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Biomedical subjects

C Ripamonti

Publications and source records attributed to C Ripamonti.

At least 73 records · Page 4Linked to original sources
PubMed1993

Management of bowel obstruction in advanced and terminal cancer patients.

BACKGROUND: Bowel obstruction is a common and distressing outcome in patients with abdominal or pelvic cancer. PATIENTS AND METHOD: Patients may develop bowel obstruction at any time in their clinical history, with an incidence ranging from 5.5% to 42% in ovarian carcinoma and from 10% to 28.4% in colorectal cancer. The causes of the obstruction may be benign postoperative adhesions, a focal malignant or benign deposit, relapse or diffuse carcinomatosis. The symptoms which are almost always present are intestinal colic (reported in 72%-76% of patients), abdominal pain due to distension, hepatomegaly or tumor masses (in 92% of patients) and vomiting (68%-100%) of cases. CONCLUSION: While surgery must remain the primary treatment for malignant obstruction, it is now recognised that there is a group of patients with advanced disease or poor general condition who are unfit for surgery and require alternative management to relieve distressing symptoms. A number of treatment options are now available for the patient with advanced cancer who develops intestinal obstruction. In this review of the literature, the indications for surgery will be examined, the use of nasogastric tube and percutaneous gastrostomy evaluated and the place of drugs for symptom control described.

Abdominal Neoplasms↗
PubMed1993

[Effect of high and low doses of methotrexate (MTX) on bone mass in subjects treated for osteosarcoma of the limbs].

Twenty-three patients with highly malignant localized osteosarcoma receiving neoadjuvant chemotherapy with MTX randomly administered at high (7500 mg/m2) and low (750 mg/m2) doses underwent serial densitometric controls at the start of treatment and after 18 and 36 months. Increasing BMC levels at both examination points were observed in all subjects examined over time, but, contrary to findings in the control group, this increase was not statistically significant using the paired T test. Significantly lower BMC levels in relation to the control group were only found in the group treated with high doses of MTX at MDP but not PM. Reduced density at MDP alone, a site in which trabecular bone is prevalent, shows that MTX predominantly acts at the level of the latter in line with its greater sensitivity to the action of osteopenic agents.

Adolescent↗
PubMed1992

A randomized double-blind crossover trial of intravenous lidocaine in the treatment of neuropathic cancer pain.

In a randomized, double-blind, crossover study, we evaluated the effect of intravenous lidocaine (5 mg/kg body weight over 30 min) on the neuropathic pain of advanced cancer patients. Pain intensity, assessed by a visual analogue scale, did not show any significant difference between lidocaine and placebo infusion. The blinded choice of patients and investigators also suggested no significant improvement from lidocaine when given by this regimen. Intravenous lidocaine does not appear to have a significant analgesic effect on neuropathic cancer pain.

Anesthetics, Local↗
PubMed1991

A clinical study on the use of codeine, oxycodone, dextropropoxyphene, buprenorphine, and pentazocine in cancer pain.

The authors report a prospective study on 944 cancer pain patients treated with one of the following opioids: codeine, oxycodone, dextropropoxyphene, buprenorphine, and pentazocine. Level of analgesia, duration of treatment, side effects, and drop out were evaluated for each drug. Twenty-four percent of the patients still benefitted from treatment at the fourth week of study, even if high drug dosages were not used. Pentazocine did not show an evident analgesic effect during the first 2 wk of treatment. The other opioids were found to be valid therapeutic instruments for chronic cancer pain control in a limited number of patients.

Adult↗
PubMed1991

Antidepressants in cancer pain.

Studies conducted in recent years have helped define the role of antidepressant drugs in the management of cancer pain. The antinociceptive action of these agents seems to be independent of beneficial effect on depression or mood. Among antidepressant drugs, those of the tricyclic class are preferred when an analgesic effect is sought. Their primary application is for pain due to nerve injury, so-called "neuropathic pain". Although the co-administration of tricyclic antidepressants may increase plasma morphine concentrations, any potentiation of morphine analgesia is thought not to be due to an increased bioavailability of the opiate, but to an intrinsic analgesic effect of antidepressants. On this basis, the use of antidepressants in combination with opioids for the treatment of cancer pain is suitable when a component of deafferentation is present or when there is concomitant depressive illness.

Antidepressive Agents↗
PubMed1991

Plasma morphine and morphine-6-glucuronide patterns in cancer patients after oral, subcutaneous, sublabial and rectal short-term administration.

Clinical studies on the effectiveness of morphine administered through different routes are contradictory. In order to further elucidate this point, the plasma concentrations of morphine and its 3- and 6-glucuronated metabolites were measured after short-term oral, sublabial, rectal and subcutaneous administration of the opiate. The bioavailability of free morphine and the 6-glucuronated active metabolite was comparable through the different routes. It was concluded that the choice of the route of morphine administration should be mainly guided by the needs of each individual patient.

Aged↗
PubMed1991

Rectal, buccal, and sublingual narcotics for the management of cancer pain.

We review current knowledge on the rectal, buccal, and sublingual routes of narcotic administration as potential alternatives to oral, intramuscular, intravenous, and subcutaneous administrations of narcotics for the management of cancer pain. Most of the experience reported in the literature is based on the use of rectal, sublingual, and buccal narcotics for the management of acute pain syndromes. Preliminary evidence suggests that both morphine sulfate and chlorhydrate can be administered rectally because there is acceptable absorption with this route even if considerable interpersonal variation exists. There are no controlled trials on the long-term use of rectal morphine for cancer pain. There are very few reports on the clinical effects of sublingual and buccal morphine, and pharmacokinetic data are often debatable. There is evidence to justify further research into all three routes of narcotic administration. At the moment rectal use is justified in clinical trials in cancer patients, but there are not enough data on the pharmacokinetics of different narcotics when administered by the buccal or sublingual routes.

