PURPOSE: This study was conducted to investigate how nurses who take care of terminal patients perceive fluid therapy and how this therapy is currently being used in hospitals. METHODS: This survey included 200 nurses, 87 of whom were working in the oncology units of 3 university hospitals in Seoul, Korea, and 113 were working in 18 hospice centers. The data for this study were collected by means of structured questionnaires and analyzed by using the Statistical Analysis System software. The differences in perception towards fluid therapy between nurses working in oncology units and those working in hospice centers were examined using the chi-square test and analysis of covariance. RESULTS: Fluid therapy was perceived more negatively by the nurses from hospice centers than by those from oncology units. Continuous subcutaneous infusion was used in hospice centers, but not in oncology units. In addition, the average amount of fluid infused daily differed significantly between the oncology units and hospice centers. CONCLUSION: Our results show that there were differences in the perception towards fluid therapy between nurses in different clinical settings. Nurses caring for terminal and palliative care patients should not simply provide or withhold fluid therapy, but rather develop a wider range of views on fluid therapy, focusing on effective alternative interventions.
Fluid Therapy ; Hospices ; Hospitals, University ; Humans ; Infusions, Subcutaneous ; Korea ; Palliative Care ; Terminally Ill ; Surveys and Questionnaires

PURPOSE: The purpose of this study was to examine whether recombinant human endostatin (rhEndostatin), an antiangiogenic agent, is effective against a human neuroblastoma cell line (designated TNB9). We employed a human neuroblastoma xenograft model, and we investigated whether continuous infusion is more effective than an intermittent administration. METHODS: In the first experiment, when the tumors on the backs of nude mice reached a weight of 90 mg, rhEndostatin was administered subcutaneously to the mice (n=5) every day for 10 consecutive days. In the second experiment, the same daily dose of rhEndostatin was administered continuously to the TNB9- bearing mice (n=6) via subcutaneous infusion pumps for 3 consecutive days with the total dose being 30% of the dose given in the first experiment. Nestin and factor VIII expression levels were assessed immunohistochemically to elucidate whether the effects of rhEndostatin was present according to the histologic evidence at day 4 in the second experiment. RESULTS: In the first experiment, the relative tumor weight in treated mice (n=5) was significantly less than that in the controls (n=12) on day 2 after treatment initiation only (P<.05). The maximum inhibition rate (MIR) of TNB9 xenograft growth by rhEndostatin was 46.4%, indicating the lack of efficacy. In the second experiment, the effects of rhEndostatin were much more marked than those noted in the first experiment, with the MIR being 60.7%. The mean relative tumor weight in the treated group (n=6) in the second experiment was significantly less than that in the controls (n=10) on days 2, 4 and 6 (P<.01), as well as on days 8 and 10 (P<.05). The nestin staining in the endothelium of the control tumors (n=2) was remarkable, whereas the nestin staining showed as a loss of fibrillar structure in the rhEndostatin-treated tumors (n=2). The number of vessels immunostained with antifactor VIII antibody was markedly reduced in the tumors (n=2) from the rhEndostatin-treated mice compared with that from the control mice (n=2). CONCLUSION: Continuous administration of rhEndostatin resulted in more significant tumor regression than an intermittent administration of the agent. This result suggests that the continuous infusion of rhEndostatin is an effective agent and administration method for treating patients with neuroblastoma in the future.
Animals ; Cell Line ; Endostatins* ; Endothelium ; Factor VIII ; Heterografts* ; Humans* ; Infusions, Subcutaneous ; Mice ; Mice, Nude ; Nestin ; Neuroblastoma* ; Tumor Burden

