Comparison of numerical and verbal rating scales to measure pain exacerbations in patients with chronic cancer pain

Background  

Numerical rating scales (NRS), and verbal rating scales (VRS) showed to be reliable and valid tools for subjective cancer pain measurement, but no one of them consistently proved to be superior to the other. Aim of the present study is to compare NRS and VRS performance in assessing breakthrough or episodic pain (BP-EP) exacerbations.     

Impact économique des stratégies de recours à l’éphédrine en seringues préremplies

Objectives

Ephedrine is an emergency drug available in ampules and syringes need to be prepared in advance according to one of two strategies in our establishment: strategy 1 (S1: 1 ampule per patient) and strategy 2 (S2: 1 ampule per operating room). There are also prefilled syringes. Because of their high cost and conflicting results in the literature, we assessed the economic interest of using prefilled syringes compared with strategies S1 and S2.

Type of study

This was a prospective observational study.

Patients and methods

The consumption of ephedrine was recorded over two periods of 14 days: P1 with syringes prepared in advance according to S1 or S2 and P2 with the on-demand use of prefilled syringes.

Results

The cost of a syringe of ephedrine prepared in advance (nurse time preparation included) was evaluated at €1.65 vs. €3.57 for a prefilled syringe. In operating rooms using S1, the use of prefilled syringes reduced overall the cost per patient about €1.22 and global annual costs by 72% (€2830), while the decrease was about €0.32 for the cost per patient and about 47% (€2760) for global annual costs for operating rooms using S2.

Conclusion

The interest of our study is that we investigated different supply strategies for ephedrine within a large number of operating rooms. In our establishment, it was decided to use prefilled syringes in operating rooms that used S1. As well as the economic interest, prefilled syringes contributed to improved safety and saved nursing time.     

The infusion of somatostatin reduces the arginine-vasopressin response to insulin-induced hypoglycemia in man

The effect of an iv infusion of somatostatin (SRIH) (4.1 micrograms/min x 90 min) on the basal secretion of arginine-vasopressin (AVP) and on the AVP response to insulin (0.15 IU/Kg) - induced hypoglycemia was studied in 6 normal men. Basal AVP secretion was not modified by SRIH administration. The blood glucose decrements induced by insulin were similar in the control insulin-tolerance test (ITT) and in the ITT + SRIH test, whereas the AVP response to hypoglycemia was significantly lower in the presence of SRIH. The mean peak AVP increase was three times higher than the basal value in the control ITT, but only two times during SRIH administration. Infusion of higher doses of SRIH (7 micrograms/min x 90 min) produced similar results. These data suggest the involvement of a somatostatinergic mechanism in regulation of AVP response to hypoglycemia.     

Spinal,epidural or propofol anaesthesia for out–patient knee arthroscopy?

Background : We have compared three different methods of anaesthesia for out–patient knee arthroscopy in terms of perioperative conditions, postoperative pain, time taken and economy.
Methods : 91 ASA I–II patients scheduled for elective knee arthroscopy were included. After premedication with diazepam 10 mg and naproxene 500 mg orally, they were randomly assigned into one of three groups: Group S (n=32) received spinal anaesthesia with lidocaine 50 mg/ml 1.5–2 ml in 7.5% glucose through a 27–G Quincke needle, Group E (n=29) received epidural anaesthesia with mepivacaine 20 mg/ml and epinephrine 5 μg/ml, 15–20 ml, and Group P (n=30) received propofol anaesthesia with a bolus induction of 2 mg/kg followed by infusion.
Results : The time from start of anaesthesia until start of operation was significantly less in Group P than in the two other Groups: 7.45.4 min as compared to 23.04.8 min in Group S and 31.09.1 min in Group E (meanSD, P<0.05). After end of surgery, the duration of the postoperative regional block was 7528 min in Group S and 125 79 min in Group E (P<0.05). In Group S and Group E the postoperative pain was significantly less than in Group P at admission to the recovery unit and 60, 120 and 180 min later (P<0.05). The overall incidence of postoperative nausea or vomiting was less than 5% with no differences between the groups. One patient in Group E had block failure and one patient in Group S had a post–spinal headache. The perioperative costs of drugs and disposables were highest in Group P (30 USD) and lowest in Group S (6.5 USD).
Conclusion : Propofol anaesthesia results in the shortest stay in the operation theatre but a higher degree of postoperative pain and a higher cost of drugs and disposables.     

