bluuebunny/crossref_metadata_2025 huggingface dataset:
Factor XII deficiency and cardiopulmonary bypass
Authors: Wallock M. , Arentzen C. , Perkins J.
Published: November 2007

Factor XII initiates the intrinsic coagulation cascade and may affect the fibrinolytic system. Routine coagulation tests used during cardiopulmonary bypass (CPB) are abnormal in factor-XII-deficient patients and are useless for monitoring anticoagulation in these patients. A factor-XII-deficient patient requiring CPB is described.

The baseline celite activated clotting time (ACT) was greater than 1400 seconds and the thrombin time was 12.4 seconds (control, 11.9 seconds). Two units of plasma were given resulting in an ACT of 173 seconds. Following 300 units/kg of heparin and during CPB, the ACT ranged from 670-596 seconds with the thrombin time greater than 200 seconds. Plasma provides exogenous factor XII allowing an endpoint on the ACT test and may protect against possible postoperative hypofibrinolytic complications. A commercially available modified thrombin time may also be useful and provide an endpoint during high-dose heparinization.
Effects of pronounced haemodilution on the plasma protein binding of lidocaine
Authors: Lönnqvist PA , Herngren L.
Published: November 2007

The effects of pronounced haemodilution on the protein binding of lidocaine was investigated in vitro in plasma from five healthy adult volunteers. The plasma was diluted with a phosphate buffer to reach a plasma protein concentration normally seen during paediatric cardiopulmonary bypass (CPB) and protein binding was determined at a low (1.5 μg/ml) and a moderate (4 μg/ml) total plasma concentration of lidocaine. The effects of different haematocrits on plasma protein binding was also determined over the haematocrit range 20-60%.

The binding of lidocaine was found to be inversely related to the degree of dilution, i.e. the free fraction increased significantly with increasing dilution (p < 0.0001). Furthermore, the binding was dependent on the total plasma concentration of lidocaine, since a significantly higher percentage of free drug was found at the higher total lidocaine level (4 μg/ml) compared with the lower level (1.5 μg/ml) (p < 0.05). No significant difference in the free fraction of lidocaine could be found over the studied haematocrit range.

The results of the present study indicate that plasma protein levels commonly associated with CPB in neonates and infants are associated with a significant increase in the free, unbound and pharmacologically active fraction of lidocaine compared with normal conditions. The use of commonly recommended dosages of lidocaine might result in toxic-free concentration in this setting.
Activation of the intracellular glutathione system by oxydative stress during cardiopulmonary bypass and myocardial perfusion
Authors: Shu Tao  , Calza G. , Lerzo F. , Virgone A. , Camassa N. , Panizzon G. , Brunelli L. , Moretti R. , Grasso P. , Ghiggeri GM , Bertolini A.
Published: November 2007

The glutathione (GSH) system is the main defence of tissues against free radicals and red blood cells (RBC) are the most efficient sites for GSH redox cycle activation.

Total GSH was assayed during cardiopulmonary bypass (CPB) in RBC and serum from the coronary sinus, peripheral arteries and veins in 18 children corrected of their cardiac defect. Our conclusions are: (1) RBC-GSH redox cycle is activated during heart ischaemia and reperfusion; (2) the activation of intracellular GSH system is preponderant compared with the extracellular one; (3) variations in intraerythrocytic total GSH during heart ischaemia and perfusion are detectable in peripheral veins and arteries, which can be the convenient sites for monitoring changes in the GSH cycle; and (4) increased total GSH levels are present in RBC before aortic crossclamping: at the beginning of mechanical ventilation in veins and, when CPB is started, also in arteries.
The validation of auricular densitometry for indocyanine green clearance measurement of hepatic blood flow during and after cardiopulmonary bypass in children
Authors: Mitchell IM , Pollock Jcs , Jamieson Mpg
Published: November 2007

The clinical measurement of hepatic perfusion is complicated by a dual blood supply and the invasive nature of the majority of techniques available. The aim of this study was to validate indocyanine green clearance and noninvasive auricular densitometry as a measure of hepatic perfusion in the context of paediatric cardiac surgery.

The effects of different dye concentrations on densitometer recording were assessed in vitro and found to have a linear relationship. Similarly, variations in haematocrit, within the range 21-47%, also had little effect on accuracy.

Comparison of densitometry and direct blood sampling with plasma spectrophotometry in six postoperative, normothermic children showed no significant difference between the noninvasive and invasive techniques (r = 0.968; p > 0.05, t-test). Comparison in 10 hypothermic children during cardiopulmonary bypass also showed no significant difference between the two methods, provided that no further cooling or rewarming took place (r = 0.83; p > 0.05, Wilcoxon test). Noninvasive auricular densitometry can, therefore, provide a reliable assessment of hepatic perfusion in children undergoing cardiac surgery.
Endotoxaemia detected during cardiopulmonary bypass with a modified Limulus amoebocyte lysate assay
Authors: Bowles Christopher T , Ohri Sunil K , Klangsuk Nongchana , Keogh Bruce E , Yacoub Magdi H , Taylor Kenneth M
Published: November 2007

