Der Internist
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The sepsis syndrome has only recently been defined as a clinical syndrome but despite its unspecific definition it has evolved rapidly into an important concept. Although specific therapeutic interventions targeting the inflammatory pathway have not yet been effective in treating sepsis, a better understanding of mechanisms leading to organ dysfunction has led to better management of patients with sepsis. Clinical signs of systemic inflammatory response syndrome (SIRS) or sepsis are hallmarks for the definition of severe infections. Current guidelines are presented for the management of a number of severe infectious syndromes.
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Owing to its activity against multidrug-resistant gram-negative bacteria, colistin (like other older antibiotics) is experiencing a surprising resurgence. In the 50 years following its discovery, little effort was put into studying its dosing and pharmacodynamic properties. Recent data have been filling the gaps, and individualized dosing recommendations targeting an optimal AUC/MIC ratio have been published. ⋯ Even the highest doses studied so far do not universally result in sufficient drug levels. Therefore, colistin remains a last-resort drug which should be used in combination with other antibiotics only. Regardless of the presence of resistance, carbapenems seem to be the most promising combination partners.
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Colorectal cancer is one of the leading causes of cancer-related morbidity and mortality. Colorectal cancer commonly develops slowly via adenomatous polyps, a process usually requiring ≥ 10 years. This allows for early detection. ⋯ Colon contrast enema is no longer recommended for screening. As colonoscopy serves as a diagnostic and therapeutic tool and is the reference method in hemoccult and sigmoidoscopy studies, it is viewed as the gold standard for the diagnosis of colonic disease. New methods including capsule colonoscopy and virtual colonoscopy have great potential but are currently not recommended for early detection of colonic neoplasia.
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A 70-year-old man presented with subacute dyspnea, cough, weight loss, and mild fever. Blood analysis revealed an elevated C-reactive protein level. Chest x-ray and CT of the chest showed alveolar opacities with a migratory tendency during the clinical course. After extensive diagnostics, treatment with prednisolone under the presumed diagnosis of a cryptogenic organizing pneumonia was started, which lead to a rapid clinical response.