Dexmedetomidine use for patients in palliative care with intractable pain and delirium: A retrospective study.

Patients seen by the palliative care team often have difficult and intractable symptoms. The current standard of practice to manage these symptoms is the deeply sedating midazolam continuous subcutaneous infusion for patients who are expected to expire within hours to days. Dexmedetomidine provides sedation but lacks evidence in palliative care use. This study describes continuous subcutaneous infusion of dexmedetomidine's effect on refractory pain and delirium. Retrospective, observational chart review and conducted in accordance with SQUIRE (quality improvement study). Twenty adult patients (18 years of age or older) with metastatic cancer disease admitted to three palliative complex care units of Fraser Health who received continuous subcutaneous infusion of dexmedetomidine between January 2017 to August 31, 2019. Average length of dexmedetomidine use was 9 days (1/3 length of stay). Eight of the 13 patients with pain symptoms exhibited an overall decline in pain. Four of the 6 patients with delirium had an initial decrease in delirium, but it did not last beyond the first day. Despite progressive clinical deterioration, adjunctive medications decreased or remained the same for 53% of as needed medications and 65% for regularly scheduled medications. Forty-five percent of patients had ≥50% days of rousable sedation. Hypotension occurred in 85% of patients. Dexmedetomidine provided benefit in managing intractable pain while allowing patients to remain rousable, but only had a short effect on delirium symptoms.

Outcomes of endoscopic and microscopic transsphenoidal surgery on non-functioning pituitary adenomas: a systematic review and meta-analysis.

Both microscopic and endoscopic transsphenoidal surgery are effective approaches for nonfunctioning pituitary adenomas. The issue on the comparison of their efficacy and safety remains inconsistent. A thorough search of the literatures (PubMed, EMBASE, MEDLINE) were performed up to March 2017. Studies reporting outcomes of microscopic or endoscopic transsphenoidal surgery on nonfunctioning pituitary adenomas were included. A meta-analysis was performed focusing on the early stage and long term outcomes. The final search yielded 19 eligible studies enrolling 3847 patients, 389 of them underwent microscopic approach and 3458 of them with endoscopic approach. As to the early stage outcomes, the rate of gross tumor resection was significantly higher in the endoscopic group than that in microscopic group (73% versus 60%, P < 0.001). Meanwhile, endoscopic approach showed priority over microscopy on postoperative hypopituitarism (63% versus 65%, P < 0.001) and CSF leakage (3% versus 7%, P < 0.001). For the long term outcomes, the rate of visual improvement was significant higher in the endoscopic group than that in microscopic group (77% versus 50%, P < 0.001). However, there was no significant difference between the groups regarding the rate of permanent diabetic insipidus and meningitis. The endoscopic approach may be associated with higher rate of gross tumor movement and lower risk of postoperatively complications for treating nonfunctioning pituitary adenoma, when compared with microscopic approach. However, the confidence was shorted due to limited high quality evidence (largely randomized and controlled studies).

A clinical evaluation of serological diagnosis for pancreatic cancer.

AIM:To assess the diagnostic values of tumor markers for pancreatic cancer.METHODS:Pancreatic cancer-associated antigen from colonic mucosa (PCAAc), pancreas-specific antigen (PaA), pancreatic oncofetal antigen (POA) and minimolecular pancreatic antigen (mPOA) were detected by double antibodies Sandwich ELISA; CA19-9,elastase 1 (E1), human pancreatic elastase 1 (HPE1) and carcinoembryonic antigen (CEA) by radioimmunoassay (RIA); general activities of ribo-nuclease (RNase) and its isoenzymes (RNase I and RNase I) by biochemistry and PAEG;glycylproline dipeptidyl aminopeptidase (GPDA) by biochemistry andalpha 1-antitrypsin (alpha1AT) by rocket immunoelectrophoresis (rocket-IE).RESULTS:The detection of serum POA,mPOA,PaA,PCAAc,CA19-9,RNase and RNase I was able to differentiate pancreatic cancer from the benign disorders and non-pancreatic malignancies with a sensitivity from 66.75% to 80.0% and a specificity from 88.5% to 96.69%. POA, mPOA, PCAAc, HPE1, E1 and GPDA were related to the pancreatic cancer at the head which demonstrated higher sensitivity from 63.64% to 85.71%. The detection of serum HPE1 was especially helpful for the diagnosis of pancreatic cancer with smaller diameters. The determination of 3 or 4 kinds of tumor markers simultaneously would increase the detection rate of pancreatic cancer, which will be an important procedure for the diagnosis of this malignancy.CONCLUSION:A single test of tumor markers is helpful to detect pancreatic cancer clinically,but the determination of 3 or 4 kinds of tumor markers simultaneously would significantly increase the detection rate of pancreatic cancer, which will be an important procedure for the diagnosis of this malignancy.