Der Internist
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Chest pain is a common symptom for which patients present to their primary care provider. Patients with acute chest pain pose a diagnostic challenge for the general practitioner since a wide range of diagnoses are possible, ranging from life-threatening acute myocardial infarction and pulmonary artery embolism to the far more frequent and harmless muscular tension belonging to the group of chest wall syndromes, as well as gastrointestinal causes such as gastroesophageal reflux disease. ⋯ This is followed by further technical examinations, such as a 12-lead electrocardiogram, and targeted laboratory diagnostics with point-of-care tests, including troponin and D‑dimer tests. Diagnostic pathways and score systems, such as the Marburg Heart Score, have been specially developed to enable patient assessment and provide orientation in the primary care setting.
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Back pain is a common reason for consulting a general practitioner. For 80% of patients, the back pain is nonspecific. Specific back pain has a determinable cause that needs to be rapidly identified. ⋯ In addition to laboratory diagnostics, structured morphological imaging is necessary. Causes of specific back pain include: fractures, infections, radiculopathy, tumors, axial spondylarthritis, as well as extravertebral causes. The diagnosis, treatment and continuous follow-up of the patient with specific back pain is interdisciplinary and requires close communication with the relevant specialists.
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Case Reports
[Weight loss, diarrhea and dystrophic alterations of the fingernails in an 80-year-old male patient].
Cronkhite-Canada syndrome (CCS) is a rare noninherited condition characterized by gastrointestinal polyposis, alopecia, onychodystrophy, hyperpigmentation, weight loss and diarrhea. We report the case of an 80-year-old patient presenting with weight loss, diarrhea and dystrophic changes of the fingernails. The symptoms began 3 months prior to the admission. ⋯ Together with the ectodermal changes a CCS was diagnosed and treatment with corticosteroids, intravenous nutrition and proton pump inhibitors was initiated. In the further course of the hospital stay a moderately reduced left ventricular function was diagnosed and the patient had to be temporarily monitored in the intensive care unit due to a prolonged QTc time. In the follow-up 3 months later the patient showed good clinical and endoscopic response to the treatment with cessation of the diarrhea, weight gain of 8 kg and regrowth of the fingernails and head hair; however, the left ventricular function remained moderately impaired.
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A 19-year-old female patient was admitted to hospital for further diagnostics and treatment of a febrile infection. The cause was found to be a bronchopulmonary infection due to methicillin-sensitive Staphylococcus aureus (MSSA), which led to an infective endocarditis with mitral valve infestation and two splenic abscesses. ⋯ Even during the physical examination there was a suspicion of Cushing's syndrome, which was confirmed by laboratory and radiological investigations and is associated with a general immune deficiency. Remarkable was that the initially difficult to adjust high blood pressure became normalized after transsphenoidal resection of the pituitary adenoma.