Therapeutische Umschau. Revue thérapeutique
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Delirium (i.e., acute confusional state) is a frequent syndrome due to different exogenous (physical, chemical or biological) factors. The prevalence of delirium increases with higher age (e.g., signs indicative of dementia) and particularly in those patients with severe somatic illness. ⋯ The article summarizes data on symptomatology, aetiology and pathogenesis of delirium. In addition syndromes sharing phenomenology similar with delirium are discussed and treatment recommended.
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In this paper the basic knowledge about the morphology of gunshot wounds is presented, which should help the physician to answer the most important questions imposed on a criminal case. The paramount measures to be taken are the documentation of the gunshot wounds, the excision of the injury and separate debridement of each lip of the wound, the careful observation of the projectile, the cataloging of the victim's clothes and the omission of cleaning the hands of the victim. Some forensic aspects are demonstrated, particularly the professional discretion respectively the obligation to notify the authorities.
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Sudden loss of consciousness in childhood presents itself usually as a syncope and occurs in approximately 15% of all children. Although syncope in the pediatric age group appears to be an isolated phenomenon with good prognosis, it could also be a manifestation of a life-threatening disease. Thus, even the first syncope should be evaluated in children. ⋯ Cardiac syncope is rare in children with a structurally normal heart and may be associated with Wolff-Parkinson-White syndrome, long QT syndrome or congenital AV block. Children with congenital heart defects and cardiomyopathies who present with syncope must raise a high degree of suspicion for a cardiac syncope. Cardiac syncopes often yield a poor prognosis with substantial percentages of sudden death; therefore, a vigorous attempt has to be made to diagnose and adequately treat cardiac syncope in children.
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Vasovagal syncope, also called neurocardiogenic syncope, is common with younger people. It results from an inappropriate, excessive autonomic reflex activity. In the elderly patient the syncope may be provoked by massage of the carotid bodies and is then known as carotid sinus syndrome. ⋯ In the therapy of recurrent vasovagal syncope, a thorough information of the patient and an adaptation of behaviour are often successful. Some authors have reported goods results with betablockade, etilefrin or mineralocorticoids. The patient with repeated severe syncopal attacks and asystole may benefit from an implantable DDD pacemaker.
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Headache, facial pain and toothache are poorly localized and irradiate in distant areas. Thus, toothache often causes facial pain and headache, but, in turn, it can also be mimicked by several forms of these disorders, in particular by a myoarthropathy of the masticatory system, a migraine, a tension-type headache, a neuropatic pain and a trigeminal neuralgia. The atypical odontalgia is a nonodontogenic form of toothache that is difficult to diagnose; therefore, it leads to a number of invasive dental procedures which normally worsen the pain condition. ⋯ The burning-mouth syndrome is an other poorly understood form of intraoral pain that occurs primarily in postmenopausal females. Several etiologic factors have been described, but treatment based on one or more of these factors is often ineffective. Spontaneous remission occurs in about half of the patients after several years.