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Ikterus Ikterus
DoctorConsult - The Journal. Wissen für Klinik und Praxis Pub Date : 2011-11-01 DOI: 10.1016/j.dcjwkp.2011.10.006
Henryk Dancygier
{"title":"Ikterus","authors":"Henryk Dancygier","doi":"10.1016/j.dcjwkp.2011.10.006","DOIUrl":"https://doi.org/10.1016/j.dcjwkp.2011.10.006","url":null,"abstract":"<div><p>Jaundice (also called icterus) is a yellowish pigmentation of sclerae, mucous membranes, skin as well as body tissues and fluids, caused by increased bilirubin residue. The classification of jaundice depends on the predominant type of bilirubin occurring in blood serum (unconjugated or conjugated hyperbilirubinaemia). According to pathogenesis, it is distinguished between pre-hepatic (excess supply of bilirubin), hepatic (decreased uptake of bilirubin by hepatocytes or diminished conjugation in the liver) and post-hepatic icterus (reduced excretion of conjugated bilirubin). Most common cause of hyperbilirubinaemia is cholestasis, and other causes include haematological or hepatocellular disorders as well as a hereditary defect of the bilirubin metabolism. Jaundice can easily be detected by visual inspection and is confirmed by measuring the serum concentration of bilirubin. Treatment and prognosis depend on the underlying disease.</p></div>","PeriodicalId":100380,"journal":{"name":"DoctorConsult - The Journal. Wissen für Klinik und Praxis","volume":"2 3","pages":"Pages e185-e191"},"PeriodicalIF":0.0,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.dcjwkp.2011.10.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136851000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cholestase 胆汁淤积症
DoctorConsult - The Journal. Wissen für Klinik und Praxis Pub Date : 2011-11-01 DOI: 10.1016/j.dcjwkp.2011.10.009
Henryk Dancygier
{"title":"Cholestase","authors":"Henryk Dancygier","doi":"10.1016/j.dcjwkp.2011.10.009","DOIUrl":"https://doi.org/10.1016/j.dcjwkp.2011.10.009","url":null,"abstract":"<div><p>Cholestasis is a condition where too little bile gets to the duodenum. This delayed or stagnating bile flow may be caused by disturbances in bile formation, bile secretion or blocked bile drainage. The defect can be localised on different levels, from basolateral hepatocyte membrane to complete biliary duct to major duodenal papilla. Clinical signs of cholestasis include increased blood concentrations of bile acids as well as of certain enzymes typical in cholestasis, impacts on the intestine caused by less or lacking bile, and effects of bile stasis on the liver tissue. Typical symptoms include pruritus, jaundice as well as pale stool and dark urine. Sonography, CT, MRCP, ERCP, percutaneous transhepatic cholangiography (PTC) and liver biopsy are of outstanding importance for diagnosis and differential diagnosis.</p></div>","PeriodicalId":100380,"journal":{"name":"DoctorConsult - The Journal. Wissen für Klinik und Praxis","volume":"2 3","pages":"Pages e171-e184"},"PeriodicalIF":0.0,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.dcjwkp.2011.10.009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136851002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Biologikatherapie in der Rheumatologie 风湿病生物学治疗
DoctorConsult - The Journal. Wissen für Klinik und Praxis Pub Date : 2011-11-01 DOI: 10.1016/j.dcjwkp.2011.10.010
Peter Peichl
{"title":"Biologikatherapie in der Rheumatologie","authors":"Peter Peichl","doi":"10.1016/j.dcjwkp.2011.10.010","DOIUrl":"10.1016/j.dcjwkp.2011.10.010","url":null,"abstract":"<div><p>Biologicals have been in use for approximately 10 years in Europe. Initially developed for the treatment of sepsis, these molecular biologically produced drugs now successfully combat diseases such as rheumatoid arthritis (RA): They specifically inhibit rheumatoid processes in the joints that are controlled by the body's natural defence system. Meanwhile different agents are on the market, and controlled clinical studies prove a high effectiveness as well as a good safety standard. Pneumonia or shingles are among the possible although rare side effects of this kind of therapy. Biologicals also require close surveillance of patients who are subtly infected with tuberculosis.</p></div>","PeriodicalId":100380,"journal":{"name":"DoctorConsult - The Journal. Wissen für Klinik und Praxis","volume":"2 3","pages":"Pages e164-e166"},"PeriodicalIF":0.0,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.dcjwkp.2011.10.010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90871420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Chronische Polyarthritis 慢性多关节炎
