Schweizerische Rundschau für Medizin Praxis = Revue suisse de médecine Praxis
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Schweiz. Rundsch. Med. Prax. · Mar 1993
Review[Pain assessment and documentation in patients with tumors: theory and reality].
Each tumor patient with pain is not only entitled to a careful diagnostic workup and to effective treatment of his pain syndrome, but also to a clear and useful documentation of the course of his pain(s). This documentation ('pain evolution chart') should at least include the main location(s) of the treated pain and the varying pain intensity during the course of the day as well as at night. A respective pain documentation instrument, the St. ⋯ The 'pain evolution chart' should be a regular part of the patient's hospital chart, as it forces the patient and his care-givers to cope more constructively with the present pain syndrome. The (well instructed) patient himself is responsible for an accurate and realistic pain documentation. Such longitudinal 'pain evolution charts' are not only useful for clinical oncology practice but also for clinical pain and analgesic research.
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Pain as a psychophysical experience and in particular its treatment have always been--and are particularly nowadays--an essential problem in medicine. Beyond that pain has a multitude of connections to human existence. The phenomenon of pain appears in almost all areas of art (painting, sculpture, music and poetry), philosophy and the religions. ⋯ Both belong together in an inseparable act of passive acceptance and active creative experience. Whereas the phenomenon of pain has earlier been seen in its alternative respective components such as physical or spiritual, it is in modern times, following the holistic perception of medicine, regarded as complementary. This complementary view is also the basis for the various forms of combined pain-treatment in use today.
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Mortality and physical impairment in patients undergoing cardiac surgery are to a large extent due to cerebro-vascular complications that are second in frequency only to cardiopulmonary incidents. In spite of the extracorporeal circulatory support as well as progress in cardiac surgery that have improved the perioperative conditions, neurologic complications mainly of embolic nature are still common after extracorporeal circulatory assistance.
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Schweiz. Rundsch. Med. Prax. · Dec 1992
Case Reports[Drug-induced hyperprolactinemia and galactorrhea].
A 21 year old female treated for recurring gastric troubles with dopamine-antagonists (domperidone, metoclopramide) developed a clinically manifest hyperprolactinemia (3055 microU/l; normal value < 650 microU/l) with galactorrhea only two days after a new two day course of metoclopramide. The drug was withdrawn and within days mastodynia and galactorrhea subsided. A control of plasmatic prolactin two weeks later yielded a normal value (358 microU/l). ⋯ It is unclear why this patient inspite of repeated administration of one dopamine antagonist remained asymptomatic whereas the other after a short time and only a few doses led to galactorrhea. It is conceivable that differences in passage into the cerebrospinal fluid or the better penetration of the blood-brain barrier favored the development of galactorrhea under metoclopramide. This case served to discuss the pathophysiologic background of drug-induced hyperprolactinemia.
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Schweiz. Rundsch. Med. Prax. · Nov 1992
Review[Diagnosis of neurological symptoms of psychogenic origin].
The principles of neurological examination of patients in which psychogenic disturbances are suspected are first described. After mentioning the frequency of this type of disturbances in the medical literature, some of the most characteristic and most frequent psychogenic disturbances in neurology are described: cranial nerve symptoms, sensory disturbances as well as psychogenic paralysis including paraplegia and psychogenic disturbances of gait. ⋯ Finally a description is given of those organic neurological diseases in which in our experience the erroneous diagnosis of psychogenic disturbances is most frequently made. Some recommendations, how to behave in the presence of a patient with psychogenic neurological symptoms is added.