Continuous subcutaneous infusion of peplomycin for advanced prostatic cancer patients

Continuous subcutaneous infusion of peplomycin was performed on 17 patients with metastatic prostate carcinoma, 9 of whom were refractory to conventional hormone therapy. Peplomycin was administered 5 mg daily through a newly-developed "microinfusion pump" for 14 consecutive days. This therapy was discontinued in 3 patients at the cumulative dose of 35, 35 and 55 mg. The mean cumulative dose was 84.7 mg. One patient who received 140 mg of peplomycin developed pulmonary fibrosis which was so mild that he recovered soon after the conservative therapy was instituted. There were no other episodes of pulmonary toxicities. Other major toxicities observed were anorexia (47%) and fever (41%). Of 15 patients who were evaluable with the response criteria of NPCP, 4 patients achieved objective partial regression (two for pulmonary metastases, one for bone metastases and the other for supraclavicular lymphnode metastases) and the other 11 patients remained stable. No progression of the disease was noted. Continuous subcutaneous infusion of peplomycin is advantageous over the bolus injection for increasing its anti-tumor activity as well as for decreasing its pneumotoxicity. It can also be performed for out-patients without difficulty. We believe this therapy should be incorporated in the multidisciplinary therapy of prostatic cancer.     

术前区域性动脉灌注化疗治疗进展期胃癌的临床研究

目的:探讨新辅助化疗中应用术前区域性动脉灌注化疗治疗进展期胃癌的临床疗效.方法:35例临床诊断Ⅱ期以上胃癌病人在手术前接受新辅助化疗,方案为:丝裂霉素C 15 mg/m2,顺铂60 mg/m25-氟尿嘧啶1 000 mg/m2,经股动脉插管区域冲击化疗一次,6～9 d后接受手术.同期收治的41例Ⅱ期以上进展期胃癌病人行常规手术治疗.比较观察新辅助化疗后肿瘤原发病灶的缓解情况、毒副反应及两组间的远期生存率变化.结果:新辅助化疗组35例全部完成术前区域性动脉化疗,毒性反应主要为胃肠道反应和骨髓抑制,均属可控范嗣内1～2级,其中29例(82.9%)病人获得根治性切除(R0切除),中位生存期26.6个月,1、3和5年生存率分别为68.6%、37.1%和14.3%.常规手术组41例中有28例(68.3%)获得R0切除,中位生存期为15.3个月,1、3和5年生存率分别为63.4%、19.5%和7.3%.结论:术前区域性动脉化疗耐受性良好;新辅助化疗有望提高进展期胃癌病人的远期疗效.     

A regime for controlling pain in far advanced cancer patients

A regime for pain relief in far advanced cancer is described. Simple sedatives, coal tar analgesics, mild then stronger analgesics are used in increasing scale.The importance of pharmacologic action, individualization of drug and patient, danger of overdosage, control of morphine addiction, consideration of methods other than drugs to relieve pain are emphasized.     

晚期前列腺癌患者骨痛的处理(附八例报告)

目的　探讨晚期前列腺癌患者骨痛的治疗方法。　方法　对 8例晚期前列腺癌骨痛患者分别予多种止痛剂 ( 8例 )、二膦酸盐 (博宁 ,8例次 )、89Sr( 8例次 )、外放射 ( 4例次 )等治疗。　结果　 8例患者中 1例死于呼吸衰竭 ,7例疼痛缓解 3～ 5个月 ;博宁治疗者中 2例每次治疗疼痛缓解 1～ 2个月 ;外放射治疗的 2例疼痛缓解期分别为 4和 6个月 ;89Sr治疗的 2例每次治疗疼痛缓解约 1个月。　结论　骨痛是晚期前列腺癌常见的并发症 ,采取综合措施可不同程度缓解患者的痛苦。     

The pain control infusion pump for postoperative pain control in shoulder surgery.