Administration, Buccal↗
PubMed1990

The management of inoperable gastrointestinal obstruction in terminal cancer patients.

The aim of the study was to assess vomit and pain control in terminal cancer patients with inoperable gastrointestinal obstruction, using a pharmacologic symptomatic treatment which prevents recourse to nasogastric tube placement and intravenous hydration, in hospital and home care settings. Twenty-two symptomatic patients, who were judged as inoperable, were treated with a pharmacologic association of morphine hydrochloride and scopolamine butylbromide as analgesics and haloperidol as an antiemetic. The drugs were administered by continuous subcutaneous infusion via a syringe driver or intravenously only when a central venous catheter had been inserted previously. Daily recordings included assessment of pain, number of vomiting episodes, dry mouth, drowsiness, and thirst sensation. Data were examined before starting the treatment (T0), 2 days after (T2) and 2 days before death (T-2). They showed that there was a significant decrease in the pain score (p less than 0.001) on T2 and a further decrease on T-2 (p less than 0.05). Vomiting was controlled in all patients, with the exception of three patients with upper abdomen obstruction who required nasogastric tube placement. Dry mouth showed an upward trend throughout the observation period (p less than 0.05) but was successfully treated by administering liquids by mouth or ice-cubes to suck. Drowsiness too presented an upward trend from T0 to T-2 (p less than 0.001). Only one patient out of 16 who reported to be thirsty required intravenous hydration. We believe that in terminal cancer patients, vomit and pain resulting from inoperable intestinal obstruction, with the exception of obstruction of the upper abdomen, can be controlled through administration of analgesic and antiemetic drugs, in the hospital and at home, without recourse to nasogastric tube placement or intravenous hydration.

Abdominal Neoplasms↗
PubMed1990

Quality-of-life assessment during a palliative care programme.

By means of a cross-sectional study, 115 terminal cancer patients (53 males, 62 females) who were no longer responsive to anticancer treatment, were investigated. The sample included all patients who had been undergoing palliative care (PC) during a single week (at the out-patient clinic, in hospital or at home). From the start of PC, the quality of the patients' lives was assessed by a weekly self-descriptive record comprising 32 items at four levels of intensity. The responses given on the questionnaire during the sample week were compared to those given by the same patients at the beginning of PC (T0). From T0 to time during treatment, figures show a significant increase in the percentage of patients who reported drowsiness, and a significant decrease in pain, weakness, functional impairment and psychological distress. The global judgment of not feeling well was reduced from 49% of the patients at TO to 31% during the period of treatment (p less than 0.01). This result shows that, although the disease progressively develops, PC can enhance the quality of the lives of patients during the terminal stages of illness. The subjective judgment of not feeling well was much more closely correlated with physical, functional and psychological symptoms. Of the physical symptoms, pain has the closest correlation with feeling bad. However, pain has a low number of statistically significant correlations with respect to the other items, in marked contrast to the high number of correlations regarding psychological and functional items.(ABSTRACT TRUNCATED AT 250 WORDS)

Cross-Sectional Studies↗
PubMed1990

Symptom prevalence and control during cancer patients' last days of life.

The lack of control of physical suffering among cancer patients in the last days or hours of life is a common medical problem but it is rarely discussed in an open fashion. We carried out a prospective study of the dying of 120 terminal cancer patients assisted by a home care team. We documented how long it was before death that physical symptoms, unendurable to the patient and controlled only by sedation-inducing sleep, appeared. In 63 patients (52.5%), unendurable symptoms due to tumor progression or irreversible acute organic phenomena appeared, on average two days before death. Of the 63 patients, 47 had only one uncontrollable symptom, 15 had two symptoms and one patient had three symptoms. The most common symptoms included dyspnea (33 patients), pain (31), delirium (11), and vomiting (5). The most frequent symptoms were dyspnea in lung and head and neck disease; pain in breast, gastrointestinal tract, colon-rectum, and male genitourinary tract cancer; and vomiting in female genitourinary tract malignancies. Data reported emphasize the clinical relevance of physical symptoms in the last days of life in terminal cancer patients and how these serve to indicate imminent death. More than 50% of these patients die with physical suffering that is controllable only by means of sedation.

Adult↗
PubMed1990

The importance of urinary hydroxyproline and serumal osteocalcin in the evaluation of post-menopausal osteoporosis.

Forty-nine women aged 49 to 65 who had been in menopause for more than fifteen years were selected on the basis of densitometric data and clinical symptomatology. Twenty-four of these suffered from severe backaches and had a bone mineral content (B.M.C.) level inferior by at least three standard deviations to the average level according to the standards of our laboratory; these women were diagnosed with severe osteoporosis. The remaining twenty-five subjects were asymptomatic with a B.M.C. between one and two SD from the average; these were diagnosed with moderate asymptomatic osteopenia. A control group was formed by ten apparently healthy women of childbearing age. The women with severe osteoporosis showed a significantly lower level of serumal osteocalcin (Student t Test: P less than 0.05) than the control group, while no significant difference was observed between the latter and the women with moderate asymptomatic osteopenia. The level of hydroxyproline was significantly higher (Student t Test: P less than 0.01) in both groups of menopausal women than in the control group. This data shows that the increase in the level of urinary hydroxyproline characterizes menopause independent of the severity of bone loss. On the other hand, low levels of osteocalcin mainly appear in menopausal women who show severe skeletal demineralization. As a result, we feel that the urinary hydroxyproline/osteocalcin ratio is shown to be useful in both evaluating the risk of post-menopausal osteoporosis and monitoring it.

Adult↗