Therapeutische Umschau. Revue thérapeutique
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Palliative Care is an approach that improves quality of life of patients in complex situations with life-threatening illness. The relief of suffering is important. In this meaning palliative care has a lot to do with symptomatic therapy, because we can't treat the underlying illness. ⋯ We have only one evidence-based pharmacological treatment of dyspnoea, that's morphine. The decision whether to give or not nutrition to a patient with advanced cancer or advanced dementia seems to be a difficult one. But if we have a look into the literature it's much easier to decied, because there is almost no advantage for the patient if we nourish him.
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Polymyalgia rheumatica and Fibromyalgia are probably not distinct clinical entities. Rather polymyalgia rheumatica is the common denomiator of a large spectrum of different diseases. ⋯ Similarly, fibromyalgia is one manifestation of chronic pain syndromes of undetermined etiology. In addition, fibromyalgia can often not be delineated clearely from functional disorders, including depression.
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Medication overuse headache (MOH) occurs in about 1% of the general population. A marked increase of its prevalence has to be expected in the future, since more and more adolescents are subject to medication overuse. The revised International Classification of Headache Disorders contains detailed diagnostic criteria for headache due to particular groups of substances. ⋯ Long-term treatment for headache is ineffective during medication overuse. Relapse rate is variable depending on the substance overused, and may be considerable. Therefore, prophylaxis in patients with migraine or chronic tension type headache who do not yet suffer from MOH, is essential.
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North American Lyme disease and European borreliosis differ in many aspects: Whereas in North America infection by Borrelia burgdorferi sensu stricto almost invariably leads to erythema migrans, frequently followed by oligoarthritis in untreated individuals, most infections in Europe are caused by Borrelia garinii and Borrelia afzelii and are contracted asymptomatically. A minority of the infected individuals develop neuroborreliosis, consisting of various combinations of meningitis, radiculitis and (cranial) neuritis. ⋯ Diagnostic limitations and the protean manifestations of Lyme borreliosis frequently give rise to misunderstandings and overdiagnosis of Lyme disease. Targeted use of Lyme serology, judicious application of a case definition, strict adherence to established treatment options and thorough patient information may lead the narrow path between unjustified exclusion and careless assumption of the diagnosis of Lyme borreliosis.
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The child who presents with acute coma runs a high risk of cardiopulmonary insufficiency, direct brain injury or even cerebral herniation. The case-management of such child requires a coma-specific emergent evaluation, immediate treatment of any hypoxicischemic insults and of the underlying cause. The coma-specific examination includes performance of child-adapted Glasgow Coma Score, the evaluation of brain stem functions such as pupillary response to light, cough- and gag reflex, and determination of all vital signs including body temperature. ⋯ Immediately treatable causes are hypoglycemia, meningitis/encephalitis, opioid overdose and status epilepticus. Exclusion of rapidly progressive intracranial lesions almost always requires referral to the tertiary centre with head CT-scan facilities. Finally, an extensive etiology search of the stable coma is performed by looking for disease or trauma of the brain, for metabolic causes, for intoxications and for cardiopulmonary problems.