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Query: UMLS:C0027651 (tumor)
 685,946 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Patient-controlled analgesia (PCA) is a well-accepted technique in postoperative pain management. We used PCA in three different protocols to find the optimum application form. Our study compared 100 patients with radical prostatectomy or transperitoneal tumor nephrectomy in three groups using piritramide. Group 1 (n = 16) received 1.2 mg/h continuously and a 3 mg bolus with a lock-out time of 90 min. Group 2 (n = 30) received 0.8 mg/h continuously and a 3 mg bolus with a lock-out time of 60 min. Group 3 (n = 54) received the same continuous infusion, but the lock-out time was only 30 min. After 24 hours we evaluated the quality of analgesia using VAS scale. The quantity of piritramide was equal in all groups (35.1 mg). An average of seven bolus applications were made during the observation period. In 27.6% of the patients (group 1: 30.4%; group 2: 35.0%; group 3: 23.1%) the bolus demand was refused by programme. The analgesia level was satisfactory in each group, with a VAS value of 27. There was no respiratory depression observed. In conclusion, on-demand analgesia proved to be a good and practicable method in postoperative pain management. Although the dosage of piritramide was not different in the three groups, we recommend the protocol of group 3 because of the lower refusal of bolus application. Therefore, this seems to be the best patient-adapted application form. Even though respiratory complications in the group 3 scheme are not expected, monitoring of respiration and vigilance are recommended.
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PMID:[Patient-controlled analgesia (PCA) after urologic interventions]. 852 66

We report our combined experience on video-assisted thoracoscopic (VAT) anatomic lung resections from two major hospitals in Hong Kong over a 17-month period. From August 1993 to December 1994, 82 cases of major lung resections were attempted using the VATS approach, of which 60 were successfully completed (55 lobectomies, 2 bilobectomies, 2 pneumonectomies, and 1 segmentectomy). Of these 60 cases, there were 43 men and 17 women with a mean age of 66 years (range, 37 to 85 years). The final pathologies were 52 primary lung cancers (37 adenocarcinoma, 11 squamous cell carcinoma, 2 bronchoalveolar carcinoma, 1 adenosquamous carcinoma, and 1 undifferentiated carcinoma); 1 pulmonary metastasis (from nasopharyngeal carcinoma); and 7 benign lesions (3 tuberculosis, 1 bronchiectasis, 1 sclerosing hemangioma, 2 organizing pneumonia). There was one postoperative death (mortality rate, 1.8%). Complications include persistent air leak over 10 days (four), wound infection (two), supraventricular tachycardia (three), and recurrence of tumor over the utility thoracotomy scar (one). All the patients were followed up from 8 weeks to 19 months (mean, 10 months). The mean duration of chest drainage was 5.4 days (range, 2 to 25 days). The mean hospital stay was 7.2 days (range, 4 to 35 days). The average postoperative parenteral narcotic (meperidine hydrochloride [Pethidine]) requirement by patient-controlled analgesia was 275 mg (range, 75 to 800 mg). This compared favorably with an age- and sex-matched historic group of patients who underwent posterolateral thoracotomy and had a hospital stay of 10.4 days (statistically non-significant) and narcotic requirement of 950 mg (statistically significant by paired t test). We conclude that VAT anatomic lung resection is technically feasible. However, there are some specific complications associated with major lung resection through minimal access. Refinement of our present technique and attention to details are important to improve our results.
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PMID:Video-assisted thoracoscopic anatomic lung resections. The initial Hong Kong experience. 854 66

