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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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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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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Headache is a common symptom in patients suffering from cervical spine disorders. The percentage of headaches in association with degenerative changes of the cervical spine ranges from 13 to 79% and that in association with indirect trauma of the cervical spine from 48 to 82%. Based on neuroanatomical and neurophysiological studies, the relationship of the upper cervical spine and the trigeminal nuclei has been demonstrated and serves as an explanation for perceived head pain in cervical spine disorders. ⋯ In 1983, Sjaastad et al. postulated the concept of 'cervicogenic headaches': a migraine-like headache due to certain disorders of the cervical spine, strictly located unilaterally, its manifestations being in the temporal, frontal, and ocular areas, with associated symptoms such as slight lacrimation, conjunctival injections, tinnitus, runny nose, and erythema in the forehead ipsilaterally. As arguments in favour of a cervical origin, Sjaastad mentioned the following features: precipitation of the headaches either by neck movements or by pressure against certain tender spots on the neck, the possibility of homolateral shoulder or arm pain, stiffness and pain of the neck, and reduced mobility of the cervical spine. In 1988, the Headache Classification Committee of the International Headache Society set strict criteria for 'headaches' to be classified as to be of cervical origin.