ABSTRACT
Partially covered self-expanding metallic stents (SEMS) are the main recommendation for palliative treatment of malignant dysphagia. Delivering self-expanding metallic stents in stenosing oesophagus neoplasia's are often challenging due to the difficulty on passing a guide wire through the tumour. We describe a case in which the guidewire was only able to franchise the tumour retrogradely, after entering the gastric cavity through the percutaneous endoscopic gastrostomy orifice using an ultra slim scope.
ABSTRACT
OBJECTIVES: Ketamine has been widely used in refractory pain as an opioid adjuvant. Evidence suggests that ketamine can also have an essential role in easing depressive symptoms. Its rapid onset of action makes it a valuable choice in palliative care. METHODS: We present a case of a 70-year-old man with stage IV renal carcinoma and bone metastasis. The main symptoms included neuropathic pain, depression, and a persistent and severe desire for death. RESULTS: We started continuous subcutaneous infusion with morphine 30 mg and ketamine 100 mg/day. The dose of ketamine was incremented to the maximum of 250 mg/day. During the 28-day treatment, we observed an overall improvement in neuropathic pain, depressive symptoms, and other end-of-life psychological aspects of distress. Only minor psychological side effects were identified, which were controlled by using midazolam in the continuous subcutaneous infusion. SIGNIFICANCE OF RESULTS: Some studies have already demonstrated the benefits of ketamine use in alleviating depression, using parental infusion or oral formulas, which are administered in hospice care. Our report enhances the benefit of the subcutaneous route for palliative patients cared for at home.
ABSTRACT
BACKGROUND: The use of continuous subcutaneous infusion of drugs using the repeated filling of elastomeric infuser pumps (EIP) has gained clinical recognition for palliative care at home. However, to date, there has been a notable absence of research examining the cost implications associated with the repeated EIP filling procedure. We aimed to evaluate the cost associated to the repeated filling of EIP used in a home-based palliative care team. METHODS: We conducted an analysis of the cost associated to the repeated filling of 240 EIP (1-day, n = 136; 2-day, n = 102; 7-day, n = 2) (110 patients). RESULTS: The refilling procedure led to a reduction in the utilization of 409 devices, resulting in savings of 4.031. EIP refilling did not result in a decrease in the number of home visits, the duration of each visit, the expenses associated with transportation to patients' residences, or the nurse-to-hour cost. CONCLUSION: Refilling EIPs reduces costs by reducing the number of devices purchased. No additional cost savings were noted in nursing time, number of home visits and duration, and expenses with transportation. Further cost savings could be realized by training laycarers to refill EIP at home independently. Future research should assess the feasibility of laycarers training programs on performing EIP filling at home.
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Abstract Objective To assess obstetric/puerperal/neonatal outcomes in an inflammatory bowel disease (IBD) population and to analyze disease characteristics that may be associated to adverse outcomes. Methods Retrospective descriptive analysis including 47 pregnant women with IBD (28 with Crohn's disease - CD and 19 with ulcerative colitis - UC) who delivered between March 2012 and July 2018 in a tertiary hospital. We reviewed clinical records to extract demographic information, previous medical history, disease subtype, activity, severity, treatment, and obstetric, puerperal, and neonatal outcome measures. Results Obstetric and neonatal complications (composite outcomes) occurred in 55.3% and 14.6% of the IBD population, respectively, and were more frequent in UC patients. Preterm birth (PTB), preeclampsia, anemia, low birth weight (LBW), and neonatal death were also more frequent in UC patients. The rate of postpartum hemorrhage (PPH) was 14.9%, and it was higher in CD patients. Women with active IBD had more obstetric/neonatal adverse outcomes (fetal growth restriction and LBW in particular) and cesarean sections. Patients with medicated IBD had less obstetric/neonatal complications (PTB and LBW in specific) and cesarean sections but more PPH. Conclusion Women with IBD may have an increased risk of obstetric/puerperal/neonatal adverse outcomes. Ulcerative colitis patients had more obstetric and neonatal complications, whereas PPH was more frequent if CD patients. Other disease characteristics were considered, which allowed a better understanding of their possible influence. Although more research is needed, this work reinforces the importance of adequate surveillance to allow prompt recognition and treatment of complications.
