[Symptom management of pain and breathlessness]. / Symptomatische Behandlung von Schmerzen und Atemnot.

Pain and breathlessness are common symptoms in advanced disease. Pain should be treated with a combination of non-opioids and opioids. Coanalgesics play an important role in the treatment of neuropathic pain. Side-effects of opioids should be treated prophylactically but can make opioid rotation necessary. Management of breathlessness needs a combination of non-pharmacological and pharmacological measures. Fans and rollators showed to be effective in relieving breathlessness. Opioids are the drugs of choice for breathlessness. The efficacy of benzodiazepines could not be confirmed, they should only be used as second line therapy. Also, oxygen should only be given regularly after an individual test.

[Outpatient opiate therapy in cancer patients during their last days of life]. / Ambulante Opiattherapie bei Tumorpatienten in den letzten Lebenstagen.

BACKGROUND: Pain is one of the symptoms that many tumor patients are especially afraid of in the final phase of their illness. Symptoms can change rapidly, making quick adaptation of the therapy necessary. This poses particular challenges to organizational structures in outpatient treatment if the patients' desire to spend their last days of life in their accustomed surroundings is to be realized. METHODS: Pain intensity and the associated symptoms in a WHO step III opiate therapy during the last 3 days of life were investigated retrospectively among 601 tumor patients who had received medical care from Home Care Berlin. Differences in gender, age, living conditions/care situation and place of death were evaluated with due consideration for the different pain medications administered and for the different forms and routes of administration. RESULTS: More than 80% of the patients reported freedom from pain or only moderate pain during the opiate therapy. Care provided by the hospice-at-home medical service Home Care Berlin allowed excellent control of tumor patients' symptoms with only moderate side-effects in their final days of life. Among patients receiving opioids by the transdermal route there were significantly more frequent complaints of pain (p=0.004) and nausea (p=0.001). During the last days of life continuous subcutaneous infusions containing opiates facilitated good analgesia within an acceptable spectrum of side-effects. Most problems with controlling symptoms in outpatients were encountered in younger patients. CONCLUSION: Morphine emerged as the drug of first choice in this investigation, because it can be given parenterally and also because of its price. The use of subcutaneous and intravenous administration systems such as PCA pumps requires trained nursing services and regular house visits by physicians experienced in palliative medicine.

[The influence of pressure loading upon haemodynamics and myocardial metabolism during beta-adrenoreceptor blockade (author's transl)]. / Hëmodynamik und Energiebilanz beta-blockierter Herzen während einer Erhöhung der linksventrikulären Nachlast.

This study compares the effects of a primary increase in afterload (induced by angiotensin) upon haemodynamics, myocardial function and metabolism of anaesthetized, closed chest dogs with (n = 7) and without (n = 7) beta-adrenoreceptor blockade. In both groups cardiac index (-20%) and stroke index (-30 resp. 40%) decreased by afterload increase. Pressure loading and beta-adrenoreceptor blockade were associated with a higher left ventricular enddiastolic pressure (+60%) and a higher heart rate (+35%) than in the control group. The high left ventricular enddiastolic pressure is supposed to be induced by the loss of homoiometric autoregulation. The increase in heart rate is due to the Bainbridge reflex. In the group of dogs with beta-adrenoreceptor blockade the myocardial oxygen consumption rose in proportion more than in the control group. The clinical implications are discussed.

[Prognosis and long-term prognosis of epidural haematoma (a study of 83 patients) (author's transl)]. / Prognose und Spätprognose des epiduralen Hämatoms Eine Studie über 83 Patienten

1. Early detection and treatment of epidural haematoma is vital to the chance of survival. In this respect physician's training needs to be improved. 2. The operation method of choice, particularly in the case of advanced midbrain lesions, is the extensive decompression operation (hemicranectomy) with duraplasty. In each case it is imperative to pay special attention to the relationship between blood pressure and brain perfusion until the state of decompressive is reached. 3. Late complications such as a disturbed circulation of the cerebrospinal fluid may occur and should be prevented by a shunt-operation. 4. ECG changes are still detectable even after many years. However, they give little indication on the patient's tendencies to fits. Post-traumatic cases of epilepsy may even occur more than five years after injury. 5. Patients suffering from epidural haematoma are in need of careful medical, psychiatric and social care for many years after injury, even if they seem to have been restored both neurologically and psychiatrically at the time of hospital discharge.