MMW Fortschritte der Medizin
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With modern immunological and molecular biological laboratory techniques, some 100 primary immunodeficiencies can now be diagnosed and differentiated. The importance of diagnosing a primary immunodeficiency (PID) as early as possible cannot be overemphasized. ⋯ Relevant warning signals and a possible family history should also prompt at least such simple laboratory tests as a blood differential and the quantitative determination of immunoglobulins, followed where necessary by more specific evaluations. Early treatment, for example, with immunoglobulins may enable many patients to lead a virtually normal life, and in some cases bone marrow transplantation or gene therapy may even result in a cure.
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Mild injuries to the head are a common everyday occurrence. Only one out of 30,000 patients suffering mild traumatization of the brain subsequently goes on to develop a complication that requires treatment. Such patients can be identified on the basis of the Glasgow Coma Scale and the determination of risk factors, and these data also serve as an aid for deciding whether surveillance at home or hospitalization is indicated.
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Differential diagnosis in disordered acid-base homeostasis is usually possible by measuring the pH, pCO2, pO2 and bicarbonate concentration, and enables differentiation between respiratory alkalosis and acidosis, and metabolic alkalosis and acidosis. Compensatory counter-regulation (respiratory or renal) can make correct assessment of the primary disorder problematic. ⋯ In chronic forms of metabolic acidosis, for example in chronic renal insufficiency and elderly patients, bicarbonate substitution should be initiated in order to prevent the negative effects on various organ systems. Sodium bicarbonate formulations that can be assimilated from the small bowel are especially tolerable and suitable.