Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Jan 1996
[Intraventricular morphine administration as a treatment possibility for patients with intractable pain].
The treatment of intractable pain, especially in cancer patients, often sets problems to patient and therapist. While epidural and intrathecal spinal administration of opiates is a routine treatment in pain with a sub-diaphragmatic topography it is almost ineffective in cervicocephalic or thoracic cancer. An alternative here is the administration of morphine into the lateral or third ventricle by a catheter-reservoir system. ⋯ Analgesia takes effect within a few minutes and the necessary doses are low. Our results agree with those of other authors describing good to excellent results in 95% of patients with somatogenic pain. However, no or only minimal effect is achieved in the treatment of neurogenic pain by intracerebroventricular morphine therapy.
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Wien. Klin. Wochenschr. · Jan 1996
Biography Historical Article[Rudolf Ekstein's contributions to psychotherapy and child psychiatry].
Rudolf Eksteins scientific career is closely linked to his personal history, with his Jewish heritage, his political involvement and his social work with young people, which guided him towards psychoanalytic educational theory. Following his forced emigration to the USA in 1938 he became a world-famous child therapist, psychoanalyst, scientist and professor of medical psychology at the Department of Psychiatry, UCLA. The most significant areas of Eksteins extensive scientific output are described in an attempt to do justice to his contributions to psychotherapy and child psychiatry. ⋯ His underlying concept of schizophrenic psychosis and borderline personality disorders in children is outlined. Further, we have tried to show in what way his contributions to psychoanalytic theory and techniques were influenced by his profound knowledge of philosophy and linguistics. Finally Eksteins dedications to the teaching and learning of psychotherapy is stressed, from which a whole generation of Austrian psychiatrists, psychologists and pedagogues have profited enormously, as a result of his long-standing teaching commitments as guest professor at Vienna University.
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Wien. Klin. Wochenschr. · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialThe management of pneumothorax with the thoracic vent versus conventional intercostal tube drainage.
The thoracic vent is a new minimally invasive device for the treatment of spontaneous and iatrogenic pneumothorax. It consists of a polyurethane catheter connected to a plastic chamber containing a one-way valve. As there is no need to connect the thoracic vent to an underwater seal device, immobilization and hospitalization can be avoided. ⋯ Hence, we have performed a randomized study comparing the treatment of pneumothorax by means of the thoracic vent versus conventional intercostal tube drainage in 30 patients, including some with tension pneumothorax. 17 patients were treated with the thoracic vent, 13 with conventional intercostal tube drainage. We found no significant differences in the rate of reexpansion and rate of complications between the group treated with the thoracic vent and the group treated with intercostal tube drainage, but the patients treated with the thoracic vent needed significantly less analgesics. 70% of the patients treated with the thoracic vent were successfully managed on an outpatient basis. All patients treated with intercostal tube drainage were hospitalised; duration of inpatient-therapy was 8 +/- 6.2 days (mean +/- SD).
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Wien. Klin. Wochenschr. · Jan 1996
Review[The value of adjuvant and neoadjuvant chemotherapy in treatment of stomach carcinoma].
The incidence of gastric adenocarcinoma has decreased dramatically in most Western countries over the past five decades. However, the five-year survival rate remains poor and late diagnosis is one of the main reasons for the lack of marked improvement in outcome. More than 50% of the patients found to have advanced local (stage T III), or systemic (stage T IV) gastric cancer at the time of diagnosis. ⋯ The efficacy of neoadjuvant chemotherapy in potentially resectable gastric carcinoma cannot be definitely assessed at the present time since only scant, preliminary findings are available. Future goals for the treatment of gastric carcinoma should include studies evaluating preoperative chemotherapy using effective, but less toxic substances, based on exact tumor-staging by means of endoluminal sonography. Furthermore, research projects investigating the value of intraperitoneal therapeutic regimens such as hyperthermic chemoperfusion or intraperitoneal instillation of the requisite substances in the prevention of intraperitoneal carcinomatosis and local recurrence will be of great importance.