Therapeutische Umschau. Revue thérapeutique
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Many patients with advanced diseases complain about refractory breathlessness when breathlessness is present although the underlying disease is optimal treated. After exclusion of potential curable causes of breathlessness, management of refractory breathlessness includes general approaches, pharmacological (opioids) and non-pharmacological (e.g. handheld fan, rollator) interventions. Oxygen should be used far less than used in clinical practice at the moment and needs critical appraisal of effectiveness.
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In the last 15 years the Fast Track Concept or Enhanced Recovery after Surgery (ERAS) as a clinical pathway for improving perioperative care, maintaining physiological functions, reducing intraoperative stress and shortening the length of hospital stay, has become more common in colorectal surgery. After first promising results in prospective studies an expert group developed recommendations of a modified, multimodal Fast Track Concept in 2009. Main elements in this concept are laparoscopy, no nasogastric tubes, perioperative peridural anaesthesia and quick mobilisation of the patient after surgery. ⋯ Furthermore the Fast Track Concept constitutes a challenge for the interdisciplinary collaboration of all involved treatment groups. Especially the postoperative outpatient treatment remains a problem due to unavailable rehabilitation capacities or ambulant care. Therefore a proper preoperative planning of the Fast Track Concept and the outpatient care should be performed interdisciplinary by the surgeons and the general practitioners.
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Aiming at primary wound healing, the majority of surgical interventions end with a wound closure. The wound edges are brought together and secured using sutures, staples or glue, respectively. A common surgical wound therefore tends to undergo an orderly and timely repair process with the result of sustained restored anatomic and functional integrity. ⋯ In the last two decades, negative-pressure wound therapy has been one of the major innovations in wound care. In addition to acting as an occlusive dressing, it may increase blood flow to the wound site, decrease edema, decrease bacterial contamination, and promote wound contraction. Further strategies to enhance wound healing or scar formation still under investigation include growth factors or regenerative cell therapy.
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Hand transplantation has been indicated in selective patients after traumatic upper extremity amputation and only performed in a few centers around the world for the last decade. In comparison to solid organ transplantation, there is a challenge to overcome the host immunological barrier due to complex antigenicity of the different included tissues, the skin being the most susceptible to rejection. ⋯ Current research is working towards the understanding mechanisms of composite tissue allograft (CTA) rejection. Worldwide, in 51 patients 72 hands (21 double hand transplants) and once both arms have been successfully transplanted since 1998.
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The introduction of monoclonal antibodies has been a milestone in the treatment of hematologic neoplasms. The CD20 antibody rituximab has been a trailblazer and represents meanwhile a fixed combination partner of different first- and second-line chemotherapies in CD20-positive B-cell-non-Hodgkin's lymphoma (NHL). Rituximab maintenance is established in follicular lymphoma. ⋯ Rituximab was followed by the CD52 antibody alemtuzumab and recently by the CD20 antibody ofatumumab for the therapy of CLL and the radioimmunconjugate ibritumomab-tiuxetan indicated for the treatment of refractory or relapsed CD20-positive follicular lymphoma or as consolidation after induction chemotherapy. In the near future, approval of several new antibodies is expected. For the treatment of refractory or relapsed Hodgkin's lymphoma and relapsed systemic anaplastic large cell lymphoma, the CD30 antibody brentuximab vedotin has been shown to be a highly active new treatment option.