Morfina oral en el tratamiento de los pacientes con enfermedad terminal / Oral morphine in the treatment of patients with terminal diseases

Dentro del marco conceptual del cuidado terminal, se utilizó clorhidrato de morfina en solución por vía oral, en forma racional y pautada, desde mayo de 1986. Se hizo un estudio retrospectivo de los 40 pacientes a los que se trató de esta forma hasta julio de 1987; ellos representaron el 24% del total de pacientes terminales asistidos en el mismo lapso. La edad promedio fue de 70 años. Alrededor de 1/3 fueron ambulatorios. La dosis inicial diaria media de morfina fue de 60 mg y la dosis promedio diaria media, de 120 mg y el tiempo medio de tratamiento, 45 días. Cuando se consideró necesario, de acuerdo al síntoma, se asoció medicación coadyuvante. El síntoma más frecuente fue dolor por masa tumoral (67,5%), y en menor proporción (alrededor de un 20% cada uno) "dolor por compresión - invasión nerviosa", "dolor óseo", y en secundarios, especialmente náuseas, vómitos, estreñimiento, y somnolencia o torpor por más de 4 días. Los resultados se valoraron como "buenos" en un 85% de los casos, y "regulares" en el 15% restante. La única diferencia estadísticamente significativa entre ambos grupos, fue una concentración mayor de síntomas diversos en los pacientes con resultados "regulares"

Morfina oral en el tratamiento de los pacientes con enfermedad terminal / Oral morphine in the treatment of patients with terminal diseases

Dentro del marco conceptual del cuidado terminal, se utilizó clorhidrato de morfina en solución por vía oral, en forma racional y pautada, desde mayo de 1986. Se hizo un estudio retrospectivo de los 40 pacientes a los que se trató de esta forma hasta julio de 1987; ellos representaron el 24% del total de pacientes terminales asistidos en el mismo lapso. La edad promedio fue de 70 años. Alrededor de 1/3 fueron ambulatorios. La dosis inicial diaria media de morfina fue de 60 mg y la dosis promedio diaria media, de 120 mg y el tiempo medio de tratamiento, 45 días. Cuando se consideró necesario, de acuerdo al síntoma, se asoció medicación coadyuvante. El síntoma más frecuente fue dolor por masa tumoral (67,5%), y en menor proporción (alrededor de un 20% cada uno) "dolor por compresión - invasión nerviosa", "dolor óseo", y en secundarios, especialmente náuseas, vómitos, estreñimiento, y somnolencia o torpor por más de 4 días. Los resultados se valoraron como "buenos" en un 85% de los casos, y "regulares" en el 15% restante. La única diferencia estadísticamente significativa entre ambos grupos, fue una concentración mayor de síntomas diversos en los pacientes con resultados "regulares" (AU)

[Current status and perspectives of bioethics in Argentina]. / Estado actual y perspectivas de la bioética en la Argentina.

The study of bioethics in Argentina owes much to the efforts of José Alberto Mainetti, who in 1972 founded the Institute of Medical Humanities, devoted to researching, teaching, and publicizing the discipline. Because of growing interest in the field of bioethics, a Bioethics Center was created in the Institute in 1987 and it has stimulated the organization of several groups in various provinces in the country. One of the most important of them, located at the National University of Mar del Plata, is responsible for designing a graduate-level specialization in bioethics and for organizing the First Mar del Plata Bioethics Workshop. This interdisciplinary group examines the bioethical implications of concrete scientific and professional activities as well as legislative measures and decisions affecting the public.

[Oral morphine in the treatment of patients with terminal disease]. / Morfina oral en el tratamiento de los pacientes con enfermedad terminal.

From May 1986 until July 1987, oral morphine hydrochloride in water solution was used in terminal patients, under a strict protocol of administration, and complying with the basic principles of Palliative Care. A retrospective study was carried out on the 40 patients who had received the drug for more than three consecutive days. As shown in Table 1, the average age of the treated patients was 70 years. The ambulatory patients represented 27.5% of the sample. The average initial dose was 60 mg, and the average maintenance dose was 120 mg. The median treatment time was 45 days. "Good" results were achieved in 85% of the patients, and "fairly good" in the remainder ("good" results were defined as "satisfactory symptom control, good life quality"--in this group there were some patients who obtained total suppression of the symptoms and optimal life-quality, i.e. "excellent" results; "bad" results were defined as "total absence of therapeutic effect"; and "fairly good" results, the intermediate cases). The more frequently treated symptoms were: 67.5%, pain due to tumor mass; and 20%, pain due to nerve compression-invasion, bone pain, and dyspnoea due to pulmonary metastases or primary lung cancer: total symptoms was more than a hundred per cent, because a number of patients had more than one symptom. Whenever necessary, adjuvant drugs were employed. Side effects were seen in 37% of the patients (specially nausea, vomiting, constipation, and somnolence for more than four days).(ABSTRACT TRUNCATED AT 250 WORDS)

Present status and prospects of bioethics in Argentina.

Most developments supporting the study of bioethics in Argentina are of relatively recent vintage. This article is dedicated to describing those developments--including creation of Argentina's Institute of Medical Humanities, formation of a bioethics working group at the National University of Mar del Plata, initiation of a two-year graduate bioethics course at the same university, and the holding of an international symposium and workshop on bioethics at Mar del Plata in 1988. Particular attention is devoted to the graduate course, the detailed design of which is outlined in Annex 1.

Morfina oral en el tratamiento de los pacientes con enfermedad terminal. / [Oral morphine in the treatment of patients with terminal disease]

From May 1986 until July 1987, oral morphine hydrochloride in water solution was used in terminal patients, under a strict protocol of administration, and complying with the basic principles of Palliative Care. A retrospective study was carried out on the 40 patients who had received the drug for more than three consecutive days. As shown in Table 1, the average age of the treated patients was 70 years. The ambulatory patients represented 27.5

of the sample. The average initial dose was 60 mg, and the average maintenance dose was 120 mg. The median treatment time was 45 days. [quot ]Good[quot ] results were achieved in 85

of the patients, and [quot ]fairly good[quot ] in the remainder ([quot ]good[quot ] results were defined as [quot ]satisfactory symptom control, good life quality[quot ]--in this group there were some patients who obtained total suppression of the symptoms and optimal life-quality, i.e. [quot ]excellent[quot ] results; [quot ]bad[quot ] results were defined as [quot ]total absence of therapeutic effect[quot ]; and [quot ]fairly good[quot ] results, the intermediate cases). The more frequently treated symptoms were: 67.5

, pain due to tumor mass; and 20

, pain due to nerve compression-invasion, bone pain, and dyspnoea due to pulmonary metastases or primary lung cancer: total symptoms was more than a hundred per cent, because a number of patients had more than one symptom. Whenever necessary, adjuvant drugs were employed. Side effects were seen in 37

of the patients (specially nausea, vomiting, constipation, and somnolence for more than four days).(ABSTRACT TRUNCATED AT 250 WORDS)