Der Urologe. Ausg. A
-
Der Urologe. Ausg. A · Feb 2009
Review[Secondary hormonal ablation in hormone-independent prostate cancer].
After an average of 18-24 months under androgen suppression therapy, almost all patients with prostate cancer show a PSA progress. At this hormone-independent stage, a PSA regress can be achieved by secondary hormonal manipulation in approximately 50% of patients for 6-12 months before they become hormone-refractory. After progress under complete androgen ablation, in 40% of cases a temporary regress can be achieved by discontinuing of the anti-androgen. ⋯ Inhibition of the adrenal testosterone synthesis by oral administration of ketoconazol can further delay disease progression. Transdermal application of estrogens also allows temporary control of tumor activity by modulating the LHRH and testosterone release as well as directly effecting tumor cell apoptosis. Recent therapeutic modalities as for example somatostatin analogues influence the microenvironment of tumor cells and thereby intensify the effect of anti-tumor therapy.
-
Since 1990, laparoscopic surgery has undergone a tremendous evolution. As patients and surgeons alike push toward minimally invasive surgery, more and more complex operations have been performed by laparoscopy. However, highly complex and technically demanding procedures--such as radical prostatectomy--have revealed the limits of classical laparoscopic surgery. ⋯ As of April 2008, 120 urological operations had been performed. Because robotic surgery is associated with a specific learning curve, divisions with limited case numbers may refrain from doing this type of surgery. The aim of this article is to evaluate the feasibility and efficiency of the initial period of a robotic program in a midsize division.
-
Pain therapy and palliative medicine have gained new importance in medical treatment in recent years. Pain is no longer considered an acceptable evil; in fact, awareness has increased that even in tumor patients and those with chronic pain the available options for special pain therapy can provide long-term pain relief. Pain therapy is not limited to these fields but applies to all areas of medicine. ⋯ She is charged with ordering inappropriately high doses of morphine and in part excessive administration of diazepam. Legal practice shows however that the predominant number of preliminary criminal proceedings and civil liability lawsuits do not involve pain specialists and palliative physicians, but rather other specialties such as the surgical disciplines and patient care. This is not surprising since good pain therapy is at present expected in all branches of medicine but obviously those fields not specialized in this subject lag further behind in these expectations than those already dedicated to pain therapy or palliative medicine.
-
Symptoms involving the gastrointestinal tract are very common in patients who require palliative treatment. They can be caused by the patient's underlying (malignant) disease or by the treatment of this disease. Nausea and vomiting as well as constipation are of the utmost importance in this context due both to their frequency as well as their complex consequences. A careful evaluation of the patient's history combined with a few diagnostic procedures will help to provide a treatment which is orientated on pathophysiology.
-
Terminal illnesses can cause distressing symptoms such as severe pain, mental confusions, feelings of suffocation, and agitation. Despite skilled palliative care in some cases these symptoms may not respond to standard interventions. After all other means to provide comfort and relief to a dying patient have been tried and are unsuccessful, clinical caregivers and patients can consider palliative sedation. ⋯ Palliative sedation is not intended to cause death or shorten life. The patient and family should agree with plans for palliative sedation. Because cases involving palliative sedation are emotionally stressful, the patient, family, and health care workers can all benefit from talking about the complex medical, ethical, and emotional issues they raise.