Der Internist
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How physicians within the specialty of internal medicine perceive their stress-related working conditions, especially due to a changing health system with an impact on workflows and working hours, is examined in this study. ⋯ This study should be a cause for concern, since current data suggest a future shortage of qualified employers in the specialty of internal medicine. Taking this into account, working conditions in hospitals should be improved in order to bind current employees and attract new employees.
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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 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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Rheumatoid factor and antinuclear antibodies are detectable in many different conditions and are ordered by various specialities. The interpretation of results, however, is quite complex. The objective of this article is to help apply these tests correctly and enable an accurate interpretation of the test results. Furthermore, we describe the steps in the differential diagnostics for selecting those patients who need to be referred to a rheumatologist.
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The use of thyroid-stimulating hormone (TSH) testing in routine laboratory screening and testing of TSH before administration of contrast medium, resulted in an increased number of incidentally detected elevated TSH levels. In the case of slightly increased values in asymptomatic patients, repeated measurement of TSH is recommended for confirmation. ⋯ In subclinical hypothyroidism it remains unclear at which TSH levels the initiation of substitution therapy makes sense. In the case of simultaneously elevated peripheral thyroid hormones rare diseases, such as secondary hyperthyroidism and thyroid hormone resistance should be considered.