Der Internist
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Palliative care patients do not only suffer from cancer pain but also from painful muscle spasticity due to multiple sclerosis, amyotrophic lateral sclerosis, after stroke or due to dementia if damage of the pyramidal motor system is present. Centrally active muscle relaxants can be helpful also when used as coanalgesics for cancer pain. ⋯ Idiopathic Parkinsonism or multiple system atrophy leads more to a painful rigor and pain control should be supported here by optimal adjustment of L-DOPA or DOPA agonist therapy. However, pain treatment should always address the psychological, social and spiritual demands of the patient.
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Personalized medicine in the sense of individualized therapy concepts plays an important role in breast cancer. In early breast cancer the molecular subtypes luminal A and B and basal-like are important for planning adjuvant systemic therapy. Prognostic and predictive markers, such as hormone receptor status, HER2, Ki-67, uPA/PAI-1 or multiple gene tests, such as Oncotype DX® currently allow avoidance of an over therapy or under therapy. ⋯ Decisive for the future will be the confirmation of this development by modern study concepts contemporarily with adequate evidence. It could then be expected that a personalized therapy for early breast cancer and in particular adjuvant chemotherapy would only be used for those patients for whom it is really necessary. In advanced stage disease there is justified hope that the survival time in the sense of a chronic disease can be improved by the use of targeted therapy.
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An 87-year-old woman presented with a left-sided pleural effusion. The milky aspirate fulfilled the criteria of a chylothorax. ⋯ In the diagnostic work-up of pleural effusion the determination of triglycerides should be considered to confirm the diagnosis of chylothorax. In the presence of a chylothorax the differential diagnosis of lymphangioleiomyomatosis should be included even in advanced age.
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Sepsis is a complex systemic inflammatory reaction in response to an infection and must be treated as an emergency. The diagnosis of sepsis is often delayed even though early goal-directed resuscitation and therapy with antibiotics within the first hours can reduce sepsis-related mortality. This article presents the most important points concerning the pathophysiology, diagnosis and therapy of sepsis.