Delirium in a Palliative Care Unit

Abstract

Intractable pain and other intolerable symptoms or the patients' wish to exercise self-determination can mandate palliative sedation. Yet, three bioethical principles must be balanced in comparable situations: one and two being beneficence (to do the best for our patient) and non-maleficence (do no harm) versus patient autonomy (the right for self-determination). Theoretically, palliative sedation incurs the potential risk of accelerating death, particularly in cases in which the disease is not advanced, because the consequences of sedation (perhaps no calorie or fluid uptake) would be likely to cause death (refusal to eat or drink sufficiently). If, however, the disease is far advanced (and the prognosticated life-span short) and the patient unwilling to eat and drink anyway, then initiated sedation might not be associated with accelerated death (and thus do harm to the patient, from an external viewpoint). Therefore, palliative sedation continues to be an area of discussion and a challenge as to when and how to implement it. Here, we introduce the case of a patient with advanced gastric cancer who asked for palliative sedation. We briefly describe his and the family's thoughts and follow the course of the disease until his death. With this report, we re-emphasize that, with precise sedation by continuous infusion of midazolam, it is possible to let the patient wake up for voiding and defecation and communicate with family members. By such individual approaches, it is possible to let the natural course of disease continue. Our patient had at no point in time asked for physician-assisted suicide.     

Complementary medicine: the facts

Abstract

This article is aimed at giving a critical and factual overview of the heterogeneous field of complementary medicine. It focuses on four major complementary therapies: acupuncture, homoeopathy, phytotherapy and spinal manipulation. Each of these therapeutic entities are scrutinized in terms of efficacy, safety, demand, indications and contra-indications. Even though generalizations in such a diverse field are problematic, one main conclusion emerges: essential data to allow final judgements are still missing. For the sake of the field of complementary medicine and, more importantly, in the interest of our patients, these overt gaps urgently need filling.     

AIDS as chronic illness: epidemiological transition and health care in south-eastern Botswana

This paper suggests that people in south-eastern Botswana experience the AIDS epidemic as part of a recent epidemiological transition in which rates of chronic debilitating illness have risen, even as the degree of acute infectious disease has fallen (HIV/AIDS aside). Whereas international health programmes and practitioners focus on AIDS as an acute, lethal, infectious disease, patients and care-givers experience AIDS as a set of chronic, degenerative (and deadly) conditions. This is true whether or not patients know or acknowledge their HIV status. Neither the national health system nor the Tswana medical sector (bongaka) cope well with the particular issues that chronic illnesses present. Thus, the epidemiological context of the AIDS epidemic in Botswana is critical to understanding uneven patient confidence in a comparatively robust health system.     

Association between sclerostin and bone density in chronic spinal cord injury

Spinal cord injury (SCI) results in profound bone loss due to muscle paralysis and the inability to ambulate. Sclerostin, a Wnt signaling pathway antagonist produced by osteocytes, is a potent inhibitor of bone formation. Short-term studies in rodent models have shown increased sclerostin in response to mechanical unloading that is reversed with reloading. These studies suggest that complete spinal cord injury, a condition resulting in mechanical unloading of the paralyzed lower extremities, will be associated with high sclerostin levels. We assessed the relationship between circulating sclerostin and bone density in 39 subjects with chronic SCI and 10 without SCI. We found that greater total limb bone mineral content was significantly associated with greater circulating levels of sclerostin. Sclerostin levels were reduced, not elevated, in subjects with SCI who use a wheelchair compared with those with SCI who walk regularly. Similarly, sclerostin levels were lower in subjects with SCI who use a wheelchair compared with persons without SCI who walk regularly. These findings suggest that circulating sclerostin is a biomarker of osteoporosis severity, not a mediator of ongoing bone loss, in long-term, chronic paraplegia. This is in contrast to the acute sclerostin-mediated bone loss shown in animal models of mechanical unloading in which high sclerostin levels suppress bone formation. Because these data indicate important differences in the relationship between mechanical unloading, sclerostin, and bone in chronic SCI compared with short-term rodent models, it is likely that sclerostin is not a good therapeutic target to treat chronic SCI-induced osteoporosis.     

腹腔镜卵巢打孔术结合中医周期疗法治疗痰湿型难治性多囊卵巢综合征的临床观察

【目的】观察腹腔镜手术结合中医周期疗法治疗痰湿型难治性多囊卵巢综合征(PCOS)的临床疗效。【方法】将40例PCOS患者随机分为A、B、C组。A组20例采用腹腔镜手术加中医周期疗法治疗;B组10例采用腹腔镜手术加西药促排卵治疗;C组10例单纯采用腹腔镜手术治疗。观察3组患者的内分泌激素变化及排卵、妊娠情况。【结果】A组的黄体生成素(LH)、雄激素(T)治疗前后比较,差异有显著性意义(P<0.05),B、C组的LH、T值治疗前后比较,差异无显著性意义(P>0.05);治疗后A组的LH、T值与其他2组比较差异有显著性意义(P<0.05),B、C组的LH、T值比较,差异无显著性意义(P>0.05)。A组的妊娠率与其他2组比较,差异有显著性意义(P<0.05);B、C组的妊娠率比较,差异无显著性意义(P>0.05)。【结论】腹腔镜手术结合中医周期疗法治疗对改善痰湿型难治性PCOS患者的生殖健康状态有一定的优势。     

实验动物比格(Beagle)犬自发性病变的研究

对46只实验比格犬（10～12月龄）,进行一般临床检查,并随机选用18．只犬进行组织病理学观察。实验结果为部分犬的肝功能各丙转氨酶和谷草转氨酶偏高;肝、肺、肾和大脑等重要脏器有自发性病理改变;肺的间质性肺炎和大脑室管膜炎及血管围管性浸润发生率较高,部分肝细胞和肾小管上皮细胞呈现浊肿或空泡变等。提示对实验动物宜加强饲养管理,并需增加某些非传染疾病监测,尽可能减少实验动物的自发性病变对研究结果的干扰。     

中西医结合治疗急性胰腺炎56例临床分析

目的：探讨中西医结合非手术治疗急性胰腺炎的疗效。方法：对56例急性胰腺炎的治疗方法和结果进行分析、总结。结果：56例中45例治愈，占80．4％(其中重症胰腺炎10例，治愈7例，占70％)。结论：中西医结合非手术疗法是治疗急性胰腺炎实用、有效的方法，可以缩短病程，减少并发症的发生，并可用于治疗重症胰腺炎。