Cardiopulmonary bypass (CPB) is associated with blood heparin level fluctuations and a reduction in haematocrit due to crystalloid haemodilution. The effect of these changes on the reliability of the Limulus amoebocyte lysate (LAL) chromogenic microassay for the measurement of plasma endotoxin was assessed in vitro. It was shown that the assay could be significantly compromised by twofold haemodilution which can occur during CPB. The interference effect on the assay caused by CPB-associated heparin was not significant if a comparatively large amount of heparin (25 IU/ml) was added to the blood at the time of sampling. The effect of haemodilution was counteracted by prediluting plasma samples with crystalloid by a factor dependent on the sample haematocrit (to ensure that the proportion of plasma was similar in all samples). A correction was then required to determine the endotoxin level in the original sample. The modified assay was used to determine sequential plasma endotoxin levels in 14 patients undergoing hypothermic nonpulsatile CPB. Endotoxaemia occurred at the time of aortic cross-clamp release and reached a peak of 48.9 ± 12.9 ng/l shortly before the end of CPB, which was significantly higher than baseline values pre-CPB (p <0.05). Thereafter, there was a decline in endotoxin levels to 28.9 ± 13.6 ng/l 24 hours later which was still significantly higher than baseline levels ( p <0.05). Peak endotoxaemia was a predictor of protracted hospital stay when compared with haemodynamic and tissue perfusion parameters.
The combination of mannitol and albumin in the priming solution reduces positive intraoperative fluid balance during cardiopulmonary bypass
Authors: Jenkins Ian R , Curtis Andrew P
Published: November 2007

During cardiopulmonary bypass (CPB) an adequate reservoir volume is maintained by the addition of crystalloid, colloid or packed cells to the reservoir. This volume contributes to the overall perioperative positive fluid balance. We studied the effect of the preoperative addition of either 75 g albumin, or 50 g mannitol followed by 50 g at commencement of rewarming or both of the above to a bypass circuit prime of lactated Ringer's solution (LR) on intraoperative fluid balance, postoperative indices of oxygenation and time to extubation. The study was a prospective, randomized, single-blinded controlled trial of 103 patients undergoing cardiac surgery requiring CPB. There was a large and highly significant reduction in volume of fluid added to the reservoir during CPB (2137 ± 1499 ml versus 144 ± 230 ml), the fluid balance during bypass, including prime volume (3236 ± 650 ml versus 5876 ± 1465 ml), and perioperative fluid balance (4470 ± 936 ml versus 7023 ± 1760 ml) in the group receiving both mannitol and albumin in the pump prime compared with the group receiving only lactated Ringer's solution. There were no differences between the groups with respect to both measured indices of oxygenation measured on return to ICU (alveolar-arterial oxygen tension difference (DA-aO2) or arterial oxygen tension to inspired oxygen fraction ratio (PaO2/F iO2), or time from ICU admission to extubation.
Perfusion technique for treatment of right heart failure
Authors: Beck James R , Mongero Linda B , Goldstein Daniel J , Oz Mehmet C
Published: November 2007

A simple heparin-bonded circuit to facilitate a femoral vein to femoral artery shunt for the treatment of right-sided circulatory failure is proposed. Desaturated venous blood is shunted to the left-sided circulation to increase systemic blood pressure at the expense of saturation.

The circuit comprised ¼ inch x 3/32 inch tubing with a paediatric Bio-Medicus centrifugal pump head allowing adequate regulation of flow. Paediatric Bio- Medicus cannulae provide flows between 500 and 2000 ml/min. Measurements of pulmonary artery pressure, central venous pressure, arterial pressure, arterial saturation and cardiac output were recorded.

In the four case studies presented, the treatment included unloading of the right ventricle with venous to arterial shunting. Likewise, eight Holstein calves underwent shunt utilization after placement of a left ventricular assist device and induction of right ventricular failure.

The future use of this device may be instrumental in aiding the cardiothoracic surgical team in the treatment of right-sided circulatory failure.
Cold agglutinins : preoperative diagnosis leads to an uneventful perfusion
Authors: Innet Leanne M , Lancelot Lester J. , Tait Nathan
Published: November 2007

This report presents the successful use of normothermic cardiopulmonary bypass (CPB) and warm continuous retrograde cardioplegia to facilitate coronary artery bypass grafting (CABG) in a patient with cold agglutinins. As a result of their agglutinating action and resultant haemolysis, cold-reactive autoantibodies have the potential for causing morbidity and mortality when a patient is placed on hypothermic CPB and the heart is arrested with profoundly cold cardioplegia. The crux of the situation is to keep the temperature above the critical temperature of the cold agglutinin; this technique guarantees accomplishing that goal.
A mathematical analysis of haemorheologic factors during cardiopulmonary bypass for congenital heart disease
Authors: Chen Yijiang , Berglin Eva , Belboul Ali , Roberts Donald
Published: November 2007

Rheologic properties of blood are impaired by cardiac surgery using cardiopulmonary bypass. This study was set out to establish a mathematical model in order to assess seven known haemorheologic factors and evaluate their degrees of influence on blood rheology in cardiopulmonary bypass.

