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Actualment, la mort encara és tractada com un tema que la societat el considera tabú. És per això, que no se’n tenen prou coneixements ni s’aborda de forma eficaç, tot vulnerant els principis bioètics i drets dels pacients. Malauradament, també presenten dificultats els professionals sanitaris, encara que són els que conviuen diàriament amb ella. No estan preparats, no presenten coneixements, actituds i habilitats, ja que manquen de preparació a les universitats i de programes d’educació emocional en el procés de final de vida a les mateixes institucions sanitàries. Els sanitaris, únicament, estan preparats pel manteniment de la vida a conseqüència del gran avanç tecnològic, i la mort és considerada com el fracàs de la medicina. OBJECTIUS: L’objectiu principal és aprofundir en el coneixement del procés de final de vida; com a específics es troben descriure la gran rellevància de les CP, definir el paper dels professionals d’infermeria davant del procés de final de vida, explorar el significat de dignitat i mort digna, indagar sobre els drets humans i els principis bioètics dels pacients, i analitzar la possible vulneració dels principis bioètics i drets dels pacients en el procés de final de vida. MATERIAL I MÈTODE: Es realitza una revisió bibliogràfica i una anàlisi de la literatura científica general i específica sobre el procés de final de vida, concretament sobre la vulnerabilitat dels principis bioètics i els drets humans. S’utilitzen i analitzen fonts amb un rang temporal de 10 anys. La recerca ha estat realitzada en bases de dades de ciències de la salut com SCIELO, PUBMED i MEDLINE, MHMEDICAL; i bases de dades d’altres disciplines, en aquest cas jurídica, com NOTÍCIAS JURÍDICAS. També s’han consultat pàgines web d’associacions científiques nacionals i internacionals, revistes, diaris i Google acadèmic. Per últim, s’ha utilitzat informació aportada de llibres que es troben a la Biblioteca de les Escoles Universitàries Gimbernat del Campus de Sant Cugat del Vallès. CONCLUSIONS: És necessari impartir formació bàsica sobre atenció pal·liativa als professionals sanitaris, ja que sovint acostuma a arribar massa tard i de forma inadequada. L’enfocament actual ha de passar de ser curatiu a pal·liatiu; és a dir, la finalitat no ha de ser remetre una malaltia, sinó aconseguir el màxim benestar possible. Així doncs, s’ha de basar en les CP, on es considera i es cuida a la persona de forma holística, en les seves quatre dimensions (física, psicològica, social i espiritual). Per així, col·laborar en el procés d’aconseguir una bona mort, acceptada i amb companyia; on es respectin les decisions i desitjos dels pacients, sense vulnerar els principis bioètics (autonomia, beneficència, no-maleficència, justícia) i els drets humans; i reconèixer la mort com un procés natural i digne de viure’s. Per últim, és important la realització d’un DVA o d’un PAC, ja que aquest ajudarà als professionals a conèixer els desitjos i necessitats dels pacients, així com les seves últimes voluntats, tot respectant el principi fonamental d’autonomia. PARAULES CLAUS: Mort, Procés de Final de Vida, Cures Pal·liatives, Patiment, Agonia, Professionals sanitaris, Bioètica, Principis Bioètics, Vulnerabilitat dels Principis Bioètics, Dignitat, Vida digna, Mort digna, Drets Humans, Drets dels pacients, Vulnerabilitat dels Drets dels pacients, Autonomia, Consentiment Informat, Pla Anticipat de Cures, Document de Voluntats Anticipades, Testament Vital, Decisions Clíniques Bàsiques, Rebuig del malalt, Obstinament terapèutic, Limitació de l’actuació, Futilitat, Sedació pal·liativa, Eutanàsia, Suïcidi assistit, Comitès d’Ètica Assistencial. Currently, the death is still treated as an issue that society considers taboo. For this reason, you don’t have enough knowledge or is addressed effectively, all in violation of the principles of bioethics and rights of patients. Unfortunately, they also present difficulties are health professionals, although those who live daily with her. They aran’t ready, son’t have knowledge, attitudes and skills, because they lack training in universities and emotional education programs in the process of the end of life in the same health institutions. The professionals, only, are ready for the maintenance of life as a result of great technological advancement, and death is considered to be the failure of the medicine. OBJECTIVES: The main objective is to deepen the knowledge of the process of the end of life; as they are specific to describe the great relevance of the CP, define the role of nursing professionals in front of end of life process, explore the meaning of dignity and dignified death, probe on human rights and the principles of bioethics patients, and analyze the possible violation of