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Biomedical subjects

S Mercadante

Publications and source records attributed to S Mercadante.

At least 109 records · Page 6Linked to original sources
PubMed1995

Bowel obstruction in home-care cancer patients: 4 years experience.

Conservative management of bowel obstruction in advanced cancer patients has been recognized as efficacious in controlling distressing symptoms such as nausea, vomiting and pain. A retrospective analysis of prevalence, treatment and outcome was performed. A group of 25 patients with signs of bowel obstruction were studied from 1001 consecutive patients receiving palliative care at home. A score for total distress was calculated to assess the gastrointestinal symptoms at diagnosis, after 1 week of treatment and 1 day before death. The mean survival was 19 days. Six patients were admitted to hospital, 3 of whom underwent surgery and died in the immediate postoperative period. The patients diagnosed in hospital and discharged received a nasogastric tube (7 cases) and a central venous line. The nasogastric tube was removed after gastrointestinal secretions had been controlled by a combination of drugs, and parenteral nutrition or hydration, mainly started in hospital, was discontinued only a few days before death (13 cases, mean duration 19 days). The distress symptom score was statistically reduced after 1 week of treatment and on the day before death when compared to the referral time. The most frequent combination of drugs was octreotide, haloperidol and low doses of morphine. A subcutaneous route was preferred for administering the drugs. Utilization of a wide range of drugs permits good symptom control for bowel obstruction in patients followed at home.

Abdominal Neoplasms↗
PubMed1995

Diarrhea in terminally ill patients: pathophysiology and treatment.

Diarrhea is a distressing symptom that limits the quality of life in terminally ill patients. In these patients, many factors can affect intestinal secretion, absorption, and motility, including drugs, infective agents, antibiotics, chemotherapy, radiotherapy, surgery, malnutrition, neuroendocrine tumors, and mechanical bowel obstruction. Diarrhea can result in water and electrolyte losses. This review discusses the pathophysiology, assessment, and treatment of diarrhea in advanced cancer patients.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Parenteral nutrition at home in advanced cancer patients.

There is controversy regarding the utility of parenteral nutrition in advanced cancer patients. In selected populations, such as those with digestive tract cancers, death may result from the absence of oral intake and not progression of disease. In some cases, patients and relatives request that artificial nutrition begun in the hospital continue after discharge. Clinical experience with the management of home parenteral nutrition in 13 cancer patients is described to highlight the ethical and technical problems that emerge during the treatment of such patients.

Adult↗
PubMed1995

Long-term ketamine subcutaneous continuous infusion in neuropathic cancer pain.

Neuropathic cancer pain may be less responsive to opioids than other pain. Several studies suggest that N-methyl-D-aspartate (NMDA)-receptor antagonists could play a role in the treatment of neuropathic pain. Ketamine is an NMDA-receptor antagonist that is used as an anesthetic and has been suggested as a useful drug for neuropathic pain. Subanesthetic doses of ketamine can yield analgesia without hypnosis. We describe a patient who developed neuropathic cancer pain unresponsive to opioid escalation and spinal administration of a combination of bupivacaine-morphine and was subsequently treated by subcutaneous continuous ketamine infusion. A starting dose of 150 mg/day provided good pain relief and a dramatic reduction of the oral morphine dose (from 5 g to 200 mg). A slow and progressive increase of ketamine and morphine dosage (400 mg and 200 mg by the subcutaneous route, respectively) continued to provide adequate pain relief after 13 months of therapy despite signs of progressive disease.

Aged↗
PubMed1995

Propofol in terminal care.

In advanced cancer patients close to death, delirium, multifocal myoclonus, and restlessness may occur. Multi-organ failure and related metabolic changes are mostly responsible for these symptoms. A pharmacologic approach to manage the delirium is necessary in the majority of cases. Benzodiazepines, neuroleptics, and barbiturates are the most common drugs used. In the case reported, propofol administered at very low doses provided good control of neuropsychiatric symptoms. After a loading dose of 20 mg, an infusion of 50-70 mg per hr was started. The patient died peacefully after 8 hr of propofol infusion, without requiring opioids. Propofol seems to be a promising drug in treating the terminal agitated state that can be associated with the dying process.

Delirium↗
PubMed1995

Tolerability of continuous subcutaneous octreotide used in combination with other drugs.