DoctorConsult - The Journal. Wissen für Klinik und Praxis Pub Date : 2011-11-01 DOI: 10.1016/j.dcjwkp.2011.10.002
Peter Peichl
{"title":"Chronische Polyarthritis","authors":"Peter Peichl","doi":"10.1016/j.dcjwkp.2011.10.002","DOIUrl":"https://doi.org/10.1016/j.dcjwkp.2011.10.002","url":null,"abstract":"<div><p>Rheumatoid arthritis (RA) is the most common chronic inflammatory autoimmune disease in human beings, with a prevalence of 1–2% of the world's population. Phases of recurrent, generally symmetrical arthritides may lead to destruction of the articular structure without treatment, and result in immobility and total disability of the patient. Epidemiological data give evidence that already as many as 30% of patients in the first year and 70% after 24 months develop osseous defects that are traceable with X-ray. In the past, the aggressiveness of RA has often been underestimated. But basically it is not a benign disease with its inflammation limited to the joints.</p></div>","PeriodicalId":100380,"journal":{"name":"DoctorConsult - The Journal. Wissen für Klinik und Praxis","volume":"2 3","pages":"Pages e167-e170"},"PeriodicalIF":0.0,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.dcjwkp.2011.10.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136851001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Diagnostik bei HyperCKämie ungeklärter Genese 还有诊断学和过早发生事故
DoctorConsult - The Journal. Wissen für Klinik und Praxis Pub Date : 2011-11-01 DOI: 10.1016/j.dcjwkp.2011.10.003
Carl D. Reimers
{"title":"Diagnostik bei HyperCKämie ungeklärter Genese","authors":"Carl D. Reimers","doi":"10.1016/j.dcjwkp.2011.10.003","DOIUrl":"10.1016/j.dcjwkp.2011.10.003","url":null,"abstract":"<div><p>Eine erhöhte Aktivität der Kreatinkinase (CK) ist typischerweise ein Hinweis auf eine Läsion der Herz- oder Skelettmuskulatur. Anhand der Bestimmung der Aktivitäten der Isoenzyme CK-MB und CK-MM lässt sich die Herkunft der erhöhten CK-Aktivität klären. Gelegentlich wird eine persistierend erhöhte CK-MM Aktivität aus der Skelettmuskulatur festgestellt, ohne dass es anamnestische (z. B. Myalgien) oder klinische (z. B. Paresen) Hinweise auf eine Skelettmuskelerkrankung gibt. Die vorliegende Übersicht präsentiert diagnostische Empfehlungen für derartige Situationen. Insbesondere gilt es, behandelbare Muskelerkrankungen (z. B. Myositiden) frühzeitig zu erfassen. Findet sich auch paraklinisch (Elektromyographie, muskuläre Bildgebung, Muskelbiopsat incl. Immunhistochemie) keine weitere Auffälligkeit, so spricht man von einer idiopathischen HyperCKämie. Katamnestische Untersuchungen zeigen, dass sich aus einer derartigen HyperCKämie nur sehr selten eine manifeste Myopathie entwickelt.</p></div><div><p>An increased activity of the creatine kinase (CK) typically indicates a lesion of cardial or skeletal muscles. Determining the activities of the isoenzymes CK-MB and -MM clear the origin of the increased CK activity. Occasionally a persisting increased CK-MM activity without any hint for neuromuscular diseases (e. g., myalgia or muscle weakness) occurs. This review presents diagnostic pathways in case of increased skeletal muscle CK activity. It is of special interest to early detect treatable disease such as myositis. The so-called idiopathic hyperCKaemia is characterized by also unsuspective paraclinical findings (electromyography, muscle imaging, muscle biopsy including immunhistochemical examinations). Follow-up studies proved the good prognosis of such a abnormality. The development of a manifest myopathy is rather rare.</p></div>","PeriodicalId":100380,"journal":{"name":"DoctorConsult - The Journal. Wissen für Klinik und Praxis","volume":"2 3","pages":"Pages e197-e200"},"PeriodicalIF":0.0,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.dcjwkp.2011.10.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76516969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Therapie des zirrhotischen Aszites 脊椎动物治疗