Sixteen patients undergoing elective congenital cardiac surgery were studied. High shear blood viscosity, low shear blood viscosity, haematocrit, red blood cell filtration rate, red blood cell electrophoresis time, plasma viscosity and fibrinogen were monitored. The method for mathematical calculation was the stepwise regression analysis.

The results showed that both high shear and low shear blood viscosity were mainly influenced by haematocrit and plasma viscosity. Red blood cell filterability contributed more than red blood cell electrophoresis time for low shear blood viscosity. The mathematical model was re-tested statistically and demonstrated that the selected factors in the model represented approximately 75% of rheologic changes during the surgery. Therefore, this mathematical analysis can be used to estimate the role of various possible haemorheologic factors and evaluate cardiopulmonary bypass techniques and therapeutic interventions.
Neutrophil activation during cardiopulmonary bypass in paediatric and adult patients
Authors: Larson Douglas F , Bowers Mark , Schechner H William
Published: November 2007

It has been reported that the 'systemic inflammatory' response occurring during cardiopulmonary bypass (CPB) may be responsible for postoperative complications. This inflammatory response is triggered by the platelet coagulation system, complement activation, resulting in neutrophil activation and degranulation. The aim of this study was to quantify the specific markers of neutrophil activation in the adult and paediatric patient during CPB. We report that neutrophil myeloperoxidase (MPO) and human neutrophil elastase (HNE) are significantly increased in both the paediatric and adult patients. This study utilized enzymatic assays that quantified the enzymatic activity in the blood circulation rather than measurement of the enzyme protein complex. Increased concentrations of MPO were, in part, related to the blood prime with the paediatric patients and the HNE concentrations were related to time on CPB in both the paediatric and adult patient. This study demonstrated that there are significantly elevated neutrophil enzyme activities in the CPB patient and underscores the pivotal role of the neutrophil in the pathophysiology of CPB.
Mechanical circulatory support: lessons from a single centre
Authors: El-Banayosy A. , Posival H. , Minami K. , Arusoglu L. , Kizner L. , Breymann T. , Seifert D. , Körner MM , Körtke H. , Fey O. , Körfer R.
Published: November 2007

Over recent years, a number of different mechanical circulatory support (MCS) products have been developed to a stage where they are no longer investigational devices. Registry data provide some information, but this is limited by the mix of historical and contemporary data and the voluntary nature of the contributions. As yet, there are no clear guidelines for patient selection, the differential application of generically different devices or for optimal patient management. Ours is a busy centre offering a comprehensive cardiovascular service. This review details our experience since 1987 and 189 patients supported with five different types of device, used in all of the common applications. Our experience has permitted the formulation of some general principles and guidelines. Data published by registries and by individual manufacturers are, as yet, not standardized. We hope that our experience will be of interest to those centres wishing to establish a mechanical assist service.
The use of a load cell for continuous cardiotomy reservoir level measurement during cardiopulmonary bypass
Authors: Montano Stewart R , Morris Richard W , Pybus D Andrew
Published: November 2007

We have examined the use of a 6 kg strain-gauge load cell for the purpose of continuous measurement of cardiotomy reservoir volume during cardiopulmonary bypass. It performed reliably and reproducibly and was found to be simple to interface to an anaesthesia monitor. The resolution of the cell was ±15 ml and the bias and limits of agreement for a series of 221 measurements were +15 ml and 175 ml, respectively.

A continuously available digital level signal can present significant advantages to the perfusionist. The signal can be presented remotely in the form of a bar graph or a digital display, or can be interfaced to an intelligent alarm system which can be triggered on the basis of 'time to expected reservoir exhaustion' rather than absolute reservoir level. The alarm state can also be conveyed in spoken form using speech synthesis. Finally, when recorded by an automatic record keeping system, the reservoir level constitutes an important addition to the perfusion record.
Complement consumption during cardiopulmonary bypass: comparison of Duraflo II heparin-coated and uncoated circuits in fully heparinized patients
Authors: Hamulu Ahmet , Discigil Berent , Özbaran Mustafa , Çalkavur Tanzer , Kara Erkan , Kokuludag Ali , Büket Suat , Bilkay Önol
Published: November 2007

Heparin attachment to synthetic surfaces is one means of improving the biocompatibility of clinically used cardiopulmonary bypass (CPB) circuits. To assess the effect of heparin-coated circuits on complement consumption during CPB, 40 patients undergoing elective myocardial revascularization were prospectively randomized either to a group in which a completely Duraflo II heparin-coated circuit was used for perfusion (heparin-coated Group, n = 20 patients) or to a control group (n = 20 patients) in which an uncoated, but otherwise standard circuit was used. Full systemic heparinization was induced (activated clotting time, 480 seconds) in all the patients included in the study, regardless of which perfusion circuit was used. The two groups did not differ significantly in terms of bodyweight, aortic crossclamp and extracorporeal circulation times. No patient had difficulty in weaning from bypass and the postoperative period was uneventful in all patients. Concentrations of C3 and C4 were found to be within the 'normal' range in the prebypass period in both groups. There were no significant intergroup differences with regard to C3 and C4 consumption during CPB. We conclude that Duraflo II heparin- coated circuits have no effect in reducing complement consumption during CPB in fully heparinized patients.
Cerebral blood flow in the diabetic patient
Authors: Pallas Faith , Larson Douglas F
Published: November 2007

