Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Mar 2020
Review[Diagnostics and Treatment of indeterminate Biliary Stenoses].
Biliary stenoses represent a differential diagnostic challenge. Diagnostic methods to clarify the underlying dignity are often invasive, and provide high specificity beside insufficient sensitivity. In many cases, an accurate diagnosis is only possible over time, and therefore limits curative treatment options. This article provides an overview of the diagnostic challenges and treatment options for unclear biliary stenosis.
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Nosocomial pneumonia is one of the leading entities of nosocomial infections in Germany and worldwide with invasive ventilation being one of the major risk factors. However nosocomial pneumonia without ventilator support is an underappreciated complication as demonstrated by prevalence studies of the European Centre for Disease Control in 2011 and 2016. ⋯ For non-ventilated patients early mobilization and/or frequent position changes, correct use of feeding tubes and mouth care are key components. In preoperative patients training of a simple breathing exercise combined with mnemonic aids for its use in the postoperative period has been proven to be helpful.
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Dtsch. Med. Wochenschr. · Mar 2020
["The last doctor's visit": External post mortem during emergency medical services].
The declaration and investigation of death cases is a non-delegable task of medical doctors and should be mastered in the same quality as all examinations on living patients. A person is death when at least one sign of death is established (livores mortis, rigor mortis, putrefaction, injuries incompatible with life, brain death). In all other cases of unconscious patients a sufficient cardiopulmonary resuscitation should be started. ⋯ Doctors must be alarmed, when petechial bleedings are established at the face or the conjunctives, raising the suspicion of strangling forces to the neck. Internal causes of death are often invisible from the body surface, resulting in difficulties to declare the cause of death of the individual by external's only. Injuries are most often visible and could be a hint of a crime scene scenario or external harm.
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Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are rare, autoimmune mediated cholestatic liver diseases. Other auto-immune diseases are often associated with PBC and PSC, and inflammatory bowel disease is present in the majority of PSC patients. In the course of disease, chronic inflammation in the liver leads to fibrotic restructuring and ultimately cirrhosis. ⋯ For both PBC and PSC novel treatments are currently being tested in clinical trials. Disease management should address compromising symptoms like pruritus and sicca as well as complications due to maldigestion and concomitant autoimmune diseases. The only curative treatment available is liver transplantation and should be considered at a MELD score of 15.
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Dtsch. Med. Wochenschr. · Mar 2020
[Removal of impacted cerumen by irrigation of the external auditory canal - Step-by-step].
Cerumen impaction is a common consultation issue at general medical practices and causes symptoms like hearing loss, itching, pain or tinnitus. Without any indication of eardrum perforation, ear irrigation with warm water is a safe, effective and fast aid.