The Use of Humor in Palliative Care: A Systematic Literature Review.

BACKGROUND: Humor has its own place in the context of medicine. Nevertheless, its acceptance by terminal stage patients and health-care professionals has not been studied in depth and is not free from controversy. OBJECTIVES: To understand the significance, appropriateness, and pertinence of the use of humor in palliative care and to analyze its applicability. DESIGN: A narrative systematic review was undertaken and included in PROSPERO. DATA SOURCES: Online searches were carried out on PUBMED, PSYCINFO, EBSCO (CINHAL), EMBASE, SCIELO, SCOPUS, TESEO, WEB of SCIENCE, and COCHRANE between their launch date and December 31, 2015, complemented with manual searches with queries to experts. A total of 156 studies were identified, which were then filtered in pairs by means of an established hierarchy, selecting studies that discussed the use of humor specifically in palliative care from all perspectives and designs, and finally published in Spanish, English, French, or Portuguese. Critical reading of all the selected studies took place, with no exclusions due to quality evaluation. RESULTS: Thirty-four studies were included. Five main topics were identified: (1) definition of humor, (2) use and functions of humor in palliative care, (3) how to use humor, (4) when not to use humor, and (5) humor before and after the diagnosis of terminal illness. CONCLUSIONS: Humor plays an unquestionable role in palliative care, but its use needs training and appropriate use.

[Experience with third, fourth and fifth kidney transplants and their complications.] / Experiencia en terceros, cuartos y quintos trasplantes renales y sus complicaciones.

OBJECTIVES: Kidney transplant may be a good choice to treat chronic renal failure even in patients with two or more previous renal grafts. However, there might be several surgical complications and other difficulties we have to deal with. The aim of this report is to analyze the third, fourth and fifth transplants performed in our center focusing on the surgical complications and graft and patient survivals. METHODS: We performed a retrospective analysis of the 73 third, fourth and fifth kidney transplants performed in our center between February 1975 and December 2015. Statistical analysis has been performed with IBM SPSS 23.0 software. RESULTS: 62 patients received a third graft, 10 received a fourth one and one patient received a fifth graft. The median age of the recipients was 48 years, while for donors it was 50. Median cold ischemia time was 21 hours. Transplantectomy was not necessary in 49.31% of the cases. In 59.7% of the cases the graft vessels were anastomosed to the external iliac vessels. There were 21 cases of relevant postoperative complications (27.4% of the total grafts). Vascular thrombosis appeared in 5.5%. After 49 months of follow-up, the 1-, 3-, and 5-year graft survival were 64.3%, 56.16% and 50.69%, respectively. CONCLUSIONS: A new renal transplant in patients with two or more previous grafts is feasible, being necessary to individualize the cases. In spite of being more complex operations than previous transplants with a higher complication rate, we can obtain both acceptable graft and patient survival outcomes with an appropriate approach.

Experiencia en terceros, cuartos y quintos trasplantes renales y sus complicaciones / Experience with third, fourth and fifth kidney transplants and their complications

Objetivos: El trasplante renal puede ser una buena opción terapéutica en la insuficiencia renal terminal, incluso en los pacientes con dos o más injertos previos. Sin embargo, pueden existir una serie de dificultades y complicaciones quirúrgicas a las cuales el equipo de trasplante debe enfrentarse. El objetivo de este artículo es revisar los terceros, cuartos y quintos trasplantes realizados en el Hospital Universitario Marqués de Valdecilla (HUMV) analizando las dificultades quirúrgicas, sus complicaciones y la supervivencia de injertos y pacientes. Método: Revisión retrospectiva desde Febrero de 1975 hasta Diciembre de 2015 que incluye 73 trasplantes (3º,4º y 5º) realizados en el HUMV. El estudio estadístico ha sido realizado con el programa informático IBM SPSS versión 23.0. Resultados: 62 pacientes han recibido un tercer trasplante, 10 de ellos posteriormente han recibido un cuarto y 1 única paciente ha recibido un quinto. La mediana de edad de los receptores fue 48 años y la de los donantes 50. La mediana de isquemia fría fue de 21 horas. No fue necesaria la trasplantectomía de los injertos previos en un 49,31 % de los casos. En un 59,7% de los casos se pudieron anastomosar los vasos del injerto a los vasos iliacos externos del receptor. Se registraron un 27,4% de complicaciones postquirúrgicas relevantes, con un 5,5% de trombosis en los vasos de los injertos. Tras una mediana de seguimiento global de 49 meses la supervivencia del injerto a 1, 3 y 5 años fue del 64,3%, 56,16% y 50,69% respectivamente. Conclusión: A pesar de ser necesario individualizar los casos, un nuevo trasplante en pacientes con dos o más injertos renales previos, sigue siendo una opción terapéutica a considerar. Aunque pueden ser cirugías complejas y de alto riesgo de complicaciones, con un manejo óptimo y cirujanos expertos se pueden obtener cifras de supervivencia de injerto aceptables (AU)

