Therapeutische Umschau. Revue thérapeutique
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The chronic myelogenous leukemia [CML] is a clonal disease of hematopoietic stem cells with unknown etiology. The incidence is around 2/100,000/year, the median age at diagnosis about 47 years. The course of CML is characterized by a chronic phase with few symptoms and good therapeutic response of about 4 to 5 years duration and by transition to a prognostically unfavourable blast phase of about 3 months duration. ⋯ In the future, intensive chemotherapy with or without autografting might play an important role in the therapy of chronic-phase CML. Forthcoming trials have to consider both, conventional and new experimental treatment modalities. An example is the treatment strategy of the ongoing randomized study of the German CML Study Group which compares allogenous BMT with the best available drug therapy and, in addition, analyses the influence of intensified drug therapy on survival.
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The symptom of vertigo can be due to many different causes. Differential diagnosis will be discussed primarily from a neuro-otologic point of view. Vertigo can be thought of as a subjective disturbance of the integration of different sensory inputs. ⋯ Instability and nystagmus towards a specific direction point to a vestibular disorder, especially if the nystagmus is suppressed by optical fixation. The most common causes of a vestibular disorder are benign paroxysmal positional vertigo (BPPV), a sudden vestibular loss (or vestibular neuritis), and Ménière's disease. These three diseases are discussed briefly.
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Randomized Controlled Trial Clinical Trial
[Intensive insulin therapy--is it worth the effort?].
Diabetes mellitus is associated with a number of well-known, specific macro- and microvascular as well as neuropathic complications. The typical and specific association of microvascular and neuropathic complications with diabetes suggests a causal relationship with hyperglycemia or associated metabolic abnormalities. The results of the Diabetes Control and Complications Trial (DCCT) as well as other recent studies have demonstrated that in patients with insulin-dependent diabetes mellitus (IDDM) the incidence of retinopathy, nephropathy and neuropathy can be reduced by intensive treatment. Strategies of intensified insulin therapy and the clinical importance of improved diabetic control are outlined in view of these studies.
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Pulmonary embolism is a frequent event, even today the diagnostic comes often too late or not at all. Symptoms, clinical results and additional examinations like ECG, echocardiography, scintigraphy and angiography permit the differentiation between small peripheral and massive central pulmonary embolism [PE], important for the therapeutic procedure. ⋯ The goals of therapy in massive PE consist in a rapid reduction of the threatening load on the right ventricule by the embolism. If the patient is in cardiogenic shock, surgical embolectomy is indicated, without shock the immediate start of thrombolytic therapy must be considered.
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Burns are among the most common accidental injuries, occurring in almost any environment to victims of all ages. Most of them are minor injuries and may be treated on an out-patient basis. Superficial (first-degree and superficial second-degree) burns will heal uneventfully in about two weeks without scarring, as long as no infection complicates the healing process. ⋯ Finally, every burn victim requires tetanus prophylaxis. Major burns and burn wounds at sensitive locations such as head and hands should be treated in specialized burn centers. This provides best chances for survival and increases the probability for a good cosmetic result.