Dtsch Arztebl Int
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Obstetric brachial plexus palsy is rare, but the limb impairments are manifold and often long-lasting. Physiotherapy, microsurgical nerve reconstruction, secondary joint corrections, and muscle transpositions are employed with success. The role of conservative and operative treatment options should be regularly reviewed. ⋯ The potential for scientific analysis is limited, due to the rarity and interindividual variability of the lesions and the varying effects on function and growth. Expectations and compliance are different in every patient. Surgical techniques are not yet standardized. Knowledge of the consequences for joint growth and congruence is inadequate. Today, functional improvement can be achieved by surgery in most clinical manifestations of obstetric brachial plexus palsy, within the framework of an interdisciplinary treatment concept.
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Crohn's disease and ulcerative colitis are chronic inflammatory diseases resulting from an inappropriate immune response, in genetically susceptible individuals, to microbial antigens of commensal microorganisms. This inappropriate response is promoted by certain environmental factors. Both diseases manifest themselves primarily in the gastrointestinal tract yet can, in principle, affect all of the organ systems of the body. The purpose of this review article is to heighten awareness of these diseases among physicians whose primary clinical activities lie outside gastroenterology. ⋯ A cure is still not possible, yet the opportunities for diagnosis and treatment have improved significantly. Early diagnosis is important so that patients can be referred onward for further diagnostic evaluation and appropriate treatment without delay.
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In the era of evidence-based medicine, one of the most important skills a physician needs is the ability to analyze scientific literature critically. This is necessary to keep medical knowledge up to date and to ensure optimal patient care. The aim of this paper is to present an accessible introduction into critical appraisal of scientific articles. ⋯ Basic methodological knowledge is required to select and interpret scientific articles correctly.
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Review
The assessment of environmental and occupational exposure to hazardous substances by biomonitoring.
Modern biomonitoring has expanded beyond its origins in occupational medicine to cover a wide variety of diagnostic procedures and assessments of environmental pollution, ranging from exposure to heavy metals and chemicals to the effects of pesticides and environmental tobacco smoke. In biomonitoring, the overall pollutant load and hazardous exposure of an organism is quantitatively determined, by monitoring the pollutants themselves, their metabolic products and/or conjugates with protein or DNA, in either serum, urine or other body fluids, as well as tissue samples in exceptional circumstances. ⋯ In combination with diagnostic procedures, biomonitoring provides an important contribution to the rational assessment of currently recorded pollutants and resulting health risks. It is as an evaluation tool available in daily practice as well as in health and environmental research applications. Legislation is already implemented that incorporates biomonitoring within the remit of specified occupational health screening.