Intravenous hydration for terminal patients: what are the attitudes of Israeli terminal patients, their families, and their health professionals?

Dehydration in terminally ill patients is a common condition and its treatment in an active oncology unit often involves intravenous (IV) hydration programs. The decision to use IV hydration is only partly determined by an objective assessment of the clinical data. The other component is the attitudes of those involved in the decision-making process. This pilot study surveyed the attitudes of patients, family members/friends, nurses and doctors toward IV hydration in this patient population. Although the majority of the conscious patients (95%), family members/friends (81%), and nurses (64%) were not involved in the decision-making process, the expressed attitudes were generally positive. The three most commonly stated reasons for IV therapy were "medication," "giving fluids" and "giving morphine." Interestingly, among the reasons expressed, the amelioration of thirst was never explicitly cited.

The sensation of thirst in dying patients receiving i.v. hydration.

Cancer patients in the terminal phase of their disease often experience fluid deficits. This is mainly due to their inability to ingest adequate amounts of oral fluids to meet the body's physiological demands. In order to correct this deficit, intravenous (i.v.) fluid programs are often instituted. This pilot study was conducted on a group of terminal patients hospitalized in an oncology unit who died while receiving i.v. fluids. It sought to assess the effects of these fluids on their level of thirst. Data were collected on 30 patients in the last 24 hours of life. However, of the 30 patients only 19 were sufficiently alert to be able to verbally evaluate their thirst intensity. Of the 19 patients, six experienced mild thirst, eight moderate thirst, and four severe thirst. This was in spite of IAV hydration regimens which ranged from 500 mL to 3000 mL. Little relationships was found between level of thirst and the amount of i.v. fluids received, blood urea nitrogen (BUN), or sodium blood levels. In addition, although 70% of the patients had fluid retention signs, there was little correlation between these signs and the amount of fluids received. Since the pilot study's sample was small, definitive conclusions could not be drawn. However, our results highlight the need for future research in this area.

[Platysma myocutaneous flap for oral cavity reconstruction].

The use of myocutaneous flaps has revolutionized reconstructive surgery following tumor resections in the head and neck area. The platysma myocutaneous flap described almost a century ago has not received much attention, although it has been reported to be a satisfactory technique. Its successful use in 2 patients with squamous cell carcinoma of the tongue, a man of 61 and a woman of 77, is presented.

An improved stent for use in the surgical management of congenital posterior choanal atresia.

The advantage of Foley catheter stenting for choanal atresia are that: 1. It is well tolerated by the patient. 2. It is simple to introduce, fix and remove. 3. It minimizes septal or columellar necrosis. 4. It minimizes nasal cavity and paranasal sinus infection. 5. It is adjustable in that pressure on the choanal walls can be controlled by inflation or deflation of the balloon as necessary. 6. It is easy to fix in cases of unilateral atresia. To date the use of this method has been uniformly satisfactory, without complications.

Vallecular papilloma simulating chronic pulmonary disease.

Presented here is a case of chronic persistent cough, in a patient in whom squamous papilloma of the base of tongue was found. The cough disappeared completely after removal of the tumour.

Untreated persistent middle ear effusion.

Seventy-nine children have been followed with persistent middle ear effusion (MEE). They were scheduled for myringotomy and insertion of ventilating tubes (VT). Several factors delayed elective surgery for two-and-a-half years in a closed population. After that period, the children were again examined otomicroscopically and hearing tests were performed. MEE persisted in 69 per cent of the ears, but was absent in 31 per cent. Atelectasis appeared in 26 per cent of the ears; in only a very few cases did severe atelectasis develop. Complications following delay of myringotomy and introduction of VT are minor.

Hemangioendothelioma of the lymph node: a case report.

Primary benign vascular tumors of lymph nodes are very rare. Various forms of lymph nodal vascular transformations defined as hemangiomatoid lesions, pannodal vasodilatation, or nodal angiomatosis have been described. We present a patient who was thought to have an epithelial salivary gland tumor, but instead was found to have an hemangioendothelioma of an adjacent enlarged lymph node in the region of the left submandibular gland.

Epidermal cysts of temporal fossa: an unusual complication of ear surgery.

Otologic procedures have been described as etiologic factors in the development of epidermal cysts in the middle ear as well as in the tympanic membrane. We recently treated two cases of large epidermal cysts of the temporal fossa with extension to the infratemporal space; both cases had histories of ear surgery on the same side as the cysts and therefore the cysts are presumed to have originated from implanted epidermal elements at the time of surgery.