Wiener klinische Wochenschrift
-
Wien. Klin. Wochenschr. · Jun 2006
Randomized Controlled Trial[Benefits of an add-on treatment with the synthetic cannabinomimetic nabilone on patients with chronic pain--a randomized controlled trial].
The aim of this study was to investigate the efficacy and efficiency of an add-on treatment with the synthetic cannabinomimetic nabilone on patients with chronic pain. Of major interest were the evaluation of the influence the treatment had on pain and on quality of life as well as the subjective assessment of positive effects and side effects by the study participants. ⋯ In summary, the study results allow the conclusion that a majority of patients with chronic pain classify nabilone intake in addition to the standard treatment as a measure with a positive individual benefit-riskratio. Thus, this kind of treatment may be an interesting and attractive enrichment of analgetic therapy concepts.
-
Wien. Klin. Wochenschr. · Jun 2006
Intentionally hastening death by withholding or withdrawing treatment.
This study aims to provide empirical data on physicians' intentions in withholding and withdrawing treatment, and to discuss possible implications for the ethical debate. ⋯ In almost every second case, a medical decision to withhold or withdraw treatment is taken with the explicit intention of hastening the end of the patient's life. No clear association can be found between the intent to hasten the end of life and features of the treatment forgone that can be determined objectively, such as the likelihood and extent of a life-shortening effect, the immediacy of death, or the expected burden of any potential life-sustaining measure. The findings of the study challenge the usefulness of doctors' intentions with regard to hastening the end of life as criteria for moral judgements on decisions to withhold or withdraw medical treatment.
-
Wien. Klin. Wochenschr. · May 2006
The role of preoperative lymphoscintigraphy in surgery planning for sentinel lymph node biopsy in malignant melanoma.
To evaluate four years of preoperative lymphoscintigraphy experience and the accuracy of sentinel lymph node biopsy in our institution in melanoma patients with various tumor thicknesses. An additional aim was to evaluate the recurrence rate related to pathohistological findings. ⋯ Preoperative lymphoscintigraphy is a sensitive, inexpensive and essential method for the identification of drainage basins, determination of the number and position of sentinel nodes and their location outside the usual nodal basins. Scintigraphic findings may lead to changes in surgical management due to the unpredictability of lymphatic drainage. The low incidence of regional disease recurrence in patients with tumor-negative sentinel nodes supports the use of preoperative lymphoscintigraphy and sentinel node biopsy as a safe and accurate procedure for staging the regional nodal basin in patients with malignant melanoma.
-
Wien. Klin. Wochenschr. · May 2006
Case ReportsA woman with red eyes and hypokalemia: a case of acquired Gitelman syndrome.
Gitelman syndrome is a rare hereditary disorder of the thiazide-sensitive NaCl transporter in the distal renal tubular cells, but mimicking of such hereditary tubular disorders has been described in different autoimmune diseases (Sjögren syndrome, SLE, ...). A 62-year-old woman with painful red eyes and sicca syndrome presented at the ophthalmological department. The diagnostic evaluation identified a Sjögren syndrome with early endophthalmitis as the reason for the red eyes. ⋯ Together with the urine analysis, a rare case of an acquired Gitelman syndrome was diagnosed. Substitution with potassium and magnesium improved the initial symptoms of weakness, but renal electrolyte wasting persisted even after treatment of Sjögren syndrome. In patients with autoimmune disease, laboratory analysis of serum electrolytes should be performed because different acquired tubular disorders can lead to severe hypokalemia.