In the period 01.01.93 to 01.02.95 a total number of 40 patients underwent a diagnostic pelvic lymphadenectomy. All patients had bladder carcinoma. Twenty-one had the procedure performed as an open operation and 19 had a laparoscopic approach. The groups were comparable as to age, sex and tumor stage. The median number of harvested lymph nodes was found to be the same in the two groups (median 5 lymph nodes). The percentage of lymph node positive patients was comparable -5 of 21 in the open and 4 of 19 in the laparoscopic group. One patient in the laparoscopy group had to be converted to an open procedure because of peroperative bleeding. In the open group one accidental ureteric lesion occurred. It was repaired intraoperatively. Only few postoperative complications were seen. In the open group two cases of troublesome lymphoceles occurred and one case of wound infection. In the laparoscopy group one patient experienced prolapse of an omental snip through a port incision and one patient had a scrotal haematoma which resolved spontaneously. The need for postoperative analgesia was significantly less in the laparoscopy group. The postoperative hospital stay was 8 days in the open versus 1 day in the laparoscopy group.
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PMID:Pelvic lymphadenectomy (staging) in patients with bladder cancer laparoscopic versus open approach. 857 50

The purpose of this study was to review ventilation and postoperative analgesic technics in 137 dogs and 13 cats with congenital or acquired heart disease. The animals were referred to the Department of Veterinary Clinical Sciences at The Ohio State University, U.S.A, for the following surgical interventions: correction of patent ductus arteriosus (PDA-ligation, 28%), cardiac catheterization with angiogram and angioplasty (22%), pacemaker implantation (18%), exploratory lateral thoracotomy (8.7%), correction of right aortic arch ring anomaly (3.3%), correction of subvalvular aortic stenosis (2.7%), correction of PDA with coil in patients with mitral regurgitation and congestive heart failure (2%), pericardectomy and removal of heart base tumor (2%), and palliative surgery for ventricular septal defect (VSD, 0.7%). Controlled ventilation was used in all animals during thoracotomy. Anesthesia was maintained over 2.3 +/- 1.3 hours by using either isoflurane, halothane, propofol, or diazepam-ketamine in 64%, 32%, 2%, and 0.7% of animals, respectively. Postoperative analgesia was necessary in 20% of animals and was provided by using different technics over several hours. The technics and respective percentages of animals in which they were used, were: intravenous buprenorphine (3.3%), intercostal nerve blocks (8.7%), epidural morphine (4%), and interpleural regional analgesia (4%).
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PMID:[Sedation and anesthesia in dogs and cats with cardiovascular diseases. III. Ventilation, respiratory monitoring, treatment for postoperative pain]. 876 47

Two patients suffering with severe pain due to metastatic abdominal neoplasm were selected to examine whether subarachnoid neostigmine provided effective pain relief. Neostigmine was injected through a catheter introduced into the subarachnoid space at L4-L5. Patients were monitored for changes in arterial blood pressure, cardiac and respiratory rates, body temperature, level of consciousness and neurologic change. Pain was classified by the patients on a verbal four-grade scale, and analgesia was classified on a verbal three-grade scale. Complete pain relief was obtained 2 h after neostigmine (0.2 mg) in one patient and 4 h after neostigmine (0.1 mg) in the second patient. Pain of mild intensity returned 20 and 22 h after drug administration, respectively. Gastrointestinal discomfort was observed in both cases, but nausea and vomiting occurred only in the patient treated with the highest dose of neostigmine. No significant change in the monitored parameters was observed, except for a 6-h period of decreased blood pressure in the patient treated with the lower dose of neostigmine which required no specific treatment. The results obtained in these anecdotal cases indicate that subarachnoid neostigmine may provide analgesia in patients with pain arising from neoplasia, but further studies using controlled trials are needed before the drug is brought into clinical use.
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PMID:Analgesic effect of subarachnoid neostigmine in two patients with cancer pain. 888 Aug 64

Osteoarthritis and cancer pain are two types of chronic pain commonly seen in small animal practice. The management of osteoarthritic pain consists of both pharmacologic therapy and nonpharmacologic strategies, including exercise control, dietary management and surgical therapy. Nonsteroidal antiinflammatory drugs are commonly used, although there is still controversy about their effect on the underlying pathologic processes of osteoarthritis. Despite a lack of well-designed clinical trials, chondroprotective drugs and neutraceuticals have gained popularity. Cancer pain can result from direct tumor invasion, paraneoplastic syndromes or diagnostic and therapeutic procedures, including surgery, chemotherapy and radiation. Treatment of cancer pain consists of definitive or palliative therapy and management of therapy induced pain. Analgesic therapy should be based on the World Health Organization's three step analgesic ladder for the administration of analgesia to cancer patients.
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PMID:Chronic pain: osteoarthritis and cancer. 915 69

