1/131. Low-dose ketamine in the management of opioid nonresponsive terminal cancer pain.Two patients with far-advanced cancer, near death, who were experiencing excruciating and intractable pain that was poorly responsive to rapidly escalating doses of morphine and hydromorphone were treated with low-dose intravenous ketamine (0.1-0.2 mg/kg). This intervention eliminated the need for any further opioid use, providing profound analgesia and a sense of calm during the last hours and days of these patients' lives. These case reports add to the small but growing body of clinical literature suggesting that ketamine may have a significant place in the care of patients with pain that is poorly responsive to opioids, or who experience dose-limiting adverse effects, near the end of life. This is an important matter to disseminate in order to reassure the public that we do have the tools necessary to keep the promise that no one need die with uncontrolled pain. This therapeutic approach may also serve to reassure concerned physicians that their efforts to assure pain relief may not be misconstrued as hastening death.- - - - - - - - - - ranking = 1keywords = cancer (Clic here for more details about this article) |
2/131. Histological findings after long-term infusion of intrathecal ketamine for chronic pain: a case report.ketamine, a selective, noncompetitive N-methyl-D-aspartate (NMDA)-receptor antagonist, is able to alter pain perception at the spinal level. Little clinical data exist on the intrathecal and epidural use of ketamine in chronic pain. Histopathologic findings after intrathecal injection of ketamine with and without preservatives are rarely reported. This outcome was evaluated in a 72-year-old woman with abdominal pain due to cancer who was treated with the intrathecal application of bupivacaine, clonidine, and morphine. We reached satisfactory pain relief with the addition of ketamine to the mixture for 7 days. On postmortem, focal lymphocytic vasculitis close to the catheter injection site was found. This finding has not been described previously after long-term application of ketamine intrathecally. The intrathecal infusion of ketamine with preservative, or the mixture of ketamine, clonidine, morphine, and bupivacaine resulted in isolated lymphocytic vasculitis of the spinal cord and leptomeninges without any clinical signs of neurological deficit.- - - - - - - - - - ranking = 0.2keywords = cancer (Clic here for more details about this article) |
3/131. disseminated intravascular coagulation in a patient treated with strontium-89 for metastatic carcinoma of the prostate.strontium-89 is effective in the palliation of bone pain caused by skeletal metastases. Its primary side effect is mild thrombocytopenia that typically recovers in 3 or 4 months. Subclinical disseminated intravascular coagulation is reported to be present in approximately 10% to 20% of patients with advanced prostate cancer. These patients may be at increased risk for severe marrow depression after radionuclide therapy for bone pain palliation. This report describes a patient with painful bony metastases resulting from prostate carcinoma. He had a normal platelet count and no clinical evidence of a coagulation disorder at the time of strontium-89 therapy, and a severe disseminated intravascular coagulation developed and lead to death after treatment. A normal platelet count before strontium-89 therapy does not preclude subsequent disseminated intravascular coagulation, and we support the Society of nuclear medicine's bone pain treatment procedure guideline that patients referred for bone palliation should be screened for disseminated intravascular coagulation before therapy.- - - - - - - - - - ranking = 0.2keywords = cancer (Clic here for more details about this article) |
4/131. paraplegia following intraoperative celiac plexus injection.The technique for percutaneous and open neurolytic celiac plexus injection, using ethanol or phenol, for relief of intractable pancreatic cancer pain has been well described. Prospective randomized studies, demonstrating safety and efficacy with few complications, have led to widespread acceptance and use of this palliative procedure. The complications of neurolytic celiac plexus injection are rare, and are usually minor. However, transient or permanent paraplegia has been reported previously in 10 cases. The case described herein represents the third reported case of permanent paraplegia following open intraoperative neurolytic celiac plexus injection using 50% ethanol. The literature surveying the indications for this procedure, routes of administration, known complications, and their pathophysiology are reviewed.- - - - - - - - - - ranking = 0.2keywords = cancer (Clic here for more details about this article) |
5/131. Sedation for intractable distress of a dying patient: acute palliative care and the principle of double effect.Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at massachusetts General Hospital (MGH), founded the Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient, support to caregivers, and encourages the healing process. The Center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. The case presented is of a young man dying of recurrent epithelioid hemangioendothelioma, distressed with stridor and severe pain, whose poorly controlled symptoms were successfully treated with an infusion of propofol, titrated to provide effective comfort in the last few hours of the patient's life. The tenet of double effect, which allows aggressive treatment of suffering in spite of foreseeable but unintended consequences, is reviewed. The patient's parents were invited and contributed to the Rounds, providing compelling testimony to the power of the presence of clinicians at the time of death and the importance of open communication about difficult ethical issues.- - - - - - - - - - ranking = 0.2keywords = cancer (Clic here for more details about this article) |