PURPOSE: This study was initiated to evaluate the effect of a pain control infusion catheter in managing postoperative pain. Type of Study: In a prospective, randomized trial, 62 consecutive patients undergoing arthroscopic subacromial decompression had an indwelling pain control infusion catheter placed at the operative site. Materials and Methods: Thirty-one patients received 0.25% bupivacaine and 31 patients received saline infusions, each at a constant rate of 2 mL per hour. Patients evaluated their pain by visual analog scale, and also tabulated the amount of narcotic and nonnarcotic medication used each day in the first week of surgery. RESULTS: There was a statistically significant difference in pain in all parameters tested in the bupivacaine group as compared with the saline control group (P <.05). CONCLUSIONS: The bupivacaine pain control infusion pump is an effective means of decreasing postoperative pain.     

Thoracoscopic splanchnicectomy for control of intractable pain due to advanced pancreatic cancer

apd: 21 December 2000     

Long-term intrathecal infusion of morphine in the home care of patients with advanced cancer

Background: Fear of infections and other complications has made many clinicians avoid intrathecal application of morphine in chronic cancer pain. However, recent comparative studies show that, in long-term treatment, intrathecal morphine administration may give a more satisfactory pain relief with lower doses of morphine and fewer side-effects than epidural administration. In Montpellier Cancer Institute, first cancer pain patients received long-term intrathecal morphine as early as in 1979, and since then more than 400 patients have been treated.
Methods: In 1991–1994, 50 patients having refractory cancer pain were treated with a continuous intrathecal infusion of morphine using an external pump with patient-controlled boluses. In this retrospective study, the outcome of these 5602 days of morphine therapy will be analysed. The treatment consisted of a lateral puncture technique, strictly aseptic conditions during catheter insertion and changes of pump reservoirs, and effective prevention of side-effects.
Results: The average duration of intrathecal infusion was 142 (7–584) days. The mean starting dose, 2.5 (0.4–8.3) mg/day, increased to a mean final dose of 9.2 (1–94) mg/day, the average dose being 5.4 (1–23) mg/day. During the treatment period, no clinically detectable infections and no respiratory depression occurred. Leakage of cerebrospinal fluid followed by post-spinal headache occurred in only 6 patients who received a temporary external catheter: the lateral lumbar puncture technique seemed to protect from this complication in long-term treatment. The patients stayed at home, coming to agreed control visits only at 4–6-week intervals, using a telephone-telefax service for emergencies.
Conclusions: Long-term intrathecal morphine infusion seems to provide satisfactory analgesia, few side-effects and a high degree of patient autonomy.     

Intraarterial chemotherapy and hyperthermia for pain control in patients with recurrent rectal cancer

For the majority of patients with unresectable recurrence of rectal cancer, persistent pain is the most distressing problem. This brief study describes a method to control pain in 10 patients with unresectable rectal cancer confined to the pelvis after standard therapy failed. All of the patients had percutaneous placement of infusion catheters in both internal iliac arteries. A continuous intraarterial infusion of 800 mg/m2 of 5-fluorouracil per day was given for 7 days and 10 mg/m2 of mitomycin C was administered as a bolus injection on the seventh day only. Four patients also received whole body hyperthermia by way of a Erbotherm 434 mHz microwave generator on the second and fifth days of infusion. Relief of pain occurred in three of the six patients who received intraarterial chemotherapy only. All four patients who also received hyperthermia achieved prolonged pain relief when it was added. We have concluded that intraarterial chemotherapy may be beneficial in patients with uncontrolled pelvic pain due to recurrent rectal cancer. The addition of hyperthermia may augment the benefit.     

