Upload
vandieu
View
217
Download
2
Embed Size (px)
Citation preview
January 13+14th, 2017Introduction to
THERAPY SELECTED PATHOLOGIES CASE REPORTS
Which answer is wrong?
0 imaginative: computertomography is always non-invasive.
0 non-invasive diagnostic techniques are: clinicalexamination, blood pressure, urine probe, ECG, sonography.
0 minimal-invasive: blood probe, gastroscopy, colonoscopy.
0 invasive: puncture of: liquor, amniotic fluid, fineneedle puncture (cytology), biopsy (histology), angiography.
Which answer is wrong?
0 imaginative: computertomography is always non-invasive.
0 non-invasive diagnostic techniques are: clinicalexamination, blood pressure, urine probe, ECG, sonography.
0 minimal-invasive: blood probe, gastroscopy, colonoscopy.
0 invasive: puncture of: liquor, amniotic fluid, fineneedle puncture (cytology), biopsy (histology), angiography.
Introduction to THERAPY
dietetics behaviourpharmacologysurgery
Introduction to THERAPY
symptomaticcurativeconservativeoperative
symptomatic therapy
symptoms and signs are treated withoutelimination of the reason of the disease
(painkiller eg.)palliative therapy/care: special threatmentat the terminal stage of a disease (cancer,
ALS etc.)
curative therapy
reason can be eliminatedhealth will be restored
examples: operation of tumor, appendixetc.
antibiotics
conservative therapy
non-operative therapy
examples: pharmacotherapy, physico- and physical
therapy, psychotherapy, dietics
operative therapy
examples: surgical therapy
special form: radiation, gamma knife
Some therapeutical applications are not performed by physicians:
dietologyphysiotherapy
massage therapypsychotherapy
Exampels of diseases which should be treated with accompanying dietetics
diabetes mellitus (hyperglycemia)hyperlipidemiacardiovascular diseases (risc of arterioscerosis)hyperuricemia (gout: high level of uric acid: not to be confused with (hyper) uremia or hematuria)inborn metabolic disorderfood intolerances and allergiestreatment with anticoagulating medication (such as
Marcumar®) maintaining health
behavior as therapeutic key factor
e.g.:all indications for behavioural therapypsychosomatic stress and burnout syndromework-life balancephysiotherapy
movement as therapeutic key factorphysiotherapyorthopedic problemsrehabilitätioncardiovascular diseasesmethabolic syndrome, obesitaspsychiatric disorders
Psychotherapy
in many cases of psychiatric disorders
autoimmune diseases
cardio-vascular diseases
sexual disorders, erectile dysfunction
support of cancerous diseases
psychosomatic illnesses
support of relatives
interdisciplinary
psychosomatics
psychooncology
psychocardiology
gynecological psychsomatics
The biopsychosocial model
("BPS")
is a general model or approach stating that
biological, psychological, (which entails
thoughts, emotions, and behaviors), and
social (socio-economical, socio-
environmental, and cultural) factors, all play
a significant role in human functioning in
the context of disease or illness
Which answer is wrong?
0 Symptomatic therapy treats symptoms and signswithout elimination of the reason.
0 Curative therapy eliminates the reason andhealth will be restored.
0 Conservative therapy is the opposite toalternative therapy.
0 Conservative therapy is the opposite to operative therapy.
Which answer is wrong?
0 Symptomatic therapy treats symptoms and signswithout elimination of the reason.
0 Curative therapy eliminates the reason andhealth will be restored.
0 Conservative therapy is the opposite toalternative therapy.
0 Conservative therapy is the opposite to operative therapy.
Which answer is wrong?
0 Hyperglycemia, hyperlipidemia, hyperuricemia should be treated with accompanying dietetics.
0 Hyperglycemia, hyperlipidemia, hyperuricemia are inborn metabolic disorders and can not be treated withdietics.
0 Movement/physiotherpy is a therapeutic key factor in thecase of orthopedic problems and rehabilitationmedicine.
0 With the help of endurance movement hypertensionmedication can be reduced.
Which answer is wrong?
0 Hyperglycemia, hyperlipidemia, hyperuricemia should be treated with accompanying dietetics.
0 Hyperglycemia, hyperlipidemia, hyperuricemia are inborn metabolic disorders and can not be treated withdietics.
0 Movement/physiotherapy is a therapeutic key factor in thecase of orthopedic problems and rehabilitationmedicine.
0 With the help of endurance movement hypertensionmedication can be reduced.
minor surgery:non-invasivechiropractic, massage, other externalapplicartion
major surgeryminimally invasive and invasive surgery in terms of biomedicine
surgery:learned manual skill
direct interaction between patient andphysician
Surgery
Greek: χειρουργική cheirourgikē: composedof χείρ, "hand", and ἔργον, "work", Latin: chirurgiae, meaning "hand work"
DEGREE OF INVASIVENESS
minimally-invasive surgeries, involves smaller outer incision(s) to insert miniaturized instruments within a
body cavity or structure, as e.g. in laparoscopic surgery. future of surgery:
minimally-invasive surgery techniques
open surgical procedure such as a laparotomy requires a large incision to access the area of interest.