Objectives: Kidney transplant may be a good choice to treat chronic renal failure even in patients with two or more previous renal grafts. However, there might be several surgical complications and other difficulties we have to deal with. The aim of this report is to analyze the third, fourth and fifth transplants performed in our center focusing on the surgical complications and graft and patient survivals. Methods: We performed a retrospective analysis of the 73 third, fourth and fifth kidney transplants performed in our center between February 1975 and December 2015. Statistical analysis has been performed with IBM SPSS 23.0 software. Results: 62 patients received a third graft, 10 received a fourth one and one patient received a fifth graft. The median age of the recipients was 48 years, while for donors it was 50. Median cold ischemia time was 21 hours. Transplantectomy was not necessary in 49.31% of the cases. In 59.7% of the cases the graft vessels were anastomosed to the external iliac vessels. There were 21 cases of relevant postoperative complications (27.4% of the total grafts). Vascular thrombosis appea-red in 5.5%. After 49 months of follow-up, the 1-, 3-, and 5-year graft survival were 64.3%, 56.16% and 50.69%, respectively. Conclusions: A new renal transplant in patients with two or more previous grafts is feasible, being necessary to individualize the cases. In spite of being more complex operations than previous transplants with a higher complication rate, we can obtain both acceptable graft and patient survival outcomes with an appropriate approach (AU)

A randomized crossover clinical trial to evaluate the efficacy of oral transmucosal fentanyl citrate in the treatment of dyspnea on exertion in patients with advanced cancer.

BACKGROUND: Morphine is the only opioid which has been clearly demonstrated as effective in the treatment of dyspnea. The role of other opioids has not been sufficiently substantiated. OBJECTIVE: To evaluate the efficacy of oral transmucosal fentanyl citrate (OTFC) in the treatment of dyspnea on exertion in patients with advanced cancer. DESIGN: This is a randomized, double-blind crossover clinical trial to evaluate the efficacy of OTFC in dyspnea on exertion after the completion of a 6-minute walk test (6MWT). All patients were attended in 2011 by the Palliative Care Supportive Team from Badajoz. In visit 1, patients were randomly assigned to 1 of the 2 treatment groups. In visit 2, the patients who had been receiving the investigational product were given placebos and vice versa. RESULTS: Thirteen patients were recruited (26 6MWT), with a mean age of 65 years. Of the patients, 11 (76%)were males and lung cancer was the most frequently represented etiology. The patients were classified into 3e categories: better response in the first period, the same response in both the periods, and better response in the second period. No differences between the treatments were demonstrated (P: 1). There were no differences in changes in oxygen saturation (P: .7541) nor in the distance walked in the different sequences (P: .6550). No significant differences were found in relation to the Edmonton Symptom Assessment System, either before or after the 6MWT (P: .1234). No secondary effects associated with the medication were observed. CONCLUSION: It could not be demonstrated that the OTFC improved exertion dyspnea in patients with advanced cancer. A placebo effect was observed in all the patients.

About a case report of giant hydronephrosis.

Introduction. Our objective is to report a case of an infrequent entity as the giant hydronephrosis. Case Report. We report the case of an 82-syear-old male referred for a poor general condition. A radiological study revealed a great left hydronephrosis secondary to an urothelial carcinoma. The patient died due to his poor general condition. A histological diagnosis revealed a transitional cell carcinoma of renal pelvis and ureter and atrophic renal parenchyma. Conclusion. Giant hydronephrosis represents a very often entity to be taken into account in cases with big cystic abdominal masses in absence of unilateral or bilateral kidney. Simple nephrectomy is the treatment of choice in most cases. Nevertheless, in cases of nonsubsidiary surgery, percutaneous drainage may be necessary.

Bilateral xanthogranulomatous orchitis in a tetraplegic patient.

Xanthogranulomatous orchitis (XGO) is a rare chronic inflammatory process characterized by destruction of tissue that is replaced by an outstanding cellular infiltrate of lipid-laden macrophages. To date, 20 cases of this process have been reported previously. We present herein the case of a 55-year-old man who had sustained complete tetraplegia at C-6 level and neuropathic bladder for 21 years. After repeated episodes of urinary tract infection, the patient developed a bilateral XGO and a right xanthogranulomatous epididymitis (XGE) that were treated with bilateral orchiepididymectomy. To our knowledge, a bilateral XGO has not yet been reported. Repeated episodes of high-pressure urinary reflux along the vas deferens during dyssynergic voiding possibly led to retrograde extension from the urinary tract by common urinary pathogens and development of bilateral XGO and right XGE. Since tissue destruction is a feature of this process, curative treatment required antibiotic therapy followed by bilateral excision of testes and epididymes.

Dyspnea--a bad prognosis symptom at the end of life.

PURPOSES: Dyspnea as refractory symptom leading to sedation at the end of life and the place of death. Survival study in population with dyspnea. METHODS: Longitudinal study of terminally ill patients in a year (n = 195). We divided populations as (a) population with dyspnea: prevalent and incident dyspnea and (b) population without dyspnea. We used the statistical program Stata9 (Kaplan-Meier and Cox logistic regression models). RESULTS: The probability of being sedated was 5 times higher in population with dyspnea. Dying in hospital odds ratio was 2.13 in patients with dyspnea. The average survival time was 52 days in patients with dyspnea and 69 in non-dyspnea patients. The average survival was similar between both groups. Patients with incident dyspnea showed a higher average survival than those with prevalent dyspnea. CONCLUSIONS: The connection between dyspnea and sedation was clearly shown. There were significant differences between prevalent dyspnea and incident dyspnea groups.