The journal of supportive oncology
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Palliation of pain in pancreatic cancer often requires a multidisciplinary approach, with options including oral analgesics, chemoradiotherapy, and celiac plexus neurolysis (CPN). Although CPN may be performed endoscopically, percutaneously, or surgically, endoscopic ultrasonography (EUS)-guided CPN is becoming more commonplace, given the overall improved real-time visualization and reduced risk of major (neurologic) complications. Regardless of the technique used, CPN may have a long-lasting benefit in between 70% and 90% of patients with pancreatic cancer.
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Randomized Controlled Trial Multicenter Study
Methylnaltrexone for treatment of opioid-induced constipation in advanced illness patients.
Methylnaltrexone, a peripheral mu-opioid receptor antagonist with restricted ability to cross the blood-brain barrier, may relieve opioid-induced constipation (OIC) without reversing analgesia. A total of 154 patients with advanced illness and OIC enrolled in a double-blind, randomized, placebo-controlled trial, with optional open-label phases (up to 4 months) in hospice and palliative care centers during 2003-2005. They received a single subcutaneous injection of methylnaltrexone (0.15 mg/kg or 0.3 mg/kg) or placebo. ⋯ The most common adverse events (AEs) were abdominal pain and flatulence. Three patients had serious AEs attributed to methylnaltrexone. Subcutaneous methylnaltrexone was efficacious in rapidly inducing laxation and was generally well tolerated in patients with advanced illness and OIC.
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Letter Case Reports
Urinary and rectal incontinence during gabapentin therapy.