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.