Articles: palliative-care.
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Am. J. Gastroenterol. · Dec 1999
Case ReportsPalliative transhepatic biliary drainage and enteral nutrition.
Simultaneous intestinal and biliary obstruction is a rare but agonizing complication of metastatic abdominal cancer. Although endoscopic procedures exist that relieve jaundice or restore enteral nutrition, they can be impossible to perform for technical or anatomical reasons. We propose a palliative approach for these patients that includes transcutaneous common bile duct drainage, progressive dilation of the transhepatic channel over 1 wk, and, finally, insertion of a permanent silicon catheter that drains bile into the duodenum and is combined with an enteral feeding line. ⋯ As a result, the patients chose to return to home care with enteral nutrition and pain medication. The creation of a transhepatic access for simultaneous enteral bile drainage and nutrition is a technically simple procedure that causes little discomfort to a terminally ill patient. It relieves the symptoms of tumor obstruction, and the option of enteral nutrition and medication can obviate the need for intravenous infusions.
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To develop an outcome measure for patients with advanced cancer and their families which would cover more than either physical symptoms or quality of life related questions. To validate the measure in various specialist and non-specialist palliative care settings throughout the UK. ⋯ The POS has acceptable validity and reliability. It can be used to assess prospectively palliative care for patients with advanced cancer.
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Dyspnoea is a frequent symptom in advanced cancer patients. The control of breathing can be impaired by different mental and physical factors that may coincide and change over time. ⋯ Only few controlled trials evaluating the efficacy of symptomatic treatment of dyspnoea in advanced cancer patients are available. There is evidence that systemically administered opioids are effective in alleviating breathlessness in patients with cancer.