Diabetes is a major risk factor for cardiovascular disease. Coronary revascularization utilizing cardiopulmonary bypass (CPB) is frequently required for the diabetic patient. Nondiabetic individuals can autoregulate cerebral blood flow (CBF) through metabolic and perfusion pressure mechanisms during CPB. However, it has been reported that diabetic patients have impaired CBF autoregulation during CPB. It is possible, therefore,

that impaired CBF autoregulation may contribute to postoperative neuropsychologic dysfunction. The mechanisms for this defect may reside in impaired endothelial-dependent responses in the diabetic that are related to morphological and functional changes linking the vascular endothelium and the vascular smooth muscle. The morphological changes occurring in the diabetic include microangiopathy and macroangiopathy which are characterized by endothelial cell (EC) hyperplasia and basement membrane thickening. Also, significant functional changes in local control of vascular tone, such as an imbalance in the synthesis and secretion of vasoactive factors by the EC and abnormal reactivity of the vascular smooth muscle, are seen in the diabetic when compared to the nondiabetic. More specifically, vascular responses to both calcium-dependent pathways of vasoconstriction and nitric oxide pathways of vasorelaxation have been shown to significantly differ between the diabetic and nondiabetic. The emphasis of this discussion is to examine the molecular mechanisms by which diabetes alters vascular function, with emphasis placed on regulation of cerebral artery blood flow during CPB.
The impact of perfusionist education programme characteristics on programme directors' responsibilities
Authors: Plunkett Patrick F
Published: November 2007

The purpose of this study was to measure the effect of four programme characteristics (curriculum design, type of degree offered, length of programme and number of students per class) on perfusionist education programme directors (PDs) in the USA in terms of the number of hours worked per week, number of cases pumped per year and workload mix. Descriptive and statistical analyses were performed on the responses to questionnaires sent to all perfusionist programmes between March 1993 and April 1994.

PDs reported working an average of 51.8 h/week and pumping an average of 68.8 cases per year. All but one respondent reported spending more than 50% of his/her time (mean 74.5% ± 19%) on programme-related issues such as administration, classroom teaching and clinical instruction. This level of commitment, as well as the total number of hours worked per week, were not found to be influenced by the programme's length, duration, class size or type of degree awarded. However, PDs of baccalaureate programmes, and programmes with more than nine students spent a significantly greater proportion of their time on administrative issues than their colleagues in other types of programmes. The bureaucratic demands of baccalaureate and large programmes require PDs to devote an average of 39.5% of their time to administration, compared to 27.2% in the other programmes. The results of this study show that the operation of all perfusionist education programmes requires a major commitment of time on the part of the individual designated as PD.
Leakage across hollow-fibre membranes in oxygenators: a pilot study
Authors: Visser C. , de Jong DS
Published: November 2007

The purpose of this study was to create an in vitro system to quantify the fluid loss over two different types of hollow-fibre membrane oxygenators. In the first stage of the study, the circuit was primed with 0.9% NaCl and the line pressure was 200 mmHg; in the second stage, the line pressure was 400 mmHg. The experiment was repeated using bovine blood. A clear difference (p < 0.005) was found in the first stage, accumulating to 47.46 ml (SD 0.41) in the Capiox-SX group and 72.33 ml (SD 3.77) in the Univox group after 4 h. This difference persisted when using bovine blood. Surprisingly, no differences in volume loss occurred when the line pressure was increased to 400 mmHg. In conclusion, leakage in hollow-fibre microporous polypropylene membrane oxygenators can be quantified and the amount of leakage appears to be dependent on the type of membrane and the manufacturing process.
Relationship between aerobic fitness and quality of life in female fibromyalgia patients
Authors: Ayán C. , Martín V. , Alonso-Cortés B. , Álvarez M.J. , Valencia M. , Barrientos M.J.
Published: November 2007

Objective: To determine whether there is a direct link between quality of life and aerobic capacity among female fibromyalgia patients.

Design: Cross-section study.

Setting: University of León.

Subjects: Twenty-nine women belonging to the León Fibromyalgia and Chronic Fatigue Association.

Main measurements: Aerobic capacity and quality of life were measured by means of the Six-Minute Walk Test and the Fibromyalgia Impact Questionnaire. Outcome measures included heart rate and rate of perceived fatigue and dypsnoea.

Results: The average distance walked was 432.8 (61.2) m and the total average Fibromyalgia Impact Questionnaire score was 47.5 (18.9). Only item 1 of the Fibromyalgia Impact Questionnaire, physical function, showed any statistically significant link with the distance walked, which had no statistically significant relationship with any of the variables studied.

