Wiener medizinische Wochenschrift
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Wien Med Wochenschr · Dec 2009
ReviewManagement of refractory breathlessness in patients with advanced cancer.
Breathlessness is a common and distressing symptom in advanced cancer. Management comprises non-pharmacological and pharmacological interventions, which are best combined. ⋯ Opioids are the drugs of choice for pharmacological management of breathlessness. There is currently not enough evidence to support the routine use of benzodiazepines, other anxiolytics, antidepressants, phenothiazines, inhaled furosemide and oxygen.
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Wien Med Wochenschr · Dec 2009
Review Case Reports[Nasal application of fentanyl citrate as symptom control against breathlessness in palliative care--overview and case report].
Severe dyspnoea is the most threatening symptom of the dying and one of the main reasons for undesirable hospitalisation in end of life. Especially in home care there is a need for a noninvasive, safe and highly effective method for symptom control. Fentanyl is an appropriate drug because of its fast onset and short duration of action. ⋯ Clinical experience let us assume that intranasal administration against dyspnoea is not inferior to the intravenous symptom control. In ambulant care caused by the use of the caring relatives or the patients themselves non-invasivity is a great advantage. Prospective studies are in need to prove the method.
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Wien Med Wochenschr · Dec 2009
Case ReportsOpioids for symptomatic therapy of dyspnoea in patients with advanced chronic heart failure--is there evidence?
In times of reduced mortality from myocardial infarction and ageing of the population, the number of patients suffering from chronic heart failure continues to rise. In spite of optimal cardiological treatment, many patients suffer from dyspnoea. The use of commonly used drugs in palliative care such as opioids for the relief of dyspnoea is uncommon in this group of patients. ⋯ Three randomised controlled trials with opioids could be identified. The quality of the identified studies does not support the avoidance of the use of opioids in patients with chronic heart failure to relieve dyspnoea. But further studies are recommended to support the use of opioids in patients with chronic heart failure for relief of breathlessness to improve the quality of life of this growing population.
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Wien Med Wochenschr · Dec 2009
Case Reports[Invasive and non-invasive ventilation in conflict with best palliative care in severe COPD].
This example of an 80-year-old patient with severe lung disease and respiratory failure demonstrates the difficult relationship between the patient's needs, physical symptoms, and social problems. This man decides after a prolonged and difficult in-patient treatment actively for home ventilation rather than die of respiratory failure. ⋯ It requires professional communication and support to gain the acceptance of family and caregivers for home ventilation. A survey of existing data on end of life decision-making in end-stage lung disease is given.
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Wien Med Wochenschr · Oct 2009
Review[Prevention of perioperative venous thromboembolism in children].
Venous thromboembolic events (VTE) occur in children at the time of surgery. Few guidelines about how to assess the risk and provide prophylaxis have been developed and published so far. It is uncertain if any of these guidelines have been adopted into clinical practice. ⋯ Decision for VTE prophylaxis must widely be based on individual risk assessment by experienced physicians. Newly developed scores and guidelines may provide assistance. Well designed clinical studies in children that provide proper evidence on risk assessment for VTE at the time of surgery and investigate safety and efficacy of antithrombotic prophylaxis/treatment are urgently needed.