Der Urologe. Ausg. A
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Der Urologe. Ausg. A · Aug 2007
Case Reports[Spontaneous renal angiomyolipoma rupture. Rare differential diagnosis of renal ruptures].
Spontaneous renal rupture is a rare but nevertheless life-threatening complication in cases of benign and malignant space-occupying lesions in the kidneys. A precise preoperative differentiation often turns out to be difficult because of the formation of a hematoma. ⋯ In search of the cause, sonography, abdominal computed tomography, and digital subtraction angiography were conducted, which could provide findings suggestive of a space-occupying lesion, but because of the distinct hemorrhagic infarction could not determine whether it was benign or malignant. As shown in this case, when the radiological result is ambiguous, renal exposure is indicated from both a diagnostic and therapeutic standpoint.
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Pain therapy and palliative medicine have gained new importance in medical treatment in recent years. Pain is no longer considered an acceptable evil; in fact, awareness has increased that even in tumor patients and those with chronic pain the available options for special pain therapy can provide long-term pain relief. Pain therapy is not limited to these fields but applies to all areas of medicine. ⋯ She is charged with ordering inappropriately high doses of morphine and in part excessive administration of diazepam. Legal practice shows however that the predominant number of preliminary criminal proceedings and civil liability lawsuits do not involve pain specialists and palliative physicians, but rather other specialties such as the surgical disciplines and patient care. This is not surprising since good pain therapy is at present expected in all branches of medicine but obviously those fields not specialized in this subject lag further behind in these expectations than those already dedicated to pain therapy or palliative medicine.
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Der Urologe. Ausg. A · May 2007
[Tolerance to perioperative anemia. Mechanisms, influencing factors and limits].
The expected cost explosion in transfusion medicine increases the socio-economic significance of specific institutional transfusion programs. In this context the estimated use of the patient's physiologic tolerance represents an integral part of any blood conservation concept. ⋯ Critically ill patients with multiple trauma and sepsis do not seem to benefit from transfusions up to Hb concentrations >9 g/dl (>5.59 mmol/l). In cases of massive hemorrhaging and diffuse bleeding disorders the maintenance of a Hb concentration of 10 g/dl (6.21 mmol/l) seems to contribute to stabilization of coagulation.
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Symptoms involving the gastrointestinal tract are very common in patients who require palliative treatment. They can be caused by the patient's underlying (malignant) disease or by the treatment of this disease. Nausea and vomiting as well as constipation are of the utmost importance in this context due both to their frequency as well as their complex consequences. A careful evaluation of the patient's history combined with a few diagnostic procedures will help to provide a treatment which is orientated on pathophysiology.
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Terminal illnesses can cause distressing symptoms such as severe pain, mental confusions, feelings of suffocation, and agitation. Despite skilled palliative care in some cases these symptoms may not respond to standard interventions. After all other means to provide comfort and relief to a dying patient have been tried and are unsuccessful, clinical caregivers and patients can consider palliative sedation. ⋯ Palliative sedation is not intended to cause death or shorten life. The patient and family should agree with plans for palliative sedation. Because cases involving palliative sedation are emotionally stressful, the patient, family, and health care workers can all benefit from talking about the complex medical, ethical, and emotional issues they raise.