DoctorConsult - The Journal. Wissen für Klinik und Praxis Pub Date : 2011-11-01 DOI: 10.1016/j.dcjwkp.2011.10.011
Henryk Dancygier
{"title":"Therapie des zirrhotischen Aszites","authors":"Henryk Dancygier","doi":"10.1016/j.dcjwkp.2011.10.011","DOIUrl":"10.1016/j.dcjwkp.2011.10.011","url":null,"abstract":"<div><p>The development of ascites in the course of liver cirrhosis is very important for its prognosis and associated with a mortality of more than 50% 2 to 5 years after the first episode of ascites occurred. The increase of creatinine concentration in the serum to &gt; 1.5<!--> <!-->mg/dl is accompanied by a mortality of up to 80% within 6 to 12 months. Depending on whether the ascites can be washed out by salt restriction and treatment with diuretics alone or not, a distinction is made between uncomplicated and complicated ascites. Ascites treatment is a step-by-step therapy and starts with bedrest, salt and fluid restriction. In addition, aldosterone antagonists and loop diuretics may be applied. In therapy-refractory ascites paracentesis or transjugular intrahepatic portosystemic shunt (TIPS) may be administered. Therapy-refractory ascites occurs in 5-10% of patients. Its prognosis is very severe with a 1-year survival rate of &lt; 50%.</p></div>","PeriodicalId":100380,"journal":{"name":"DoctorConsult - The Journal. Wissen für Klinik und Praxis","volume":"2 3","pages":"Pages e192-e196"},"PeriodicalIF":0.0,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.dcjwkp.2011.10.011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76665793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Restriktive Kardiomyopathie 恢复性心肌病
DoctorConsult - The Journal. Wissen für Klinik und Praxis Pub Date : 2011-08-01 DOI: 10.1016/j.dcjwkp.2011.07.001
Heiko Kilter, Michael Böhm
{"title":"Restriktive Kardiomyopathie","authors":"Heiko Kilter,&nbsp;Michael Böhm","doi":"10.1016/j.dcjwkp.2011.07.001","DOIUrl":"https://doi.org/10.1016/j.dcjwkp.2011.07.001","url":null,"abstract":"<div><p>Restrictive cardiomyopathy is a rare disease, which is characterized by an increased stiffness of the heart with involvement of myocardium, interstitium and endocardium. Many causes are possible. Restrictive cardiomyopathies are classified into primary and secondary forms. The primary forms include idiopathic restrictive cardiomyopathy, Loeffler endocarditis, endomyocardial fibrosis and hypereosinophilic syndrome. Among the secondary forms infiltrative heart diseases like amyloidosis or sarcoidosis and storage diseases like haemochromatosis or glycogen storage diseases can be found. For diagnosis echocardiography, cardiac catheter including invasive pressure measurement and myocardial biopsy, are useful. Treatment is performed according to the primary disease.</p></div>","PeriodicalId":100380,"journal":{"name":"DoctorConsult - The Journal. Wissen für Klinik und Praxis","volume":"2 2","pages":"Pages e81-e86"},"PeriodicalIF":0.0,"publicationDate":"2011-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.dcjwkp.2011.07.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137162275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Arrhythmogene rechtsventrikuläre Kardiomyopathie
DoctorConsult - The Journal. Wissen für Klinik und Praxis Pub Date : 2011-08-01 DOI: 10.1016/j.dcjwkp.2011.07.002
Heiko Kilter, Michael Böhm
{"title":"Arrhythmogene rechtsventrikuläre Kardiomyopathie","authors":"Heiko Kilter,&nbsp;Michael Böhm","doi":"10.1016/j.dcjwkp.2011.07.002","DOIUrl":"10.1016/j.dcjwkp.2011.07.002","url":null,"abstract":"<div><p>Arrhythmogenic right ventricular cardiomyopathy (arrhythmogenic right ventricular dysplasia) is a rare syndrome that affects mostly adolescents and young adults. It is characterized by right ventricular atrophy and dilatation. Arrhythmias and syncopes as well as signs of right heart failure can be seen. Some patients report an increased frequency of sudden cardiac deaths in their families. Diagnostic options are for instance ECG, 24 hour ECG and cardiac imaging (Echocardiography, Cardiac MRI). The diagnosis can be confirmed by myocardial biopsy. In the therapy besides other options cardioverter defibrillators or antiarrhythmics like sotalol, amiodarone or beta blockers play a role.</p><p>Although there are similar morphologic changes, Uhl's disease seems to be an independent disease. It is associated with a very thin right ventricular wall and therefore with an increased risk of right heart failure.</p></div>","PeriodicalId":100380,"journal":{"name":"DoctorConsult - The Journal. Wissen für Klinik und Praxis","volume":"2 2","pages":"Pages e131-e133"},"PeriodicalIF":0.0,"publicationDate":"2011-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.dcjwkp.2011.07.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77951819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Differenzialdiagnostik der Myalgien 诊断学
