Praxis
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Breaking bad news is one of the most important and most difficult tasks of a physician. The training for this dialogue should be intensified during the medical curriculum. ⋯ In the northern countries of Europe the truth in medical diagnosis and prognosis is revealed in a straight way, whereas in the south and the southeast the truth is generally hidden from the patient. A few simple rules are given for the initial and the subsequent dialogues between the physician and a patient with an incurable disease.
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Chronic obstructive pulmonary disease (COPD) is rather common. It is nearly always associated with excessive smoking. ⋯ This review addresses nonpharmacological treatment of these episodes of acute decompensation. The value of mechanical ventilation is discussed in view of two recent advances: noninvasive ventilation by face or nose mask as alternative to tracheal intubation and improved notions about the pathogenesis of fluids and salt retention as causes of occasionally occurring edema.
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This study evaluates the use of MR angiography in the diagnosis of vertebrobasilar stroke. The MRI/MR angiography and clinical presentation of 50 unselected adult patients who presented with ischemic symptoms in the vertebrobasilar territory (10 TIAs, 40 strokes) were prospectively evaluated. Conventional T1 and T2-spin echo sequences were obtained for evaluation of the brain parenchyma, with gadolinium injection in 41 cases and 3D time-of-flight MR angiography in all patients. ⋯ MR angiography showed intracranial vertebrobasilar lesions in 30 patients (5 stenosis or occlusion of a vertebral artery, 17 stenosis or occlusion of the basilar artery, 6 stenosis of arterial branches of the basilar artery, 10 dolichoectasia of the basilar artery). 7 patients had multiple lesions. Recognized etiologies of the strokes were: 23 vertebrobasilar lesions, 16 nonvertebrobasilar causes, 6 mixed (vertebrobasilar and associated alternative causes) cases, while 5 cases had no recognized cause of stroke. Our study demonstrates a high incidence of intracranial arterial lesions in patients suffering from vertebrobasilar stroke and suggests that MRA can help in a noninvasive way to determine the origin of vertebrobasilar strokes.