External radiotherapy is the treatment of choice for metastatic localized bone pain without adequate response to analgesic drugs. 1 Previous clinical studies that measure analgesic response to radiation therapy in advanced cancer patients accepted both an improvement in the intensity of pain or a reduction in the dose of analgesic drugs (morphine equivalent) as response criteria. 2 Recently, we developed a prospective study in advanced cancer patients with painful bone metastases: 29 palliative radiotherapy treatments were administered to 25 patients to alleviate malignant bone pain secondary to clinically evident bone metastases. Four episodes were not included in the analysis because three patients died and one developed symptomatic brain metastases before evaluation. Pain intensity was measured on a scale of 0 (no pain) to 10 (maximum pain). We found a reduction of 3.5 points (95% confidence interval [CI]: 2.5 to 4.8; P Ͻ 0.001, Wilcoxon test) in median pain intensity after radiotherapy. However, this pain reduction was associated only to a slight decrease of 6.0 mg (95% CI: Ϫ 12.0 to 30.0; P ϭ 0.53, Wilcoxon test) in median daily dose of oral morphine equivalent. In only two episodes (8%), the threshold of significant dose reduction of 50% or more in opioid consumption was exceeded; in both of them a parallel reduction of basal pain was achieved as well. No significant differences were observed in the proportion of patients receiving nonsteroidal anti-inflammatory drugs or adjuvant analgesics before and after radiotherapy (Table 1).Palliative radiotherapy for painful bone metastases decreases pain intensity 3 but, according to our data, does not reduce overall analgesic needs in advanced cancer patients. We suppose that overwhelming progressing disease in advanced cancer patients does not allow a reduction in analgesic therapy even when an adequate local bone pain control is achieved with palliative radiotherapy. Thus, decrease in opioid intake is not a good independent criteria of response to palliative radiotherapy for bone metastases related pain in advanced cancer patients.
Introduction:We study the hematological and microbiological characteristics from the autologous blood processed through the intraoperative cell saver used in our centre (Orthopat®) during the correction of pediatric scoliosis, which is known to be a potentially bleeding surgery. Material and methods: Descriptive analysis of 31 patients undergoing pediatric scoliosis surgery. All of them received blood processed by cell saver intraoperatively. The variables collected were: demographic data, volume of the autogenous red blood cell (RBC) concentrate, blood count, biochemistry, blood culture, preoperative and postoperative blood tests of the patients, incidence of fever during reinfusion of RBC concentrate, postoperative surgical site infections and length of hospital stay. Results: Average volume obtained 288.06ml (sd 154.68). Hematocrit 70.38% (sd 10.03) in accordance with cell-saver commercial data (75%). Of the blood samples obtained, 42.86% had blood cultures that were positive for aerobes and 48.28% for anaerobes. The relation between postoperative infections and contamination of blood concentrates was not statistically significant. When comparing the pre-surgery and post-surgery analytical samples, statistically significant differences (p <0.05) were found in the following: hemoglobin and hematocrit decreased in the postoperative period, while coagulation parameters show a tendency to coagulopathy. Conclusion: Our cell saver obtains RBC concentrates with a percentage of hematocrit in agreement with available information. The reinfusion of them is safe from an infectious and biochemical point of view, but its immunological implications are not clear. This surgery continues to result in a significant loss of blood. Measures taken to avoid allogenic transfusions remain necessary and should be enhanced.
Introduction We study the hematological and microbiological characteristics from the autologous blood processed through the intraoperative cell saver used in our centre (Orthopat®) during the correction of pediatric scoliosis, which is known to be a potentially bleeding surgery. Material and methods Descriptive analysis of 31 patients undergoing pediatric scoliosis surgery. All of them received blood processed by cell saver intraoperatively. The variables collected were: demographic data, volume of the autogenous red blood cell (RBC) concentrate, blood count, biochemistry, blood culture, preoperative and postoperative blood tests of the patients, incidence of fever during reinfusion of RBC concentrate, postoperative surgical site infections and length of hospital stay. Results Average volume obtained 288.06ml (sd 154.68). Hematocrit 70.38% (ds 10.03) in accordance with cell-saver commercial data (75%). Of the blood samples obtained, 42.86% had blood cultures that were positive for aerobes and 48.28% for anaerobes. The relation between postoperative infections and contamination of blood concentrates was not statistically significant. When comparing the pre-surgery and post-surgery analytical samples, statistically significant differences (p <0.05) were found in the following: hemoglobin and hematocrit decreased in the postoperative period, while coagulation parameters show a tendency to coagulopathy.Conclusion Our cell saver obtains RBC concentrates with a percentage of hematocrit in agreement with available information. The reinfusion of them is safe from an infectious and biochemical point of view, but its immunological implications are not clear. This surgery continues to result in a significant loss of blood. Measures taken to avoid allogenic transfusions remain necessary and should be enhanced.
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