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CONTROLLED-RELEASE OXYCODONE IN THE TREATMENT OF CHRONIC MUSCULOSKELETAL PAIN: A PRELIMINARY EXPERIENCE OF A RHEUMATOLOGY CENTER
No full textU etiologiji nemaligne boli znatan udio bolesnika ima boli podrijetla mišićno-koštanog sustava. Uporaba jakih opioida u liječenju nemaligne boli još je prijeporna. Stoga je cilj istraživanja bio utvrditi učinkovitost i podnošljivost oksikodona s postupnim otpuštanjem aktivne tvari (CR) u liječenju bolesnika s nedovoljno kontroliranom boli mišićno-koštanog podrijetla, a u ovom radu iznose se preliminarni rezultati.
U ovome prospektivnom, otvorenom, opservacijskom istraživanju jednoga reumatološkog centra tercijarne zaštite konsekutivno su bili uključeni bolesnici s različitim bolestima mišićno-koštanog podrijetla koji su unatoč primjeni lijekova protiv boli osjećali umjerenu do jaku bol. Bolesnici su bili prebačeni na terapiju oksikodonom CR i praćeni 14 dana. Početna doza lijeka bila je 10 mg na dan, a potom je doza ovisno o potrebi povisivana. Primarni cilj bio je ispitati učinkovitost oksikodona na intenzitet boli, a sekundarni cilj istraživanja bio je ispitati učinkovitost na opće zdravlje bolesnika (oboje na vizualno-analognoj skali, VAS 0 – 10). U studiju je bilo uključeno 15 bolesnika (12 žena, 3 muškarca) prosječne dobi 61 ± 12 godina, s dijagnozama osteoartritisa, lumboishialgije i upalnih artritisa. Bol je trajala 41 ± 12 mjeseci. Prije početka liječenja oksikodonom CR jačina boli bila je 7,87 ± 2,28 (raspon 7 – 10), a na kraju praćenja 5,92 ± 2,43 (raspon 4 – 9) (p = 0,069). Također, opće zdravstveno stanje bilo je ocijenjeno 7,27 ± 2,14 (raspon 3 – 10) prije početka, a 6,00 ± 1,53 (raspon 3 – 9) na kraju praćenja (p = 0,028). Dva su bolesnika tijekom istraživanja prekinula primjenu lijeka; jedan zbog nuspojava (mučnina i vrtoglavica), a drugi zbog straha i mišljenja da mu lijek nakon 2 dana primjene nedovoljno smanjuje bol. Profil nuspojava oksikodona bio je očekivan.
Rezultati našeg preliminarnog istraživanja pokazuju da je u bolesnika s kroničnom nemalignom boli mišićno-koštanog podrijetla, u kojih bol nije dobro kontrolirana jednostavnim analgeticima, nesteroidnim antireumaticima i slabim opijatima, liječenje oksikodonom s kontroliranim otpuštanjem aktivne tvari znatno smanjilo razinu boli i poboljšalo opće zdravlje bolesnika.In the etiology of non-malignant pain, a significant proportion is constituted by patients with pain originating in the musculoskeletal system. Th e use of strong opioids in the treatment of non-malignant pain is still controversial. Therefore, the aim of this study was to establish the efficacy and safety of oxycodone with a controlled release of the active substance (CR) in the treatment of patients with chronic, not well-controlled musculoskeletal pain. Here we present our preliminary results.
In this prospective, open, single-center study conducted at a rheumatology center we enrolled consecutive patients with musculoskeletal pain due to a variety of musculoskeletal diseases (osteoarthritis, pain in the lower back, spondyloarthritis), who suffered from moderate to severe pain despite previous analgesic therapy (with NSAIDs, weak opioids, or a fixed combination of paracetamol and weak opioids). Patients were switched to therapy with oxycodone CR and followed for 14 days. The starting dose of oxycodone CR was 10 mg, and later the dose was adapted as necessary. The primary endpoint was to assess the effectiveness of oxycodone CR on pain intensity, and the secondary goal was to assess the efficiency on the general health of the patient (both on a horizontal visual analogue scale, VAS 0 = best, 10 = worst). Fifteen patients (12 women, 3 men), with a mean age of 61 ± 12 years and a diagnosis of osteoarthritis, pain in the lower back, or inflammatory arthritis, were included in the study. Th e duration of pain was 41 ± 12 months. The average intensity of pain before oxycodone CR treatment was 7.87 ± 2.28 (range 7-10), and at the end of the study it was 5.92 ± 2.43 (range 4-9) (p=0.069). General health was rated 7.27 ± 2.14 (range 3-10) before the start and 6.00 ± 1.53 (range 3-9) at the end of the study (p=0.028). In one patient the treatment was discontinued due to dizziness and nausea, and one patient voluntarily left the study because of fear and the subjective impression of no adequate pain control after 2 days of treatment. The oxycodone side-effect profile was as expected.