Conclusion: The physical fitness of women with fibromyalgia, as determined by the Six-Minute Walk Test and the Fibromyalgia Impact Questionnaire, has no direct relation with quality of life as the patients perceive it.
Usefulness of the Elderly Mobility Scale for classifying residential placements
Authors: Yu Mabel S. W. , Chan Chetwyn C. H. , Tsim Robin K. M.
Published: November 2007

Background and purpose: To investigate the factor structure and cut-off scores of the Elderly Mobility Scale for making placement decisions in extended care settings.

Subjects: Ninety elderly residents of mean ages ranging from 79.0 to 86.4 years were recruited from homes for the aged (OAH group), and care and attention homes with or without supplemental infirmary care (IS and non-IS groups, respectively).

Methods: The Elderly Mobility Scale was administered to all the residents by five trained practising physiotherapists.

Results: Factor analysis revealed a two-factor structure, with two items into a bed mobility subscale and the other five items into a functional mobility subscale. Significant differences were found in the residents' Elderly Mobility Scale scores among the OAH, non-IS and IS groups. The accuracy of the three cut-off scores based on the five functional mobility items reached 90% for classifying the residents into different placements.

Discussion and conclusion: The findings suggested that Elderly Mobility Scale scores can be better interpreted with the `bed mobility' and `functional mobility' subscales. The high accuracy of classification based on the cut-off scores reflects a good item and construct match of the Elderly Mobility Scale. Our findings support the usefulness of the Elderly Mobility Scale for residential placement of elderly people, which can be generalized to residential settings and post-discharge plans similar to those used in this study.
Review article : The spinal administration of opioids in the treatment of acute and chronic pain: bolus doses, continuous infusion, intraventricular administration and implanted drug delivery systems
Authors: Cherry David A , Gourlay Geoffrey K
Published: November 2007

The spinal administration of opioids has been a significant addition to the previously available alternatives for pain control for patients with pain related to cancer. This article does not debate the more widespread use of these techniques in patients with nonmalignancy related pain. The incidence of destructive neurolytic procedures has fallen in most centres where spinal opioids have been administered. Some types of cancer pain have proved to be more effectively controlled than others, but in most circumstances potentially reversible procedures, such as outlined in this article, should be given a therapeutic trial before embarking on neuro-destructive procedures.1

It should be reemphasized however, that the spinal route of administration should be instituted only after systemically administered opioids have been shown to be ineffective or associated with intolerable side effects.
Pain assessment charts in the management of chronic cancer pain
Authors: Walker Valerie A , Dicks Barbara , Webb Pat
Published: November 2007

A chart was designed for the assessment and monitoring of chronic cancer pain. A pilot study involving thirty hospital in-patients indicated that the chart was useful in 53% of cases. Problems identified in this study and initial experience with the chart enabled us to incorporate improvements in its design and also made it possible to identify patients for whom the chart may be inappropriate. The revised charts were used throughout the hospital for a trial period. Questionnaires completed by 50 nurses and patients indicated that the chartwas a valuable tool for pain assessment in 89% of cases. The factors contributing to the successful use of the chart and its possible disadvantages are discussed.
A comparison of hospice and hospital: care goals set by staff
Authors: Lunt Barry , Neale Cherie
Published: November 2007

It has been suggested an important difference between hospice and hospital care is that hospice care is more geared to the attainment of patient and family goals, and that these goals concern a broader range of comfort, psychosocial, and rehabilitation issues. This study investigated whether such differences exist. Structured interviews were conducted with doctors and nurses in two NHS hospices, and three medical and two surgical wards of a district general hospital (DGH), to ascertain their goals of care and treatment for random samples of newly admitted terminally ill cancer patients (29 in the DGH and 29 and 28 in the hospices). DGH doctors set fewer goals in total, dealing with fewer issues, than hospice doctors or DGH nurses, and took longer to do so. Hospice and DGH nurses did not differ in the number or content of goals set, or speed of goal setting. DGH doctors set fewer goals concerning rehabilitation and the patient's emotional state than hospice doctors or DGH nurses, and fewer goals concerning patient-family relationships and the family's emotional state than hospital nurses. The hypothesis that hospice care is more 'goal-oriented' than hospital care is supported in relation to doctors, but not nurses. The staff's follow-up assessments showed greater perceived success in one hospice than the other hospice or the DGH. The optimism of nurses' and doctors' goals was similar from the outset in one hospice, became similar in the other hospice, but diverged in the DGH, with the nurses setting less optimistic goals after the first week. These differences illustrate poorer communication between DGH staff than hospice staff about what they were trying to do for their patients. To parallel the hospices' approach, DGH doctors should heed the views of their nursing colleagues and attend more positively to their patients' rehabilitation and emotional needs, to patient-family relationships and to the families' emotional needs.
Counselling and psychotherapy in palliative/hospice care: a review
Authors: Vachon Mary LS
Published: November 2007

