Praxis
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Mild craniocerebral injury or mild traumatic brain injury (MTBI) predominates, occurring with an 80% frequency. A 1997 publication by the American Academy of Neurology clearly defines MTBI as a transient alteration of mental status, without any neurological deficit, that may or may not involve loss of consciousness or amnesia. On the Glasgow Coma Scale (GCS), mild craniocerebral injury corresponds to a score of 14 and 15. ⋯ In smaller hospitals, 24-hour monitoring is imperative. Wherever computerized tomography (CT) is available, a CT examination is broadly indicated. There is no knowledge of any adverse effects on patients whose GCS worsened when the CT revealed normal findings.
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Autoimmune hepatitis (AIH) is a rare autoimmune disease (incidence about 5% among all chronic liver disorders) that reflects a loss of tolerance to normal hepatic proteins. AIH is characterized by female preponderance, hypergammaglobulinemia, extrahepatic syndromes and a good response to immunosuppressive treatment. AIH may be subdivided into two or three subtypes. ⋯ In PSC patients expressing typical ERCP findings and suffering from inflammatory bowel disease (IBD), the diagnosis of an overlap syndrome between PSC/AIH can be readily made in the presence of ANCA and AIH relevant autoantibodies. Apart from this kind of overlap syndrome involving different types of autoimmune disorders within the liver AIH can be also associated with other organspecific autoimmune disorders as documented in the autoimmune polyglandular syndrome type 1 (APS-1). In this disease homozygosity for a defect in a single gene (AIRE) leads to a broad spectrum of organ specific autoimmune diseases.
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The cutaneous manifestations of leukemias are conventionally divided into nonspecific benign lesions and specific malignant lesions. Specific lesions (leukemia cutis) are localized or disseminated infiltrations of the skin by malignant leukemic cells which may involve all layers of the skin. The clinical appearance of leukemia cutis is variable and may range from papules and nodules to a generalized cutaneous eruption and erythroderma. ⋯ However, an overall survival of patients with specific skin lesions of chronic lymphocytic leukemia is significantly better, as compared with other types of leukemia. Rarely, skin lesions containing leukemic cells are present before evidence of leukemia cutis can be detected in the peripheral blood and bone marrow (aleukemic leukaemia cutis). Leukemic skin lesions should be differentiated from numerous nonspecific lesions, which may be present in up to 80% of all patients with leukemia.