Therapeutische Umschau. Revue thérapeutique
-
The many different oncological concepts of gene therapy can be classified into three major groups. These include immunopotentiation, compensation of oncogene and tumor suppressor gene alterations, and suicide gene strategies. Gene marker studies and the transfer of drug resistance genes to normal cells have also shown to be of some importance in oncology. Although there is no clear demonstration of the efficacy of gene therapy so far, it will most likely become part of the therapeutic armamentarium of oncologists within the next two to three decades.
-
Guidelines in cardiopulmonary resuscitation [CPR] improve survival of patients in cardiac arrest. Programs with both Basic Life Support [BLS], promptly initiated, and early defibrillation must be designed to motivate persons trained in prehospital CPR. ⋯ Administration of 1.0 mg epinephrine iv as the drug of choice, followed by defibrillation [360 J] in patients with recurrent/persistent VF remains gold standard in Advanced Cardiac Life Support [ACLS]; epinephrine administered in the same, or higher, dosage can be repeated every 3-5 minutes followed by defibrillation within 30-60 seconds. Management of asystole and pulseless electrical activity is discussed, including the necessity to search for treatable causes as one major action, in addition to performing ACLS and administering epinephrine.
-
Basic Life Support [BLS] includes both prompt recognition and immediate support of ventilation and circulation in case of respiratory or cardiac arrest. The major objective of BLS is to provide oxygen to the heart and the brain and to sustain tissue viability until definitive electrical or medical treatment [Advanced Cardiac Life Support = ACLS] can restore spontaneous circulation. ⋯ The key for successful ACLS, especially defibrillation, is the prompt initiation of correct rescue breathing, and correct chest compressions in a patient with a cardiac arrest. Promptly and optimally performed BLS is most effective and one major key to save life, thus, both family physicians and specialists must be able to administer optimal BLS-survival will be poor if one link in the chain of survival is inadequate!
-
After initiation of cardiopulmonary resuscitation [CPR] with ventilation, chest compression and defibrillation when necessary, venous access, which allows administration of drugs and fluids, is the next measure. A large diameter peripheral vein should be the first choice and should be cannulated with a plastic catheter. If this is delayed or impossible, alternative routes such as central iv lines, intraosseous infusion or endobronchial drug administration should be considered.
-
Forensic psychiatric diagnosis and treatment should be guided by juridical goals and never be an end in itself. As a whole it is a public service concerning the interests of the perpetrators and the security of the entire population as well. Recent progress in forensic psychiatry is based on integral and comprehensive concepts. ⋯ Only an integral multiprofessional approach can be regarded as successful in the therapy of forensic high risk patients with paraphilas and aggressive impulse-control disorders. In Switzerland there is still a considerable lack of appropriate institutions for these patients. The vast amount of data accumulated during forensic psychiatric routine should be analysed in multicenter studies with scientific documentation systems to achieve progress in forensic risk calculation and efficiency of therapies.