Abstract:
BACKGROUND:The histomorphological changes of lung damage in severe coronavirus disease 2019 (COVID-19) have not yet been adequately characterized. In this article, we describe the sequence of pathological changes in COVID-19 and discuss the implications for approaches to treatment. METHODS:Standardized autopsies were performed on thirteen patients who had died of COVID-19. The findings were analyzed together with clinical data from the patients' medical records. RESULTS:Most (77%) of the deceased patients were men. Their median age at death was 78 years (range, 41-90). Most of them had major pre-existing chronic diseases, most commonly arterial hypertension. The autopsies revealed characteristic COVID-19-induced pathological changes in the lungs, which were regarded as the cause of death in most patients. The main histological finding was sequential alveolar damage, apparently due in large measure to focal capillary microthrombus formation. Alveolar damage leads to the death of the patient either directly or by the induction of pulmonary parenchymal fibrosis. Diffuse lung damage was seen exclusively in invasively ventilated patients. CONCLUSION:Autopsies are crucial for the systematic assessment of new diseases such as COVID-19: they provide a basis for further investigations of disease mechanisms and for the devising of potentially effective modes of treatment. The autopsy findings suggest that focal damage of the microvascular pulmonary circulation is a main mechanism of lethal lung disease due to the SARS-CoV-2 virus. It may also be a cause of persistent lung damage in patients who recover from severe COVID-19.
journal_name
Dtsch Arztebl Intjournal_title
Deutsches Arzteblatt internationalauthors
Kommoss FKF,Schwab C,Tavernar L,Schreck J,Wagner WL,Merle U,Jonigk D,Schirmacher P,Longerich Tdoi
10.3238/arztebl.2020.0500subject
Has Abstractpub_date
2020-07-20 00:00:00pages
500-506issue
29-30issn
1866-0452pii
arztebl.2020.0500journal_volume
117pub_type
杂志文章abstract:BACKGROUND:Clinical guidelines recommend psychosocial care as an integral part of medical treatment, but access is often limited. Technology-based approaches provide an attractive opportunity to optimize health outcomes and quality of life in people with chronic somatic diseases e.g. by means of Internet- and mobile-ba...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2018.0659
更新日期:2018-11-05 00:00:00
abstract:BACKGROUND:The prevalence of abdominal aortic aneurysms (AAA) with a maximal diameter of 3 cm or more is age-dependent; among persons over age 65, it lies between 4% and 8% in men and between 0.5% and 1.5% in women. About 10% of all AAAs have a maximum diameter of 5 cm or more. The prognosis of ruptured AAA (rAAA) is d...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,meta分析,评审
doi:10.3238/arztebl.2009.0657
更新日期:2009-10-01 00:00:00
abstract:INTRODUCTION:Gender identity disorders (GID) can appear even in early infancy with a variable degree of severity. Their prevalence in childhood and adolescence is below 1%. GID are often associated with emotional and behavioral problems as well as a high rate of psychiatric comorbidity. Their clinical course is highly ...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2008.0834
更新日期:2008-11-01 00:00:00
abstract:INTRODUCTION:The choice of type of heart valve prosthesis is determined by the patient's age since bioprostheses have a limited lifespan. This article reviews current recommendations and the literature on cardiac valve replacement. METHODS:Selective literature search in Medline/PubMed back to 1996 and review of curren...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2008.0143
更新日期:2008-02-01 00:00:00
abstract:BACKGROUND:One-third of all patients with epilepsy have persistent seizures despite medical treatment. If the origin of the seizures can be localized to a particular site in the brain, epilepsy surgery is a treatment option that addresses the cause of the problem. METHOD:The presurgical assessment and surgical treatme...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2014.0313
更新日期:2014-05-02 00:00:00
abstract:BACKGROUND:The German Federal Law on Radiation Control contains no special provisions for X-ray studies in children and adolescents, even though exposure to ionizing radiation must be kept especially low in young persons, because their tissues are highly radiosensitive. Children, who have many years left to live, are m...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2011.0407
更新日期:2011-06-01 00:00:00
abstract:BACKGROUND:Dermatologists, paediatricians, and general practitioners are often consulted by worried parents for the evaluation of a cutaneous tumor. METHODS:Selective literature review. RESULTS:Only 1-2% of skin tumors excised in children turn out to be malignant when examined histologically. Warning signs of maligna...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2011.0347
