Therapeutische Umschau. Revue thérapeutique
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In this article we review the most relevant acronyms, scores and classifications in the fields of nephrology and urology, including the newest definitions of acute kidney injury and chronic kidney diseases. We will also present a short overview of the histopathological Lupus nephritis classification, the renal cysts Bosniak classification and the vesicoureteral reflux grading.
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The differential diagnosis of back pain in children and adolescents is wide. The prevalence of low back pain is increasing with age and after puberty is similar to what is known from the adult population, but in smaller children a structural cause for the pain is more common. Careful history taking and physical examination will help with the decision of when to perform further investigations. This article lists the most common differential diagnoses of back pain in children.
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The treatment of chronic, non-malignant low-back pain is based on the patients' history and the clinical examination. It can be assumed that half of the cases present with a neuropathic pain component which needs to be treated with antidepressive and antiepileptic drugs instead of "pure" analgesics. Opioids should be considered with extreme caution because of their toxicity. ⋯ Their indication must be considered carefully, especially if the invasive diagnostic intervention has no therapeutic consequences. The interventional procedures should only be used as part of a multimodal approach in patients without any psychological problem. The sole use of interventions supports the purely somatic orientation of many patients and thus leads us in the wrong direction.
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Next to conventional x-ray examinations, modern imaging modalities as computed tomography (CT) and magnetic resonance imaging (MRI) play an important role in the assessment of back pain. Guidelines and recommendations should be helpful for the - not always simple - indication for imaging for back pain. However, the latter have to be individually adapted regarding clinical symptoms and appearance for every patient. Choosing the adequate imaging modality depends on several criteria, as the suspected- and differential diagnosis, the acuteness, age of patient and the temporal availability of the examination.
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The arterial blood gas analysis (ABGA) is a valuable diagnostic tool in daily clinical practice. It yields information about oxygenation, ventilation and acid-base status. ABGAs should always be interpreted within a clinical context. ⋯ When FIO2 is changed, steady state conditions must be awaited before a next control especially in the case of ventilation-perfusion mismatch, e. g. in COPD, pneumonia, pulmonary embolism. In a hypoxic state, immediate application of oxygen is warranted, in hypercapnia, ventilation should be increased. In acid-base disorders, treatment of the underlying disease is most often conducive.