Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
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Support Care Cancer · May 2003
Opioid plasma concentration during switching from morphine to methadone: preliminary data.
Opioid switching is often used to improve the opioid response in cancer patients experiencing poor analgesia or adverse effects. However, no data are available on plasmatic changes of opioids and their metabolites during these phases, and whether there exists a relationship with the clinical events. In a prospective study of 10 consecutive cancer patients on oral morphine but with uncontrolled pain (greater >4 on a numerical scale of 0 to 10) and/or moderate to severe opioid adverse effects (on a level of 2 and 3 of a verbal scale) and not responsive to adjuvant medications, switching to oral methadone was performed using a fixed ratio of 5:1, leaving extra-doses of 1/5 of the daily dose of methadone calculated as needed. ⋯ The results of this study confirm the need to stop rapidly morphine, and to use a priming dose of methadone, rather than using progressive decrements and increments of morphine and methadone, respectively, during opioid switching. This method allows for a rapid clearance of morphine and its metabolites are rapidly cleared, except in patients with renal failure. Opioid plasma changes substantially overlap the clinical changes observed in these patients, in terms of benefit between analgesia and adverse effects.
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Support Care Cancer · Apr 2003
Leucopenia is an independent predictor in cancer patients requiring invasive mechanical ventilation: a prognostic factor analysis in a series of 168 patients.
To determine prognostic factors predicting success of invasive mechanical ventilation in medical cancer patients admitted to ICU for a complication, in terms of extubation and ICU and hospital discharges. ⋯ Leucopenia appeared to be the only independent poor prognostic factor for both extubation and hospital discharge. None of the variables related to the cancer disease process was shown to be a predictor of success.
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Support Care Cancer · Mar 2003
ReviewEstablished and potential therapeutic applications of cannabinoids in oncology.
Cannabis occurs naturally in the dried flowering or fruiting tops of the Cannabis sativa plant. Cannabis is most often consumed by smoking marihuana. Cannabinoids are the active compounds extracted from cannabis. ⋯ CB2 receptors are found in certain nonneuronal tissues, particularly in the immune cells. Recent discovery of both the cannabinoid receptors and endocannabinoids has opened a new era in research on the pharmaceutical applications of cannabinoids. The use of cannabinoids should be continued in the areas indicated, and further studies are needed to evaluate other potential uses in clinical oncology.
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Support Care Cancer · Mar 2003
Clinical TrialEvaluation of an ultrasound-guided technique for central venous access via the internal jugular vein in 493 patients.
Ultrasound guidance for percutaneous puncture of the internal jugular vein provides many advantages over the classic landmark-guided technique, particularly in complicated cases (e.g. thrombocytopenia, obesity, dyspnea). The present prospective investigation involved analysis of 493 punctures and provides patient- and operator-dependent variables with respect to the impact on puncture success and the complication rate. These 493 punctures of the internal jugular vein were performed using identical puncturing equipment and a standardized two-operator catheterization technique and were prospectively recorded on the hematology-oncology ward of a university hospital. ⋯ Ultrasound-guided cannulation of the internal jugular vein provides safe central venous access with high success rates and low complication rates. Difficulties due to patient-inherent risk factors (e.g. thrombocytopenia, obesity, dyspnea) can be managed well using ultrasonographic guidance. The success rate achieved and the frequency of complications are decisively influenced not by the experience of the physician performing the puncture, but by the experience of the physician acting as sonographer.