Wiener medizinische Wochenschrift
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Wien Med Wochenschr · Nov 2010
Review Comparative Study[Possibilities in oncoplastic and reconstructive surgery for patients with breast cancer].
Although systemic treatment strategies are improving continuously, breast surgery still plays a central role in the management of breast cancer. Because breast conserving therapy is feasible in more than two thirds of breast cancer patients, breast surgeons should be aware of the different oncoplastic techniques. The development of skin sparing techniques combined with immediate reconstruction provides good cosmetic results in many cases in which mastectomy is required. Therefore the reconstructive element should be offered and integrated in the therapy plan as soon as mastectomy is indicated.
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Complete axillary lymph node dissection has been the traditional operation to determine whether cancer has spread beyond the breast. In the large majority of patients with breast cancer, lymphatic mapping and γ-probe-guided and/or blue dye sentinel node biopsy can be used to locate the first node in the axilla, and thereby provide important information about the status of axillary nodes. ⋯ Thus, they may be spared complete axillary dissection if the sentinel node is negative. Decreased arm swelling and pain are associated with sentinel lymph node biopsy compared with axillary lymph node dissection.
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Wien Med Wochenschr · Sep 2010
ReviewChondrosis of the disc - risk factor for osteoporotic vertebral fractures (biomechanical analysis).
Based on biomechanical analysis, we present an until now unrecognised new view on pathological interactive relations in basic functional motor segments of the spine (vertebra - disc - vertebra), elevating the risk of osteoporotic vertebral fractures. They are classified as follows: 1. Degenerative alterations of intervertebral disc (chondrosis); 1a) decrease of intervertebral disc viscoelasticity; 1b) increase of compressive and tensile stress in the intervertebral disc. ⋯ Osteoporosis of vertebrae; 2a) decrease of vertebra elasticity and strength; 2b) phenomenon of local elevated compressive stress in the vertebra fracture site. In the vertebral body endplate infraction or fracture site develop a locus minoris of resistance and it contributes to the progression of breaking the vertebra and its whole compression by loading the spine with compressive force. With regard to the fact that above-mentioned risk factors are influenceable, we suggest preventive measures.
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Hypoplastic infrarenal aorta or infrarenal aortic coarctation is an uncommon vascular pathology characterized with diffuse stenosis in the infrarenal abdominal aorta. It is a variant of atherosclerotic occlusive diseases. ⋯ Here, we report a 49-year-old male patient diagnosed with abdominal aortic coarctation together with the review of the literature. He underwent successful revasvcularization of the lower extremities.
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This article discusses ethical implications of palliative sedation at the end of life. Terminal or palliative sedation, like other denominations are discussed in literature, which invite to a profound discussion. From an ethical point of view, terminal or palliative sedation seems to be a way out when in intolerable suffering or situations without prospects, the demand for euthanasia arises. ⋯ This has led to ethical concerns on the use and limits of sedation. Therefore it seems to be necessary to elaborate clear guidelines in handling sedation in end-of-life care to prevent misuse. The contribution of ethical considerations can clarify the position and use of palliative sedation.