A basic tenet of hospice/palliative care is the provision of emotional support for the patient/family unit. However, little systematic data is available to document the counselling and psychotherapy which is provided within hospice and palliative care settings. This paper reviews the emotional needs of cancer patients and family members, the psychiatric symptoms which result from unmet needs as well as the response to dying, provides an overview of models of intervention and reviews studies of the effectiveness of hospice intervention. Serious deficiencies are found in the data available to document the counselling and psychotherapy which occurs in hospice programmes and to measure the effectiveness of these interventions. Suggestions for research and future programme development are given.
The significance of touch in palliative care
Authors: Sims Sally
Published: November 2007

Although the purposeful use of touch has significance for all patients, it has particular significance for patients with far advanced disease. When curative treatment is no longer appropriate, the emphasis of interventions shifts from cure to palliation and symptom control, and comfort measures assume greater significance. Touch is a powerful way of facilitating communication and enhancing psychological and physical comfort. This paper reviews some of the studies which point to the significance of touch in palliative care and suggests that systematic forms of touch, such as gentle massage, should be explored further for the potential benefits they may have for patients.
Palliative gastrointestinal endoscopy
Authors: Valori Roland M , Dover Simon
Published: November 2007

Therapeutic endoscopy has a useful place in palliative medicine. It can provide rapid and effective nonoperative relief of a number of symptoms. Endoscopy should be considered for oesophageal obstruction, obstructive jaundice, locally troublesome carcinoma of the rectum and perhaps for feeding gastrostomy. The indications for, practice of, and outcome from each of these techniques are considered.
Facilitating coping with cancer pain
Authors: Davidson Paul
Published: November 2007

Pain can be regarded as a complex sociosomato psychic phenomenon. Helping people with cancer pain requires more than skilled drug prescribing. It calls for a holistic approach which takes into account the society and culture of the patient, and necessitates optimal communication with patient and family and knowledge of the psychological processes of coping with stress. Only a multilevel approach is likely to be effective in such total patient care.
Specialist medical training in the UK
Authors: Ford Gillian
Published: November 2007

The increasing need to establish palliative medicine training in the UK has recently resulted in recognition of this need by the Royal Colleges. The reasons for, and implications of opting into established training systems are discussed and the mechanisms outlined
Working with a bereaved family: focusing on prevention not pathology
Authors: Hildebrand Judy
Published: November 2007

Ours is not a culture which generally prepares people for death, despite the fact that death comes to us all. The author suggests that open communication following a death may reduce psychological trauma. Extracts from a family therapy session demonstrate how a healthy family can constructively face issues which follow parental death. This approach does not concentrate on pathology, instead it focuses on the family's strengths to deal with a tragic situation.
Family therapy and life threatening illness in children or parents
Authors: Black Dora , Wood David
Published: November 2007

This article focuses on the principles used in working with families where a child or parent is dying. Case reviews show how family therapy can help families cope in such situations, particularly when there are disagreements, divorced parents, barriers to communication, interference and feelings of powerlessness and despair.
Effect of epidural morphine on various kinds of cancer pain
Authors: Kiss Ivan E , Simini Bruno , May Johannes W
Published: November 2007

Thirty cancer patients with intractable pain were examined before and after five days of epidural opiate administration. The pain measurement was carried out with the German version of the McGill Pain Questionnaire. The patients with bone pain - the largest group - responded very well to the therapy. The spinal analgesia was less effective in patients whose complaints were mainly caused by visceral tumour growth or by the distension of pain-sensitive structures. The poorest results were seen in patients with predominantly nerve lesions and without bone involvement. However, a significant pain relief could be achieved in all patients due to the usually widespread sources of cancer pain.
Review article : The use of nerve destruction for rel ief of pain in cancer: a review
Authors: Wells Jcd
Published: November 2007

Neurolytic blocks may be required in as many as one in 10 patients with cancer pain. Despite the potential adverse effects, such blocks can produce good analgesia without the adverse effects sometimes associated with analgesic regimens.
Bowel obstruction in ovarian carcinoma: a retrospective study and review of the literature
Authors: Beattie Gerald J , Leonard Robert CF , Smyth John F
Published: November 2007

The incidence and management of bowel obstruction in a series of 105 patients with ovarian adenocarcinoma presenting to this unit were studied retrospectively. Forty-three of these patients developed bowel obstruction during the course of their illness. Patients with more advanced disease at presentation developed obstruction more rapidly. Small bowel obstruction was more common than large bowel obstruction. Surgical intervention at the time of obstruction appeared to produce more favourable responses and longer survival times. Patients treated surgically were less likely to reobstruct. No patient showed any response to chemotherapy given following resolution of the obstruction. Early surgical intervention should be considered in the management of patients with bowel obstruction secondary to ovarian adenocarcinoma.
Cancer pain and intrathecal morphine
Authors: Gonzalez-Navarro Andres , Molinero-Aparicio Tomas , Manzo Liliana
Published: November 2007

A total of 40 cancer patients suffering from chronic pain were treated with morphine by intrathecal administration through a subcutaneous implanted reservoir. All patients had been treated previously with other methods without good results. Pain evaluation was made using the visual analogue scale (VAS) and our INO scales. A morphine intrathecal test was made initially, to disclose if this method of administration would be effective.

