A 58-year-old woman with a long history of renal stone disease and urinary tract infection presented to the emergency room with exhaustion and air hunger. Laboratory data confirmed profound metabolic acidosis. Unduly large quantities of bicarbonate and potassium were required for correction of the deficits. She had been taking 6 g daily of ammonium chloride as a urine-acidifying agent for a period of six months in addition to agents directed against urinary tract infection. The combination of impaired renal function and effective hydrogen ion loading resulted in profound systemic acidosis. The metabolic derangements associated with the administration of ammonium chloride and its use as a therapeutic agent are discussed.
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Cachexia is a frequent syndrome in patients suffering from advanced cancer; it is characterized by anorexia, weight loss, and malnutrition, which combined with other psychic and social consequences lead to a deterioration in a patient's quality of life. Various factors play a role in the development of cachexia; these depend on the patient, the type of tumor, and the treatments received. Its complexity warrant the intervention of an interdisciplinary team, in which nursing plays an essential role. Up to present time, the results of pharmaceutical treatment have been rather unfavorable; therefore, nutritional treatments based on advise for concrete problems and dietary supplements gain importance; enteral or parenteral nutrition are reserved for selected cases. Other important aspects are psychological support, control of associated symptoms and the prevention and treatment of any complication which may appear.
A peripheral blood finding in which a large number of erythrocytes are shaped in a slightly oval-shaped form.
Laparoscopic appendectomy has practically replaced open surgery. Appendectomy, i.e. surgical excision of the appendix, is one of the most common procedures of a specializing surgeon, and serves to help learn the basics of laparoscopy - first by following and later independently performing the operation. Properative preparation, precise diagnosis, correct surgical technique and follow-up treatment are the cornerstones of successful care. The anatomy of the patient must be considered in the placement of trocars. The appendix is usually easily found, but its position and location may vary. In the operation, the base and the artery of the appendix are ligated, and the appendix removed in a plastic bag. Also a healthy appendix should be removed, but in this case other causes of the symptoms should be searched for. Surgical excision of a perforated appendix is considerably more challenging, and peritonitis should be operated without delay. Surgery of a periappendicular abscess requires experience and should be postponed until daytime. Most patients having undergone an excision of non-perforated appendix can be discharged within 23 hours after the operation.
Invasive treatment of pericardial effusion comes into question when the volume of liquid in the pericardium limits the pumping action, the cause of effusion is unclear, the response to conservative treatment has been poor, or administration of a drug into the pericardium is desired. A number of surgical means or puncture techniques are available for pericardial drainage. We present the indications and modes of treatment for invasive treatment of pericardial effusion. Thrombi, pus or air may also occasionally be present in the pericardium, limiting the heart's pumping action.
Acute pericarditis is typically associated with a viral infection. Chest pain appearing in connection with or soon after the symptoms of infection is the characteristic symptom. Diagnosis is based on the recognition of two characteristic findings (pericardial chest pain, pericardial friction rub, new ECG changes or new pericardial effusion). Medication with an anti-inflammatory analgesic for 1 to 2 weeks is the first-line treatment. A longer course of colchicine is recommended for the prevention of recurrence of the disease. The use of glucocorticoids should be avoided due to the associated risk of recurrence. Exercise and physical activity are harmful during pericarditis.
The importance of communication in medical practice is widely recognized, but what is good communication in patient encounter? Feedback and surveys based on patient experience or "smileys" provide a narrow and often too insignificant view of communication. In addition to patient experience, communication benefits the information gathering by the physician and the patient, the patient's ability to promote his/her recovery, the physician's coping with workload, and the effectiveness of health care. In order to evaluate communication and improve it, one has to recognize the criteria and objectives of good communication. Medical communication that supports the rehabilitation of patients is reasonably good and responsible communication.
