ABSTRACT
Cáncer pain is a frecuent symptom in patients with primary or metastastic neoplasm and is a clinical challenge due to the difficulty in achieving adequate control despite múltiple strategies, generating suffering and great impact on the quality of life. When there is a tumoral iinvasion to the thoracic wall, it generates Progressive respiratory symptoms and severe pain that require multidisciplinary management, multimodal analgesic pharmacological management with different strategies, such as no opioids, strong opioids and opiooids rotation through different routes of administration, adjuvant analgesics, and added to these, the use of interventional options to achieve a good response. In most cases the patients have an advanced disease and a objective of palliative management then, the control of the symptoms and the quality of life are the priority. We report 2 cases of chest wall pain due to cancer refractory to pharmacological management that were managed with the use of phenol neurolysis of the spinal erector plane, achieving an adequate response.
El dolor por cáncer es una manifestación frecuente en los pacientes con tumores primarios o metastásicos y un reto para los clínicos por la dificultad para lograr un control adecuado a pesar de múltiples estrategias, lo que genera gran impacto en la calidad de vida y sufrimiento. Cuando se presenta invasión tumoral de la pared torácica se generan síntomas respiratorios progresivos y dolor severo que requiere un manejo multidisciplinario, manejo farmacológico analgésico multimodal con diferentes estrategias como uso de no opioides, opioides potentes y rotación de opioides a través de diferentes vías de administración, analgésicos adyuvantes, y sumado a estos, el uso de opciones interventivas para alcanzar una adecuada respuesta. En muchos casos los paciente se presentan con enfermedades en estadios avanzados y en plan de manejo paliativo; así, el control de síntomas y la calidad de vida son los objetivos mas importantes. Reportamos 2 casos de dolor de pared torácica por cáncer refractario a manejo farmacológico que fueron manejados con el uso de neurolisis con fenol del plano erector espinal alcanzando adecuada respuesta.
Subject(s)
Humans , Male , Female , Middle Aged , Phenol/administration & dosage , Paraspinal Muscles , Cancer Pain/drug therapy , Palliative Care , Thoracic Wall , Pain Management/methods , Analgesia/methods , Analgesics/administration & dosage , Injections , Nerve Block/methodsABSTRACT
Abstract Decision making is a challenge faced by physicians in clinical practice. It requires a profound analysis of all the different factors which may influence the choice of treatment or diagnostic interventions. Factors related to the patients and their environment, the availability of resources, the clinician, and the proper handling of care information. The decision-making process becomes more complex in patients with advanced diseases or in the final stage of life, and requires a comprehensive approach by a professional trained in the communication process and in an empathic doctor-patient relationship which allows the participation of the patients and their families, as well as an acknowledgement of their wishes. It is imperative to engage in discussions regarding the prognosis, terminality and therapeutic goals, which are determining factors in this process and are discussed in this review. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2254).
Resumen La toma de decisiones es un reto que enfrenta el médico en la práctica clínica. Requiere un análisis profundo de todos los diferentes factores que pueden influir en la elección de tratamientos o intervenciones diagnósticas. Factores relacionados con el paciente y su entorno, con la disponibi lidad de recursos, con el clínico y con el manejo correcto de la información sobre los cuidados. El proceso de toma de decisiones se vuelve más complejo en pacientes con enfermedades avanzadas o en la fase final de la vida y requiere estrictamente el abordaje integral por un profesional capa citado en el proceso de comunicación y en una relación médico-paciente empática que permita la participación del paciente y su familia, así como el reconocimiento de sus deseos. Es imperativa la introducción de discusiones acerca de pronóstico, terminalidad y objetivos terapéuticos, que son factores determinantes para este proceso y son discutidos en esta revisión. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2254).
ABSTRACT
Despite medical advances, the diagnosis and management of acute intermittent porphyria continues to be challenging. Acute pain is one of the most important clinical manifestations in acute intermittent porphyria, but management and pain assessment have been poorly studied in these patients. The lack of information and evidence based recommendations regarding these topics in the medical literature is certainly surprising. Furthermore, pain management is discussed based on extrapolating concepts adopted for other pain syndromes. An important arsenal of medications, including reportedly safe opioid and non-opioid analgesics, is available for use in this type of patient. In addition to conducting an extensive review of the current literature, the present article aims to show the general aspects of a disease that generates a challenge for the clinician, emphasizing what is related to pain as a cardinal symptom and to create awareness about the need for studies supporting the development of guidelines, based on evidence obtained from analgesic management in patients presenting with this disorder. A systematic assessment directed at understanding the physiopathological processes underlying acute pain combined with a stepwise approach to pain management with safe opioid and non-opioid drugs constitutes the fundamental basis for a successful pain management program in patients with acute intermittent porphyria.
Subject(s)
Acute Pain , Porphyria, Acute Intermittent , Acute Pain/drug therapy , Acute Pain/etiology , Analgesics/therapeutic use , Humans , Porphyria, Acute Intermittent/complications , Porphyria, Acute Intermittent/diagnosis , Porphyria, Acute Intermittent/therapyABSTRACT
Presentamos un caso de osteomielitis aguda en un paciente con fractura cerrada de cúbito y radio por accidente de tránsito, a quien se le aisló Cedecea lapagei en cultivo de tejido óseo obtenido en cirugía cuando fue llevado para lavado y curetaje. La evolución clínica del paciente y el tratamiento son presentados y discutidos en este reporte. Se realiza una revisión acerca de esta bacteria y los principales tipos de infección que causa y los factores relacionados con su presentación. (Acta MedColomb 2015; 40: 246-248).
A case of acute osteomyelitis in a patient with closed fracture of the ulna and radio by a traffic accident is presented. Cedecea lapagei was isolated in bone tissue culture obtained in surgery when he was brought to washing and curettage. The clinical evolution and treatment are presented and discussed in this report. A review on this bacterium and the main types of infection that it causes as well as factors related to its presentation, are made. (Acta Med Colomb 2015; 40: 246-248).
Subject(s)
Humans , Male , Middle Aged , Bacteremia , Osteomyelitis , Therapeutics , Fractures, Closed , InfectionsABSTRACT
La obstrucción intestinal maligna es una patología compleja que, a pesar de la baja prevalencia, produce un alto grado de incomodidad, debido a síntomas secundarios producidos por alteraciones mecánicas y funcionales en los diferentes mecanismos fisiopatológicos; entre estos mecanismos se encuentran la oclusión del lumen intestinal, las alteraciones en la motilidad y la acumulación de secreciones. En el tratamiento de la obstrucción intestinal maligna se debe individualizar cada paciente para definir la mejor estrategia, ya sea una intervención quirúrgica -gastrostomía o yeyunostomía descompresiva, realización de ostomías y endoprótesis vasculares (stents] o un tratamiento médico -opioides, anticolinérgicos, antieméticos y esteroides-. En general, se recomienda una estrategia que de manera sinérgica combine diferentes opciones para logar un control adecuado de los síntomas.
Malignant intestinal obstruction is a complex disease that, despite the low prevalence, causes a high level of discomfort, due to the secondary symptoms produced by various mechanical and functional alterations in the different pathophysiological mechanisms. These symptoms include occlusion of the intestinal lumen, changes in motility, and accumulation of secretions. The treatment of the malignant intestinal obstruction must be individualized to each patient in order to establish the best strategy, either surgical intervention - decompressive gastrostomy or jejunostomy, performing of ostomies and vascular stents - or a medical treatment - opioids, anticholinergics, antiemetics, and steroids. A strategy that synergically combines the different options is generally recommended, in order to achieve suitable control of the symptoms.