Articles: palliative-care.
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Palliative medicine · Jan 1999
Review Case ReportsThe role of endoscopic biliary stents in palliative care.
This article reviews the role of endoscopic biliary stents in palliative care. In particular it focuses on the indications for stents, and recognition and management of possible complications. These issues are illustrated with three case reports.
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Adenocarcinoma of the pancreas is the cause of 3-4% of cancer related deaths in Italy and over 80% of all patients exhibit advanced disease. Treatment with surgery and chemio-radiotherapy may have meaningful results in resectable and locoregional tumours respectively. Chemotherapy is the treatment of choice in metastatic disease as palliative intent, although pancreatic tumour is considered resistant to treatment with conventional cytotoxicity drugs. ⋯ In conclusion, future studies should focus on phase III trials with gemcitabine, alone or in combination and phase II with new promising drugs. Quality of life, pharmaco-economic studies, CB should be the principal end-point of these studies. All patients with advanced pancreatic cancer should be included in clinical cooperative trials.
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Over a period of four years the authors developed and integrated into the curriculum of their medical school training programs in palliative medicine. Critical required elements in the freshman year focus on attitudes and the physician's role in the care of terminally ill patients and their families. A 16-hour module has been designed to be a required element for junior students. It includes in-depth classroom and experiential training in palliative medicine. The results of the pilot of this module are presented. ⋯ The majority of students attained the course objectives. Student evaluations of the module were very positive, particularly with regard to the home visits and the need for this training. It is anticipated that the module will be required during the 1999-00 academic year, with each student's performance contributing to his or her final grade in junior medicine.
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Arch Orthop Trauma Surg · Jan 1999
Outcome after palliative posterior surgery for metastatic disease of the spine--evaluation of 106 consecutive patients after decompression and stabilisation with the Cotrel-Dubousset instrumentation.
From 1987 to 1996, 106 consecutive patients with metastatic disease of the spine who underwent palliative decompression from a dorsal approach and subsequent stabilisation with Cotrel-Dubousset instrumentation (CDI) were followed prospectively, and independent of the surgeons. Parameters evaluated were neurological function, perioperative complications, survival and rehabilitation. Following the Frankel system for the assessment of neurological disorder, 33 patients had a major deficit (grade A, B or C), 23 a minor deficit (grade D) and 50 no deficit. ⋯ Overall survival time was 19.2 months, with 5 patients still alive. Six patients required re-operation for tumour recurrence at the same or at a new level. The results of this study show that neurological function, pain level and mobility can be enhanced by decompression and stabilisation through a posterior approach.
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Editorial Comment
The evolving face of palliative care in cancer medicine.