised HISORt criteria. When indicated, patients were treated with steroids and relapses were treated with azathioprine. All patients have been followed up to date.Results: Twenty-two patients were diagnosed with AIP during this period. All patients had pancreatic protocol CT performed while some patients had either MR or EUS as part of the work up. Fourteen out of 22 (64%) had an elevated IgG4 level (mean: 10.9 g/L; range 3.4 - 31 g/L). Four (18%) patients underwent surgery. Extrapancreatic involvement was seen in 15 (68%) patients, with biliary involvement being the commonest. Nineteen (86%) were treated with steroids and five (23%) required further immunosuppression for treatment of relapses. The mean follow up period was 36.94 months (range 7 - 94).Conclusion: Autoimmune pancreatitis is being increasingly recognized in the British population. Extrapancreatic involvement, particularly extrahepatic biliary involvement seems to be a frequent feature.Diagnosis should be based on accepted criteria as this significantly reduces the chances of overlooking malignancy. Awareness of this relatively rare condition and a multi-disciplinary team approach will help us to diagnose and treat this condition more efiectively thereby reducing unnecessary interventions.

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