BACKGROUND: Generally, for patients with cancer, chronic disease, burn injury or pediatric patients to whom oral medication is difficult or whose vessels are fragile, it is difficult to inject analgesics parenterally. To know the effect of subcutaneous infusion which would be directly used by patients themselves or their care givers, we compared subcutaneous patient-controlled analgesia (SQ PCA) with intravenous patient-controlled analgesia (IV PCA) morphine for acute postoperative pain. METHODS: We undertook a study to prospective, randomized, controlled patients (n = 30) undergoing elective total hysterectomy to compare SQ PCA with IV PCA morphine for postoperative pain control. We prepared a 5 mg/ml solution of morphine for the SQ PCA group (n = 15) and a 1 mg/ml solution of morphine for the IV PCA group (n = 15). The regimen of morphine was a basal rate 20 microgram/kg/h, 1 mg bolus, 10 min lockout interval, 1 hour limit of 8 mg. We evaluated the VAS score at rest and at coughing after postoperative 6, 12, 18, 24, 30, 36, 42 and 48 hours, 6 hourly doses of morphine, total requirement of infused morphine for 48 hours and delivery to demand ratio. Side effects and satisfactory score were checked too. RESULTS: The Visual analogue scale (VAS) pain score at rest and with coughing, the 6 hourly doses of morphine, the total requirement of infused morphine for 48 hours, the delivery to demand ratio, side effects and the satisfactory score were not significantly different in the two groups (P<0.05). CONCLUSION: Thus SQ PCA morphine represents a clinically acceptable alternative to IV PCA in the treatment of postoperative pain control.
Analgesia, Patient-Controlled* ; Analgesics ; Burns ; Caregivers ; Chronic Disease ; Cough ; Humans ; Hysterectomy ; Infusions, Subcutaneous ; Morphine* ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Prospective Studies

BACKGROUND: Flecainide is an antiarrhythmic agent that is used primarily in the treatment of cardiac arrhythmias. Some evidences also suggest that flecainide can participate in alveolar fluid clearance and inflammatory responses. This experiment was aimed to evaluate the effects of flecainide on sepsis induced acute lung injury in a rat model. METHODS: Rats were treated with subcutaneous infusion of saline or flecainide (0.1 or 0.2 mg/kg/hr) by a mini-osmotic pump. Subcutaneous infusion was started 3 hours before and continued until 8 hours after intraperitoneal injection of saline or endotoxin. Animals were sacrificed for analyses of severity of acute lung injury with wet to dry (W/D) ratio and lung injury score (LIS) in lung and inflammatory responses with level of leukocyte, polymorphonuclear neutrophils (PMNs) and inteleukin-8 (IL-8) in bronchoalveolar lavages fluid (BALF). RESULTS: Flecainide markedly improved dose dependently sepsis induced acute lung injury as analysed by W/D ratio (from 2.24 ± 0.11 to 1.76 ± 0.09, p < 0.05) and LIS (from 3 to 1, p < 0.05), and inflammatory response as determined by leukocyte (from 443 ± 127 to 229 ± 95, p < 0.05), PMNs (from 41.43 ± 17.63 to 2.43 ± 2.61, p < 0.05) and IL-8 (from 95.00 ± 15.28 to 40.00 ± 10.21, p < 0.05) in BALF. CONCLUSIONS: Flecanide improve sepsis induced acute lung injury in rats by controlling inflammatory responses.
Acute Lung Injury* ; Animals ; Arrhythmias, Cardiac ; Bronchoalveolar Lavage ; Flecainide* ; Infusions, Subcutaneous ; Injections, Intraperitoneal ; Interleukin-8 ; Leukocytes ; Lung ; Lung Injury ; Models, Animal ; Neutrophils ; Rats ; Sepsis*

A 25-year-old woman transferred to pain clinic complaining of severe throbbing eye ball pain, eyelid edema and severe tearing in her left eye under the diagnosis of herpes zoster ophthalmicus that was developed 3months ago. In addtion to conventional medication, she had been taken stellate ganglion block, supraorbital and supratrochlear nerve block to contol of pain, but the response was poor. So we tried to administer ketamine subcutaneously, because not only ketamine, NMDA receptor antagonist, played a significant role to reduce neuropathic pain and pain caused by nerve injury, but also she wanted to work in her office during the treatment. We used subcutaneous ketamine 3 mg/hr (0.06 mg/kg/hr) in patient with postherpetic neuralgia of the ophthalmic nerve, and accomplished almost complete pain relief without any sign of side effect.
Adult ; Diagnosis ; Edema ; Eyelids ; Female ; Herpes Zoster Ophthalmicus ; Humans ; Infusions, Subcutaneous* ; Ketamine* ; N-Methylaspartate ; Nerve Block ; Neuralgia ; Neuralgia, Postherpetic* ; Ophthalmic Nerve* ; Pain Clinics ; Pain Management* ; Stellate Ganglion