Polymorphism of the h allele and the population frequency of sporadic nonfunctional alleles

BACKGROUND: Current polymerase chain reaction-based strategies for phenotype prediction often fail when sporadic nonfunctional alleles are encountered. The population frequency of such mutations was not known for any gene under low selection pressure and may be best examined in blood groups systems lacking prevalent nonfunctional alleles. The frequency of the very rare Bombay blood group (Oh, genotype hh sese) was recently determined in a systematic survey of more than 600,000 white individuals. STUDY DESIGN AND METHODS: With this survey used in conjunction with additional blood samples, the population frequency of nonfunctional alleles of the gene encoding the alpha (1,2)fucosyltransferase (H or FUT1) was determined. RESULTS: Seven different h alleles were found in five unrelated individuals, three of whom were homozygous for unique alleles. There was no prevalent h allele. Five missense and one frameshift mutations were observed, that were the presumptive causes of the null phenotype; the coding sequence of one h allele was identical to the H sequence. The average inbreeding factor alpha was 0.00116. The frequency of nonfunctional alleles at the H gene locus was calculated as 1 in 347 in a large white population (95% CI: 1:185-1:824). CONCLUSION: The Bombay blood group phenotype in white is due to diverse, sporadic, nonfunctional alleles without any prevalent allele. Assuming similar rates of nonfunctional alleles in glycosyltransferase genes like ABO, current genotyping strategies may fail as often as once in about 300 individuals of blood group O. Sporadic neutral alleles may also pose a serious obstacle for population-wide screening of many disease-associated genes.     

高效液相色谱法测定人血中普鲁卡因酰胺及其代谢产物N-乙酰普鲁卡因酰胺

本文用高效液相色谱法测定人血中普鲁卡因酰胺(PA)及其代谢产物N-乙酰普鲁卡因酰胺(NAPA)。以正丙醇—氯仿(1:9)提取血清样品,蒸干,残渣用流动相溶解;色谱分析条件:NOVA-PAK 5μm ODS柱,醋酸(40 ml)—醋酸钠(4g)—水(1000ml)—乙腈(100ml)为流动相;定量分析以普鲁卡因为内标,样品的比率色谱图表明分离良好,PA和NAPA的线性测定范围分别为0.5～12.0μg/ml和0.5～6.0μg/ml,相关系数均优于0.99,平均回收率分别为99.4%和100.5%,平均变异系数分别为4.16%和4.36%。方法适用于血清样品分析和治疗药物监测,对病人血样的测定结果表明方法不受干扰。     

Structural Requirements in the Fc Region of Rabbit IgG Antibodies Necessary to Induce Cytotoxicity by Human Lymphocytes

Rabbit IgG anti-chicken erythrocyte antibodies were compared with the Fab/c or Facb fragments of IgG and with partially reduced and alkylated IgG for the capacity to induce cytotoxicity by normal human lymphocytes. The Fab/c antibody fragment, which lacks one Fab region, was still able to induce cytotoxicity. In contrast, the Facb antibody fragment, which lacks the Cγ3 domains, was nearly ineffective in activating the effector cells, whereas intact antibody activity was demonstrated by its ability to inhibit the cytotoxicity induced by unsplit IgG. Similarly, partial reduction and alkylation of the IgG antibodies, under conditions affecting the interchain disulphide bonds only, greatly diminished their ability to induce cytotoxicity, although they effectively inhibited the cytotoxicity induced by untreated IgG. On the basis of these results and previous data, we suggest that the reaction of the Fc region of IgG with the effector cell depends on the integrity of the Cγ² domain in the native, divalent state or on the interaction between the Cγ² and Cγ³ domains.     

