Praxis
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Emergencies in oncologic patients are common and diverse. Almost every cancer patient will develop at least one emergency situation at the beginning or in the further course of his disease. ⋯ In this review detailed descriptions of spatial cord compression syndrome, superior vena cava obstruction as well as hypercalcemia are given. Finally problems due to cerebral metastases, pulmonary embolism, hyperviscosity and hyperuricemia are briefly summarized.
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The rationale and indication, but also the efficacy and limitation of lumbar epidural corticosteroid injection in patients suffering from acute lumbosacral radicular pain are explained. Epidural administration of corticosteroids with longterm effect and bupivacaine by a translumbar approach in patients suffering from acute low back pain and sciatica causes an immediate, persistent pain relief and a more prompt regression of nerve root compression compared to patients just treated by bed rest and analgesics. ⋯ The postulate of an application performed by an experienced anaesthesiologist is stressed. Advantages of this invasive form of therapy include reduction of addictive analgesic drugs, decreased time of absolute immobilisation, respectively strict bed rest, and of hospitalisation.
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Based on case reports pathogenesis and treatment of the following diabetic emergencies were discussed: 1. The hyperosmolar non-ketotic coma without or with only modest ketosis occurring mainly in type II diabetics and the severe ketoacidosis with or without disturbed consciousness occurring mainly in type I diabetics are the two forms of severe metabolic decompensation of diabetes mellitus. 2. Severe hypoglycaemia may be caused by treatment with sulfonylureas and insulin. 3. ⋯ Under insulin treatment the following risk factors for severe hypoglycaemia need to be considered: metabolic control in the near normal range, intensified treatment with rapidly decreasing HbA1c-levels, impaired renal function, unawareness o hypoglycaemia. When the renal function is impaired, biguanide treatment is not indicated because of the risk of lactic acidosis. Most of the diabetic emergency situations are avoidable by proper education of the patients.
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Dyspnea is abnormal respiration experienced as unpleasant, concomitant with excessive respiratory labor. This review limits differential diagnoses of dyspnea to common pulmonary causes in which dyspnea often assumes a "sudden" character. ⋯ The following disease states are illustrated with respect to history, clinical presentation and emergency treatment: hyperventilation-syndrome, pulmonary embolism, pneumothorax, central airway-stenosis, asthma and chronic obstructive pulmonary disease. In the case of asthma the conception of "home management" and telemedicine are presented.
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Acute abdominal pain remains a diagnostic challenge even today. Although computer-assisted diagnostic aids have been designed, these are not yet well established in clinical practice. ⋯ In the first section of this presentation some practical issues are discussed with regard to basic diagnostic steps (history, clinical findings, laboratory tests, plain abdominal film, abdominal ultrasound), as seen from the internist's point of view. In the second part interdisciplinary management of complicated peptic ulcer disease, acute pancreatitis, acute diverticulitis, right lower quadrant pain, and spontaneous bacterial peritonitis are briefly outlined.