Schweizerische Rundschau für Medizin Praxis = Revue suisse de médecine Praxis
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Half of the patients with advanced cancer suffer from shortness of breath. This may be due to the cancer itself, result from its treatment or arise from concurrent conditions. ⋯ Treatment should be directed toward altering the underlying pathological process as far as possible (e.g. tumour reduction or pleural puncture). The relieve of symptoms by reassuring presence and morphine application are the mainstay, when it is not possible to reverse the cause of dyspnea, and can also successfully complement specific therapy.
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Dyspnea can be defined as an unusual perception of respiration and/or urge to breath more than usual. Up to 70% of all tumour patients suffer at one time from this complaint, and often only an incomplete palliation is achieved. Dyspnea in the tumour patient is often associated with anxiety, which leads itself to a further exacerbation of dyspnea (through increased respiratory work and dead-space ventilation). ⋯ Therapeutic measures include bronchoscopic suction of retained secretions and physical measures to reduce secretions. Supplemental oxygen is indicated in hypoxemic patients and in those who derive benefit of it. The nonspecific drug therapy with benzodiazepines and/or opiates remains clinically useful, although its efficacy is questioned by some controlled studies.
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Schweiz. Rundsch. Med. Prax. · Dec 1991
[Orthotopic liver transplantation--indications and results].
Indications for and results of orthotopic liver transplantation (OLT) were modified over the past ten years by new immunosuppressive agents, earlier timing of transplantation and better knowledge of potential complications. In 1990, OLT appears justified in the treatment of all liver disease threatening life, in the absence of contraindications and other possible treatments. Between July 1987 and December 1990, 21 patients were transplanted at the Geneva University Hospital. ⋯ Four OLTs had to be performed in an emergency situation. Two patients died within six months of transplantation, one after 7.5 months, and the last patient died after one year from cancer recurrence. 17 patients are presently alive (81%) at 4 to 39 months (median 14 months) following OLT. More than the mere survival, however, the quality of life regained after transplantation prompts us to consider transplantation early in the progress of the disease.
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Schweiz. Rundsch. Med. Prax. · Nov 1991
Case Reports[Demand-controlled continuous spinal-cerebral morphine administration via an implanted programmable pump].
The significance of the demand-controlled spinal and cerebral administration of morphine has increased with the improvements in the variable techniques (including programmable implanted pumps). Continuous low-dose infusion enables sustained pain-free state with minimal risks and side effects, so that this method is also feasible for treatment of very severe therapy-resistant pain in benign conditions. ⋯ In our view, the assumption that spinal and cerebral application of morphine is not appropriate in deafferentation pain is not justified on the basis of the most recent discussions and our own observations. Merely higher doses are probably required for this type of pain.
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The multifactorial aspects of rehabilitation of hemiplegic patients are reported. Medical and neuropsychological aspects as well as the significance of therapies, such as occupational and language training, physiotherapy and recreation therapy, are discussed. The importance of the role of the family, the architectonic aspects, institutional placement, an early start to rehabilitation and the limits are emphasized.