Gastric secretion pH measurement: what you see is not what you get!

We evaluated the accuracy of gastric secretion pH measurements as performed in three ICUs. The pH of 275 samples was measured with pH paper using established techniques. The pH of 85 additional samples was determined with a hand-held pH meter. All specimens also were measured using a research laboratory pH meter to learn the true pH. Analyses included mean and SD of the difference between the two measurements, the correlation coefficient (r value), and the concordance correlation coefficient. The pH meter values disagreed significantly with pH paper measurements. Measurements of gastric secretion pH with pH indicator paper do not guide therapy reliably. Inaccurate values derived from pH paper measurements could have resulted in inappropriate treatment in 28% of the samples tested. A portable, battery-powered pH meter accurately reproduced laboratory pH meter measurements and is a reasonable device for clinical use.

Epidural morphine by continuous infusion with an external pump for pain management in oncology patients.

Ten patients with advanced malignancies and severe pain were given epidural morphine (EDM) by continuous infusion. The pain had been treated previously with large doses of oral or parenteral narcotics, without success. The pain was disabling in all the cases. The total dose of morphine administered was 10-90 mg per day; median dose was 25 mg. Treatment lasted from 9 to 400 days. Pain relief was complete in seven patients, near complete in two, and moderate in one. Five patients became fully ambulatory. Two patients were treated as outpatients and resumed work activities. No central nervous system or gastrointestinal adverse effects, respiratory depression, or pruritus were noted. One patient developed urinary retention. EDM by continuous infusion produced constant pain relief for prolonged periods. This technique is safe for analgesia in oncology patients and suited for outpatient management.

Long-term, ambulatory, continuous IV infusion of 5-FU for the treatment of advanced adenocarcinomas.

Twenty-three patients with metastatic adenocarcinomas were treated with long-term, continuous, ambulatory iv infusion of 5-FU. Length of infusion ranged from 54 to 324 days. The usual daily dose was 300 mg/m2. Toxicity was primarily stomatitis. Hand/foot syndrome occurred in 11 patients. Nausea, vomiting, myelosuppression, and alopecia were not observed. Thirteen patients had stomatitis. Eighteen patients had evaluable lesions; eight achieved partial response, five had stable disease, and five had progressive disease. Further studies are necessary to confirm the level of tumor response and survival period of patients treated with this method.