ABSTRACT
From the start, World Health Organization has proposed that palliative medicine is applicable early in the course of illness. However, regrettably, palliative care has been usually provided to patients in the advanced cancer stage, as a terminal care. Recently, palliative medicine begins at the time-point when patients are diagnosed with cancer. In response to change in clinical settings of palliative medicine, cancer pain management has also changed. Considering long-term cancer treatment periods and increasing numbers of cancer survivors, cancer pain management should be recommended based on not only non-opioid pharmacotherapy but also the exercise/rehabilitation medicine and the cognitive-behavioral therapy. Especially, the exercise/rehabilitation medicine can provide beneficial effects on both pain management and cancer treatment itself: Sarcopenia is closely associated with poor prognosis of cancer and debilitating complications of chemotherapy. Further, non-sarcopenia patients can maintain their quality of life higher and show less fatigue during cancer treatment periods. To accomplish such favorable effects for cancer patients and cancer survivors, cancer pain should be managed adequately.
ABSTRACT
Diffuse peritonitis due to perforation of pyometra is relatively rare. We experienced three cases of this type of peritonitis between 1993 and 1999. Three women aged 77, 83 and 91 years had mild abdominal pain, slight fever and defecation for nearly one week. Following these, severe abdominal symptoms developd. These patients underwent emergency laparotomy as they were diagnosed with diffuse peritonitis. At first, intestinal perforation was suspected, but perforation of pyometra was confirmed when lapasortomy was done. On preoperative examinations, physical findings were scanty in comparison with hemological ones, and free air on abdominal X-ray films was not detected. Thus, we failed to establish the preoperative diagnosis. The prognosis was very poor in two of the three patients. One was with advanced cervical cancer and the other was in multiple organ failure on admission. Differential diagnosis of this disease is important for the management of acute abdominal diseases in elderly women.