INTRODUCTIONThis study aimed to describe the patterns of sedative use among terminally ill cancer patients who were referred to a hospital-based specialist palliative care service for symptom management. It also aimed to examine whether sedative use among terminally ill cancer patients during the last two days of life had any impact on their survival.

METHODSA retrospective review of case notes was carried out for patients with a diagnosis of terminal cancer, who died in a 95-bedded oncology ward between September 2006 and September 2007. Data was collected on patient characteristics, duration of palliative care, indications and doses of sedatives used at 48 hours and 24 hours before death.

RESULTSA total of 238 patients died while receiving specialist palliative care, 132 of whom (55.5%) were female. At 48 hours and 24 hours before death, 22.6% and 24.8% of patients, respectively, were on sedatives like midazolam, haloperidol or both. The median dose of midazolam was 5 mg/day while the haloperidol dose at 48 hours and 24 hours before death was 3 mg/day and 4 mg/day, respectively. The indications for midazolam were anxiety, breathlessness and stiffness, while those for haloperidol were confusion agitation and nausea. Survival analysis showed no significant difference in survival between patients who were on sedatives and those who were not. The p-value for log-rank test was 0.78.

CONCLUSIONThe results showed that the doses and overall frequency of sedative use in this patient population tended to be low and that usage of sedatives had no deleterious influence on survival.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Analgesics, Opioid ; therapeutic use ; Female ; Haloperidol ; therapeutic use ; Humans ; Hypnotics and Sedatives ; therapeutic use ; Male ; Midazolam ; therapeutic use ; Middle Aged ; Neoplasms ; drug therapy ; mortality ; Palliative Care ; methods ; Retrospective Studies ; Terminal Care ; methods ; Terminally Ill ; Time Factors ; Treatment Outcome

Endoscopy ; methods ; Female ; Foreign Bodies ; Humans ; Male ; Urinary Bladder ; pathology

INTRODUCTIONGlucocorticoids cause osteoporosis by decreasing bone formation and increasing bone resorption activity. Glucocorticoid action in bones depends on the activity of 11-beta-hydroxysteroid dehydrogenase type 1 (11β-HSD1) enzyme, which plays an important role in regulating corticosteroids. 11β-HSD1 is expressed by human and rat osteoblasts. We aimed to investigate the relationship between 11β-HSD1 dehydrogenase activity and bone histomorphometric changes in glucocorticoid-induced osteoporotic bone in rats.

METHODSA total of 30 male Sprague-Dawley rats (aged three months, weighing 200-250 g) were divided into three groups of ten each. Group 1 rats were the baseline control, which were sacrificed untreated at the beginning of the study. Group 2 rats underwent sham operation and were administered with vehicle olive oil intramuscularly at 0.05 ml/kg. Group 3 rats were adrenalectomised and administered with an intramuscular injection of dexamethasone 120 μg/kg body weight/day. The treatment was started two weeks after the operation, for a duration of two months. Plasma osteocalcin, plasma pyrodinoline, plasma corticosterone and 11β-HSD1 were measured, and bone histomorphometry analysis was performed.

RESULTSDexamethasone treatment caused an increase in plasma corticosterone level, together with a significant reduction in 11β-HSD1 dehydrogenase activity of the bone, along with a higher plasma level of the bone resorption marker, pyridinoline. Dexamethasone treatment also caused a reduction in trabecular volume, number and thickness, and an increase in trabecular separation.

CONCLUSIONLong-term glucocorticoid treatment reduces the 11β-HSD1 dehydrogenase activity in the bone, which can otherwise lead to bone loss due to the increased level of active glucocorticoids.

11-beta-Hydroxysteroid Dehydrogenase Type 1 ; metabolism ; Adrenal Cortex Hormones ; metabolism ; Amino Acids ; pharmacology ; Animals ; Body Weight ; Bone and Bones ; metabolism ; Corticosterone ; blood ; Dexamethasone ; pharmacology ; Enzyme-Linked Immunosorbent Assay ; methods ; Gene Expression Regulation, Enzymologic ; Glucocorticoids ; metabolism ; Humans ; Male ; Osteoporosis ; metabolism ; Rats ; Rats, Sprague-Dawley

Aerospace Medicine ; history ; trends ; Humans

INTRODUCTIONGabapentin has demonstrated efficacy in clinical trials as a pre-emptive analgesic and in acute postoperative pain management. However, our experience with the drug is still limited. The present study was conducted in order to evaluate the effect of gabapentin on reduction of postoperative pain in the first 24 hours after internal fixation of the tibia under spinal anaesthesia.

METHODSIn a double-blind, randomised controlled clinical trial, 64 American Society of Anesthesiologists Class I or II patients, who underwent internal fixation of the tibia, were administered 300 mg of gabapentin or a placebo two hours before surgery. The postoperative pain was assessed using Visual Analogue Scale two, 12 and 24 hours after surgery. The time from the end of surgery until the first bolus dose of morphine on demand (pain score > 4) and the total morphine requirement were recorded. Patients were also asked about the possible side effects of gabapentin.

RESULTSThe pain score was significantly lower in the gabapentin group at two hours post surgery (p-value is 0.004), while the scores at 12 and 24 hours post surgery were not significantly different between the two groups. No side effect of gabapentin was observed.

CONCLUSIONPre-emptive use of gabapentin 300 mg orally significantly decreases postoperative pain two hours after surgery.