The most frequent initial dose of morphine was 2mg/day and according to the pain relief, the dose was modified during the treatment. The tolerance phenomenon was present in our series but in a very large number of patients, the initial dose was maintained until the end of treatment.

Side effects were comparable with those described by other authors. Respiratory depression did not occur in our series. The most important complications consisted of infection in the nervous system. This method of treatment can alleviate pain in cancer patients, but should not be done routinely, only when other methods have failed.
Perceptions of cancer by patients: a student project
Authors: Voltz RD
Published: November 2007

Twenty-two patients with advanced cancer, in a hospice and on the oncology ward of a teaching hospital, were interviewed by a medical student. Two patients were distressed by the interview, but the others gave useful information about their knowledge of and attitude towards their disease. Interviewing dying patients can be a valuable and positive experience for medical students.
The cancer pain relief programme of the World Health Organization
Authors: Stjernswärd Jan , Teoh Noreen
Published: November 2007

At any one time 14 million people suffer from cancer. The WHO has established a Global Cancer Control Programme aimed at prevention, detection, therapy and pain relief. Much has been achieved in the 1980s, but an expanded programme is planned for the 1990s.
Management of ascites in advanced cancer - a flow diagram
Authors: Regnard Claud , Mannix Kathryn
Published: November 2007

Ascites is here defined as an exudate into the peritoneal space due to malignancy. It can cause symptoms such as pain, nausea, vomiting and dyspnoea, which are most easily resolved by removing the ascites. This can be done by mechanical means (e.g. paracentesis) or pharmacological means (e.g. diuretics). This flow diagram describes the decision steps in choosing a treatment appropriate to the patient.
Dementia, grief and dying
Authors: Benbow S.M. , Quinn A.
Published: November 2007

Four case studies are presented to illustrate dilemmas in the care of demented people who are grieving or who are themselves dying. The grieving process is complicated in those who suffer from cognitive impairment, but patients can be helped to mourn if carers recognize their memory difficulty and facilitate learning over a prolonged period. Sometimes the grief may be exhibited as behavioural changes which may not be recognized as representing grief. Relatives' attitudes and those of staff can further complicate management of the bereaved person, but an awareness of the relatives' fears may allow staff to modify their own and relatives' attitudes, and thus assist the demented bereaved person's mourning. The person with dementia who is dying can also present a complex of problems, and an understanding of the effects of dementia is essential in allowing sensitive management of their terminal illness.
Isolated digital metastasis in bronchogenic carcinoma
Authors: Stone Ruth L. , Davies Jonathan P.
Published: November 2007

Malignant metastasis to the bones of the hand is rare. Metastases may be isolated and presentation deceptive. Routine bone scan involves only the axial skeleton and therefore does not rule out metastasis elsewhere. A specific request must be made to scan peripheral bones if this is the area of interest.

We present a case which illustrates these points and emphasizes the role of palliative surgery where other measures have failed.
Review article : Pain in prostatic cancer
Authors: Ventafridda V. , Sbanotto A. , De Conno F.
Published: November 2007

The authors report an overview of current specific antitumoral and other methods for treating the pain associated with advanced prostatic cancer. Pathological studies show that bone involvement is the main cause of pain. Bone and spinal metastases and pathological fracture are the most frequent challenges of this pathology. The role and results of chemotherapy, radiotherapy and hormonal treatments for pain relief are reported and discussed. Analgesic drugs are the mainstay of specific pain management, in which NSAIDs associated with opiates play an important role. Other forms of treatment (neural-blockade techniques) must be used only in selected cases. The authors conclude that the terminal stage of prostatic cancer requires multidisciplinary supportive care in which symptom control should be linked with active psychosocial help.
The contribution of nursing to palliative care
Authors: Dicks Barbara
Published: November 2007

Nursing has a major role in palliative care as part of a truly interdisciplinary framework. The nurse's primary responsibility is to assist the patient to cope with the effects of advancing disease. The idea of a paramedical model must be replaced by a professional role where the nurse offers unique skills to the team. Only nurses themselves can determine the direction and influence of nursing in palliative care.
Palliative care services in New Zealand
Authors: Lichter Ivan
Published: November 2007

Palliative care services in New Zealand are provided in a variety of forms dependent on the local needs and the resources available. There is increasing awareness of the need for education in the care of the terminally ill and this is being addressed in undergraduate and postgraduate medical training. Comprehensive instruction in palliative care is being given in nursing training courses.
Palliative care in Finland
Authors: Vainio Anneli
Published: November 2007

Palliative care in Finland is in its infancy. The Finnish National Board of Health issued 'Instructions for terminal care' in 1982, and subsequently the specialty has been fostered by the National Board, the Lutheran church and the voluntary sector. The first hospices in Finland opened in 1988, and have been well received both by the public and by other medical services. Community palliative care is largely provided by the voluntary sector. It is hoped that further development will include educating health care workers so that the principles of palliative care are incorporated into other areas of medical practice.
Methods of assessment of bowel fu nction in patients with advanced cancer
Authors: Sykes NP
Published: November 2007

