Der Internist
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Pathological coagulation parameters may reflect life-threatening hemorrhagic or thromboembolic diseases but may also be a laboratory result without any clinical significance, result from in vitro phenomena or preanalytical errors. This article gives an overview of potential pitfalls in coagulation diagnostics, lists the differential diagnoses of pathological coagulation parameters and describes further steps in the diagnostic approach to clarify pathological results. The focus lies on coagulation parameters that are frequently determined in routine clinical investigations, e.g. platelet count, prothrombin time, activated partial thromboplastin time (aPTT) and fibrinogen. ⋯ The clinical utility of D-dimer assays is limited by their poor specificity. Elevated D-dimer concentrations can be found in various diseases and also under normal physiological circumstances (e.g. in the elderly). Thus, the most useful clinical application of D-dimer is evidence of normal values to essentially rule out venous thromboembolism.
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A relative or absolute increase of lymphocytes in peripheral blood is a frequent incidental finding. The differential diagnosis of such a finding includes a broad spectrum ranging from normal variations to neoplastic diseases. ⋯ Further diagnostics aim to reliably differentiate between reactive and neoplastic conditions. If a lymphoma or leukemia is suspected this should lead to a rapid hemato-oncological investigation.
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A 71-year-old woman was admitted to our emergency department due to sore throat and swelling of the neck and face. She had a history of chronic obstructive pulmonary disease grade 4 based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Clinical examination revealed subcutaneous emphysema of the neck and face. ⋯ Laparotomy confirmed the diagnosis of a retroperitoneal colon perforation due to colon diverticulitis. The colon was partially removed followed by a surgical debridement and Hartmann's procedure. The postoperative course was without complications, the clinical symptoms resolved rapidly.
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A 41-year-old physically active man with no significant past medical history presented with sudden thoracic pain. The patient was referred to the next tertiary care hospital. ⋯ A triphase ECG-synchronized cardiothoracic flash protocol performed on a 256 line CT scanner confirmed an aortic intramural hematoma and a covered aortic perforation. Shortly afterwards the patient collapsed and had to be resuscitated.
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The major goal of cancer screening programs is the reduction of disease-specific mortality by detecting malignant tumors in an early and still curable stage. Sensitive screening tests are used in apparently healthy people and conspicuous findings are referred for further investigations. ⋯ This information, together with personal preferences, is the basis for a well-informed decision for or against participation in a screening program. This article imparts essential knowledge that is needed for individual medical counseling on screening for colorectal, skin, breast and prostate cancer.