Dtsch Arztebl Int
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The indications for follow-up endoscopy have not been established in all diseases that can be diagnosed by endoscopy. ⋯ With particular reference to further gastrointestinal diseases discussed in the main text, this review unfortunately shows that many of the indications for follow-up endoscopy remain to be ascertained. Controlled studies are needed to establish with sufficient certainty what really helps our patients.
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Physicians of any specialty may be the first persons to whom prospective parents turn for information about the acquisition and storage of stem cells derived from cord blood. Stem cells can potentially be used to treat many diseases, yet they are not a panacea. This article provides an overview of their current and possible future applications. ⋯ Autologous stem cells from cord blood have poor prospects for use in regenerative medicine, because they have to be cryopreserved until use. Physicians should tell prospective parents that they have no reason to feel guilty if they choose not to store cord blood in a private bank.
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Chronic renal disease is common, and its prevalence is rising. Its main causes are hypertension and diabetes mellitus. An abnormally low glomerular filtration rate (GFR) often escapes medical notice in the earliest, most treatable stage, so that an increasing number of patients progress to end-stage renal failure. Early recognition of low GFR would thus be an important clinical advance. ⋯ Creatinine- and cystatin C-based equations for the estimation of GFR are valuable tools for the early diagnosis of chronic renal disease and for disease staging according to the US National Kidney Foundation criteria.
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Chronic urticaria often points the way to the diagnosis of a systemic disease, particularly when urticarial vasculitis can be demonstrated. Hypocomplementemic urticarial vasculitis syndrome (HUVS) is considered to be an independent immunological disease. ⋯ The main manifestation of HUVS is chronic urticarial vasculitis with complement deficiency and the demonstration of C1q antibody in the serum. Multiple other organs are involved, sometimes severely. The diagnosis is confirmed by skin biopsy, which reveals leukocytoclastic vasculitis as a pathogenetic correlate of this systemic disease. Although HUVS is relatively rare, the medical specialists that might encounter it-ophthalmologists, rheumatologists, nephrologists, dermatologists, general practitioners, and pediatricians-should include it in their differential diagnoses whenever appropriate. Awareness of HUVS and rational diagnostic evaluation will lessen the chance of it being misdiagnosed as another type of systemic immunological disease and will reduce superfluous diagnostic testing in patients suffering from it.
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Children account for only a small percentage of pre-hospital emergency patients but are a special challenge for the treating physician. ⋯ A mastery of basic emergency techniques including clinical evaluation of the child, establishment of venous access, airway management, resuscitation, and drug dosing is essential for the successful emergency treatment of children. We recommend classifying the common non-traumatic pediatric emergencies by four cardinal manifestations: respiratory distress, altered consciousness, seizure, and shock. Classifying these rare emergency situations in this way helps assure that their treatment will be goal-oriented and appropriate to the special needs of sick children.