Praxis
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Comparative Study
[Role of surgical treatment of low back pain and lumbo-sciatica].
Low back pain alone without any sciatica is not an appropriate indication for lumbar disc surgery. The only exception might be a clinically and radiologically proven segmental instability. However a conservative multidisciplinary treatment should precede surgery. ⋯ The appropriate surgical indication and the postoperative reeducation are of utmost importance for good results. The patients history, neurological examination, neuroradiological imaging and failed conservative treatment modalities are key elements to define appropriate surgical candidates. Microdisectomy remains the "gold standard" for surgical treatment of lumbar disc disease assuring a better quality of life at long term follow up.
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Many conditions are associated with neck stiffness. Because of the threatening consequences, bacterial meningitis needs special consideration. The sensitivity of the physical examination is discussed: absence of fever, neck stiffness and altered mental status excludes the diagnosis of bacterial meningitis. ⋯ A previous CT-scan to exclude increased intracranial pressure is indicated only in special risk situations and delayed antibiotic treatment must be avoided. Ceftriaxon is the standard empiric treatment in immunocompetent adult patients. According to the risk for pneumococcal resistance addition of vancomycin or rifampicin is indicated.
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To evaluate a new therapy protocol for local dose escalation by high dose rate (HDR) brachytherapy for survival, morbidity and prognostic variables in men with localized prostate cancer. The prospectively recorded files of 189 men aged in median 69 years with a mean follow-up of 6 years (12-143 months) receiving curatively intended combined high dose rate (HDR) 192-iridium-brachytherapy (BT) and external beam radiation (EBR) for locally confined prostate cancer were analyzed. Mean age was 68.2 (range 44-84 years). ⋯ In multivariate analyses PSA status was an independent prognostic factor. The six year results confirm that local dose escalation by HDR-brachytherapy and external beam radiation is curative in men with locally confined prostate cancer. The results are especially in high risk patients encouraging.
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Cannabis use has increased considerably during the last 15 years. One of the major problems dealing with cannabis use is driving under the influence of drugs. With the exception of ethyl alcohol, the majority of the epidemiological studies have shown that cannabis is the most frequently detected substance in people suspected of driving under the influence of drugs. ⋯ In forensic practice, cannabis impairment of driving performance must be related to cannabinoids blood concentrations. To facilitate the interpretation of cannabinoids blood levels, several models were set up recently. These models must be further improved in order to fit in with all circumstances of cannabis use.