Wiener klinische Wochenschrift
-
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.
-
During the past years perinatal mortality in diabetic pregnancy has been lowered significantly, in special collections with highly motivated diabetic women even below 2%. In case of optimal metabolic control and absence of diabetic angiopathy the perinatal survival rate is identical to that in normal pregnancy. But adequate metabolic control cannot be reached in all pregnant women during the whole period of gestation, and pre-existing diabetic angiopathy exists frequently; therefore diabetic pregnancy will be associated with elevated perinatal mortality and morbidity also in the future. ⋯ Diabetic women with macroangiopathy, especially with coronary artery disease show a high risk for cardiovascular events during pregnancy. The occurrence of acute myocardial infarction in pregnant diabetic women is associated with elevated fetal and maternal mortality. Though there are case reports in the literature describing a successful fetal and maternal outcome after myocardial infarction during pregnancy.
-
Wien. Klin. Wochenschr. · Jan 1994
Review["Small volume resuscitation"--does it open new possibilities in the treatment of hypovolemic shock?].
Hypertonic-hyperoncotic solutions are a supplementation to conventional fluid regimens in the management of hypovolemia due to trauma, hemorrhage and shock. In this review the possible modes of action of these solutions are discussed and their efficacy both in experimental and clinical settings is presented. Possible side effects, such as hypernatremia and possible problems in the presence of increased intracranial pressure, following administration of hypertonic-hyperoncotic solutions are discussed, as well as the reaction of normovolemic patients to such infusions.
-
In spontaneous breathing intrathoracic pressure alternates between positive and negative in a biphasic sequential pattern. By contrast, during mechanical ventilation (IPPV, CPPV) the intrathoracic pressure remains above atmospheric all the time. ⋯ In order to minimize these deleterious effects of positive pressure ventilation it is essential to keep the procedure as short and little invasive as possible. The following strategy enables this goal to be brought closer: 1) early commencement of ventilation; 2) optimal adjustment of artificial ventilation to the individual needs of the patient, 3) early weaning from assisted ventilation through augmented rather than controlled modes of ventilation: 4) kinetic therapy (systematic changing of the patient's position) with the back up of the requisite thoracic CT scan findings; 5) reduction of the invasiveness of the procedure in order to ensure early commencement of spontaneous respiration.
-
Seasonal changes in human behavior have been recognized since ancient times. Starting in 1980 systematic research has been carried out by Rosenthal et al. (1984), who described and characterized a psychopathological and clinical syndrome which is linked to fall/winter and shows remission in spring/summer and which was termed seasonal affective disorder (SAD). ⋯ The efficacy of light therapy with bright, fluorescent, full-spectrum light has been widely demonstrated for treatment of fall/winter SAD. In addition, treatment with selective serotonin reuptake inhibitors appears to be successful in this condition.