Results of our preliminary study show that in patients with chronic non-malignant pain which is not well controlled by simple analgesics, NSAIDs, and weak opioids, treatment with oxycodone CR contributed to a significant reduction in the level of pain and improved the general health of the subjects
A pilot study—is there a role for mitoxantrone pleurodesis in the management of pleural effusion due to lung cancer?
No full textBackground: Lung cancer is the leading cause of malignant pleural effusion (MPE). Management of MPEs remains a clinical challenge due to recurrence and poor quality of life. An ideal sclerosing agent has yet to be found. The aim of this cohort pilot study was to evaluate the role of mitoxantrone pleurodesis (MP) as an alternative to talc sclerotherapy for managing MPEs in lung cancer patients.
Methods: A retrospective chart review was conducted on consecutively admitted patients with MPE to the Department of Post-Intensive Care at the Clinic for Respiratory Diseases “Jordanovac”, University Hospital Centre Zagreb, in Croatia.
Results: Of 34 patients with MPE, twenty-one (64.8±9.46 years; 47–84 years) with primary lung carcinoma who received MP (30 mg of mitoxantrone) between December 2003 and February 2009 were included in this study. Chest radiographs taken prior to sclerotherapy and at 1-, 2-, and 3-month follow-up were compared. At the post-sclerotherapy evaluation periods, overall success (OS) rates of MP were 88.2% [17.6%, complete response (CR); 70.6%, partial response (PR)], 53.9% (7.7% CR; 46.2% PR), and 45.5% (PR), respectively. Kaplan-Meier median survival from MP until death was 5.2 months, while that from diagnosis of primary lung cancer was 12.3 months.
Conclusions: MP may be a safe and effective method of managing MPE due to lung cancer. Future randomized controlled studies comparing mitoxantrone and talc pleurodesis in lung cancer patients are warranted to elucidate whether a significant difference exists between these agents. Factors affecting success, survival probability, and quality of life also require further investigation
Physical therapy and rehabilitation after spine tumor operation
No full textSpecifičnost onkološke rehabilitacije čine kraći vremenski okviri za intervencije nego kod rehabilitacije bolesnika s drugim bolestima. Cilj onkološke rehabilitacije jest postizanje maksimalnog funkcioniranja na svim područjima unutar ograničenja nastalih zbog bolesti ili postupaka liječenja. Sveobuhvatni rehabilitacijski tim čine onkološki bolesnik okružen specijalistom fizikalne medicine i rehabilitacije, fizioterapeutom, edukacijskim rehabilitatorom, psihologom, medicinskom sestrom, rekreacijskim terapeutom, duhovnikom, terapeutom za profesionalnu rehabilitaciju, socijalnim radnikom etc. S rehabilitacijom onkološkog bolesnika treba započeti odmah i prije samog operativntog liječenja kako bismo pripremili bolesnika i lako postigli njegovu bolju adherenciju. U oblike fizikalne terapije ubrajamo kineziterapiju, krioterapiju, hidroterapiju; elektroterapiju u obliku transkutane električne stimulacije, funkcionalne električne stimulacije, elektromiografski biofeedback i opskrbu ortopedskim pomagalima. Onkološka rehabilitacija sveprisutni je modalitet liječenja tijekom kompleksne medicinske skrbi o bolesniku s tumorima kralježnice, stoga je pred rehabilitacijsku struku postavljen izazov za pružanjem još kvalitetnije rehabilitacije.The specificity of oncology rehabilitation is its shorter time frame for intervention than in the rehabilitation of patients with other diseases. The goal of oncology rehabilitation is achieving maximum functioning in all areas within the limitations caused by illness or treatment procedures. Comprehensive rehabilitation team consists of oncology patient surrounded by a specialist in physical medicine and rehabilitation, physical therapist, educational rehabilitator, psychologist, nurse, recreational therapist, spiritual therapist, vocational rehabilitation therapist, social worker, etc. The rehabilitation of the patient with cancer should start immediately before the surgical treatment to prepare patients and thus achieve its better adherence. The forms of physical therapy consist of kinesiotherapy, cryotherapy, hydrotherapy; electrotherapy as transcutaneous electrical stimulation, functional electrical stimulation, electromyographic biofeedback and supply of orthopedic devices. Oncological rehabilitation is a ubiquitous mode of treatment for complex medical care of patients with tumors of the spine. Therefore, rehabilitation profession is challenged to provide even better rehabilitation
Outcome of older patients with b-large cell lymphoma (b-lcl) – an observational study of KroHem, the Croatian cooperative group for hematologic diseases
No full textUtječu li novi dijagnostički kriteriji za gestacijski dijabetes na ishod trudnoća?
