Praxis
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A 22 year old man from Ethiopia suffered from progressive left inguinal pain and weight loss for ten months. The pain aggravated with leg movement, in particular with flexion of the left hip. ESR and CRP were slightly elevated, and a PPD was strongly positive. ⋯ Primary Tb psoas abscess is extremely rare. Only four cases are described in the literature. In analogy to Pott's disease, therapy consists of tuberculostatic treatment, supported by surgical debridement.
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Delirium is a common psychiatric complication in somatically ill in-patients and is associated with increased morbidity and mortality, longer lengths of stay and higher cost of treatment. It remains often unrecognized and thus inadequately treated. ⋯ For the treatment of the non alcohol associated delirium, haloperidol remains the treatment of choice, whereas for the treatment of delirium related to alcohol withdrawal benzodiazepines and clomethiazole are recommended. Other treatment strategies, especially the use of newer atypical antipsychotic medications are outlined.
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Acute appendicitis remains a diagnosis based primarily on the history and the physical examination performed by an experienced surgeon. Ultrasonography and CT can be an useful adjunct, but they should not be used without context to the clinical picture. In therapy, open appendicectomy remains the golden standard. ⋯ In these situations open appendectomy is indicated. In the case where ultrasonography reveals no appendicitis, negative appendectomy rate is 31%. In this situation further abdominal exploration and thus diagnostic laparoscopy and laparoscopic appendectomy is indicated.
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Historical Article
[Old European "ars moriendi" (the art of dying) as a challenge for our approach to death and dying].
In Europe, there was once a time when death and dying were approached differently than they are today. Ars moriendi was cultivated as a means of consciously preparing for death. In modern times, constant thoughts of death are no longer considered as necessary for leading a responsible life.
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Hypertensive emergencies are acute, life-threatening events, characterised by high blood pressure and concomitant acute hypertensive target organ damage. These patients need immediate lowering of blood pressure mostly with parenteral drugs in the range of the autoregulative capacity of organ circulation and in-hospital monitoring of the vital functions. ⋯ Blood pressure should be lowered within 24 to 48 hours. Oral therapy is normally sufficient and hospitalisation is rarely necessary, but maintenance of antihypertensive therapy outside the hospital has to be ascertained.