Revue médicale de Bruxelles
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The initial management of Parkinson's disease and is adaptation is presented. Levodopa remains the most efficacious treatment of the disease. However, with the long term, the efficacity of the drug is slowing down and secondary effects are frequent. ⋯ If the patient is younger than 65 years, we would usually start therapy with a dopamine agonist because of the lower risk of motor complications. Levodopa is a potent alternative and can be given if there is an inadequate response to the agonist. When motor complications are present, some options are usefull like the administration of dopaminergic agonists or apomorphine, the utilisation of inhibitors of the dopamine catabolism, the deep brain stimulation and the jejunal administration of dopa.
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Since September 2002, more than 2.000 legal euthanasia's were performed in Belgium. The present paper reviews the necessary steps to be followed by the physician for a correct achievement of the process initiated by the patient's demand to die. Interpretation of the legal conditions to be respected by the physician is discussed from reports of ten cases of requests for euthanasia.
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Pain is an important and often under-treated symptom of life-threatening illness. A complete evaluation of pain facilitate optimal treatment. Correct use of analgesic medication, following the guidelines of the W. ⋯ O. step ladder, with attention to detail, with addition of adjuvant analgesics, should control the pain in most of the cases. The use of weak and strong opioid analgesics, their tolerance, the breakthrough doses, principle of opioid rotation and the place of adjuvant drugs are discussed. Proper pain management in end-of-life is never easy and require to become more familiar with the use of these analgesics and to surround oneself with a multidisciplinary team.
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Conforming to the Belgian Law on Euthanasia of 28 May 2002, the definition of euthanasia is "an act practised by a third party intentionally, ending the life of a person at that person's request". Doctors who practise euthanasia commit no offence if they follow the prescribed conditions and procedures. The voluntary, well considered request for euthanasia must be initiated by an adult patient, complaining of unbearable physical or mental suffering caused by a serious and incurable medical condition, whether accidental or pathological. ⋯ This law on the de-criminalization of euthanasia recognizes the right of personal autonomy for the patient and the principle of freedom of conscience for everyone. The law refers explicitly to the concept of euthanasia but does not specify the method to be used by the doctor. If it is the wish of the patient, and if the physical condition of the patient allows this solution, "assisted suicide" is permitted.
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Acute renal failure is still associated with a high mortality rate among intensive care patients, despite improvements in renal replacement therapies. The available intermittent and continuous renal replacement therapy techniques all have their own advantages and disadvantages. ⋯ For these reasons, daily consultation between intensivists and nephrologists is necessary to select the best technique for the ICU patient with acute renal failure, based on the hemodynamic status, biological variables (uremia, coagulation, acid-base balance, electrolytes) and effects on other organ systems (cognitive state, pericarditis, myopathy). In the future, new markers of renal dysfunction may facilitate treatment choices.