Fortschritte der Medizin
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Fortschritte der Medizin · May 1982
Review[Disorders of hemostasis in liver cirrhosis. 2. Therapy].
Hemostatic changes in liver cirrhosis regularly have complex causes. In addition to a quantitative deficiency of hemostatic factors, also qualitative changes in coagulation factors, disturbances in coagulation factor metabolism and possible iatrogenic disturbances in plasmatic and thrombocytic hemostatic mechanism are to be considered. To diagnose a deficit of hemostatic factors is no problem, but to answer the question which of the numerous pathogenetic factors dominates in an individual case at this moment is very difficult and often impossible.
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The most important morphological aspects and pathogenesis of necrobiosis lipoidica concerning histological and clinical aspects are reported. In case of diabetes we find more frequently necrobiosis lipoidica localized out of the shank than in cases of necrobiosis lipoidica without diabetes. Necrobiosis lipoidica must be differentiated from granulomatosis disciformis, localized scleroderma and atrophy of the skin of another origin. Beside normalization of diabetes and application of corticosteroids physical and surgical treatment is recommended.