Med Klin
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Within the last years, health services research has gained increasing attention in Germany. This trend could also be observed in dentistry although this research field must be considered rather young. The methodical approach of health services research is complementary to the traditional clinical research paradigm. The latter focuses on the comprehension of causal mechanisms and the efficacy of interventions under ideal and standardized study conditions. In contrast to that, health services research focuses on the effectiveness under everyday conditions and the efficacy in the normal course of medical care. ⋯ Hence it can be said that dental health services research in Germany is not sufficiently established yet. It can be assumed that the cumulating problems to be expected within the health care system will lead to an increasing demand for the respective research.
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This review may serve as a basis for evaluating publications on the topic "myocardial biopsy for myocarditis and dilated cardiomyopathy" in the clinical practice. The literature is particularly analyzed to answer the question, whether an endomyocardial catheter biopsy is indicated in patients with these myocardial disorders in the clinical routine besides its unequivocal scientific value. The judgment of the biopsy samples has been based on the classically histological and for years on the additional immunohistochemical and molecular biological-virological examination. ⋯ It is missleading to replace the well-established clinical diagnosis myocarditis by the bioptic diagnosis "inflammatory cardiomyopathy". However, endomyocardial catheter biopsy is clearly indicated in rare patients with fulminant myocarditis, giant-cell myocarditis and myocardial storage disease. Its probably underestimated role in sarcoid heart disease still needs to be clarified by systematic studies.
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Differential diagnosis of acute tetraparesis includes paraplegia caused by trauma, ischemia, inflammation or tumor, Guillain-Barré syndrome, periodic paralysis, myasthenia gravis, and dissociative paralysis. ⋯ Hypokalemic thyrotoxic periodic paralysis (HTPP), a subtype of hypokalemic paralysis, is unusual in Caucasians. In Asian men the disease is more common. The underlying mechanism is an extra-intracellular shift of potassium in the voluntary muscle cells. In contrast to hereditary autosomal dominant paralyses, a genetic defect is not known. Usually, symptoms of hyperthyreosis in HTPP are mild which can hamper the correct diagnosis.