Wiener medizinische Wochenschrift
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Wien Med Wochenschr · Jan 2001
Review Comparative Study[Therapy of invasive organ mycoses in patients with systemic hematologic diseases].
Fungal infections have increased substantially in patients with acute leukemia as well as in patients receiving allogeneic stem cell transplantations. Most frequently Aspergillus ssp. and Candida ssp. are observed. Despite the recent introduction of new azoles and lipid-based formulations of amphotericin B, there are few randomized, controlled studies on the use of antifungal drugs in patients with proven invasive fungal infections. ⋯ An additional serious problem is an emerging resistance of non-albicans species to fluconazole. Lipid-formulations of amphotericin B seem to be attractive alternative, but considerably higher medical costs limit broader application of lipid formulations of amphotericin B. The current strategies for the treatment of documented fungal infections as well as the role of new antifungal agents are discussed in this review.
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Hallucinations are perceptions lacking any extern or physical stimulus. They can affect all senses and may occur in the course of different physical or psychiatric diseases. ⋯ It is important not only to diagnose the basic disorder or illness but also to deal with the patient's anxiety, respect his/her perceptions and to try to establish alternative models of explanation. Apart from therapy of the underlying disorder it is wise to recommend psychotherapy and the attendance of self-help groups.
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Wien Med Wochenschr · Jan 2001
Review Comparative Study[Antifungal prophylaxis in neutropenic patients].
During the last two decades the incidence of systemic fungal infections has been rising steadily. The prognosis of infected patients is often poor and the therapeutic strategies are limited. The prophylaxis of systemic fungal infections thus appears worthwhile. ⋯ Due its toxicity profile prophylactic amphotericin B should be used only for selected cases and in clinical studies. Nystatin can be used topically whenever topical amphotericin B is not well tolerated. All currently available prophylactic antimycotics bear the risk of either unsatisfactory effectiveness or severe toxicity.
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Wien Med Wochenschr · Jan 2001
Review[Exhaustion and fatigue--a neglected problem in hematologic oncology].
Exhaustion and tiredness are frequent symptoms in cancer patients. They are caused by the tumour itself and by application of chemotherapy, surgery, radiation or cytokine treatment. Exhaustion and tiredness are not a consequence of lacking sleep or exaggerated physical or mental labour, but are due to several other factors: Anemia, tumour cachexia, toxicity of chemo- and radiation treatment probably are the most decisive factors for the development of exhaustion and tiredness. ⋯ However, regarding lacking interests, diminished energy and reduced mental capacity, exhaustion and fatigue partly overlap. From a therapeutic point of view behavioural interventions and drug therapy have successfully been tried. Beside physical exercise and psychostimulants application of Erythropoietin represents an innovative treatment of exhaustion and tiredness.
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Wien Med Wochenschr · Jan 2001
Review[Neuromodulation as an alternative method in the treatment of refractory angina pectoris].
Epidural stimulation of the spinal cord affects the activation of afferent nerve fibres. Patients refractory to conventional therapy of angina pectoris can be treated with epidural stimulation since 1985. The stimulation electrode is inserted by a small incision to the skin at Th4-Th5 and positioned to the epidural space at Th1-C7. ⋯ Clinical trials demonstrated increased exercise tolerance, reduction in severity of exertional angina and ST-depression and reduction of nitrate dosage. No impairment of overall prognosis by neuromodulation has been shown in several clinical studies. Epidural spinal cord stimulation represents an alternative therapy for the treatment of selected patients with angina pectoris refractory to conventional therapy.