右美托咪定或丙泊酚复合芬太尼用于晚期癌痛植入式鞘内药物输注系统植入手术的比较

目的比较右美托咪定或丙泊酚复合芬太尼用于晚期癌痛鞘内药物输注系统植入手术的有效性及安全性。方法选择晚期癌痛行鞘内药物输注系统手术的患者40例,男31例,女9例,年龄48～78岁,ASAⅡ或Ⅲ级,采用随机数字表法分为两组:右美托咪定复合芬太尼组(D组)和丙泊酚复合芬太尼组(P组),每组20例。D组于术前10 min内静脉泵入右美托咪定0.5μg/kg,继以0.2～0.5μg·kg~(-1)·h~(-1)持续泵注至术毕,以维持患者Ramsay评分3～4分。P组于术前10 min内共静脉泵注丙泊酚2 mg/kg,后以1.5 mg·kg~(-1)·h~(-1)持续泵注丙泊酚并适当增减维持剂量,以维持患者Ramsay评分3～4分至术毕。两组患者于术前5 min均静注芬太尼1μg/kg,并间断追加芬太尼。记录入室时(T_0)、手术开始时(T_1)、手术开始后30 min(T_2)、60 min(T_3)、90 min(T_4)、术毕(T_5)、入PACU后30 min(T_6)的MAP、HR、SpO_2和VAS评分;记录呼吸循环干预情况,恶心呕吐等并发症的发生情况;记录芬太尼用量、手术时间、患者完全恢复时间、患者满意度评分等。结果与T_0时比较,T_1—T_6时两组MAP、VAS评分明显降低,HR明显减慢(P0.05),T_1—T_5时P组SpO_2明显降低,T_1时D组SpO_2明显降低(P0.05)。与P组比较,D组T_2—T_5时HR明显减慢,VAS评分明显降低,而T_1—T_5时SpO_2明显升高(P0.05),且芬太尼用量明显减少,低血压发生率明显降低(P0.05)。结论与丙泊酚复合芬太尼比较,右美托咪定复合芬太尼用于晚期癌痛患者鞘内药物输注系统手术镇痛效果更完善,且对呼吸影响较小,并可减少芬太尼的用量及低血压的发生率。     

奥沙利铂联合5-FU术前动脉化疗对进展期胃癌的临床疗效

目的：探讨进展期胃癌患者术前用奥沙利铂（OXA）联合5-氟尿嘧啶（5-FU）行区域性动脉灌注化疗的临床效果。
方法：48例Ⅱ期以上胃癌患者,术前行区域性动脉灌注化疗（A组）,方案为OXA 130 mg/m+ 5-FU 750 mg/m,经股动脉插管行区域冲击化疗1次,8～12 d后接受手术。同期另48例相同临床分期的胃癌患者直接行手术治疗（B组）。两组术后均接受OXA /甲酰四氢叶酸钙/5- FU方案化疗6个周期,观察两组的毒副反应、手术并发症和临床疗效。
结果：A组有38例（79.2%）获得根治性切除;镜检32例（66.7%）出现组织病理学改变,如肿瘤组织坏死、淋巴细胞炎性浸润、癌细胞凋亡、以及间质水肿纤维组织增生等。B组有30例（62.5%）行根治性切除,根治切除率显著低于A组,两组间差异有统计学意义（P<0.05）,且B组病理检查未出现上述变化。A组术前化疗的毒性反应均限于Ⅰ～Ⅱ级;两组的术后并发症无统计学差异。A组患者的中位生存期为36.0个月;1,2,3年总生存率分别为79.2%,62.5%和52.1%。B组中位生存期为21.5个月;1,2,3年总生存率分别为66.7%,45.8%和35.4%。A,B组比较,2年和3年总生存率差异有统计学意义（P<0.05）。
结论：术前应用OXA/5-FU方案行区域性动脉灌注化疗可使肿瘤组织产生显著的组织病理学改变,有利于提高进展期胃癌根治性手术切除率及2,3年生存率。     

Intra-arterial infusion chemotherapy in combination with angiotensin II for advanced bladder cancer

A combination of 50 to 80 mg. per m.2 cis-platinum and 30 to 50 mg. per m.2 doxorubicin or 30 to 50 mg. per m.2 tetrahydropyranyl-doxorubicin instead of doxorubicin was infused into the bilateral internal iliac artery for the treatment of 20 patients with T3 or T4 advanced bladder cancer. Angiotensin II was administered together with these chemotherapeutic agents by means of an infusion pump at a rate of 1.5 to 2.0 micrograms. per minute for 20 minutes for both sides. Among the 20 patients complete (9) and partial (8) responses were obtained after only 1 or 2 courses of this intra-arterial treatment. Histological examination showed severe tumor destruction with no viable cells in 6 and no tumor in 4 of the 15 evaluable cases. Selective enhancement of regional blood flow in the tumor region after intra-arterial infusion of angiotensin II was observed by continuous target arterial 81mkrypton infusion. Intra-arterial chemotherapy with combined angiotensin II may be clinically useful for treatment of primary or metastatic bladder carcinoma.     