No full textThe incidence of pregnancy related diabetes has been steadily increasing during the past decade. The aim of this retrospective study was to evaluate the type and prevalence of gestational diabetes complications after implementing new diagnostic criteria for gestational diabetes. The incidence of gestational diabetes, maternal age, mode of delivery and birth weight were analyzed. Study patients were divided into three groups. The first group consisted of patients who gave birth during 2005, the second group during 2011 and the third group during 2012. In 2005, the World Health Organization criteria were used on diagnosing gestational diabetes, whereas in 2011 and 2012 the criteria issued by the International Association of Diabetes and Pregnancy Study Groups were considered. Th ere was no statistically significant difference among the groups according to maternal age, birth weight (p=0.203) and mode of delivery (p=0.883). Cesarean section was performed in about 30% of deliveries in all groups combined. There was no significant difference in the number of neonatal hypertrophy (p=0.348), although the distribution of hypertrophy showed a tendency towards higher values in 2005. Th e incidence of gestational diabetes was 2.2% in 2005, 6.6% in 2011 and 12% in 2012. In conclusion, difference in the incidence of pregnancy related diabetes appeared to have resulted directly from using different diagnostic criteria. The new criteria contributed to a relatively higher incidence of gestational diabetes but also achieved better gestational glycemic control and consequently better fetal growth regulation.Incidencija gestacijskog dijabetesa je u stalnom porastu u proteklom desetljeću. Cilj ove retrospektivne studije bio je utvrditi komplikacije gestacijskog dijabetesa i ishode trudnoća nakon promjene kriterija za dijagnozu gestacijskog dijebetesa. Analizirana je incidencija dijabetesa u trudnoći, dob majki, način dovršenja porođaja i težina novorođenčadi. Ispitanice su bile podijeljene u tri skupine. U prvoj skupini su bile žene koje su rodile u 2005. godini, u drugoj skupini one koje su rodile 2011. godine, a u trećoj skupini one koje su rodile 2012. godine. Za dijagnozu gestacijskog dijabetesa 2005. godine korišteni su kriteriji Svjetske zdravstvene organizacije, a 2011. i 2012. godine kriteriji IADPSG (International Association of Diabetes and Pregnancy Study Groups). U ispitivanim skupinama nije nađena statistički značajna razlika s obzirom na dob rodilja. Nije bilo statistički značajne razlike u prosječnoj težini novorođenčadi (p=0,203) među ispitivanim skupinama. Također nije nađena statistički značajna razlika niti u načinu dovršenja porođaja (p=0,883). U ispitivanom uzorku carskim rezom rodilo je oko 30% trudnica. Nije bilo statistički značajne razlike u pojavnosti fetalne hipertrofije (p=0,348), ali je 2005. godine rođeno više djece u skupinama s većom porođajnom masom. Godine 2005. incidencija gestacijskog dijabetesa bila je 2,2%, 2011. godine 6,6%, a 2012. godine 12%. Razlika u incidenciji gestacijskog dijabetesa posljedica je primjene različitih dijagnostičkih kriterija. Novi kriteriji su doprinijeli porastu incidencije gestacijskog dijabetesa, ali i boljoj regulaciji glikemije te posljedično boljoj regulaciji fetalnoga rasta
Malignant disease in patients with hypetrophic osteoarthropathy: a retrospective case - study from a tertiary center
No full textHypertrophic osteoarthropathy (HOA) is a rare condition characterized with clubbing fingers on hands and feet and with typical radiological finding of periostitis on long tubular bones. Primary HO is of unknown etiology while secondary HO is closely associated with malignant disease. The aim of this study was to determine the association between HO and malignant disease and features of secondary HOA from the database of a single tertiary rheumatology center
63-Year-Old Male Opts to Delay Surgical Resection of Intralobar Pulmonary Sequestration: A Case Report
No full textIntralobar pulmonary sequestration (IPS) is an exceptional finding in adults over the age of 50. The hallmark of lung sequestration is a systemic arterial blood supply to dysplastic and functionless parenchymal lung tissue which is susceptible to chronic infection. Recognition of IPS is frequently delayed or even missed due to respiratory symptoms mimicking common diseases such as periodic pulmonary infections. The aim of this report is to raise awareness of IPS, as well as its surgical treatment in older adults, who may initially choose the watch-and-wait approach despite being symptomatic
Novel approaches in hand rehabilitation
No full textHand rehabilitation is a constructive activity to gradually restore health and functionality of hand and fingers. Motion disabilities of hand and fingers are a common problem and can be a result of a wide variety of diseases and traumas. This problem is especially emphasized in the elderly population.
Common methods in hand rehabilitation include physical therapy that should be performed frequently. However, patients tend not to follow the program strictly and perform exercises the wrong way, making progress slower or even stagnant. With the development of novel contactless and noninvasive sensors for tracking hand and finger motion the hand rehabilitation can be further upgraded. In this paper we looked into existing hand rehabilitation systems and presented a concept of a novel system by empowering capabilities of new sensors with virtual reality (VR) environment. The existing hand rehabilitation exercises were analysed, adapted and verified in order to be implemented into the system