Therapeutische Umschau. Revue thérapeutique
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Brain metastases occur in 20-30% of patients with systemic cancer and represent one of the most unfavourable prognostic parameters. In the majority of cases brain metastases are multiple and are usually treated with whole brain irradiation. The treatment of single brain metastases often includes surgery, followed by whole brain radiotherapy. ⋯ As long as high quality studies are not available, any definitive assessment of the relative effectiveness of radiosurgery to standard treatment for brain cannot be defined. Radiosurgery can be used to treat patients, whose metastases recur after traditional therapies. As with other definitive therapies for patients with brain metastases, highly functional patients with well-controlled systemic cancers derive the greatest benefit from treatment with radiosurgery.
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Noninvasive mechanical ventilation is provided without establishing an endotracheal airway. In acute respiratory failure due to chronic obstructive lung disease, noninvasive positive-pressure ventilation delivered through a nasal or face mask may eliminate the need for intubation and related complications, reduce the duration of hospitalisation and improve survival compared to assisted ventilation through an endotracheal tube. ⋯ During introduction of noninvasive ventilation, patients must be monitored closely. Patient selection and information, meticulous optimization of the ventilator settings and delivery system, education and experience of the personnel have an important impact on the success of this novel way of providing mechanical ventilatory support.
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Tendinopathies as a result of fluoroquinolone therapy represent a new clinical entity. We report on tendinitis and tendon rupture in six fluoroquinolone treated patients of our outpatient and dialysis service between 1995 and 1997. The most important risk factors for tendinopathies were renal failure in all cases, glucocorticosteroid therapy in five patients, secondary hyperparathyroidism in three patients, advanced age in two patients, and diabetes mellitus in another patient. ⋯ Therefore, care should be used in prescribing fluoroquinolones to older renal transplant or hemodialysis patients with additional risk factors for tendinopathies. These drugs should be stopped when symptoms of tendinitis occur, particularly to prevent tendon rupture. The incidence of fluoroquinolone induced tendinopathies in patients without renal diseases is unknown.
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Tuberculosis is a continuous threat for health in all parts of the world. In industrialized centers an emerging increase of tuberculosis is observed due to low health standards, poor health education and control, increasing migration and the HIV epidemic. ⋯ In general incidence, morbidity and mortality of tbc in children of the western world is low and has good prognosis. However, the diagnostic principles and the education of pediatricians for recognizing tbc is still of utmost importance.
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Lyme borreliosis in childhood is a tick-borne disease that includes a variety of clinical symptoms in different organs. Most frequently dermatological manifestations such as erythema migrans and borrelial lymphocytoma are observed. Uni- or bilateral peripheral facial palsy and meningitis with lymphocytic pleocytosis represent typical symptoms of neuroborreliosis. ⋯ Lyme borreliosis in childhood is characterized by a good prognosis. At the present time, many efforts are given to the development of vaccines using subunits of the different genospecies of Borrelia burgdorferi. First clinical trials with Lyme borreliosis vaccines have been started.