更新日期:2011-05-01 00:00:00
abstract:BACKGROUND:The neuropsychiatric symptoms of dementia, including aggressiveness, agitation, depression, and apathy are often treated with psychotropic drugs and are a frequent reason for hospitalization, placing an economic burden on the health care system. International guidelines recommend syndrome-specific pharmacoth...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,多中心研究
doi:10.3238/arztebl.2010.0320
更新日期:2010-05-01 00:00:00
abstract:BACKGROUND:The effects of rectal surgery on patients' postoperative quality of life (QOL) and sexual function has been little studied to date. The present study aims to address this issue. METHODS:519 patients who had undergone surgery for rectal cancer from January 1997 to January 2003 were included in the study. The...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2010.0123
更新日期:2010-02-01 00:00:00
abstract:BACKGROUND:Nail disorders can arise at any age. About half of all nail disorders are of infectious origin, 15% are due to inflammatory or metabolic conditions, and 5% are due to malignancies and pigment disturbances. The differential diagnosis of nail disorders is often an area of uncertainty. METHODS:This review is b...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2016.0509
更新日期:2016-07-25 00:00:00
abstract:BACKGROUND:Although the number of elderly patients with fractures is increasing, there have been only a few studies to date of the efficacy of collaborative treatment by trauma surgeons and geriatricians. METHODS:Data on patients over age 75 with femoral neck, trochanteric, proximal humeral, and pelvic ring fractures ...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2015.0113
更新日期:2015-02-13 00:00:00
abstract:BACKGROUND:The estimated prevalence of fetal alcohol syndrome (FAS) is 8 for every 1000 live births. FAS has serious, lifelong consequences for the affected children and their families. A variety of professionals deal with persons who have FAS, including pediatricians, general practitioners, neurologists, gynecologists...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2013.0703
更新日期:2013-10-01 00:00:00
abstract:BACKGROUND:Few reliable data are available on the epidemiology and treatment of spontaneous pneumothorax. We studied the sex and age distribution, frequency of hospitalization, mortality, and conservative versus surgical care of this condition in Germany in order to draw well-founded conclusions about its in-hospital d...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2017.0739
更新日期:2017-11-03 00:00:00
abstract:BACKGROUND:Otitis externa has a lifetime prevalence of 10% and can arise in acute, chronic, and necrotizing forms. METHODS:This review is based on publications retrieved by a selective search of the pertinent literature. RESULTS:The treatment of acute otitis media consists of anal- gesia, cleansing of the external au...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2019.0224
更新日期:2019-03-29 00:00:00
abstract:BACKGROUND:Recent years have seen a marked increase in laser-pointerrelated injuries, which sometimes involve severe retinal damage and irreversible visual impairment. These injuries are often caused by untested or incorrectly classified devices that are freely available over the Internet. METHODS:We reviewed pertinen...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2017.0831
更新日期:2017-12-08 00:00:00
abstract:BACKGROUND:The German Standing Committee on Vaccination Recommendations (Ständige Impfkommission, STIKO) recommends standard vaccination against pneumococcal infections for all persons aged 60 or older, and for all persons of any age with an increased health risk. It is not known how many persons in the target group in...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2013.0743
更新日期:2013-11-01 00:00:00
abstract:BACKGROUND:In Germany, public interest in a vegan diet is steadily growing. There are, however, no current data on the macro- and micronutrient status of vegans. METHODS:In a cross-sectional study entitled "The Risks and Benefits of a Vegan Diet" (RBVD), we investigated the dietary intake, basic laboratory parameters,...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2020.0575
更新日期:2020-08-31 00:00:00
abstract:BACKGROUND:The German Standing Committee on Vaccination (STIKO) recommends vaccination against human papillomaviruses (HPV) of the high-risk types 16 and 18. The duration of protection afforded by HPV vaccines has been reported in multiple studies to date but has not been systematically evaluated. METHOD:Systematic li...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,meta分析,评审
doi:10.3238/arztebl.2014.0584
更新日期:2014-09-01 00:00:00
abstract:BACKGROUND:Basically two types of sweating exist: thermoregulatory and emotional sweating. They are controlled by different centers: thermo regulatory sweating is regulated predominantly by the hypothalamus, emotional sweating predominantly by the limbic system. Enhanced sweating, called hyperhidrosis, can be generaliz...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2009.0032
