The management of symptoms in advanced cancer: experience in a hospital-based continuing care unit.

The treatment received by 158 patients with advanced cancer admitted over one year to the Continuing Care Unit at the Royal Marsden Hospital has been reviewed. The unit is an integral part of the hospital and this is reflected in the fact that 46 patients (29%) received radiotherapy, hormone therapy, chemotherapy or surgery in addition to symptomatic treatment for palliation of troublesome symptoms. One hundred and thirty-one patients received oral morphine in doses ranging from 2.5 mg 4-hourly to 700 mg 4-hourly. Patients with renal or hepatic impairment required lower doses of morphine and there was a highly significant inverse relationship between morphine dose and age. Eighty-five patients (54%) received parenteral diamorphine at some time due to their inability to take oral morphine. One hundred and twenty-three patients (78%) received a co-analgesic drug and anti-emetics were required by 78 patients (49% overall; 56% of those receiving morphine). Transcutaneous electrical nerve stimulation, acupuncture and relaxation were employed in selected patients, and graduated compression sleeves were used to treat lymphoedema. These data highlight the wide range of therapeutic options available to control the symptoms of advanced cancer and also indicate that tumoricidal treatments used in conjunction with symptomatic treatments may have a significant part to play.     

Cognitive estimation in traumatic brain injury.

The present study explores the construct and ecological validity of the Biber Cognitive Estimation Test (BCET) in a traumatic brain injury (TBI) sample. Participants completed the BCET in the course of a neuropsychological evaluation at 1-15 years after injury. BCET scores correlated moderately with other standard measures of executive functioning, and contrary to our hypotheses, at least as high with neuropsychological tests with minimal demands on executive functioning. Moreover, partialing out the portion of BCET variance not attributable to executive functioning markedly attenuated the former correlations. With respect to ecological validity, BCET scores did not predict concurrent functional status, as measured by the Disability Rating Scale. By comparison, standard measures of executive functioning strongly correlated with each other, correlated less strongly with nonexecutive functioning measures, and predicted functional status. In conclusion, unlike standard measures of executive functioning, the BCET demonstrated poor construct and ecological validity in TBI patients.     

In situ saphenous vein bypass grafts: angiographic evaluation and interventional repair of complications

In situ saphenous vein grafts are being used with increasing frequency for bypass procedures involving the femoral and popliteal arteries. Complications of these procedures include anastomotic stenoses and persistent arteriovenous fistulae that may result in failure of the graft. Balloon angioplasty and embolotherapy with detachable balloons were employed successfully in three or four recent cases of patients with complications from in situ grafts. Tailored angiography is essential for evaluating in situ grafts, and interventional techniques are extremely useful for managing complications.