Use of Haloperidol and Lorazepam for Intractable Symptoms in the Hospice Palliative Care Unit

BACKGROUND: Terminally ill cancer patients suffer from refractory symptoms, and the last option of treatment is to consider sedatives. However, due to concerns that sedation may shorten survival time, some people prefer not to take sedatives. The purpose of this study was to investigate the effects of sedative administration on survival time among terminally ill cancer patients.METHODS: Two hundreds and thirty-seven patients who were hospitalized to the hospice care unit of public hospitals in Seoul from January, 2015 to March, 2016 were analyzed retrospectively. The univariate and multivariate Cox's proportional hazard regression model was used to determine independent factors related to survival time.RESULTS: The usage of sedation was necessary because the incidence of insomnia was 61.4% in the lorazepam only group, and the incidence of delirium was highest in the haloperidol group and the haloperidol with lorazepam group. Interestingly, multivariate analysis showed that male (HR, 1.766; P < 0.001), decreased consciousness (HR, 1.803; P=0.003), anorexia (HR, 1.506; P=0.012), resting dyspnea (HR, 1.757; P < 0.001), elevated serum bilirubin (HR, 1.657; P=0.001), and the haloperidol with lorazepam group (HR, 0.535, P < 0.001) were each significantly associated with survival time. Furthermore, patients in the haloperidol with lorazepam group survived longer than patients with no such medications.CONCLUSION: There is no evidence that treatment with sedative medication shortens the survival time of patients with terminally ill cancer with refractory symptoms.

Rehabilitation of Advanced Cancer Patients in Palliative Care Unit

OBJECTIVE: To evaluate the compliance and satisfaction of rehabilitation recommendations for advanced cancer patients hospitalized in the palliative care unit. METHODS: Advanced cancer patients admitted to a hospice palliative care unit were recruited. Patients with advanced cancer and a life expectancy of less than 6 months, as assumed by the oncologist were included. Patients who were expected to die within 3 days were excluded. ECOG and Karnofsky performance scales, function ambulatory category, level of ambulation, and survival days were evaluated under the perspective of comprehensive rehabilitation. Problem-based rehabilitations were provided categorized as physical therapy at the gym, bedside physical therapy, physical modalities, medications and pain intervention. Investigation of compliance for each category was completed. Patient satisfaction was surveyed using a questionnaire. RESULTS: Forty-five patients were recruited and received evaluations for rehabilitation perspective. The subjects were reported to have gait-related difficulties (71.1%), pain (68.9%), poor medical conditions (68.9%), bladder or bowel problems (44.4%), dysphagias (11.1%), mental status issues (11.1%), edemas (11.1%), spasticity (2.2%), and pressure sores (2.2%). In the t-test, patients with good compliance for GymPT showed higher survival days (p < 0.05). In the satisfaction survey, patients with performance scales showed a greater satisfaction in Spearman's correlation analysis (p < 0.05). CONCLUSION: Advanced cancer patients admitted to the hospice palliative care unit have many rehabilitation needs. Patients with a longer survival time showed better compliance for GymPT. Patients with a better performance scale showed a higher satisfaction. Comprehensive rehabilitation may be needed to advanced cancer patients in the hospice palliative care unit.

The Relationship between Wheezing during Methacholine Bronchial Challenge and the Severity of Acute Asthma Exacerbation in Asthmatic Children / 소아알레르기및호흡기학회지

PURPOSE:Global Initiatives for Asthma (GINA guideline) 2005 suggests that the pitch and intensity of wheezing as the determinating factor for the severity of asthma exacerbation. However, there have not yet been sufficient data to support the correlation between wheezing and the severity of asthma exacerbation. This study was aimed to estimate the relationship between wheezing threshold and the level of forced expiratory volume in 1 second (FEV1). METHODS:Among 370 pediatric patients who visited Inha University Hospital between May 2005 and June 2006, who underwent the methacholine bronchial challenge tests in order to diagnose asthma, 228 patients with PC20 less than 16 mg/mL were examined. Medical history, physical examination, skin prick test, eosinophil count and total IgE level in peripheral blood, and nasal smear for eosinophil count were performed. RESULTS:Among the 228 patients 127 (55.7%) showed wheezing during the methacholine challenge test. Among the patient with wheezing 82 patients (36%) showed more than 20% fall of FEV1, and the other, 45 patients (19.7%), showed less than 20% FEV1%fall. One hundred one patients (43.3 %) did not show any wheezing until the %fall of FEV1 was below 20%. The geometric mean (range of 1SD) [2.29 (0.86-6.13) mg/mL] of methacholine PC20 of the 127 patients with wheezing was significantly lower than that [4.11 (1.82-9.24) mg/mL] of the 101 patients without wheezing (P<0.001). The geometric mean (range of 1SD) of methacholine PC20 in the 143 patients with positive skin prick test results was 2.57 (0.97-6.81) mg/mL, which was significantly lower than that of the 37 patients with negative results [3.69 (1.57-8.66) mg/mL] (P<0.001). CONCLUSION:We could learn that most wheezing patients showed more than 20% fall of FEV1. Therefore, it is suggested that the asthmatic children with wheezing were regarded and treated as moderate or more severe state

A Case of Primary Hyperparathyroidism in Child Presented with Acute Abdominal Pain / 대한소아내분비학회지

Primary Hyperparathyroidism is the metabolism abnormality of calcium, phosphate, and bone due to the high synthesis of parathyroid hormone, a rare endocrine disease in children. It scarcely occurs in children so that till now it was reported only 4 cases in Korea, especially with abdominal symptoms. We report this case of primary hyperparathyroidism with brief review of literatures.