Wiener medizinische Wochenschrift
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On the basis of a case study, the complex problems of the final stages of a COPD will be demonstrated and discussed. Dyspnea and anxiousness are the primary symptoms. ⋯ It is important to be aware of the specific needs of the patient and of his/her family members, and to competently accompany the patient throughout the decision-making process--such as the decision to end respiratory therapy, for example. Clarifying the situation with the patient and finding out his/her wishes, accompanied by the corresponding documentation, is advisable.
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Therapy and the handling of dyspnea in the last period of one's life is described and discussed from a case report. A patient with lung cancer and a distinct chronic obstructive pulmonary disease is presented. His coping with increasing dyspnea and the therapeutic strategies are described. Problems with the side effects of therapy and coping strategies are dealt with, too.
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On the basis of a case study, the author looks for parallels in her own biography. To what extent are professional helpers helpless when it comes to the point of dealing with one's own relatives?
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Wien Med Wochenschr · May 2006
Case Reports[Intravenous S-+-ketamine for treatment of visceral pain in the final phase].
Ketamine is a hypnotic pharmacon with high analgesic potency. Ketamine is an agent blocking NMDA-receptors and involves opioid receptors, the voltage-gated sodium-channel, cholinergic receptors and the monoaminergic descending inhibitory pathways. Besides its influence in chronification of pain, NMDA-R is crucial in induction and maintainance of visceral pain, attentional perceptual processes and emotional valuation of pain. ⋯ In the presence of chronic pain states the effect ought to be more marked. There is evidence that the probability of psychotomimetic side effects does not exceed 10%. The rate of side effects can further be minimized through careful titration and prophylaxis (or treatment) with Diazepam 1 mg i.v.
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Wien Med Wochenschr · May 2006
Case Reports[Is it possible to avoid pathological grief if relatives of patients with palliative diseases are supported?].
The transition from normal to pathological grief is smooth. If it is almost impossible to define normal grief with all the existing descriptions of grief phases and systematic models, then it is all the more difficult to define pathological or complicated grief, especially as the existence of remaining grief, or remaining grief that rises to the surface again through memories, are considered normal processes of grief. ⋯ The response to grief in this case report seems to be pathological or complicated because the process involved in grieving has been replaced by a kind of emotional stagnation, marked by aggression and a feeling of guilt. The family-centred therapeutic approach, taking in the whole family and aimed at discovering potential risk factors for the relatives and the strain they are under, as well as a recognition of the next-of-kin as "secondary patients" have an important role to play in the avoidance of pathological grief.