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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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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On the basis of a case study, the author looks for parallels in her own biography. To what extent are professional helpers helpless when it comes to the point of dealing with one's own relatives?
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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.