In order to establish effective postoperative analgesia we studied the incidence and significance of pain following maxillofacial surgery. The trial included 102 patients undergoing one of six different surgical procedures. Postoperative pain was assessed using a visual analogue scale (VAS) and the short form of the McGill Pain Questionnaire (SF-MPQ) up to the third postoperative day. Postoperative pain intensity was significantly correlated to operating time, the frequency of analgesic demand and the type of surgery (orthognathic surgery > TMJ surgery > osteosynthetic surgery > osteotomy of impacted third molars > tumor resection > removal of osteosynthetic materials). Patient's age, sex and ethnic origin did not significantly affect the severity of postoperative pain.
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PMID:[Postoperative pain after interventions in the area of the mouth-jaw-face]. 941 Jun 33

The management of severe tumor-related pain in the patient with cancer may be problematic. Systemically administered opioids remain the cornerstone of treatment for moderate to severe cancer pain, while parenteral routes should be considered for patients who require rapid onset of analgesia, and for highly tolerant patients whose dose requirements cannot be conveniently administered. The use of intravenous methadone by patient controlled analgesia (PCA) is attractive for the management of severe, intractable cancer pain and may offer some advantages over morphine. We describe the safe and effective use of high-dose intravenous methadone by PCA and continuous infusion for a patient with intractable tumor-associated cancer pain who experienced inadequate pain control and dose-limiting side-effects with high-dose intravenous morphine.
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PMID:Intravenous high-dose methadone administered by patient controlled analgesia and continuous infusion for the treatment of cancer pain refractory to high-dose morphine. 941 14

Thoracic surgical oncology involves surgical treatment of lesions of the thoracic wall, pulmonary parenchyma, or mediastinum (also including heart, esophagus, or trachea). The most common neoplasms of the thoracic wall are osteosarcoma and chondrosarcoma. Histopathologic type, the use of chemotherapy for osteosarcoma, and completeness of surgical margins are prognostic for survival. Relative to solitary pulmonary masses, carcinomas are most common, with histopathologic type, tumor size, tumor grade, and lymph node status prognostic for survival. Of the aforementioned variables, lymph node status is the most significant. Extensive preoperative workup, including bronchoscopy and transthoracic fine needle aspiration of solitary lung masses, is usually not recommended. Thymomas are the most common surgical mediastinal mass. Patients are frequently affected with paraneoplastic syndromes including myasthenia gravis, polymyositis, and nonthymic neoplasia. Patients without megaesophagus with surgically resectable masses have an excellent prognosis for survival. Provision of analgesia after surgery in thoracotomy patients is extremely important. Carefully selected analgesic agents in thoracotomy patients are far less damaging to cardiovascular status than is tachycardia from excessive pain. Given these and other guidelines, perioperative mortality in thoracotomy patients is minimal, and long-term survival in selected patients is excellent.
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PMID:Thoracic surgical oncology. 963 48

Due to a rise in life expectancy as well as improved adjuvant and diagnostic measures the incidence of clinically symptomatic metastases has significantly increased. In terms of indication and operative technique in the treatment of these lesions the biologic age, general condition, diagnosis, stage and activity of the disease and the patient's prognosis are highly important. Different techniques of joint replacement have been described to treat patients suffering from metastatic disease of the periacetabular region, being resistant to any kind of adjuvant therapy. From 1977-1996 21 patients with a periacetabular lesion received a tumor prosthesis following internal hemipelvectomy (average age 60 years; average survival 23.1 months). Perioperative complication rate was 42%, functional results were good (n =), fair (n = 9) and poor (n = 2). Mobilisation and analgesia are the most important therapeutic goals. The quality of the patient's life postop is the major point.
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PMID:[Surgical management of pelvic metastases]. 964 20


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