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND:The introduction of neurological stroke units and of thrombolysis with the intravenous (IV) administration of recombinant tissue-type plasminogen activator (tPA) have markedly improved the treatment of stroke. Five randomized trials of catheter-based interventional treatment of stroke with special stents wer...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2015.0830
更新日期:2015-12-04 00:00:00
abstract:BACKGROUND:5% to 8% of 70-year-olds and some 10% of persons over age 80 have atrial fibrillation (AF). METHODS:Selective literature review. RESULTS:New scoring schemes (CHA(2)DS(2)-VASc score, HAS-BLED score) have been introduced to enable more accurate estimation of the risk of stroke and hemorrhage in patients with...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2012.0001
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:The percentage of organ donors among the German population is very low, and the supply of organs does not meet the demand. Relatively few organ explantations are performed in Germany, compared to other countries. The central element leading up to organ explantation is the donor's consent. This can be express...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2020.0183
更新日期:2020-03-13 00:00:00
abstract:INTRODUCTION:Military missions abroad carry a high risk of psychological traumatization. In this study, we examined the reasons for increased utilization of the treatments offered to soldiers by the German armed forces' psychiatric services. METHOD:We analyzed trends in initial contacts with psychiatrists and psychoth...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2012.0569
更新日期:2012-09-01 00:00:00
abstract:BACKGROUND:Multi-center observational studies in surgery can yield important findings, as long as they are appropriately designed and monitored and employ modern methods of statistical analysis. METHODS:In a multi-center quality assurance study carried out in 346 German hospitals from 2000 to 2004, data were collected...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2011.0041
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND:Red eye can arise as a manifestation of many different systemic and ophthalmological diseases. The physician whom the patient first consults for this problem is often not an ophthalmologist. A correct assessment of the urgency of the situation is vitally important for the planning of further diagnostic evalu...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2017.0302
更新日期:2017-04-28 00:00:00
abstract:BACKGROUND:Current guidelines recommend using aspirin, clopidogrel, beta-blockers, statins, and angiotensin converting enzyme (ACE) inhibitors after acute myocardial infarction (AMI). Although there is evidence that patients often stop taking these medications prematurely, long-term data reflecting the actual reality o...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2011.0856
更新日期:2011-12-01 00:00:00
abstract:BACKGROUND:Acne is the most common skin disease in adolescence, with a prevalence of nearly 100%. About 60% of affected adolescents have mild acne for which they use non-prescription preparations without consulting a physician. The remaining 40% constitute the population of acne patients seen in medical practice. The c...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2014.0301
更新日期:2014-04-25 00:00:00
abstract:BACKGROUND:Even in industrialized countries, health care is not as safe as it should be. The term "patient safety" denotes the non-occurrence of adverse events and the presence of measures to prevent them. METHODS:The literature was selectively reviewed to obtain information on the epidemiology and causes of preventab...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2010.0092
更新日期:2010-02-01 00:00:00
abstract:BACKGROUND:A meta-analysis of studies from multiple countries has shown that the incidence of incisional hernia varies from 4% to 10% depending on the type of operation. No epidemiological surveys have been conducted so far. The worst possible complication of an incisional hernia if it is not treated surgically is inca...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,meta分析
doi:10.3238/arztebl.2018.0031
更新日期:2018-01-19 00:00:00
abstract:BACKGROUND:Patients with acquired brain injury who have been discharged from inpatient neurological rehabilitation often continue to suffer from limited independence, participation, and quality of life. Participation-focused outpatient treatment (in German: teilhabeorientierte ambulan. METHODS:In a randomized, control...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,随机对照试验
doi:10.3238/arztebl.2016.0634
更新日期:2016-09-23 00:00:00