The use of corticosteroids in the management of bilateral malignant ureteric obstruction.

Ureteric obstruction is not an uncommon complication of malignant disease or its treatment. We describe the effectiveness of a corticosteroid in a patient with bilateral ureteric obstruction from metastatic colon cancer causing acute renal failure. We presume that the effectiveness was because of its activity in reducing edema related to the tumor. Other modalities of treatment are discussed but each case requires individualization of treatment with due ethical consideration.

Cancer and the twentieth century environment.

Cancers have been known from very early times. However, in the twentieth century, cancers have come to occupy an increasingly prominent position as causes of morbidity and mortality, and look large in the minds (and hearts) of contemporary men and women, especially in Western cultures.

Concurrent validity of the modified Edmonton Symptom Assessment System with the Rotterdam Symptom Checklist and the Brief Pain Inventory.

As part of a longitudinal prospective study we sought a self-completed instrument of symptom assessment suitable for a population of cancer patients who were receiving palliative therapy. The modified Edmonton Symptom Assessment System (ESAS) is such an instrument, but it required validation for this population. This study represents a validation of the modified ESAS with the Rotterdam Symptom Checklist and the Brief Pain Inventory--two instruments widely used in patients receiving palliative therapy for cancer. We conclude that the modified ESAS is a valid, self-administered instrument to assess symptoms for patients from differing palliative care settings.

Respiratory symptoms in Tasmanian adolescents: a follow up of the 1961 birth cohort.

The 1961 birth cohort of Tasmanians (n = 8410) was initially surveyed in 1968 and was followed up in 1974 for the history and presence of respiratory symptoms and signs. The study was designed to describe and compare the natural histories of wheeze and productive cough. In 1981 a 10% stratified random sample of the original cohort was again followed up and this sample's responses were compared across the three surveys. Wheezing was found to be more persistent than productive cough. Wheezers were twice as likely as coughers to persist with their symptoms to the age of 20. These persistent wheezers represented 3.6% of the cohort available for follow-up in 1974 (n = 7132). Wheezing was also invariably associated with decreased spirometric performance, particularly FEV at 0.5 s and FEF 25-75. The new wheezers first detected in 1974 had had significantly decreased spirometry measurements in 1968 compared to those of their coughing or symptom-free peers. An early history of cough was associated with triple the incidence of wheeze in previously asymptomatic children. Hayfever and eczema were associated with persistence of wheeze. A child with either of these diagnoses was four times as likely to persist in wheezing to the age of twenty than a wheezer without atopic complaint. No significant associations could be demonstrated between wheezing and smoking.

Corticosteroids in the management of bowel obstruction on a gynecological oncology unit.

The development of gastrointestinal obstruction commonly occurs as a complication of advanced gynecological cancer. While surgery remains the mainstay of treatment for these patients, it is not always feasible, and when it is performed, it does not always resolve the obstruction. In this prospective study of patients presenting to a gynecologic oncology unit, 13 patients were administered 8 mg of dexamethasone subcutaneously or intravenously for a minimum of 3 days to manage the symptoms of bowel obstruction. Nine patients (69%) had a response to this therapy with decreased pain, nausea, and vomiting and improved oral intake. This response was maintained for a median of 31 days, with 7 of the 9 patients maintaining this symptomatic response until death. Mean survival of those responding was 39 days, including a subgroup of patients with extremely limited prognosis who, at their request, were discharged from the hospital in order to die at home. This subgroup had a mean survival of 20 days. The mean survival for nonresponders was 54 days. In patients for whom surgery is not contemplated, corticosteroids may provide a palliative treatment for bowel obstruction secondary to malignancy, provided there are no contraindications.

Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey.

Breakthrough pain (BKP) is a transitory flare of pain that occurs on a background of relatively well controlled baseline pain. Previous surveys have found that BKP is highly prevalent among patients with cancer pain and predicts more severe pain, pain-related distress and functional impairment, and relatively poor quality of life. An international group of investigators assembled by a task force of the International Association for the Study of Pain (IASP) evaluated the prevalence and characteristics of BKP as part of a prospective, cross-sectional survey of cancer pain. Fifty-eight clinicians in 24 countries evaluated a total of 1095 patients with cancer pain using patient-rated items from the Brief Pain Inventory (BPI) and observer-rated measures. The observer-rated information included demographic and tumor-related data, the occurrence of BKP, and responses on checklists of pain syndromes and pathophysiologies. The clinicians reported BKP in 64.8% of patients. Physicians from English-speaking countries were significantly more likely to report BKP than other physicians. BKP was associated with higher pain scores and functional interference on the BPI. Multivariate analysis showed an independent association of BKP with the presence of more than one pain, a vertebral pain syndrome, pain due to plexopathy, and English-speaking country. These data confirm the high prevalence of BKP, its association with more severe pain and functional impairment, and its relationship to specific cancer pain syndromes. Further studies are needed to characterize subtypes of BKP. The uneven distribution of BKP reporting across pain specialists from different countries suggests that more standardized methods for diagnosing BKP are needed.