Anasthesiol Intensivmed Notfallmed Schmerzther. 2025 Oct;60(10):574-590. doi: 10.1055/a-2060-8786. Epub 2025 Oct 28.ABSTRACTThe decision to initiate extended intensive care in older patients is often challenging. The ethical principles of beneficence and non-maleficence, together with the patient’s autonomous will, form the foundation of decision-making. Important prognostic factors include frailty, functional status, and comorbidities. If intensive care treatment is initiated, it should be started promptly, but with a clearly defined treatment goal and predefined limitations regarding interventions that should not be undertaken. If, during the course, the decision is made against curative intensive care, palliative care should be provided. In situations where the…
Origen: Very old Patients in the Intensive Care Unit – Balancing Benefits and Risks – PubMed

Anasthesiol Intensivmed Notfallmed Schmerzther. 2025 Oct;60(10):557-572. doi: 10.1055/a-2351-8514. Epub 2025 Oct 28.ABSTRACTThe circadian rhythm regulates key biological processes such as sleep, hormone balance, and immune defence. Sleep disorders are particularly prevalent among patients with chronic or advanced diseases and are associated with significant physical and psychological consequences. They impair quality of life, increase morbidity, and negatively affect the immune system. Diagnosis involves a thorough medical and sleep-specific history, supplemented by sleep diaries and screening questionnaires. Polysomnography remains the gold standard, while wearables can provide useful indications but cannot fully replace comprehensive diagnostics. Treatment should primarily focus on non-pharmacological interventions and…
Origen: The Circadian Rhythm: What Role do Sleep Disorders Play in Pain Management and Palliative Care? – PubMed

Gan To Kagaku Ryoho. 2025 Oct;52(10):716-719.ABSTRACTMalignant obstruction caused by advanced upper gastrointestinal (GI) cancers significantly impairs patients’ quality of life (QOL), often leading to dysphagia, vomiting, and nutritional deterioration. While endoscopic and pharmacologic therapies serve as primary palliative approaches, surgical intervention remains a valuable option, particularly when endoscopic treatments are infeasible or ineffective. This article reviews the current role of palliative surgical treatments for malignant GI obstruction, focusing on esophageal bypass for esophageal cancer, and gastrojejunostomy or palliative gastrectomy for advanced gastric cancer. Esophageal bypass, though less commonly performed today due to the availability of self-expandable metallic stents, remains suitable…
Origen: Palliative Surgical Approaches for Malignant Upper Gastrointestinal Obstruction – PubMed

Gan To Kagaku Ryoho. 2025 Oct;52(10):705-709.ABSTRACTIn interventional radiology (IR) for malignant bowel obstruction, treatment is broadly classified into drainage and stent placement. In cases such as terminal-stage malignancy, where removal of a nasogastric or ileus tube is unlikely, gastrostomy or stent placement may be performed endoscopically. However, for patients in whom endoscopic gastrostomy is difficult-such as those with anatomical or procedural limitations-IR-guided access for gastrointestinal decompression can be considered. Representative procedures include percutaneous radiologic gastrostomy (PRG), also referred to as radiologically inserted gastrostomy (RIG), and percutaneous transesophageal gastro-tubing (PTEG). In specific cases such as afferent loop syndrome, stent placement through…
Origen: Palliative Interventional Radiology for Malignant Bowel Obstruction – PubMed

Gan To Kagaku Ryoho. 2025 Oct;52(10):710-715.ABSTRACTGastrointestinal stent placement is currently the mainstay of palliative treatment for malignant gastrointestinal obstruction. Compared to palliative surgery, this method provides more rapid improvement in oral intake. However, it is also associated with some complications such as gastrointestinal perforation and stent migration. As for determining the treatment strategy, it is important to consider the patient’s prognosis and goals. We should explain both clinical success rates and the risk of adverse events to the patient and their family before their decision-making. In recent years, various types of stents have become commercially available. Therefore, we should know…
Origen: Palliative Management by Endoscopy for Malignant Gastrointestinal Obstruction – PubMed