Physical pain in advanced cancer

This chapter describes physical pain including pain, anorexia-cachexia syndrome, nausea-vomiting, abdominal distention, ascites, constipation and dyspnea. In effect, patients are more likely to present with several concurrent symptoms. Each of these symptoms is described separately in this chapter.     

晚期乳腺癌术前局部灌注化疗的疗效观察

目的　探讨术前动脉灌注化疗对晚期乳腺癌临床治疗效果及病理特征的影响。方法　回顾性分析 5 2例晚期乳腺癌患者的临床资料 ,其中 2 2例术前行动脉内灌注化疗 (治疗组 ) ,3 0例术前未行动脉内灌注化疗 (对照组 )。结果　治疗组灌注化疗后 ,症状减轻 ,肿瘤缩小 ,有效率 (CR +PR )为 86.4%。术后病理检查均发现癌细胞核固缩、碎裂 ,胞浆凝固、坏死 ;细胞间质水肿、炎性细胞浸润、纤维组织增生 ;血管出现内膜增生 ,血栓形成。对照组癌细胞改变不明显。随访时间 2～ 7年。局部复发率治疗组 13 .6% ,对照组 3 3 .3 % (P <0 .0 1)。治疗组 5年生存率 5 9.1% ,对照组 2 6.7%(P <0 .0 5 )。结论　晚期乳腺癌术前动脉灌注化疗可以缩小肿瘤 ,降低肿瘤分期 ,改变癌细胞的组织学形态 ,提高生存率。     

Low-cost pain infusion catheter for the control of postoperative pain in ambulatory foot surgery

The authors report the use of a low-cost method of providing prolonged patient controlled anesthesia at the surgical site following elective forefoot surgery performed in ambulatory surgical settings. In this series of 54 patients there were no postoperative complications and 95.92% of patients believed the device helped to control their post-operative pain.     

Ketamine anesthesia in children--exploring infusion regimens

Aim: We aimed to produce a racemic ketamine manual infusion regimen capable of maintaining a steady‐state blood concentration associated with anesthesia in children aged 1.5–12 years. Method: The literature was searched for a ketamine blood concentration associated with anesthesia in humans. Pharmacokinetic parameter estimates were taken from published studies of infusion data in children and used in a pharmacokinetic simulation program to predict likely ketamine blood concentrations during infusions. A variability of 10% was allowed about the chosen target concentration. Results: A target concentration of 3 mg·l^?1 was chosen for simulation modeling. This target is greater than that associated with anesthesia when supplemented by nitrous oxide or midazolam in adults. Arousal to light touch or voice appears to occur at a mean plasma concentration of 0.5 mg·l^?1 in both children and adults. A loading dose of 2 mg·kg^?1 followed by an infusion rate of 11 mg·kg^?1·h^?1 for the first 20 min, 7 mg·kg^?1·h^?1 from 20 to 40 min, 5 mg·kg^?1·h^?1 from 40 to 60 min and 4 mg·kg^?1·h^?1 from 1 to 2 h resulted in a steady‐state target concentration of 3 mg·l^?1 in children 1.5–12 years. Arousal, either spontaneous or to speech, is anticipated 3 h 47 min after a 2 h infusion in an average 6‐year‐old child. The context sensitive half‐time in children was shorter than in adults after 1.5 h, rising from 30 min at 1 h to 55 min at 5 h after an infusion of 3 mg·kg^?1·h^?1 in a 10 kg child. Conclusion: Children require higher infusion rates than adults to maintain steady‐state concentrations of 3 mg·l^?1 and have shorter context sensitive half‐times than adults after prolonged infusion. These differences can be attributed to age‐related pharmacokinetics. We anticipate slow return to full consciousness after prolonged infusion, suggesting that a lower target concentration with supplementation from adjuvant short acting anesthetic drugs may be advantageous.