Praxis
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After a short review on pathophysiologic mechanisms of comatose states and their complications, a cohort of 392 comatose patients (Glasgow Coma Scale < or = 8) hospitalized in intensive care is analyzed in order to estimate the relative frequency of the different causes of nontraumatic coma. Depending on pathology, the following practical, sequential procedure is recommended: at first, identification and treatment of disorders of vital functions, objective estimate of the severity of the coma and rapid diagnostic orientation with a targeted neurologic investigation; then, simple therapeutic interventions in order to treat reversible causes of a metabolic encephalopathy as well as immediate measures for neuroprotection (anticonvulsive and antihypotensive therapy, oxygen, etc.). An initial, adequate control of the comatose patient is mandatory in order to limit disabling cerebral complications.
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Over the past 20 years the term 'Reiter's disease' has been expanded from the classical triad of sterile urethritis, conjunctivitis and arthritis to include a broader range of reactive arthritides. Indeed, the classical syndrome as described by Reiter is rarely seen in its complete form, and the presence or absence of active infection in the joint is being redefined in the light of recent techniques of molecular biology. The terminology of Reiter's syndrome, reactive arthritis and seronegative spondylarthropathy are defined here using case examples.
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Regular, continuous snoring usually does not have any sleep disturbing effects; however, discontinuous snoring may be associated with increased upper airway resistance and leads to recurrent arousals, sleep fragmentation and excessive daytime sleepiness. Loud snoring, recurrent obstructive apneas and oxygen desaturation during sleep with excessive daytime sleepiness are the hallmarks of the obstructive sleep apnea syndrome (OSAS). ⋯ Continuous positive airway pressure (CPAP) applied by a nasal mask is the primary treatment for OSAS and for snoring associated with increased upper airway resistance and symptoms of sleep disruption. CPAP may improve sleep quality, excessive daytime sleepiness, and potentially vascular morbidity and mortality among patients with severe OSAS.
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A concise overview of the pathophysiologic mechanisms of stable angina pectoris and the attempt to deduce its rational therapy presented. The possible mode of action of are beta-adrenergic blockers and calcium entry blockers is described. ⋯ The value of a combination of beta-adrenergic blockers and calcium entry blockers in the therapy of stable angina pectoris is discussed. Finally, the prognostic importance of silent ischemia with regard to stable angina pectoris and the possible therapeutic consequences are discussed.