The diagnosis and treatment of congenital hyperinsulinism (CHI) have made a remarkable progress over the past 20 years and, currently, it is relatively rare to see patients who are left with severe psychomotor delay. The improvement was made possible by the recent developments in the understanding of the molecular and pathological basis of CHI. Known etiologies include inactivating mutations of the K(ATP) channel genes (ABCC8 and KCNJ11) and HNF4A, HNF1A, HADH, and UCP2 or activating mutations of GLUD1, GCK, and SLC16A1. The understanding of the focal form of K(ATP) channel CHI and its detection by 18F-fluoro-L-DOPA positron emission tomography have revolutionized the management of CHI, and many patients can be cured without postoperative diabetes mellitus. The incidence of the focal form appears to be higher in Asian countries; therefore, the establishment of treatment systems is even more important in this population. In addition to diazoxide or long-term subcutaneous infusion of octreotide or glucagon, long-acting octreotide or lanreotide have also been used successfully until spontaneous remission. Because of these medications, near-total pancreatectomy is less often performed even for the diazoxide-unresponsive diffuse form of CHI. Other promising medications include pasireotide, small-molecule correctors such as sulfonylurea or carbamazepine, GLP1 receptor antagonists, or mammalian target of rapamycin inhibitors. Unsolved questions in this field include the identification of the remaining genes responsible for CHI, the mechanisms leading to transient CHI, and the mechanisms responsible for the spontaneous remission of CHI. This article reviews recent developments and hypothesis regarding these questions.
Asian Continental Ancestry Group ; Carbamazepine ; Congenital Hyperinsulinism* ; Diabetes Mellitus ; Diagnosis ; Diazoxide ; Glucagon ; Humans ; Hyperinsulinism ; Hypoglycemia ; Incidence ; Infusions, Subcutaneous ; Octreotide ; Pancreatectomy ; Positron-Emission Tomography ; Remission, Spontaneous ; Sirolimus

PURPOSE: We undertook this study to evaluate the usefullness of radiologic placement of subcutaneous infusion ports (SIP). MATERIALS AND METHODS: Between August 1999 and May 2000 we performed 45 implantations of SIP in radiologic suite. Both sonography and fluoroscopy were used for venipuncture and to guide port insertion. We prospectively evaluated 45 systems in 45 patients with solid tumors. RESULTS: Median follow-up time was 189 days (61~352 days). Technical success rate is 100% without any venipuncture-related complications. Early complication rate within 30 days of procedure was 4.4%, including wound dehiscence (n=1) and pocket hematoma and local infection (n=1). Catheter-related infection rate was 6.7% and catheter-related venous thrombosis rate was 4.4%. Mean duration of catheter use was 208 96 days (total, 9,381 days). Overall port survival rate was 38.5%, and four systems (8.9%) were prematurely removed because of catheter tunnel infection (n=1), pocket infection (n=1), and central venous thrombosis (n=2). CONCLUSION: Radiologic placement of SIP had higher success rate and equal or lower complication rate compared with reported conventional surgical technique using anatomical landmarks. Moreover, clinical convenience, resulting from ease of scheduling could make it replace surgical method.
Catheter-Related Infections ; Catheters ; Fluoroscopy ; Follow-Up Studies ; Hematoma ; Humans ; Infusions, Subcutaneous* ; Phlebotomy ; Prospective Studies ; Survival Rate ; Venous Thrombosis ; Wounds and Injuries

Complex regional pain syndrome (CRPS), which is a syndrome that is defined by pain and sudomotor and/or vasomotor instability, is usually resistant to conventional treatment. Here, a case involving a 30-year-old male patient with CRPS type I who showed severe intractable right shoulder pain with allodynia and hyperalgesia despite being treated with oral medications, nerve blocks including thoracic sympathetic neurolysis, and spinal cord stimulation is described. The patient frequently visited the emergency room due to severe uncontrollable breakthrough pain. Although a favorable effect was observed in response to intermittent ketamine infusion therapies that were performed on an outpatient basis, acute exacerbation of pain occurred frequently during the night and could not be controlled. Therefore, subcutaneous ketamine infusion therapy using a patient-controlled analgesic system was attempted and found to effectively control acute exacerbation of pain during 6 weeks of infusion without serious complications.
Adult ; Breakthrough Pain ; Emergency Service, Hospital ; Humans ; Hyperalgesia ; Infusions, Subcutaneous* ; Ketamine* ; Male ; Nerve Block ; Outpatients ; Pain Management* ; Shoulder Pain ; Spinal Cord Stimulation

