Praxis
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Skin- and Soft tissue infections are a frequent problem in hospital as well as in ambulatory care. Diagnostic procedures and treatment principles have to include the most frequent pathogens. While the acute forms of skin and soft tissue infections, with, necrotising fasciitis as important exception, rarely cause diagnostic or therapeutic problem, the treatment of patients with recurrent furunculosis, chronic wounds and diabetic feet is often difficult and frustration for patients and physicians. This article gives an overview of the most important problems and treatment strategies.
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The general practitioner has an important role in the acute management and during the rehabilitation process of children after a traumatic head injury. Latest research shows that sequelae may occur even after a mild head injury without loss of consciousness. Recognizing the warning signs and symptoms after a head injury allows the general practitioner to counsel the child and parents in secondary prevention, particularly in order to avoid any further head injury during the recovery phase. Under the supervision of the general practitioner, a gradual progressive return to the child's everyday activities optimizes the chances of a rapid and complete recovery.
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Resistant hypertension is defined as blood pressure that remains above therapeutic goal despite the use of 3 antihypertensive drugs including a diuretic. After exclusion of secondary causes and medical in compliance, the estimated prevalence of resistant arterial hypertension ranges from 4% to 19% in hypertensive patients. ⋯ Hyperactivation of the sympathetic nervous system plays a key role in the genesis of hypertension. Targeting renal sympathetic nerves, percutaneous catheter-based renal denervation is a new therapeutic option for the treatment of resistant arterial hypertension in selected drug resistant patients.
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For many years, the FAST examination has represented the standard procedure for diagnostics in traumatology. Until just recently, the ultrasound societies in German speaking countries did not recognize this procedure, which is the reason why it has not been included in current educational programs. The acronym FAST stands for «Focused Assessment with Sonography for Trauma» and is defined as the sonographic detection of free fluid in the intraperitoneal, pleural and pericardial spaces in patients who have suffered blunt or penetrating trauma. ⋯ Nowadays, everybody is talking about FAST-plus in reference to a broad range of applications within the field of airway management, organ injury diagnostics, cerebral hypertension as well as support for invasive procedures. However, the continued rise of FAST will depend on the future role that computed tomography (CT) will be playing. Indeed, it remains unclear whether CT utilized as FACTT («Focused Assessment with Computed Tomography in Trauma») will force out FAST and advance to become the diagnostic gold standard.
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A persistent foramen ovale can be a possible cause of paradoxical cerebral embolism. Thranscatheter closure by transcatheter technique has a high success rate and is a recurrence prevention measure. This paper reviews of patent foramen ovale anatomy, pathophysiology, and clinical impact and discusses current therapeutic options.