RESUMO
Cardiac metastasis from cervical cancer is rare. We herein present a case involving a 54-year-old woman with cervical cancer who was undergoing radiotherapy for left supraclavicular lymph node metastasis. The patient was admitted to the hospital because of shortness of breath. Transthoracic echocardiography showed a large mass in the right ventricle. To rescue the patient from circulatory collapse, we surgically resected the intracardiac mass via a right ventricular incision parallel to the posterior descending artery and left anterior descending artery. This approach prevented right ventricular outflow tract obstruction and perioperative pulmonary embolization, which could have led to death. The intracardiac mass was diagnosed as squamous cell carcinoma. After hospital discharge, the patient underwent chemotherapy. An echocardiography performed 3 months postoperatively showed recurrence of the cardiac metastasis, and the patient died 5 months later. Cardiac metastasis in the right ventricle can present as pulmonary embolization. Although rare, most cases of metastasis from cervical carcinoma to the heart have an extremely poor prognosis.
RESUMO
<b>Purpose</b>: This retrospective study aims to evaluate the effectiveness and safety of morphine for the management of dyspnea in terminal cancer patients. <b>Methods</b>: 64 terminal cancer patients, who had morphine administered for dyspnea management, were investigated. Dyspnea was assessed daily on the numerical rating scale (NRS; 0-5) before and 48 hours after the administration, and at the point of dose modifications. <b>Result</b>: The medication period was 34.7 days and the daily dose of morphine was 93.0 mg. The mean NRS decreased from 3.5 to 1.6 (<i>p</i><0.001). 46 patients (72%) were started with an oral administration of normal-release morphine when-required. The major side effects of morphine, such as hypoxemia or decrease in respiratory rate, were not observed. <b>Conclusion</b>: Morphine is effective and safe for the management of dyspnea even in terminal cancer patients with careful titration.