Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Oct 2021
Review[Hypersensitivity Pneumonitis - an important differential diagnosis of infiltrative lung diseases].
Hypersensitivity pneumonitis (HP) is an inflammatory and/or fibrotic disease of the lung parenchyma and terminal bronchioles caused by an allergic reaction to inhaled antigens. The immune response following antigen exposure results in lymphocytic inflammation as well as granuloma formation. The typical histologic pattern of HP consists of cellular interstitial pneumonia, cellular bronchiolitis, and epithelioid cell granulomas. ⋯ The diagnosis of HP is made by high-resolution computed tomography (HRCT) of the lung, evaluation of possible antigen exposure, and bronchoscopy with bronchoalveolar lavage and, if necessary, forceps biopsy. If the diagnosis is inconclusive, transbronchial cryobiopsy or surgical lung biopsy may need to follow. A multidisciplinary board is critical in making the diagnosis.
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Pain history should be adapted to their cognitive abilities of people with dementia who can still communicate. With increasing limitations of communication skills, history of a third party and standardized observation instruments increase in importance. ⋯ Opioids and coanalgetics have hardly been studied in this group although frequently used. Anticholinergic side effects are especially important in people with dementia.
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Graves' orbitopathy (GO) is an autoimmune orbital disease which is mostly associated with Graves' disease and requires good interdisciplinary cooperation. To minimize irreversible damages a stage-adapted anti-inflammatory therapy is of great importance. ⋯ The current concept for Graves' orbitopathy is as follows: first anti-inflammatory therapy then surgical correction of the permanent defects. This might be modified in the future, due to the promising effects of targeted therapies.