Guidelines on artificial nutrition versus hydration in terminal cancer patients. European Association for Palliative Care.

Whether a terminally ill cancer patient should be actively fed or simply hydrated through subcutaneous or intravenous infusion of isotonic fluids is a matter of ongoing controversy among clinicians involved in the care of these patients. Under the auspices of the European Association for Palliative Care, a committee of experts developed guidelines to help clinicians make a reasonable decision on what type of nutritional support should be provided on a case-by-case basis. It was acknowledged that part of the controversy related to the definition of the terminal cancer patient, since this is a heterogeneous group of patients with different needs, expectations, and potential for a medical intervention. A major difficulty is the prediction of life expectancy and the patient's likely response to vigorous nutritional support. In an attempt to reach a decision on the type of treatment support (artificial nutrition vs. hydration) which would best meet the needs and expectations of the patient, we propose a three-step process: Step 1: define the eight key elements necessary to reach a decision; Step II: make the decision; and Step III: reevaluate the patient and the proposed treatment at specified intervals. Step I involves assessing the patient concerning the following: 1) oncological/clinical condition; 2) symptoms; 3) expected length of survival; 4) hydration and nutritional status; 5) spontaneous or voluntary nutrient intake; 6) psychological profile; 7) gut function and potential route of administration; and 8) need for special services based on type of nutritional support prescribed. Step II involves the overall assessment of pros and cons, based on information determined in Step I, in order to reach an appropriate decision based on a well-defined end point (i.e., improvement of quality of life; maintaining patient survival; attaining rehydration). Step III involves the periodic reevaluation of the decision made in Step II based on the proposed goal and the attained result.

[Hemorheological, hemocoagulation and photoplethysmographic changes induced by the administration of pentoxifylline in patients with Raynaud's disease]. / Modificazioni emoreologiche, emocoagulative e fotopletismografiche indotte dalla somministrazione di pentossifillina in soggetti con malattia di Raynaud.

1200 mg/day per os of Pentoxyphyllin administered for 60 day brought about an improvement in symptomatology and photoplethysmographic readouts under base conditions and following the cooling test in 7 out of 11 females suffering from Raynaud's disease. These results may be explained by an improved microcirculation flow resulting from increased erythrocyte filterability and a decrease in fibrinogenemia .

[Hypotensive effect of sotalol under basic conditions and during exercise. Clinical cases]. / Effetto ipotensivo del Sotalolo in condizioni basali e sotto sforzo. Casistica clinica.

An assessment was made of the efficacy of Sotalol, a beta1 selective beta blocker, in the management of essential arterial hypertension. A single 160 mg dose per diem was administered per os to 34 patients over a period of 14 weeks. Arterial pressure and heart rate were checked periodically. In addition, SAP, DAP and heart rate were evaluated before and during the third week of treatment in 8 subjects under maximum ergometric test conditions. Excellent tolerance was observed. Under basal conditions, all subjects displayed good reduction of SAP and DAP. This was highly significant. During exercise, it was less evident, and the results were only significant for low work loads. It is nevertheless felt that the simple dose protocol of the drug, its good tolerance and its effectiveness under basal conditions suggest that more extensive ergometric studies should be conducted.

Pirenzepine does not impair liver blood flow in the rat.

The present study was performed with the aim of establishing whether the muscarinic-receptor antagonist pirenzepine impairs liver blood flow, as previously observed for H2-blockers. For this purpose, two different doses of pirenzepine (0.3 and 0.6 mg/100 g b.w. respectively) were administered to two groups of rats. Liver plasma flow was measured 30 min after treatment by the new sorbitol clearance test which is simple and does not require hepatic vein catheterization. The results were compared with those obtained in a control group and in a group treated with cimetidine. It was shown that, compared to the control group in which the observed functional liver plasma flow was 5.0 +/- 1.3 ml/min/100 g b.w. (MV +/- SD), rats treated with either dose of pirenzepine showed no significant impairment of liver perfusion. On the other hand, cimetidine treatment produced a significant reduction (p less than 0.001) of functional liver plasma flow. Our results show that pirenzepine treatment does not significantly impair liver functional activity through reduced liver perfusion. They also suggest that muscarinic receptors are probably not involved in the control of splanchnic blood flow.