Current management of breakthrough cancer pain according to physicians from pain units in Spain.

PURPOSE: Current evidence suggests the need to improve the management of breakthrough cancer pain (BTcP). For this reason, we aimed to assess the opinion of a panel of experts composed exclusively of physicians from pain units, who play a major role in BTcP diagnosis and treatment, regarding the key aspects of BTcP management. METHODS: An ad hoc questionnaire was developed to collect real-world data on the management of BTcP. The questionnaire had 5 parts: (a) organizational aspects of pain units (n = 12), (b) definition and diagnosis (n = 3), (c) screening (n = 3), (d) treatment (n = 8), and (e) follow-up (n = 7). RESULTS: A total of 89 pain-unit physicians from 13 different Spanish regions were polled. Most of them agreed on the traditional definition of BTcP (78.9%) and the key features of BTcP (92.1%). However, only 30.3% of participants used the Davies' algorithm for BTcP diagnosis. Respondents preferred to prescribe rapid-onset opioids [mean 77.0% (SD 26.7%)], and most recommended transmucosal fentanyl formulations as the first option for BTcP. There was also considerable agreement (77.5%) on the need for early follow-up (48-72 h) after treatment initiation. Finally, 65.2% of participants believed that more than 10% of their patients underused rapid-onset opioids. CONCLUSIONS: There was broad agreement among pain experts on many important areas of BTcP management, except for the diagnostic method. Pain-unit physicians suggest that rapid-onset opioids may be underused by BTcP patients in Spain, an important issue that need to be evaluated in future studies.

[Management of acute respiratory infection in the outpatient department of the Hospital Robert Reid Cabral]. / Manejo de infeccion respiratoria aguda (IRA) en la consulta externa del Hospital Robert Reid Cabral.

PIP: A prospective study was conducted of 100 children under five who were treated at the outpatient and emergency services of the Robert Reid Cabral Hospital in Santo Domingo between August 1989 and May 1990 for acute respiratory infection (ARI). The objective was to evaluate the frequency of use of antibiotics in management of ARI. 51 of the children were under one year old. Among the infants under one year, 32 had mild, 15 had moderate, and 4 had severe cases. An antibiotic was prescribed in 35 of 59 cases of mild infection, 34 of 36 cases of moderate infection, and in all 5 cases of severe infection. The most frequently used antibiotic was penicillin, used in 28%, followed by amoxycillin in 17%, ampicillin in 14%, and erythromycin in 8%.^ieng

[Intestinal atresia]. / Atresia intestinal.

The authors reviewed their experience with 20 cases of intestinal atresia (jejunum, ileum and colon) admitted between January 1972 and January 1977. International literature shows 80% mortality rate for this malformation before 1940 and 10-25% in current reports. In Mexico, before 1959, the mortality rate was 80%, but the most recent reports showed 28% mortality rate for atresia and 33% in cases of stenosis. The group of patient studied included twelve cases with a weight over 2,500 g. and eight patients under 2,500 g. Four patients showed multiple associated malformations (incompatible with life in one case) and in 17, there were no associated malformations. Nineteen cases were operated, the dilated and atresic segments were resected and anastomosis was performed. It was termino-terminal in 13 cases and termino-lateral in 6. One case was explored surgically and no attempt to repair the atresias was made, because there were malformations incompatible with life. Four patients died. Even if this series is very small, the associated malformations, low weight and techniques used do not seem to influence the prognosis of these patients.

[Duodenal obstruction in the newborn infant]. / Obstrucción duodenal del recién nacido.

The autors present their experience with nine cases of duodenal obstruction in newborns, admitted to this hospital between Janurary, 1972 and January, 1977. Six babies had duodenal atresia and three had stenosis. Two groups were formed based on the patient's weight: Group one (good prognosis) patients with weight above 2.500 g. Group two (poor prognosis) patient's weight under 2.500 g. All the patients of the first group survived and all the patients of the second died. The overall mortality was 4/9. All the patients from the second group (poor prognosis) also showed associated congenital malformations (esophageal atresia, multiple atresias, urological and cardiac disease). Even if the number of cases is not statistically significant, it seems that the weight of the baby and the associated malformations bear on the final outcome of these patients.