Laparotomyinvolves a large incision to gain access into
the abdominal cavitiy
Laparoscopyinvolves small incisions to gain access into
the abdomen or pelvis
www. medicalexpo.de
biomedical surgical methods
excision: complete removal of an organ, tissue or tumorincision: cut into a tissue
biopsy: sampling tissue for examinationpunction: with hollow needle to collect cells or liquids
extraction: removal, to pull out (tooth, baby during birth)extirpation: removal of (cancerous) organs or part of it
resection: partial removal of a bodily structureectomy: from Greek εκ-τομια = "act of cutting out"
ablatio: removal of material from the surface (breast)amputation: removal of a limb or protruding partstransplantation: moving a part to another location
rekonstruction: plastic-surgical rebuilding
ablatio (mammae) removal of material from the surface (breast)
synonym:mastectomy
amputation of breast
transplantation moving one part to another location
autograftAutografts are the transplant of tissue to the same person (e.g.: skin
grafts, vein extraction for coronary artery bypass surgery, storing blood in advance of surgery).
allograft and allotransplantationAn allograft is a transplant of an organ or tissue between two
genetically non-identical members of the same species.
xenograft and xenotransplantationA transplant of organs or tissue from one species to another. An
example is porcine heart valve transplant, which is quite common and successful.
TYPES OF SURGERY
emergency surgerymust be done promptly to save life, limb, or functional capacity
explorative surgery performed to aid or confirm a diagnosis
cosmetic surgery is done to improve the appearance of an otherwise normal structure
by body part performed on one organ system or structure, classed by the organ,
organ system or tissue involved. Examples: cardiac, vascular, gastrointestinal or orthopedic surgery
surgical equipment
Laser surgery involves use of a laser for cutting tissue instead of a scalpel or similar surgical instruments.
Microsurgery involves the use of an operating microscope for the surgeon to see small structures.
Robotic surgery makes use of a surgical robot, such as the Da Vinci surgical system, to control the instrumentation under the direction of the surgeon.
discharge papers
reason for visit/admission, assignment, signs and symptomsanamnesis, status, laboratory resultshistology (benign-malignant, TNM)diagnosis (including diagnostic methods)therapy and course of diseasefurther therapyfurther controls
Case reportwomen, 56, two children, housewife, minijobs
Assignment: palpable node in the left breast (upper left quadrant), visible in mammography
Anamnesis: migraine headache (postmenopausal relief),postmenopausal hormone replacement therapy
Histology: invasive lobular carcinoma (T2N1M0),receptor status: estrogen positive, sentinel lymph nodepositive
Diagnosis: malignant neoplasm of breast (C50-C50)Therapy: mastectomy with reconstruction, axillary
lymphonodectomy, reconstruction, postoperative 20 single sessions radiotherapy (50 Gy IF), Tamoxifen 30 mg/d.
Further therapy: Tamoxifen 30 mg/d, citalopram 20 mg orally once a day.
Further controls: quarterly
Case reportwomen, 38, no children
Assignment: tired, painful menstruation, menorrhagia, pain during sexAnamnesis: unfulfilled desire to have children, miscarriage
Dysmenorrhea, palpable swelling of the uterus, sonographicallyproven uterus myomatosuslabor: anaemia (Hb 8,2g/dl)
Histology: --Diagnosis: three intramural fibroids (corpus 3x2cm, 1,5x2cm, fundus: 3x4cm)Therapy: laparascopical extirpation of myomaFurther controls: sonographical
Which answer is wrong?
0 Surgery is derived from Greek and Latin, meaning"hand work".
0 Minimally-invasive surgery techniques are developingrapidly.
0 Resection is the partial removal of a bodily structure.0 Transplantation always moves an organ from one
person to another one.
Which answer is wrong?
0 Surgery is derived from Greek and Latin, meaning"hand work".
0 Minimally-invasive surgery techniques are developingrapidly.
0 Resection is the partial removal of a bodily structure.0 Transplantation always moves an organ from one
person to another one.
Which answer is wrong?
0 Reconstruction is the plastic-surgical rebuilding ofphysical structures.
0 Minimally-invasive surgeries, involves smaller outer incision(s) to insert miniaturized instruments within a body cavity.
0 Open surgical procedure such as a laparotomy requires a large incision to access the area of interest.
0 The Da Vinci surgical system controls the surgical team.