Quality of life and length of survival in advanced cancer patients on home parenteral nutrition.

BACKGROUND: The use of home parenteral nutrition (HPN) in patients with advanced cancer is controversial because survival is usually short and there are no data regarding the quality of life (QoL). METHODS: Sixty-nine advanced cancer patients enrolled in a program of HPN in six different Italian centers were prospectively studied as regards nutritional status (body weight, serum albumin, serum transferrin and total lymphocyte count), length of survival and QoL through the Rotterdam Symptom Checklist questionnaire. These variables were collected at the start of HPN and then at monthly intervals. All these patients were severely malnourished, almost aphagic and beyond any possibility of cure. RESULTS: Nutritional indices maintained stable until death. Median survival was 4 months (range 1-14) and about one-third of patients survived more than 7 months. QoL parameters remained stable till 2-3 months before death. CONCLUSIONS: HPN may benefit a limited percentage of patients who may survive longer than the time allowed by a condition of starvation and depletion. Provided that these patients survive longer than 3 months, there is some evidence that QoL remains stable for some months and acceptable for the patients.

High-dose intravenous desferrioxamine (DFO) delivery in four thalassemic patients allergic to subcutaneous DFO administration.

To test the hypothesis that allergy to desferrioxamine is not an immunologic mechanism, but arises from a local effect on the dermal mast cell, we have treated four patients who were not receiving chelation therapy because of hypersensitivity to standard subcutaneous (SC) therapy, with high-dose desferrioxamine (DFO) by the intravenous (IV) route. Three patients had central venous access ports implanted on the anterior chest wall. The fourth patient had the therapy delivered by the peripheral vein route. All patients had the drug delivered via an elastomeric infusor. Intravenous therapy was successful for all patients. During one year of therapy no local or systemic allergic manifestations were noted. In addition, no impairment of hearing or vision or any catheter complications were reported. A very high level of patient compliance to the therapy resulted in dramatically decreased iron stores and ferritin levels (2,759 ng/ml to 717.5 ng/ml) and a significant improvement in the clinical status of all patients. The absence of allergic episodes in this patient group after 1 year of i.v. therapy would strongly support the hypothesis that SC DFO allergy is related to a direct effect on dermal mast cells and is not an immunological reaction. This study suggests that patients with severe allergy to SC DFO can therefore safely receive their chelation therapy via the i.v. route.

[Alizapride versus placebo in premedication for esophagogastroduodenoscopy. Double-blind clinical study. Experimental research in vitro]. / Alizapride vs. placebo nella premedicazione all'esofagogastroduodenoscopia. Studio clinico in doppio cieco. Ricerche sperimentali in vitro.

The pronounced antiemetic properties of Alizapride, one of the new azimidobenzamides suggested the assessment of its efficacy on 40 patients due for oesophagogastroduodenoscopy. The drug proved highly satisfactory as premedication for the examination, significantly inhibiting vomiting and stomach wall tone during the examination as was indicated by in vitro studies.

[Holter's ECG monitoring in esophagogastroduodenoscopy. Premedication with tiropramide. Preliminary notes]. / Monitoraggio ECGD sec. Holter in esofagogastroduodenoscopia. Premedicazione con tiropramide. Note preliminari.

Endoscopy of the upper digestive tract with flexible instruments is presently a safe, widely used technique in gastrointestinal pathology. Some cases of changes in cardiac rhythm, ventricular fibrillation, ischaemia and cardiac arrest, have, however, been observed during EGDS. The incidence of arrhythmias during EGDS in 41 patients, monitored during the examination with Holter's ECG, has been observed. The results obtained confirm that EGDS does not bring noteworthy cardiovascular changes sufficient to suspend the examination. The absence of parasympathicomimetic effects makes it possible to consider thyropramide one of the drugs of choice in medication before EGDS.