Decreased occurrence of osteonecrosis of the jaw after implementation of dental preventive measures in solid tumour patients with bone metastases treated with bisphosphonates. The experience of the National Cancer Institute of Milan

Background: Screening of the oral cavity and dental care wassuggested as mandatory preventive measures of osteonecrosisof the jaw (ONJ) in patients receiving bisphosphonates (BPs).We investigated the occurrence of ONJ before and after implementationof dental preventive measures when starting BP therapy. Patients and methods: Since April 2005, 154 consecutive patientstreated with BPs (POST-Group) have undergone a baseline mouthassessment (dental visit ± orthopantomography of thejaws) to detect potential dental conditions and dental careif required. A retrospective review was also conducted of allconsecutive cancer patients with bone metastases (PRE-Group)and treated for the first time with BPs from January 1999 toApril 2005 in our clinic without receiving any preventive measure.Incidence proportion and incidence rate (IR) were used to estimatethe incidence of ONJ. Results: Among the study population (966 patients; male/female= 179/787), 73% had breast cancer. 25% of patients were givenzoledronic acid (ZOL), 62% pamidronate (PAM), 8% PAM followedby ZOL and 5% clodronate. ONJ was observed in 28 patients (2.9%);we observed a reduction in the incidence of ONJ from 3.2% to1.3%, when comparing—pre and post-implementation of preventivemeasures programme. Considering the patients exposed to ZOL,the performance of a dental examination and the applicationof preventive measures led to a sustained reduction in ONJ IR(7.8% in the PRE-Group versus 1.7% in the POST-Group; P = 0.016),with an IR ratio of 0.30 (95% confidence interval 0.03–1.26). Conclusions: ONJ is a manageable and preventable condition.Our data confirm that the application of preventive measurescan significantly reduce the incidence of ONJ in cancer patientsreceiving BPs therapy. Dental exams combined to the identificationof patients at risk in cooperation with the Dental Team canimprove outcomes and increase the number of ONJ-free patients. Key words: bisphosphonates, bone metastases, dental preventive measures, dental team, ONJ, osteonecrosis of the jaw, osteoporosis Received for publication February 15, 2008. Revision received June 17, 2008. Accepted for publication June 23, 2008.     

Incident pain and analgesic consumption decrease after samarium infusion: a pilot study

Objective The aim of this pilot study was to observe the variations of pain intensity on movement and at rest and the variation of analgesic drug consumption in patients with prostate cancer and painful bone metastases treated with a single dose of 1.0 mCi/kg of samarium-153 (153-Sm) lexidronam. Design Case series. Setting The Nuclear Medicine Unit and Pain Therapy and Palliative Care Unit, National Cancer Institute of Milan, Italy. Patients Thirteen outpatients with hormone refractory prostate cancer and painful multiple bone metastases. Interventions Infusion of a single dose of 1.0 mCi/kg of 153-Sm lexidronam, pain therapy, and the assessment of pain intensity at rest and on movement. Main outcome measures Variation of pain intensity on movement and at rest by means of a verbal scale and the reduction of analgesic drug consumption 4 weeks after infusion of 153-Sm lexidronam. Results From baseline, 61.5% of patients reported a decrease of at least two levels of pain intensity on movement and 53.8% of patients had an improvement of pain at rest. Of the patients, 15.4% were not in pain at rest or on movement at baseline and continued to be free of pain 4 weeks after the administration of samarium. All ten patients, but one, who were on analgesic drugs before samarium infusion, reduced the regular drug administration or rescue medication. Bone marrow toxicity was mild and readily reversible in three patients. Conclusions In patients with bone metastases, pain on movement is a frequent and often difficult clinical problem to treat and the most frequent cause of breakthrough pain. In patients with painful multiple bone metastases due to prostate cancer, the infusion of a single dose of 1.0 mCi/kg of 153-Sm lexidronam may be considered an effective and safe treatment for pain either at rest or during movement.