Articles: palliative-care.
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Palliative medicine · Oct 1995
Clinical TrialBlood transfusion and its benefits in palliative care.
The value of blood transfusion as a supportive treatment in haematological disease and oncology is well established and is seen as an essential part of treatment. The place of blood transfusion in the alleviation of symptoms within palliative care units is less well established. There has been no evaluation of its benefits in terms of symptom relief and impact on the quality of life. ⋯ The group of patients entered into the study were anaemic in comparison with our normal patient population, but the degree of improvement seen did not correlate with the degree of anaemia prior to transfusion. We conclude that transfusion does offer symptom relief and improvement in well-being in patients with advanced malignant disease. It should be considered as a worthwhile option in palliative treatment of weakness, dyspnoea and impaired overall sense of well-being, when associated with anaemia.
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The surgical management for bridging patients with univentricular heart and systemic obstruction to a Fontan procedure remains controversial. ⋯ Initial management of patients with univentricular heart and systemic obstruction by Norwood-like procedures provides a better outcome. Success of the Fontan operation relies on the ability to provide timely relief of subaortic stenosis.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intrathecal steroids to reduce pain after lumbar disc surgery: a double-blind, placebo-controlled prospective study.
This double-blind, placebo-controlled prospective study investigated whether corticosteroids (beta-methasone) influence residual radicular pain after lumbar disc surgery. The study population consisted of 26 patients undergoing surgery for a herniated lumbar disc at our University Neurosurgical Department. Thirteen patients received beta-methasone intrathecally prior to wound closure, and 13 patients received normal saline. ⋯ At follow-up after 6 months, residual radicular pain was rated equally by both groups (4 mm in the treatment vs. 5 mm in the placebo group, P > 0.5). Intrathecal application of steroids provides short-lasting, significant pain reduction after lumbar disc surgery. Benefits of intrathecal steroids are probably outweighed by the risks associated with violation of the dural barrier.
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The clinical, electrophysiological and haemodynamic effects of precentral gyrus stimulation (PGS) as a treatment of refractory post-stroke pain were studied in 2 patients. The first patient had a right hemibody pain secondary to a left parietal infarct sparing the thalamus, while the second patient had left lower limb pain developed after a right mesencephalic infarct. In both cases, spontaneous pain was associated with hyperpathia, allodynia and hypoaesthesia in the painful territory involving both lemniscal and extra-lemniscal sensory modalities in patient 1, extra-lemniscal sensory modality only in patient 2. ⋯ PGS analgesic efficacy may be mainly related to increased synaptic activity in the thalamus and brainstem while changes in cingulate gyrus and orbito-frontal cortex may be rather related to attentional and/or emotional processes. The inhibitory control on pain would involve thalamic and/or brainstem relays on descending pathways down to the spinal cord segments, leading to a depression of nociceptive reflexes. Painful dysesthesiae during stimulation have to be distinguished from other innocuous sensory side effects, since they may compromise PGS efficacy.
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The purpose of this study was to investigate the effects of continuous epidural blockade on acute zoster-associated pain, compared with intermittent epidural blocks. ⋯ Continuous epidural blockade for patients with acute zoster can shorten the duration of treatment and may reduce the incidence of postherpetic neuralgia.