Praxis
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Overall, pain is one of the most common symptoms associated with cancer and often produces greater anticipatory distress than other features of the disease. Drug selection depends on the intensity of pain rather than on the specific pathophysiology. Mild to moderate pain can often be treated effectively by so-called "weak" opioids. ⋯ Antidepressants, anticonvulsants and some antiarrhytmics are used as co-analgesics. Oral medication alone can guarantee pain relief in about 95% of the patients. The WHO analgesic ladder has proven effective in all settings of patients care.
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Bullet wounds are a rare occurrence during times of peace. Recently, however, there has been a general increase in the number and severity of this type of trauma in our case load. First, the possible firearms and the individual types of ammunition will be discussed. ⋯ From the therapeutic side, tetanus serum and antibiotics as a prophylactic are recommended initially. The operative treatment should take place depending on the injury with the removal of a possible projectile. Bullet wounds always require an interdisciplinary approach to treatment.
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In 1994 the International Lymphoma Study Group (ILSG) published the "Revised European-American Classification of Lymphoid Neoplasms" (R. E. A. ⋯ L. Classification forms at present the best compilation of existing knowledge upon neoplasms of the immune system, enabling cooperation between clinicians and scientists all over the world. According to the ILSG this proposal should be considered a starting point for future periodic reevaluations.
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Animal and human bites carry a high risk of infectious complications. Human bites and in particular clenched-fist injuries as well as cat bites are highly prone to infection as are wounds that involve the hand or deep structures including joints, bones and tendons. The management of bite wounds consists of intensive irrigation with large volumes of normal saline and a cautions debridement of devitalized tissues. ⋯ If a bite wound is infected, an antibiotic course with amoxycillin/clavulanic acid (first choice) or tetracyclines (second choice) for 10-14 days is recommended. In patients who present early after the injury, an antibiotic prophylaxis for 3-5 days is appropriate, particularly when the risk for the development of infection is high. Furthermore, a tetanus booster and in case of possible transfer of rabies, a rabies vaccination with immunoglobulins and inactivated virus preparation is recommended.