An implantable drug delivery system (IDDS) for refractory cancer pain provides sustained pain control, less drug-related toxicity, and possibly better survival compared with comprehensive medical management (CMM).

BACKGROUND: The randomized clinical trial of implantable drug delivery systems (IDDS) plus comprehensive medical management (CMM) versus CMM alone showed better clinical success at 4 weeks for IDDS patients. This 'as treated' analysis assessed if improvements in pain control, drug toxicity and survival were maintained over time. PATIENTS AND METHODS: We compared those who received IDDS with those who did not receive IDDS (non-IDDS). All patients had Visual Analogue Scores (VAS) for pain > or =5/10 on at least 200 mg morphine or equivalent daily. RESULTS: At 4 weeks, 46 of 52 (88.5%) IDDS patients achieved clinical success compared with 65 of 91 (71.4%; P=0.02) non-IDDS patients, and more often achieved > or =20% reduction in both pain VAS and toxicity [35 of 52 (67.3%) versus 33 of 91 patients (36.3%); P=0.0003]. By 12 weeks, 47 of 57 (82.5%) IDDS patients had clinical success compared with 35 of 45 (77.8%; P=0.55) non-IDDS patients, and more often had a > or =20% reduction in both pain VAS and toxicity [33 of 57 (57.9%) versus 15 of 45 patients (33.3%); P=0.01]. At 12 weeks the IDDS VAS pain scores decreased from 7.81 to 3.89 (47% reduction) compared with 7.21 to 4.53 for non-IDDS patients (42% reduction; P=0.23). The 12 week drug toxicity scores for IDDS patients decreased from 6.68 to 2.30 (66% reduction), and for non-IDDS patients from 6.73 to 4.13 (37% reduction; P=0.01). All individual drug toxicities improved with IDDS at both 4 and 12 weeks. At 6 months, only 32% of the group randomized to CMM and who did not cross over to IDDS were alive, compared with 52%-59% for patients in those groups who received IDDS. CONCLUSIONS: IDDS improved clinical success, reduced pain scores, relieved most toxicity of pain control drugs, and was associated with increased survival for the duration of this 6 month trial.

Psychopathology in heart transplant candidates.

Psychodiagnostic data are reported on 69 heart transplant candidates. Twenty-seven patients actually received a transplantation. A high prevalence of anxiety and depression appeared related to their desperate cardiac status. Distressful symptoms did not predict postoperative psychiatric complications. Reduced coping skills as reflected by diagnoses of personality disorders or organic mental impairment were associated with many behavioral problems capable of jeopardizing survival. Psychiatric input is necessary for, and was helpful in, the management of these patients.

Chronic in vivo evaluations of a long-term, implantable left ventricular assist system.

Total THI/Gould LVAS experience includes 59 pneumatically and electrically-actuated blood pump evaluations (in calves, goats and sheep), including 23 studies with the Gould Model V energy converter. This experience has resulted in greater than 8 cumulative years of actuation, in vivo, including electrically-actuated LVAS durations up to 6 mos.

Geographic and seasonal distribution of rabies in skunks, foxes and bats in Texas.

The geographic and seasonal distributions of the pathobiocenoses formed by rabies virus, the biotic provinces of Texas, and skunks, foxes and bats were described using synoptic mapping and enumeration by calendar month. Autocorrelation functions with 95% confidence intervals were calculated for the skunk pathobiocenose for lag periods up to 36 mo in length. The geographic distributions were fundamentally different, but all overlapped. The skunk and fox pathobiocenoses were associated with provincial ecotones. The distribution of the bat pathobiocenose was urban. The nature of the autocorrelation functions for the skunk pathobiocenose indicated that this disease association may be spreading throughout the state from an epicenter in the Texan biotic province.