Wiener medizinische Wochenschrift
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Wien Med Wochenschr · Feb 2010
[Invasive tumor pain therapy in the final stage of a cervix cancer patient].
Cancer disease is associated with a lot of very burdening symptoms. Pain is with dyspnea and emesis in the first time in a rate of about 50%, in the terminal stage up to 90% the most tormenting symptom. For more than 90% of patients the 3-step-WHO-regimen for cancer pain is able to relieve pain successfully. ⋯ The following case-report shows the steps of a difficult cancer pain therapy in a regional general hospital. It is sometimes not evidence based, on the one hand because of necessary organizational, staff-related, or other makeshifts in daily clinical practice, on the other hand because of the lack of appropriate EBM-guidelines. The pressure to reduce the pain effectively and as simple as possible produces sometimes polypragmatic, retrospective not always satisfying measures.
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Wien Med Wochenschr · Jan 2010
ReviewDiabetes and Cardiovascular Disease: Is intensive glucose control beneficial or deadly? Lessons from ACCORD, ADVANCE, VADT, UKPDS, PROactive, and NICE-SUGAR.
Type 2 diabetes is a rather complex metabolic disorder still associated with a 2-fold increased cardiovascular (CV) mortality despite a dramatic improvement in CV risk reduction by multifactorial intervention strategies. Intensive glucose control can also reduce CV morbidity, but this effect seems to be limited to younger patients with shorter duration of disease and no CV disease. ⋯ In contrast to blood pressure and lipid-lowering interventions a reduction of CV mortality cannot be seen before 10-20 years after the start of the glucose-lowering intervention (metabolic memory, legacy effect). Future ongoing outcome studies in more than 50,000 patients will clarify whether new antidiabetic drugs--not inducing hypoglycemia or weight gain--will further improve the prognosis of T2DM patients.
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Wien Med Wochenschr · Dec 2009
ReviewPathophysiology and diagnosis of dyspnea in patients with advanced cancer.
The reported prevalence of dyspnea in patients with various cancers ranges from 19% to 64%. For optimal clinical management of dyspnea in cancer patients, accurate diagnosis of the underlying cause and thorough understanding of the pathomechanisms of dyspnea seems mandatory. ⋯ These should be performed immediately to enable quick treatment decisions. In addition, self assessment of the intensity of dyspnea by the patient may help to assess patient's needs as soon as possible.
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Wien Med Wochenschr · Dec 2009
ReviewManagement of dyspnea in patients with chronic obstructive pulmonary disease.
A progressive and debilitating illness, chronic obstructive pulmonary disease (COPD) has major worldwide impact. In addition to the care for underlying causes of disease, COPD treatment involves palliative intervention to address associated symptoms; in later stages of disease, when the underlying disease has been maximally treated, symptom management assumes primacy as the goal of care. Dyspnea is the most distressing symptom experienced by COPD patients. ⋯ Numerous pharmacologic and non-pharmacologic interventions are available to achieve these goals, but supporting evidence is variable. This review summarizes options for managing refractory dyspnea in COPD patients, referring to the available evidence and highlighting areas for further investigation. Topics include oxygen, opioids, psychotropic drugs, inhaled frusemide, Heliox28, nutrition, psychosocial support, and breathing techniques.