BACKGROUND: The robot-assisted transaxillary approach to thyroid surgery is a novel method that has recently been used to improve patient safety and cosmetic outcomes. We evaluated post-operative pain, following robot-assisted endoscopic transaxillary thyroid surgery, and pain relief using a continuous wound perfusion system with local anesthetics. METHODS: In a control group of 25 female patients who underwent robot-assisted endoscopic transaxillary thyroidectomy, the post-operative pain scores and characteristics as well as analgesic use were monitored. Fifty female patients undergoing robot-assisted endoscopic transaxillary thyroidectomy were given the On-Q system. They were then randomly assigned to receive one of two different local anesthetic doses: Group I (0.25% Ropivacaine, n = 25); and Group II (0.375% Ropivacaine, n = 25). The pain score, pain site, analgesic requirements and side effects of each group were recorded during the 48 hour period post-surgery. RESULTS: Post-operative pain scores and analgesic demand were lower in the On-Q groups than in the control group. No difference was found between Group I and Group II. Until 6-12 hours after surgery, pain was mainly located in the axilla, while after 6-12 hours, the primary location of pain had a tendency to move to the neck. Pain scores gradually decreased in time for all patients. CONCLUSIONS: Patients who underwent robot-assisted endoscopic transaxillary thyroidectomy with an On-Q system injecting 0.25% ropivacaine had lower pain scores, showing the effectiveness of the system. As a potential pain blocker, continuous wound perfusion with the On-Q system attenuates side effects. This could lead to shortened hospital stays after robot-assisted endoscopic transaxillary thyroidectomy.
Amides ; Anesthetics, Local ; Axilla ; Female ; Humans ; Infusions, Subcutaneous ; Length of Stay ; Methods ; Neck ; Pain Management* ; Patient Safety ; Perfusion ; Robotics ; Thyroid Gland ; Thyroidectomy* ; Wounds and Injuries

BACKGROUND: The robot-assisted transaxillary approach to thyroid surgery is a novel method that has recently been used to improve patient safety and cosmetic outcomes. We evaluated post-operative pain, following robot-assisted endoscopic transaxillary thyroid surgery, and pain relief using a continuous wound perfusion system with local anesthetics. METHODS: In a control group of 25 female patients who underwent robot-assisted endoscopic transaxillary thyroidectomy, the post-operative pain scores and characteristics as well as analgesic use were monitored. Fifty female patients undergoing robot-assisted endoscopic transaxillary thyroidectomy were given the On-Q system. They were then randomly assigned to receive one of two different local anesthetic doses: Group I (0.25% Ropivacaine, n = 25); and Group II (0.375% Ropivacaine, n = 25). The pain score, pain site, analgesic requirements and side effects of each group were recorded during the 48 hour period post-surgery. RESULTS: Post-operative pain scores and analgesic demand were lower in the On-Q groups than in the control group. No difference was found between Group I and Group II. Until 6-12 hours after surgery, pain was mainly located in the axilla, while after 6-12 hours, the primary location of pain had a tendency to move to the neck. Pain scores gradually decreased in time for all patients. CONCLUSIONS: Patients who underwent robot-assisted endoscopic transaxillary thyroidectomy with an On-Q system injecting 0.25% ropivacaine had lower pain scores, showing the effectiveness of the system. As a potential pain blocker, continuous wound perfusion with the On-Q system attenuates side effects. This could lead to shortened hospital stays after robot-assisted endoscopic transaxillary thyroidectomy.
Amides ; Anesthetics, Local ; Axilla ; Female ; Humans ; Infusions, Subcutaneous ; Length of Stay ; Methods ; Neck ; Pain Management* ; Patient Safety ; Perfusion ; Robotics ; Thyroid Gland ; Thyroidectomy* ; Wounds and Injuries