Therapeutische Umschau. Revue thérapeutique
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In contrast to Calcitonin that is primarily synthesized in the thyroid, Procalcitonin is the prohormon that is synthesized in many different tissues of infected organs. In order to be useful for the diagnosis of mild, localized or early infections the assay needs to have a sensitivity that can measure within normal limits (0.02 microg/L). We were able to show that a Procalcitonin algorithm influences the outcome of respiratory infections in terms of minimizing use of antibiotics and duration of antibiotic treatment. ⋯ In this respect, Procalcitonin is superior to other infection markers such as C-reactive Protein (CRP). High Procalcitonin levels can also be seen in non bacterial diseases such as malaria, severe trauma, burns and medullar carcinoma of the thyroid. Together, Procalcitonin has improved the diagnosis of bacterial infections, however should always be used in context with other laboratory markers, clinical exam and medical history.
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Quality assurance in laboratory medicine up to now has been focused mainly on analytical quality. Pre-analytical errors, however, amount to two thirds of all laboratory errors, and their elimination is of particular importance. Flaws of optimal indication contribute to a sometimes ineffective benefit of laboratory medicine. ⋯ If we achieve more reliable laboratory results by better control of influence factors and interference factors as well as by a more standardized pre-analytical process, we will produce more value at the same cost. The decisive prerequisite is awareness of the problem. The means are largely available, and the mission eventually can be accomplished.
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Frailty is a complex term and has a broad influence on the elderly patients. For evaluating the monetary impact of frailty it is necessary to approach in a differentiated way. It is of great interest to discover the relevance of multidisciplinary assessment and accordant preventive actions. In this article the costs of osteoporosis and (hip) fractures are briefly presented.
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Following an international consensus conference held in Chapel Hill, North Carolina, USA, vasculitides have been divided based on the size of the vessel involved in the inflammatory process. Thus, the terms large, medium and small vessel vasculitis emerged. Wegener's granulomatosis, microscopic polyangitis and Churg-Strauss syndrome are described as small vessel vasculitides. ⋯ Bronchoalveolar lavage typically returns lavage fluid that remains hemorrhagic even after sequential sampling. The discovery that antineutrophil cytoplasmic antibodies (ANCA) are strongly associated with vasculitic disorders and their subsequent characterisation has led to improved understanding of the pathogenic mechanisms underlying vasculitis. This paper will review clinical aspects of pulmonary involvement in the systemic vasculitides.
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Rhinitis and sinusitis usually coexist and are concurrent in most individuals; thus, the correct terminology is now rhinosinusitis. Rhinosinusitis (acute and chronic, with and without nasal polyps) is defined as an inflammation of the nose and the paranasal sinuses characterised by two or more symptoms, one of which should be either nasal blockage, obstruction, congestion or nasal discharge (anterior and posterior nasal drip). For the acute rhinosinusitis one can state that the initial antibiotic treatment does not affect the outcome of the disease, therefore a symptomatic treatment as first line is adequate. ⋯ The first line treatment strategy is medical treatment using topical steroids, long-term macrolide therapy and in severe cases short courses of systemic steroids. The role of surgery is defined to treat the residual disease after medical treatment. Surgery is primarily aimed at improving ventilation of the sinuses and restoring paranasal clearance.