Wiener medizinische Wochenschrift
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Concomitant and adjuvant treatment with Temozolomide, an oral alkylating agent, has significantly improved the survival of patients with newly diagnosed glioblastoma multiforme (study EORTC 26981/22981, NCIC CE3). When given with the appropriate cautiousness including weekly clinical and laboratory controls during the concomitant phase, this therapy is generally well tolerated. The observed toxicity is mainly haematological. ⋯ Most importantly, the quality of life of the patients was maintained throughout the therapy. This success has boosted the whole field of neurooncology, after a dry spell of more than thirty years for glioblastoma multiforme. Whether this concept will be applicable to other brain tumours and which schedule modifications or combinations with biologicals will improve the effectivity of therapy in brain tumours should be explored in further studies.
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On the basis of a case study, the complex problems of the final stages of a COPD will be demonstrated and discussed. Dyspnea and anxiousness are the primary symptoms. ⋯ It is important to be aware of the specific needs of the patient and of his/her family members, and to competently accompany the patient throughout the decision-making process--such as the decision to end respiratory therapy, for example. Clarifying the situation with the patient and finding out his/her wishes, accompanied by the corresponding documentation, is advisable.
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Wien Med Wochenschr · May 2006
Case Reports[Amyotrophic lateral sclerosis--when planning is almost too late].
Amyotrophic lateral sclerosis (ALS) is a disease with progressive muscle weakness, also affecting respiratory muscles. In the terminal phase most patients experience a progression. Nutrition, speech and breathing capacity decrease. ⋯ Prolonging life is only possible by invasive long-term ventilation with all the problems of intensive care measures. The patient could have been given low dose morphine from the time of the family conference. Ventilation by CPAP-mode was insufficient for him.
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Therapy and the handling of dyspnea in the last period of one's life is described and discussed from a case report. A patient with lung cancer and a distinct chronic obstructive pulmonary disease is presented. His coping with increasing dyspnea and the therapeutic strategies are described. Problems with the side effects of therapy and coping strategies are dealt with, too.
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Wien Med Wochenschr · May 2006
Case Reports[Is it possible to avoid pathological grief if relatives of patients with palliative diseases are supported?].
The transition from normal to pathological grief is smooth. If it is almost impossible to define normal grief with all the existing descriptions of grief phases and systematic models, then it is all the more difficult to define pathological or complicated grief, especially as the existence of remaining grief, or remaining grief that rises to the surface again through memories, are considered normal processes of grief. ⋯ The response to grief in this case report seems to be pathological or complicated because the process involved in grieving has been replaced by a kind of emotional stagnation, marked by aggression and a feeling of guilt. The family-centred therapeutic approach, taking in the whole family and aimed at discovering potential risk factors for the relatives and the strain they are under, as well as a recognition of the next-of-kin as "secondary patients" have an important role to play in the avoidance of pathological grief.