stasis are thought to be of primary importance predisposing to octreotide induced gall stones,3 and this is supported by a report of impaired postprandial contractility' and our observation of a substantially increased fasting gall bladder volume.In conclusion, our findings show recovery of gall bladder function and asymptomatic resolution of gall stones when octreotide is withdrawn.
Many patients with advanced cancer have oral problems, some of which may have a microbiologic basis. The oral flora in such patients has not, however, been characterized. This study has assessed the prevalence of yeasts, coliforms and coagulase positive staphylococci in the oral flora of 197 patients with advanced cancer. Both imprint cultures (n = 197) and oral rinses (n = 161) were collected. Yeasts were isolated from the mouths of 83% of the patients, coliforms from 49.1% and coagulase-positive staphylococci from 28%. All these percentages are considerably in excess of reported levels for healthy individuals. The results indicate a loss of colonization resistance of the oral mucosa in terminal cancer, with potential implications for the development of mouth care regimes for such patients.
One hundred and ninety-seven patients with advanced cancer admitted to Holme Tower Marie Curie Centre, Penarth, Wales entered a double blind, single phase placebo-controlled clinical trial of 0.2% chlorhexidine gluconate mouth spray for the control of oral symptoms. The sprays were administered by nursing staff twice daily for two weeks. A detailed questionnaire was completed and the mouth examined at entry and after one and two weeks of spray usage. Oral rinses and imprint cultures were collected at the same time intervals to monitor the effects of each spray on oral carriage of yeasts, coliforms, Staphylococcus aureus and Streptococcus mutans. The results suggested possible limited activity of a chlorhexidine mouth spray after two weeks of use in decreasing oral yeasts, although the difference from placebo did not reach statistical significance. In addition, both active and placebo sprays provided some patients with relief from oral dryness. Overall there was no evidence for efficacy of a chlorhexidine oral spray in patients with advanced cancer. Mots-clés: soins dentaires, néoplasmes, santé buccale, traitement palliatif, soins terminaux Cent quatre-vingt dix-sept malades, atteints d'un cancer à un stade avancé, admis au Holme Tower Marie Curie Centre, Penarth, Wales, ont & e a c u t e ; t & e a c u t e ; inclus dans une étude clinique sur la vaporisation buccale de chlorhexidine gluconate à 0.2% pour le contrôle des symptômes buccaux. Cette analyse clinique a & e a c u t e ; t & e a c u t e ; effectuée en double aveugle, phase unique et contrôle par placebo. Les vaporisations ont & e a c u t e ; t & e a c u t e ; administrées par les infirmières deux fois par jour pendant quinze jours. Un questionnaire détaillé a & e a c u t e ; t & e a c u t e ; complété et la cavité buccale examinée au début de l'étude, après une semaine et au bout de quinze jours de vaporisation. at University of Manitoba Libraries on June 15, 2015 pmj.sagepub.com Downloaded from 300 Des rinçages buccaux et des prélèvements ont & e a c u t e ; t & e a c u t e ; collectés en même temps pour contrôler l'effet de chaque vaporisation sur la charge buccale en levures, colibacilles, Staphylococcus aureus et Streptococcus mutans. Par la diminution des levures buccales, les résultats montrent une possible activité limitée de la vaporisation buccale de chlorhexidine aprés deux semaines d'utilisation; cependant la différence avec le placebo n'atteint pas de signification statistique. De plus, les vaporisations de produit actif et de placebo ont toutes deux apporté un soulagement à la déshydratation de la cavité buccale chez certains patients. Pour résumer, il n'y a pas de preuve d'efficacité de la vaporisation buccale de chlorhexidrine chez les patients atteints d'un cancer & a g r a v e...
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