Constipation is said to be a problem for most patients with advanced cancer. There has been little investigation of constipation in this group perhaps partly because of their frailty and a consequent reluctance to impose burdensome investigations on them. Mean transit time (MTT-S) was measured in 17 patients with advanced cancer admitted to a hospice and was used as a standard to evaluate the use of single stool analysis of transit time (SST) and the standardized estimation of stool form as measures of bowel function in this population. Bowel frequency, stool weight and stool water content were used as additional measures of bowel function. Transit time ranged from four to 12 days, the SST method proving accurate for transit times of 96 hours or less. MTT-S correlated more strongly with mean stool form ( r=0.83) than with any other measure of bowel function. It is suggested that standardized stool form assessment may give clinically useful information about transit time and be of particular value in assessing bowel function in ill patients.
Dyspnoea in advanced cancer - a flow diagram
Authors: Regnard Claud , Ahmedzai Sam
Published: November 2007

Dyspnoea is here defined as the subjective sensation in patients with advanced cancer where the demand for oxygen is greater than the body's ability to supply oxygen. In advanced cancer causes may be unrelated to or related in a direct or indirect way to the malignancy. This flow diagram describes the decision processes required to manage such patients. It is assumed that nonmalignant causes of dyspnoea have, or are, being treated conventionally (e.g. chronic obstructive airways disease).
Palliative care in West Germany
Authors: Albrecht Elisabeth
Published: November 2007

Palliative care is just starting to develop in West Germany. Its evolution is beset by problems which are partly inherent in the structure of financing in West German health services, and partly due to imperceptions of the role of hospices and of palliative care by the public and other health care professionals. Three models of hospice care are described, and possible paths for the development of palliative care are suggested.
Death from cancer and death from other causes: the relevance of the hospice approach
Authors: Seale Clive
Published: November 2007

An interview survey of people who knew a random sample of adults who died in 1987 is reported, with analysis focusing on the differences between those dying of cancer and other causes in the context of the debate about the relevance of the hospice approach to noncancer patients. Age is identified as a key variable determining the family composition: people dying of cancer, being younger on average than people dying of other conditions, are more likely to be able to draw upon family members for help. The pattern of symptoms and restrictions in cancer suggests an illness which has a relatively short but intense period of suffering and dependency, compared to the longer duration of these periods in average noncancer deaths. Existing health service provision reflects this. Not only is a diagnosis of dying more difficult in the absence of cancer, but the communication issues are often less clear-cut because of the presence of long-term mental confusion. The focus of the hospice movement on the control of particular symptoms and on the support of family members is considered in the light of these differences.
Clinical audit by a palliative care team
Authors: McCarthy Mark , Higginson Irene
Published: November 2007

Objective: To develop a method of audit for, and evaluate the work of, a palliative care support team.

Methods: Through observation and discussion with the team, 14 items, forming the Support Team Assessment Schedule (STAS), were identified which were considered to represent independent care objectives. Definitions of scale points (0-6) were agreed for each item. The team made ratings at their weekly meeting for each patient during a 12-month period.

Results: Of 124 patients seen by the team there were a minimum of two recordings for 82 patients which provided a measure of the outcome of care. The group mean scores showed statistically significant improvements on all items, but there were differences between items in the extent of improvement. The STAS helped to make the team's assessments more systematic, and feedback of the information focused attention on the team's treatment of terminal dyspnoea. Conclusion: Audit of palliative care is practicable by this method. The approach could also be developed for use in inpatient hospital and hospice settings.
5-fluorouracil and high dose folinic acid in symptomatic advanced colorectal carcinoma: importance of symptomatic relief
Authors: Rakowsky Erica , Klein Baruch , Marshak Gideon , Lurie Hedwig
Published: November 2007

Between August 1986 and February 1987, 17 consecutive patients with symptomatic unresectable local or metastatic colorectal carcinoma were admitted to a pilot study designed to evaluate the toxicity and possible benefit, especially in terms of symptomatic relief, of 5-fluorouracil (5-FU) combined with high dose folinic acid (HDF). 5-FU 600mg/m2 IV push and HDF 500mg/m2 by a two-hour infusion were administered ambulatorily. Treatment was given once per week for six consecutive weeks. Cycles were repeated after a two-week rest period. Twelve of the patients (75%) were previously treated with 5-FU. Pain, anorexia and malaise were the most common complaints and 61 % of patients had multiple symptoms. Nine of the 16 patients evaluable for subjective response (60%) achieved marked relief of symptoms of three to ten months' duration. In all these patients improvement in performance status was recorded. Among the 14 patients evaluable for objective response, complete regression of the disease was observed in one patient and minimal regression (less than 50%) in three patients; the duration of response ranged between four and eight months. Side effects were mild and the treatment was well tolerated, with the exception of two patients who developed diarrhoea requiring the discontinuation of treatment. Our results suggest that the 5-FU and HDF regimen used in this study has a significant palliative value in symptomatic patients with advanced colorectal cancer.