ABSTRACT
RATIONALE: Stable isotope analysis (SIA) of free-swimming mysticetes using biopsies is often limited in sample size and uses only one sample per individual, failing to capture both intra-individual variability and the influence of demographic and physiological factors on isotope ratios. METHODS: We applied SIA of δ13C and δ15N to humpback whale (Megaptera novaeangliae) biopsies taken during the foraging season along the western Antarctic Peninsula to quantify intra-individual variation from repeatedly sampled individuals, as well as to determine the effect of biopsy collection site, sex, and pregnancy on isotope ratios. RESULTS: There was substantial variability in δ13C from multiple biopsies taken from the same individuals, though δ15N was much more consistent. Side of the body (left versus right) and biopsy location (dorsal, anterior, ventral, and posterior) did marginally affect the isotopic composition of δ15N but not δ13C. Pregnancy had a significant effect on both δ13C and δ15N, where pregnant females were depleted in both when compared to non-pregnant females and males. CONCLUSIONS: These results indicate that isotopic signatures are influenced by multiple endogenous and exogenous factors and emphasize value in accounting for intra-individual variability and pregnancy status within a sampled population. Placed within an ecological context, the endogenous variability in δ13C observed here may be informative for future isotopic analyses.
Subject(s)
Humpback Whale , Animals , Female , Male , Pregnancy , Biopsy , Carbon Isotopes/analysis , Humpback Whale/physiology , Nitrogen Isotopes/analysis , SeasonsABSTRACT
Based on the case of a 55-year-old male patient, the challenge of integrating early palliative care is discussed. Although this is supported by various medical societies, the use of the word palliative in clinical work is often not simple, because it is still associated with the end of life. Primary palliative care is carried out by oncological teams. Secondary palliative care is utilized by specialized interprofessional teams. Some different models of implementing palliative care in oncological treatment are described and the use of the term supportive care instead of palliative care in some of them.
Subject(s)
Neoplasms , Terminal Care , Male , Humans , Middle Aged , Neoplasms/therapy , Quality of Life , Medical Oncology , Palliative CareABSTRACT
We report about an infant who was diagnosed with spinal muscular atrophy type 1 (Werdnig-Hoffmann) at the age of 7 weeks. In a detailed discussion with the physicians the parents decided against mechanical ventilation in the event of either acute or chronical respiratory failure. During care at home all palliative actions were taken to optimize the quality of life for the child. The boy died at the age of 7 months at home. Whether continuous mechanical ventilation in a child with spinal muscular atrophy type 1 should be the individual decision of the parents or whether it should never be offered by the physicians is discussed controversially in the present medical literature.
Subject(s)
Noninvasive Ventilation , Spinal Muscular Atrophies of Childhood , Fatal Outcome , Humans , Infant , Infant, Newborn , Male , Quality of Life , Respiration, ArtificialABSTRACT
The occurrence of cachexia at the end of life of patients suffering from cancer is a common seen problem. Within the last years new definitions, diagnostic criteria and classification systems of cachexia have been developed to improve the clinical practice. Still therapeutic interventions are limited; the role of parenteral nutrition (PN) remains controversial. PN cannot be generally recommended in patients with incurable malignancies, not even in ill-nourished patients with inadequate oral or enteral nutrition due to a changed metabolism. Treating a cachectic endstage patient suffering from head-neck-cancer we were faced with different problems.
Subject(s)
Cachexia/therapy , Carcinoma, Squamous Cell/therapy , Hypopharyngeal Neoplasms/therapy , Palliative Care/ethics , Palliative Care/methods , Parenteral Nutrition/ethics , Parenteral Nutrition/methods , Pyriform Sinus , Terminal Care/ethics , Terminal Care/methods , Austria , Carcinoma, Squamous Cell/pathology , Combined Modality Therapy/ethics , Combined Modality Therapy/methods , Disease Progression , Ethics, Medical , Guideline Adherence/ethics , Humans , Hypopharyngeal Neoplasms/pathology , Male , Medical Futility/ethics , Middle Aged , Neoplasm Staging , Prognosis , Withholding Treatment/ethicsABSTRACT
Decision making concerning patients with end stage cancer is a challenging process. Since quality of life is a very important issue for patients with short-term life expectancy, benefits of antitumor therapy and possible negative side effects have to be considered carefully. The patient's desires play a pivotal role in the final decision. Informed consent becomes even more difficult when the competence of a patient in choosing treatment is questionable. In this case report, a 60 year old female patient with exulcerating breast cancer, brain metastases and long-term untreated schizophrenia refuses antitumor treatment. How can the palliative care team make the best possible decision on her behalf? Medical, ethical and legal aspects are discussed.
