Tratamiento del dolor irruptivo / Treatment of breakthrough pain

El dolor irruptivo oncológico es un dolor transitorio, de corta duración (generalmente menos de 60 min), que alcanza su máxima intensidad en 15 min y aparece a pesar de un adecuado tratamiento del dolor basal con analgesia pautada a horas fijas. Estos episodios de dolor irruptivo oncológico se tratan con medicación “de rescate”. Debido a sus características clínicas y a la intensidad de los episodios, el fármaco ideal para su tratamiento sería un opioide de inicio rápido, corta duración del efecto y pocos efectos secundarios. Tradicionalmente, en esta situación se han utilizado los opioides de liberación rápida administrados por vía oral. Sin embargo, las nuevas formulaciones de fentanilo, que se absorben de forma rápida a través de las mucosas (oral e intranasal) parecen adaptarse mejor al patrón temporal de los episodios de dolor irruptivo oncológico. El éxito en el manejo de los episodios de dolor irruptivo dependerá de unas adecuadas identificación y evaluación

Breakthrough cancer pain is a transient, short-lasting (usually less than 60 minutes) exacerbation of pain that reaches maximum intensity within 15 minutes and occurs despite adequate treatment of background pain with around-the-clock analgesia. These episodes of breakthrough pain are treated with “rescue” analgesia. Due to the clinical characteristics and intensity of these exacerbations, the ideal drug for the treatment of breakthrough pain would be a rapid-onset, short-acting opioid with few secondary effects. Traditionally, oral rapid-release opioids have been used in this situation. However, the new fentanyl formulations, which are rapidly absorbed through the mucous membranes (oral, intranasal), seem to be better adapted to the temporal pattern of episodes of breakthrough pain. The success of the management of these episodes depends on adequate identification and evaluation

No es habilidad poca saber nadar y guardar la ropa / It’s a good ability to keep all your bases covered

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[Ophthalmoplegia in a patient with prostate cancer and bone metastases]. / Oftalmoplejía completa izquierda por metástasis ósea de cáncer de próstata.

Prognosis in prostate cancer is determined, in greater part, by the presence of metastases. Bone metastases can occur in any part of the skeleton even, for example, at the base of the skull. We present a case of a 78 year old male who, in December 2001, presented with paralysis of the third cranial nerve. The NMR and CAT scans were normal and circulating levels of PSA were elevated. He was referred to the Urology Service where the treatment guidelines included complete androgen block. Subsequently, he developed retro-orbital pain, divergent strabismus and palpebral ptosis. CAT and NMR indicated a soft tissue mass at the sphenoid level. Treatment was Gamma Knife Radio-surgery. Since August 2004, in conjunction with the latest rise in PSA, the patients general status deteriorated considerably and he was referred to the Oncology Service. There was an increase in the paralysis of the third, fourth and sixth cranial nerve (complete left ophthalmoplegia) and left-central facial paralysis. Metastases from prostate cancer can be disseminated via the lymphatic or the blood system. Currently, there are more metastases from large-size tumours. Metastases are critical in prostate cancer because of their adverse effect on the patients survival. Measurements of circulating levels of prostate specific antigen and prostate acid phosphatase are very useful in the clinical diagnosis of the primary tumour, or its metastases.

Oftalmoplejía completa izquierda por metástasis ósea de cáncer de próstata / Cranial nerve paralysis in a patient with prostate cancer and bone metastases

El pronóstico del cáncer de próstata viene definido en gran medida por la afectación metastásica . Las metástasis óseas pueden afectar a cualquier parte del esqueleto, como por ejemplo a la base del cráneo. Se trata del caso de un varón de 78 años que en diciembre de 2001 presentó parálisis del III par crane-al, con TAC y RMN normales. Se acompañaba de niveles de PSA sérico elevados. Fue remitido al Servicio de Urología donde se pautó tratamiento con bloqueo androgénico completo. Posteriormente comenzó con dolor retroorbitario, estrabismo divergente y ptosis palpebral. En TAC y RM se objetivó una masa de partes blandas a nivel del esfenoides. Recibió tratamiento con radiocirugía mediante Gamma Knife. Desde agosto de 2004, coincidiendo con la última elevación del PSA, el paciente presenta importante deterioro de su estado general, por lo que se remite al servicio de Oncología para valoración. Aparece un aumento de la parálisis de los pares craneales III, IV y VI izquierdos (oftalmoplejía completa izquierda) y parálisis central facial izquierda. Las metástasis del cáncer de próstata se realizan por vía linfática o hematógena. Pero normalmente existen más metástasis en tumores de mayor tamaño. Las metástasis son de gran importancia en el cáncer de la próstata, ya que, con pocas excepciones, de ellas depende la mortalidad. Las determinaciones serológicas de antígeno prostático y fosfatasa ácida prostática son de gran utilidad para el diagnóstico clínico del tumor primario o de sus metástasis

Prognosis in prostate cancer is determined, in greater part, by the presence of metastases. Bone metastases can occur in any part of the skeleton even, for example, at the base of the skull. We present a case of a 78 year old male who, in December 2001, presented with paralysis of the third cranial nerve. The NMR and CAT scans were normal and circulating levels of PSA were elevated. He was referred to the Urology Service where the treatment guidelines included complete androgen block. Subsequently, he developed retro-orbital pain, divergent strabismus and palpebral ptosis. CAT and NMR indicated a soft tissue mass at the sphenoid level. Treatment was Gamma Knife Radio-surgery. Since August 2004, in conjunction with the latest rise in PSA, the patient’s general status deteriorated considerably and he was referred to the Oncology Service. There was an increase in the paralysis of the third, fourth and sixth cranial nerve (complete left ophthalmoplegia) and left-central facial paralysis. Metastases from prostate cancer can be disseminated via the lymphatic or the blood system. Currently, there are more metastases from large-size tumours. Metastases are critical in prostate cancer because of their adverse effect on the patient’s survival. Measurements of circulating levels of prostate specific antigen and prostate acid phosphatase are very useful in the clinical diagnosis of the primary tumour, or its metastases