Inhaled opioids for cancer pain relief: A narrative review.

ABSTRACT: Despite the many new possibilities, cancer pain treatment is not always effective and often poses a challenge for practitioners. At the end-of-life care, both oral and subcutaneous drug delivery very often are not attainable. The increasing number of patients in terminal stage of chronic diseases forced us to look for the alternative ways of administration of pain treatment. In this context, the potentially rapid onset of action and ease of use make aerosolized drug delivery an attractive option in palliative care settings. The objective of this review was to identify literature on pain relief with inhaled opioids. The evidence suggests that nebulized opioids might be effective in the treatment of pain in various aetiologies; however, randomized controlled studies on nebulization therapy for cancer pain are lacking.

Intima-media thickness in patients with obstructive sleep apnea without comorbidities.

BACKGROUND: Obstructive sleep apnea (OSA) is associated with elevated risk of cardiovascular events. The early stages of vascular complications can be visualized by means of ultrasound. Intima-media thickness (IMT) correlates with the presence of risk factors of cardiovascular diseases such as hypertension, diabetes, tobacco smoking, or hyperlipidemia. However, little is known whether OSA itself may be the cause of IMT thickening. METHODS: The study group was composed of 28 patients (6 women, 22 men; mean age = 53.8 years, mean BMI = 27.1 kg/m(2), mean AHI = 22.4/h) with OSA who had no comorbidities. The control group consisted of 28 healthy subjects (6 women, 22 men; mean age = 53.9 years; mean BMI = 27.5 kg/m(2)). In both groups IMT was assessed in common carotid arteries with the use of ultrasonography. Additionally, in patients with OSA, pulse wave velocity, echocardiography, 24-h automated blood pressure monitoring, clinical signs and symptoms, and blood tests were performed to investigate possible correlations with IMT. RESULTS: Median IMT was 0.41 mm in OSA patients and 0.46 mm in the control group (p = 0.087). Echocardiography revealed left ventricle hypertrophy in 21%, systolic disorders in 8%, and diastolic disorders in 57% of the patients. In a large majority of patients, pulse wave velocity was found to be normal. IMT correlated with age (r = 0.446, p = 0.017), total cholesterol (r = 0.518, p = 0.005), daytime systolic blood pressure (r = 0.422, p = 0.025), pulse pressure 24 h and daytime (r = 0.424, p = 0.027 and r = 0.449, p = 0.019), early mitral flow/atrial mitral flow (E/A) (r = -0.429, p = 0.023), and posterior wall diameter (PWD) (r = 0.417, p = 0.270). CONCLUSION: In a relatively nonobese group of patients, no significant differences were found in the intima-media thickness between OSA patients without concomitant cardiovascular diseases and healthy controls. This may lead to the conclusion that IMT does not reflect increased risk of cardiovascular events in patients with isolated OSA.

[Invasive aspergillosis of the paranasal sinuses, lung and brain]. / Inwazyjna grzybica kropidlakowa zatok przynosowych, pluc i mózgowia.

A case of invasive aspergillosis (IA) of paranasal sinuses, lung and brain with a fulminant fatal outcome is reported. A 43-year-old man with a history of skin carcinoma of the nasal region and a course of systemic corticosteroids, presented with symptoms of lung infection. Aspergillus fumigatus was cultured from respiratory and nasal samples. Erosion of adjacent bones of the nasal cavity was acknowledged, but no sinus surgery was performed. A computed tomography of the thorax showed thick-walled cavities of different sizes with air and scarce fluid levels in both lungs. Treatment with voriconazole was administered. The patient deteriorated in the ensuing 2 weeks because central nervous system involvement was observed. No aggressive surgical resection was performed and the patient died 2 weeks later. IA was not confirmed by histopathology because no necropsy was performed.

[Assessment of hemoptysis etiology among patients hospitalized in Pneumonology Departament of Medical University of Gdansk in the years 1998-2002]. / Analiza przyczyn krwioplucia u chorych hospitalizowanych w Klinice Chorób Pluc i Gruzlicy Akademii Medycznej w Gdansku w latach 1998-2002.

A retrospective analysis of 3400 clinical records of patients hospitalized in Pneumonology Department of Medical University of Gdansk between 1998-2002 year was performed. 431 (12,7%) of them was admitted to hospital because of hemoptysis. The cause of hemoptysis was determined in 380 (82,2%) cases. The most common diagnosis was neoplasm--174 cases (40,4%), between them squamous cell carcinoma (47,7%). In 51 cases (11,8%) the etiology of hemoptysis was undetermined.

[Assessment of drug therapy in chronic pulmonary obstructive disease]. / Leczenie chorych na przewlekla obturacyjna chorobe pluc.

UNLABELLED: Several national and international groups of experts have published guidelines for chronic obstructive pulmonary disease (COPD) diagnosis and treatment. But little is known about standards of care in real clinical practices. AIM: Of this study was to compare diagnosis and drug therapy in local medical practices against classical Polish Phthisiopneumonological Society standards for COPD management. Data has been collected in Pneumonology Dpt. Medical University of Gdansk from COPD patients referred between September 2001 and May 2002. One hundred and five consecutive cases have been included into study group. In local medical practices spirometry for COPD diagnosis and staging was used in only 42% of cases. In stable COPD theophilline was used as a first line bronchodilatator. During exacerbation treatment was much closer to guidelines recommendation. Large majority of patients, 87% of study group, was on combined inhaled bronchodilatators. CONCLUSIONS: Spirometry usage in COPD care fell below standards recommendation. Stable COPD treatment was not satisfactory. National program of guidelines implementations should be created.