Continuous subcutaneous infusion of octreotide combined with other drugs has proved to be useful in some circumstances in palliative care setting when theoral route is no longer available. Forty-four patients were administered octreotide alone or in combination with other drugs in the same syringe driver for symptom control in advanced cancer patients. Good tolerability and compatibility were observed without visual drug precipitation for a period of 48 hours at room temperature, the standard clinical situation in patients' homes. Such a combination of drugs administered by the subcutaneous route makes possible the adequate control of symptoms in the final days of life.

Adult↗
PubMed1994

Intrathecal morphine and bupivacaine in advanced cancer pain patients implanted at home.

Fifteen patients with pain due to advanced cancer who no longer obtained relief from conventional treatment using oral or parenteral opioids were administered morphine and bupivacaine by continuous intrathecal infusion. Thirteen patients were implanted at home due to poor medical condition or refusal to be hospitalized. A summary score was derived to monitor the effects of the treatment. Thirteen patients required low doses of intrathecal morphine and bupivacaine and all reported good pain relief until death. Only minor side effects were evidenced. Implantation at home of an intrathecal catheter to administer morphine and bupivacaine provided a degree of pain relief during the last days of life that would have otherwise been impossible and did so without producing important complications.

Aged↗
PubMed1994

Informatics in palliative care.

A computerized documentation system for palliative care would allow immediate availability of patient data and rapid evaluation of treatment. To develop such a system, many problems must be resolved, including choice of data and type of display. A preliminary screening of information and the introduction of codes to show some parameters are necessary to achieve a good result. We describe a program that allows data entry, storage of data, rapid display and printout of data, and recording of history, previous therapy, pathologic, physical, and laboratory findings, diagnosis, mechanisms and site of pain, drugs, and symptoms. Further improvements and problems are discussed.

Female↗
PubMed1994

The role of octreotide in palliative care.

Octreotide, an analogue of somatostatin with a more favorable pharmacokinetic profile, is a new drug that may offer some advantages in the palliative care setting. It has been used with favorable results in the management of some gastrointestinal disorders, such as gastrointestinal hemorrhage, diarrhea, short-bowel syndrome, fistula, and intestinal occlusion in the palliative care setting. These favorable results occurred without important side effects, underlining the potential role of this drug. The cost-benefit ratio of this expensive drug must be considered, however.

Gastrointestinal Diseases↗
PubMed1994

Effect of clonidine on postpartum shivering after epidural analgesia: a randomized, controlled, double-blind study.

In obstetric patients treated with epidural analgesia during labor and delivery, shivering is quite frequent due to stress, vasodilatation, infusion of fluids, low ambient temperature, and the direct effect of solution injected into the epidural space. Sixty obstetric patients who developed shivering after receiving epidural analgesia for delivery were randomly assigned to treatment with clonidine 0.150 mg i.v. (N = 20), meperidine 50 mg i.v. (N = 20), or saline solution (N = 20). Drug administration was double blind. The effect on shivering (graded as all or none), drowsiness, heart rate, and systolic arterial pressure was evaluated 5 min after the study drug was administered. Clonidine was as effective as meperidine in controlling shivering and caused a greater reduction in heart rate. Drowsiness occurred after clonidine as well as meperidine. Thus, clonidine proved to be effective in controlling shivering and adrenergic response after delivery using epidural analgesia and produced an acceptable level of drowsiness.

Adult↗
PubMed1994

Dobutamine as palliative drug in home-care advanced cancer patients.

We describe a patient with advanced cancer whose severe symptoms of congestive heart failure were successfully treated with dobutamine. The intermittent intravenous administration of dobutamine 5 micrograms/kg/min for 3 hr per day at home enabled control of dyspnea, leg edema, and pain, and increased urine output after 1 day. An improvement in renal function was observed in the following days. The mechanism and the utility of a palliative approach with dobutamine are discussed.

Dobutamine↗
PubMed1993

Octreotide in relieving gastrointestinal symptoms due to bowel obstruction.

Gastrointestinal obstruction is a common problem in advanced malignant disease, but its management remains controversial. In those patients for whom surgery is not appropriate, medical intervention is the only remaining option. We present a series of 14 patients with intestinal obstruction who were managed with subcutaneous injections of octreotide, a somatostatin analogue which reduces the volume of gastrointestinal secretions. Good control of vomiting was achieved in 12 patients, and no major side effects were observed. Octreotide would appear to be a useful drug in this clinical situation.

Aged↗