Paliative care

The authors of this presentation explain their experience with methods of paliative care of oesophagus carcinoma. The indication criteria are described and compared advantages and disadvantages of those methods. There is an accent in most frequent method--oesophagus stent implementation. The results in the group of patients after the stent implementation are described, also complications and other solutions.

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AIM: A retrospective assessment of the post-surgical and long-term results of the high biliodigestive anastomoses constructed using the authors' own technique modification. METHODOLOGY: This study evaluates 25 patient cases during an 8-year-period. The patients had high biliodigestive anastomosis affixed due to the clinically manifested obstructive icterus or due to repetitive attacks of cholangitides. The underlying causes of the attacks were malignancies of the ductus hepatocholedochus in 13 cases, a stricture of the ductus hepatocholedochus following the drainage according to Kehr in 1 case, an inflammative stenosis of the ductus hepatocholedochus during choledocholithiasis in 1 case, the Mirizzi syndrome in 2 cases, a cyst of the ductus hepatocholedochus in 2 cases, a stricture of the ductus hepatocholedochus following choledochoduodenoanastomosis in 4 cases, hepaticolithiasis in 1 case, a status after cholecystogastrostomy in 1 case, and a status after ductus hepatocholedochus contusion in 1 case...

The article describes treatment results of 1228 patients operated on because of different forms of pulmonary tuberculosis. According to spreading of tuberculosis and developed complications in spite of the medicamental treatment the patients were divided in to two clinical groups. The first group included 417 patients with direct indications for surgery. The second group included 811 patients with complications of pulmonary tuberculosis (with spontaneous pneumothorax - 237, spontaneous pyopneumothorax - 170, tuberculous pleural empyema - 271, pulmonary hemorrhage - 105, with pulmonary reoperations - 28)...

The hepatobiliary involvement in AIDS is a relatively frequent phenomenon, especially in advanced stages of immunosuppression. Opportunistic agents such as MAI, CMV, are probably the commonest among patients with CD4 counts below 200/mm3. Chronic viral hepatitis is very prevalent in this population and may acquire particular connotations regarding clinical presentation and natural history. AIDS related cholangiopathy is a syndrome characterized by abnormalities in the billary tree, generally associated with Cryptosporidium parvum, CMV and Microsporidia spp...

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The aim of study was presentation of our experiences in diagnosis and treatment in pancreatic carcinoma in confrontation with current opinions. Between 1984-1995 at our Department was treated 211 patients with carcinoma of exocrine part of the pancreas. It were 137 male and 74 female with mean age 58.9 years. In 151 cases (70.5%) primary seat of tumour was located in the head and in 60 cases (29.5.1%) in the body or tail of pancreas. The diagnosis was determined on the basis of clinical symptoms and laboratory investigation Diagnostic accuracy of X-ray investigations was as follow: Ultrasonography-86%, CT-scan-91%, ERCP-94%...

Paliative Medicine offers many possibilities to reach a good control of the bothering symptoms of terminal patients and to the support of their families. We review the different causes of suffering, suicide and of request of euthanasia as the process of Medical Decision-Making in the care of the Dying. It is necessary to search for ways to reduce the suffering and to improve the quality of life that remains instead of how to finish it earlier.

The authors report results from a sample survey in a university hospital in connection with the aspects of communication in medical team about paliative situations. The questionnaire, made from a paliative care group, consults the usual practices and during crisis just as patient is dying, in a curative medical care. Hospital is not a place to die. Difficulty in survey are probably in keeping with individual and collective defences opposite to dying patient.

Preoperative evaluation of esophageal cancer is fundamental to assess the degree of extension of the tumor and operability. Surgery remains the reference treatment for tumors with limited loco-regional extension. The prognosis depends on the degree of mural infiltration and lymph node involvement. Adjuvant chemotherapy or radiotherapy does not improve survival in randomized trials. In case of inoperability, good paliation can be achieved by electrocoagulation, laser or endoprosthesis, possibly combine with chemotherapy...

The analysis concerned 27 patients disqualified for radical surgical treatment and qualified for palliative procedures or conservative treatment in the Department of Neurosurgery, Medical Academy in Lódź in the years 1960-1976. The decisions of disqualification were based on the assessment of the clinical state, angiography of the cerebral vessels, pneumoencephalography or both these methods. Computer tomography was not available then, similarly as it is not available presently in most neurosurgical centres in Poland...

An 8-year study of the records of 127 patients with carcinoma of the esophagus revealed that the data necessary to make an evaluation of various methods of palliative treatment frequently were not recorded on the charts. Therefore, it was not possible to recommend one particular paliative treatment for carcinoma of the esophagus. The authors believe that a prospective study is required to evaluate objectively the various modes of treatment for this disease. They propose a grading system with numbered values, so that future studies can be made more objective: in addition such a system would allow comparison of series from different treatment centres...