Pain infirmity and psychotropic drugs in oncology.

The treatment of cancer pain by psychotropic drugs is a method which has been employed for a long time [8] and in which the results obtained have appeared very interesting from the beginning: there is a high percentage of success, rapid action, absence of addiction, and although there are sometimes unpleasant side-effects, they are reversible when the treatment is stopped. Even after several years of application, this therapy still sets some unsolved problems. Some consider that psychotropics are not real analgesics, but that they work on the emotional reaction rather than on the pain itself [3]. Still others consider that the results are obtained only at the price of a state of prostration of the patient similar to that obtained after lobectomy. Finally, this procedure is reproached as having unpredictable results and indications difficult to define. We think that what has, up to now, prevented these types of problems from being solved has been the absence of a really objective evaluation of the pain in the patients observed. We have wrestled with this problem for several years [1,2], and offer the following hypothesis: what is important in considering chronic pain is, above all, the infirmity conferred upon the patient. If "pain" in the broad sense of the term lends itself to objective evaluation with difficulty, it is not the same with respect to infirmity. A method of evaluation of the physical disability intended for routine practice in a cancer center has been used on a series of 100 patients. The results obtained in this series have been analyzed and give the answer to questions such as mechanism of action, indications of psychotropic drugs and prognosis of cancer pain.

Systemic thromboembolic accidents in the early post-operative period in patients with prosthetic valves.

Since 1975, of 2328 patients with prosthetic valves, 61 presented one or many systemic thromboembolic accidents (TEA) between the 12th and the 60th day of the post-operative period: 54 cases involved the brain and 14 involved other areas. Although the embolic accident was clinically detectable, EEG and scanner helped in detecting multiple emboli. Clinical history enables us to select high-risk cases: arrhythmias (47 cases), previous TEA (20), prosthetic dysfunction (4). However, several patients have no specific history. Mitral valves present the highest risk. The preventive value of anticoagulant therapy is unquestionable but it does not always prevent TEA, even the recurring type. One can meet all degrees, from the self-resolutive minor TEA up to massive cerebral emboli with severe sequelae. Warning signs include fever, high fibrinogen and HBDH levels. When TEA occurs in the hospital, early detection favours fibrinolytic treatment if there are no contra-indications. Whenever surgery was imminent, we used urokinase (29 cases). Despite better surgical techniques, efficient prostheses and anticoagulant treatment, TEA remain all too frequent as we do not have ideal methods for biological detection and effective prevention.