DoctorConsult - The Journal. Wissen für Klinik und Praxis Pub Date : 2011-08-01 DOI: 10.1016/j.dcjwkp.2011.07.012
Carl D. Reimers , Niklas Reimers
{"title":"Differenzialdiagnostik der Myalgien","authors":"Carl D. Reimers ,&nbsp;Niklas Reimers","doi":"10.1016/j.dcjwkp.2011.07.012","DOIUrl":"10.1016/j.dcjwkp.2011.07.012","url":null,"abstract":"<div><p>Myalgias<span> belong to the most frequent neuromuscular complaints. They may be due to organic and functional (psychosomatic) diseases. A purposeful differential diagnosis requires the differentiation of acute, chronic, and recurrent, focal and generalized, exercise-induced and not exercise-induced myalgias. Thoroughly collecting the patient́s history, including his family history, and general and neurological examination<span> are mandatory. The physician has to search for trigger and tender points, determine the creatine kinase<span> activity and several other laboratory parameters, and perform an electromyography<span>. Optional are muscle imaging and – depending on the actual findings – a muscle biopsy and molecular genetical investigations. In case of suspicion of functional abnormalities a psychiatric or psychosomatic examination are needed. The present review tabulates the most important etiologies of myalgias.</span></span></span></span></p></div>","PeriodicalId":100380,"journal":{"name":"DoctorConsult - The Journal. Wissen für Klinik und Praxis","volume":"2 2","pages":"Pages e157-e162"},"PeriodicalIF":0.0,"publicationDate":"2011-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.dcjwkp.2011.07.012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83294153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ventrikuläre Extrasystolie 室性期外收缩
DoctorConsult - The Journal. Wissen für Klinik und Praxis Pub Date : 2011-08-01 DOI: 10.1016/j.dcjwkp.2011.07.009
J. Christoph Geller
{"title":"Ventrikuläre Extrasystolie","authors":"J. Christoph Geller","doi":"10.1016/j.dcjwkp.2011.07.009","DOIUrl":"https://doi.org/10.1016/j.dcjwkp.2011.07.009","url":null,"abstract":"<div><p>Ventricular extrasystoles (VES, also known as premature ventricular contraction (PVC) or premature ventricular beat (PVB)) are a common cause for complaints. Normally even frequent VES are not life-threatening if no structural heart disease exists, and treatment is only required for symptomatic reasons. In addition to explaining the harmlessness of the arrhythmia to the patient as well as eliminating possible reversible causes, an attempt of drug treatment ranks first (at first with beta blockers or in individual cases with calcium antagonists of the verapamil type, and if this treatment does not show sufficient impact also with specific membrane stabilising substances). In highly symptomatic patients whose condition cannot be controlled adequately with these measures or in patients with very strong complaints catheter ablation in a centre experienced with this procedure should be considered.</p><p>In contrast, VES in the presence of heart disease and especially with reduced left ventriclular function are of prognostic importance. In addition to symptomatic treatment it is most important to protect the patient from sudden cardiac death. Treatment of the underlying condition improves the prognosis, and the implantation of a defibrillator also plays an important role.</p></div>","PeriodicalId":100380,"journal":{"name":"DoctorConsult - The Journal. Wissen für Klinik und Praxis","volume":"2 2","pages":"Pages e105-e111"},"PeriodicalIF":0.0,"publicationDate":"2011-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.dcjwkp.2011.07.009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137162743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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