Adult ; Amines ; pharmacology ; therapeutic use ; Anesthesia, Spinal ; methods ; Anesthesiology ; methods ; Cyclohexanecarboxylic Acids ; pharmacology ; therapeutic use ; Double-Blind Method ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Morphine ; therapeutic use ; Orthopedics ; methods ; Pain ; drug therapy ; Pain, Postoperative ; Placebos ; Tibia ; surgery ; Time Factors ; Treatment Outcome ; gamma-Aminobutyric Acid ; pharmacology ; therapeutic use

Ehlers-Danlos Syndrome ; pathology ; Humans ; Lung ; abnormalities ; pathology ; Male ; Patella ; abnormalities

Humans ; Male ; Prostate ; surgery ; Prostatic Hyperplasia ; surgery ; Transurethral Resection of Prostate ; instrumentation ; methods

INTRODUCTIONThe purpose of this study is to assess whether the newly-developed VBM (Medizintechnik GmbH, Sulz, Germany) laryngeal tube (LT) is able to provide adequate ventilation and oxygenation to patients with an unstable neck and require airway management. The haemodynamic responses to insertion between the two devices were also studied. We compared the LT to the laryngeal mask airway (LMA) as an alternative airway management tool in adult patients with unstable neck and who underwent intubation with manual in-line neck stabilisation.

METHODSA randomised single-blinded prospective study was conducted involving a total of 40 American Society of Anesthesiology I and II pre-medicated patients who were divided into two groups, LT or LMA, for airway management during elective surgery. There were 20 patients for each group. After pre-oxygenation, anaesthesia was induced using intravenous (i.v.) fentanyl and i.v. propofol. The neuromuscular blockade was produced with either i.v. vecuronium or i.v. atracurium. The LT or LMA was inserted after neuromuscular blockade was confirmed using a peripheral nerve stimulator (train-of-four 1). A size 3, 4 or 5 LT or a size 3 or 4 LMA was inserted while the patient's head and neck were being stabilised by an assistant who held the sides of the neck and the mastoid processes (manual in-line stabilisation). If it was not possible to ventilate the lungs, or if end-tidal carbon dioxide and/or chest movement did not indicate a patent airway, the LT or LMA was removed. After three failed attempts, the study was terminated and the airway was secured in the most suitable manner determined by the anaesthetist. After successful placement of LT or LMA, anaesthesia was maintained with 66 percent nitrous oxide in oxygen and 2 minimum alveolar concentration sevoflurane. All patients received standard anaesthesia monitoring. The ease of insertion, the number of attempts needed to successfully secure the airway, episodes of desaturation (less than 95 percent) and end-tidal carbon dioxide at various time intervals were studied. The haemodynamic parameters such as systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate at different time intervals were also studied.

RESULTSThe study showed a statistically significant difference in time required for successful insertion between the groups; time required for LT was 24.8 +/- 7.7 seconds and LMA was 36.1 +/- 17.3 seconds (p-value equals 0.01). Both groups had no statistical differences (p-value is greater than 0.05) in number of attempts needed to achieve a patent airway, and the successful insertion rate was 100 percent for both groups. There were also no statistical differences in the haemodynamic response to insertion and the end-tidal carbon dioxide in this study.

CONCLUSIONWe conclude that, under anaesthesia, the LT was a valuable and better alternative to LMA for ventilation and airway management when the patient's head and neck are stabilised by the manual in-line method.

Adolescent ; Adult ; Anesthesia, General ; methods ; Anesthetics, Inhalation ; administration & dosage ; Blood Pressure ; Elective Surgical Procedures ; Fentanyl ; administration & dosage ; Head Movements ; Heart Rate ; Humans ; Immobilization ; Intubation, Intratracheal ; instrumentation ; Laryngeal Masks ; Middle Aged ; Neck ; Propofol ; administration & dosage ; Time Factors

We report Mycobacterium fortuitum (M. fortuitum) catheter-related sepsis in a five-year-old boy with acute lymphoblastic leukaemia (ALL). This is the first reported case of M. fortuitum infection seen in our paediatric oncology patients. The patient was in haematological remission and receiving maintenance chemotherapy via an indwelling central venous catheter (Port-a-Cath). He was febrile, toxic-looking and was in respiratory distress. Clinically, he had a right pleural effusion and gross hepatomegaly. The patient was lymphopaenic and had deranged liver function test. Repeat paired blood cultures were positive for M. fortuitum. The catheter was promptly removed and he was treated aggressively with intravenous amikacin, cefoxitin, ciprofloxacin, trimethoprim-sulfamethoxazole and oral clarithromycin, with good clinical response. The patient remained well without further complications while on chemotherapy. M. fortuitum is an uncommon cause of catheter-related infection in patients with malignancies. Removal of an infected catheter is necessary for complete control of atypical mycobacterial infection in an immunosuppressed patient.
Acute Disease ; Antineoplastic Agents ; administration & dosage ; Catheters, Indwelling ; microbiology ; Child, Preschool ; Humans ; Immunocompromised Host ; Male ; Mycobacterium Infections, Nontuberculous ; complications ; microbiology ; Mycobacterium fortuitum ; isolation & purification ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; complications ; drug therapy ; Sepsis ; etiology ; microbiology

Animals ; Humans ; Tetralogy of Fallot ; embryology ; etiology