Therapeutische Umschau. Revue thérapeutique
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Anesthesia in obstetrics includes the medical attendance of women in the delivery room as well as giving anesthesia for cesarean sections in the operating room. Over the last years the treatment of labor pain with epidural anesthesia has been modified. Whereas a couple of years ago local anesthetics were used almost exclusively, the recent trend goes toward a combination of local anesthetics with opioids. ⋯ Theoretically this method seems advantageous as it allows to adjust the administration of local anesthetics and opioids to the individual needs in a very refined way. Emergency situations, such as emergency cesarean sections, life threatening hemorrhage, eclampsia, and HELLP syndrome, are the main risks of the anesthetic practice in obstetrics. Their beneficial outcome is highly dependent on the coordination of logistic problems, good communication and coordination within an interdisciplinary team of obstetricians and anesthesiologists.
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Contrary to former views the incidence rate of epilepsies after age 65 are higher than in childhood and adolescence and epileptic seizures are one of the most common neurological problems in the elderly. The most common seizure types are primary focal with possible secondary generalization in about two thirds of the patients, the most common etiology are cerebrovascular disturbances, brain tumors, head injuries and degenerative diseases. Todd's pareses or other postictal disturbances are quite common. This article covers diagnostic and therapeutic aspects with special consideration of the influence of accompanying diseases (especially of the liver and kidneys) on the pharmacotherapy.
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Palliative care in the elderly appropriately takes place within a spectrum of curative, rehabilitative, preventive, and chronic disease management interventions, and seeks to optimize quality of life. Setting priorities among numerous legitimate treatment goals is the central task in the care of chronically ill frail individuals. ⋯ Pain and dyspnea are frequently reported by significant proportions of elderly individuals hospitalized for chronic lung disease, heart failure, and cirrhosis as well as for malignancies. In the treatment of dementia, the types of interventions that improve quality of life will differ in the early and late phases of the illness.
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Almost every second trekker or climber develops two to three symptoms of the high altitude illness after a rapid ascent (> 300 m/day) to an altitude above 4000 m. We distinguish two forms of high altitude illness, a cerebral form called acute mountain sickness and a pulmonary form called high altitude pulmonary edema. Essentially, acute mountain sickness is self-limiting and benign. ⋯ Mild acute mountain sickness may also be treated with the same dose acetazolamide. Glucocorticoids are the first line treatment of the malignant form of acute mountain sickness. Nifedipine is effective only for the prophylaxis and treatment of high altitude pulmonary edema.