6/131. Successful palliation of hypoactive delirium due to multi-organ failure by oral methylphenidate.delirium is frequently observed in terminally ill cancer patients, but complete remission is often difficult to achieve. Therefore, symptom palliation is of great importance to improve patients' quality of life. Although it has been suggested that psychostimulants would be beneficial to patients with hypoactive delirium, there have been very few empirical reports so far. We report on a terminally ill cancer patient with hypoactive delirium caused by multi-organ failure, in whom methylphenidate was effective in improving the ability to maintain communication. This case highlights the efficacy of methylphenidate for hypoactive delirium in terminally ill cancer patients.- - - - - - - - - - ranking = 0.6keywords = cancer (Clic here for more details about this article) |
7/131. Irreversible spinal cord injury as a complication of subarachnoid ethanol neurolysis.ARTICLE ABSTRACT: Subarachnoid neurolysis using ethanol to destroy selectively the posterior roots of the spinal cord is a method for providing pain relief in patients with advanced cancer. Weakness of the extremities is a complication of the procedure that has been attributed to spread of the neurolytic agent to the anterior roots. The authors provide evidence of spinal cord injury as a cause of lower extremity weakness in a patient after subarachnoid ethanol neurolysis.- - - - - - - - - - ranking = 0.2keywords = cancer (Clic here for more details about this article) |
8/131. Punctate midline myelotomy for the relief of visceral cancer pain.OBJECT: This study offers clinical support for the concept that neurosurgical interruption of a midline posterior column pathway by performing a punctate midline myelotomy (PMM) provides significant pain relief without causing adverse neurological sequelae in cancer patients with visceral pain refractory to other therapies. methods: A PMM of the posterior columns was performed in six cancer patients in whom visceral pain had been refractory to other therapies. The cause of the visceral pain was related to residual, progressive, or recurrent local cancer or postirradiation effects. Clinical efficacy of the procedure was examined by comparing patient pain ratings and narcotic usage pre- and post-PMM. Follow-up periods ranged from 3 to 31 months. Examination of the results indicates a significant reduction in pain ratings as well as a significant reduction in daily narcotic use. No adverse neurological effects were observed. One spinal cord has been recovered for postmortem examination. CONCLUSIONS: These findings provide corroborating clinical evidence for the existence of a newly recognized midline posterior column pathway that mediates the perception of visceral pelvic and abdominal pain. Preliminary data indicate that significant pain relief can be obtained following PMM with minimal neurological morbidity and suggest that the procedure may provide an alternative treatment modality for cancer-related pain in patients in whom adequate pain control with narcotics cannot be achieved or narcotic side effects cannot be tolerated.- - - - - - - - - - ranking = 1.6keywords = cancer (Clic here for more details about this article) |
9/131. Preliminary evaluation of a fixed dose of zwitterionic piperazine (TVZ-7) in clinical cancer.One of the zwitterion buffers that has shown significant therapeutic value in the treatment of pain due to cancer, immunologically mediated diseases, and the pain associated with these conditions is in the class of N-substituted amino-sulfonic acids known as "Good buffers." Zwitterion molecules have neither a negative nor a positive charge; thus, they are neutral. 4-(2 Hydroxyethyl)-1-piperazine ethane sulfonic acid has been used for several decades in artificial biological systems (tissue culture) as a buffer. We have been exploring the therapeutic value of these zwitterionic buffers. Pilot animal studies have demonstrated that zwitterionic piperazine increases bone marrow hypercellularity and induces extramedullary hematopoiesis. We report the initial human use to explore dose toxic and physiologic effects of a fixed dose of the zwitterionic piperazine molecule. There appears to be potential therapeutic value in the treatment of pain due to cancer, and there are preliminary indications that tumor activity and tumor size are reduced. Immunologically mediated diseases may also be affected. Toxicity is low and there appear to be minimal side effects.- - - - - - - - - - ranking = 1.2keywords = cancer (Clic here for more details about this article) |
10/131. Efficacy and safety of repeated samarium-153 lexidronam treatment in a patient with prostate cancer and metastatic bone pain.A patient with stage D3 prostate cancer was given 11 separate doses of samarium-153 lexidronam (Sm-153 ethylenediaminetetramethylene phosphonate) of 1 mCi/kg (37 MBq/kg) in a period of 28 months for bone pain from metastases. With the first five doses, Sm-153 lexidronam clearly reduced his bone pain and improved his quality of life, as determined by pain-assessment scores and the patient's self-assessment of its effect on his ability to perform activities of daily living. With doses 6 through 11, pain at baseline was on average less, and as a result beneficial effects after treatment were not as apparent. samarium-153 lexidronam produced transient decreases in the leukocyte and platelet counts, but these never became low enough to cause clinical concern. This case shows both the efficacy and the safety of Sm-153 lexidronam in repeated treatments for metastatic bone pain in patients with prostate cancer.- - - - - - - - - - ranking = 1.2keywords = cancer (Clic here for more details about this article) |
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