ABSTRACT
Insomnia in advanced cancer patients has a highly negative impact on the patients, their families and caregivers. Insomnia is principally managed by pharmacological therapy； however, most advanced cancer patients are unable to receive oral medications. This prospective audit study investigated the efficacy of single—dose subcutaneous administration of flunitrazepam for treating insomnia in patients with advanced cancer. Sleep evaluation was conducted using the St. Mary’s Hospital Sleep Questionnaire. The primary endpoint was the quality of sleep； the secondary endpoints comprised other subscales of total sleep time, sleep latency and adverse effects. We enrolled 30 patients. The average dose of flunitrazepam dose was 0.9(0.1)mg. The good response rate for the quality of sleep was 90％. The total sleep time and sleep latency were 7.5(3.2)h and 31(9.1)min, respectively. Two patients were newly diagnosed with delirium during the study. The mean respiratory rate decreased(15/min before treatment to 14/min after treatment, P＝0.01) without any critical events. Single—dose subcutaneous administration of flunitrazepam may be potentially efficacious and simple in treating insomnia in advanced cancer patients.
ABSTRACT
<b>Purpose</b>: Since sustained cough causes great distress to cancer patients, it is important to palliate this symptom. Here, we report a case of intractable cough that could not be controlled by morphine but was successfully managed using continuous infusion of lidocaine for 1 year. <b>Case</b>: A female patient suffered from breast cancer in her fifties. Its lung metastasis invaded endobronchial space, causing frequent and sustained coughing. Further, coughing was often induced by her body motion, hampering the patient's quality of life. Morphine hydrochloride up to a dose of 480mg/day was ineffective in alleviating this symptom. Therefore, we started lidocaine administration via continuous infusion at a dose of 480mg/day. From the day administered, both frequency and duration of her coughing bouts were markedly reduced. Although its dose was increased to 960mg/day because of aggravated coughing in the course of her disease, the symptom was successively managed for 1 year with no side effects. <b>Conclusion</b>: Continuous and long-term infusion of lidocaine could be an alternative treatment for morphine-ineffective intractable cough. Palliat Care Res 2008;3(1):305-307
ABSTRACT
Two patients with spondylosis deformans and three patients with psychosomatic disease were treated by partial bathing with artificial spring of sodium sulfate. Fifteen minutes a day of bathing in artificial spring water prepared by dissolving 1000mg of sodium sulfate into 1 liter of 38°C-tap water was continued for one month.<br>Based on the findings on thermography, temperature changes were classified into four types. Correlation was found in three types as follows: p<0.01 in the crossing type, p<0.01 in the converging type, p<0.001 and p<0.05 in the ascending type. No correlation was found in the diffusing type. Plethysmography revealed a significant difference in the converging type and also a difference of p<0.01 in the diffusing type. MCV disclosed a slower change in temperature on the affected side than on the normal side. Blood gas analysis revealed a slight increase in PO<sub>2</sub>, SATO<sub>2</sub> after one month of bathing. Subjective symptoms were improved from point 9 to point 3 to 4 on the VAS scale. Numbness changed from the trembling stage to the slightly smarting sensation stage. Psychroesthesia disappeared from all patients.<br>A combination of nerve block therapy and warm bath cure with sodium sulfate brought good therapeutic results in patients with chronic pain including psychosomatic disease.