Resumo Objetivo Avaliar os desfechos obstétricos/puerperais/neonatais em uma população com doença inflamatória intestinal (DII) e analisar as características da doença, que podem estar associadas a desfechos adversos. Métodos Análise descritiva retrospectiva incluindo 47 gestantes com DII (28 com doença de Crohn - DC e 19 com retocolite ulcerativa - RCU) que deram à luz entre março de 2012 e julho de 2018 em um hospital terciário. Revisamos os registros clínicos para extrair informações demográficas, histórico médico prévio, subtipo da doença, atividade, gravidade, tratamento e medidas de resultados obstétricos, puerperais e neonatais. Resultados As complicações obstétricas e neonatais (desfechos compostos) ocorreram em 55,3% e 14,6% da população com DII, respectivamente; e foram mais frequentes em pacientes com RCU. Nascimento prematuro (PTB), pré-eclâmpsia, anemia, baixo peso ao nascer (BPN) e óbito neonatal também foram mais frequentes em pacientes com RCU. A taxa de hemorragia pós-parto (HPP) foi de 14,9% e foi maior em pacientes com DC. Mulheres com DII ativa tiveram mais desfechos obstétricos/neonatais adversos (restrição de crescimento fetal e BPN em particular) e cesarianas. Pacientes com DII medicada tiveram menos complicações obstétricas/neonatais (PTB e BPN em específico) e cesarianas, mas mais HPP. Conclusão Mulheres com DII podem ter um risco aumentado de desfechos adversos obstétricos/puerperais/neonatais. As pacientes com RCU apresentaram mais complicações obstétricas e neonatais, enquanto a HPP foi mais frequente em pacientes com DC. Outras características da doença foram consideradas, o que permitiu uma melhor compreensão de sua possível influência. Embora mais pesquisas sejam necessárias, este trabalho reforça a importância de uma vigilância adequada para permitir o reconhecimento e o tratamento imediatos das complicações.
Subject(s)
Humans , Female , Pregnancy , Inflammatory Bowel Diseases , Retrospective StudiesABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Neuroendocrine Tumors/surgery , Rectal Neoplasms/surgery , Neuroendocrine Tumors/pathology , Rectal Neoplasms/diagnostic imaging , Rectal Neoplasms/pathology , Endoscopy , ColonoscopyABSTRACT
No disponible
Subject(s)
Humans , Female , Adult , Gastrointestinal Hemorrhage/etiology , Uterine Cervical Neoplasms/pathology , Stomach Neoplasms/complications , Stomach Neoplasms/secondaryABSTRACT
No disponible
Subject(s)
Humans , Female , Adult , Dilatation/methods , Epidermolysis Bullosa Dystrophica/complications , Esophageal Stenosis/therapy , Esophagoscopy , Dilatation/instrumentation , Epidermolysis Bullosa Dystrophica/genetics , Esophageal Stenosis/etiology , Genes, RecessiveABSTRACT
Os testes de equilíbrio da Escala de Desenvolvimento Motor de Rosa Neto1 são constituídos por dez tarefas correspondentes às idades cronológicas de 2 a 11 anos e determinam a Idade Motora dos participantes. A ordem de apresentação dos testes é crescente, partindo da idade cronológica da criança e a idade motora baseia-se no sucesso ou fracasso em cada tarefa. O objetivo deste estudo foi analisar a validade de construção dos testes motores em equilíbrio, observando a ordenação e os graus de dificuldade da tarefa. Participaram 76 crianças, com idade cronológica de 6 a 9 anos, que foram distribuídas em dois grupos: grupo controle, aplicação dos testes em ordem crescente; grupo invertido, aplicação dos testes em ordem decrescente. Os resultados não apresentaram diferenças estatisticamente significativas no desempenho entre os grupos, indicando que a ordem de apresentação dos testes não interferiu no desempenho das crianças, independente da idade cronológica. Baixas taxas de sucesso ocorreram em algumas tarefas específicas, seguidas por sucesso em tarefas posteriores. Como os resultados demonstraram que os participantes conseguem executar tarefas seguintes à tarefa em que houve o fracasso, a idade motora apontada pela Escala de Desenvolvimento Motor pode estar subestimando o desenvolvimento motor dessas crianças. A variação do desempenho das crianças nos testes sugere que o processo de desenvolvimento motor é não linear. As tarefas motoras em equilíbrio propostas na Escala de Desenvolvimento Motor apresentam validade de construção.
The equilibrium tests of the Rosa Neto1 Motor Development Scale are constituted by ten tasks related to the chronological ages from 2 to 11 years and they determine the participants Motor Age. The tests presentation order is crescent from the child chronological age and the motor age is based on the success or failure in each task. The aim of this study was to analyze the construction validity of the equilibrium motor tests observing the ordering the levels of task difficulty. 76 children with 6 to 9 years of chronological age participated and were assigned in two groups: control group, tests presentation in increased order; and inverted group, tests presentation in decreased order. The results did not revealed statistical significant differences between groups, which indicate that the presentation order of the tests did not interfere in the children performance, independently of the chronological age. Low success rates occurred in some specific tasks followed by success in advanced tasks. As the results revealed that the participants could perform the tasks after that in which the failure happened the motor age ascribed by the Motor Development Scale can underestimate the children motor development. The variation of the children performance in the tasks suggests that the motor development process is nonlinear. The equilibrium motor tasks purposed in the Motor Development Scale show construction validity.