bioethical principles and the rights of patients in the end of life process. MATERIAL AND METHOD: A literature review and analysis of the scoentific literature on the general ans specific process of end of life, specifically about the vulnerability of bioethical principles and human rights. Are used and analyzed sources with a temporary rank of 10 years. The research has benn carried out in the Health Sciences databases such as SCIELO, PUBMED, MEDLINE, MHMEDICAL; nd databases of other disciplines, in this case legal, as NOTÍCIAS JURÍDICAS. It is also viewed web pages of national and international scientific associations, magazines, newspapers and Google Scholar. Finally, it has been used information provided by books that ara in library of the Gimbernat University School of Sant Cugat del Vallès. CONCLUSIONS: It is necessary to provide basic training on palliative care to health professionals, as they often tend to arrive too late and improperly. The current approach has to be healing in palliative; that is to say, the aim should not be to send a disease, but to get the highest possible welfare. Thus, it must be based on the CP, which is considered and will take care of the person of holistic form, in its four dimensions (physical, psychological, social and spiritual). So, to collaborate in the process of getting a good death, accepted and company; where will respect the decisions and wishes of patients, without infringing the bioethical principles (autonomy, charity, non-maleficència, Justice) and human rights; and acknowledge the death as a natural process and worthy of living's. Finally, it is important to the realization of a DVA or a PAC, since this will help professionals to understand the wants and needs of patients as well as their last wills, while respecting the fundamental principle of autonomy. KEY WORDS: Death, Process of End of Life, Palliative Care, Suffering, Agony, Healthcare Professionals, Bioethics, Bioethical Principles, Vulnerability of Bioethical Principles, Dignity, Decent Life, Dignified Death, Human Rights, Rights of patients, Vulnerability of Patients Rights, autonomy, informed consent, Anticipated Plan of care, Advanced care Document, Testament Vital, Basic Clinical Decisions, Rejection of Sick, Therapeutic Obstinament, Limitation of the performance, Futility, Palliative Sedation, Euthanasia, Assisted Suicide, Medical Ethics committees. Grau en Infermeria

LEMS in SCLC patients is caused by an immune response against SCLC antigens, which crossreacts with similar antigens on the motor nerve terminal, impeding neuromuscular transmission and presenting with truncal and leg weakness. The diagnosis may be suggested by the presence of dry mouth; and strongly supported by the finding of diminished tendon reflexes which reappear following a sustained muscular contraction. Appropriate neurophysiological tests can confirm the diagnosis more reliably than immunological studies, although there is rapid development in this field. A new diagnosis of LEMS should prompt a careful and ongoing search for underlying SCLC, with serial thoracic CT scans. In patients with established SCLC/LEMS, neuromuscular symptoms usually improve following successful anticancer treatment, or immunosuppression. While awaiting the benefits of these strategies, and for patients in whom they are inappropriate, DAP provides useful palliation of weakness and sometimes of autonomic dysfunction. It is available at a small cost, from specialist centres, on a named patient basis. LEMS is not widely recognized, and is commonly mistaken for myopathy or neuropathy. It appears that many physicians are not surprised to find that SCLC patients are weak, and therefore do not pursue a neurological diagnosis. Those providing palliative care may be the first to consider LEMS in SCLC patients complaining of weakness, and can offer useful therapy once the diagnosis has been established.

Objectives Patients who are no longer eligible for curative treatment often suffer from multiple complaints and require a multidisciplinary treatment approach. We incorporated two pharmacists in the palliative team, one hospital pharmacist and one pharmacist who were trained as a community pharmacist. The objective of our study was to evaluate their contribution to the palliative team. Methods During 13 months, the two pharmacists participated in all regular patient reviews and rounds and were available for individual consultation by all members of the palliative team on a daily basis. Each intervention (consults at request or during the patient rounds) was logged and categorised. Key findings During the study period, 115 patients were under the care of the palliative treatment team. The pharmacists were actively involved in 107 of these (93%). Pharmacists interventions occurred in 76% of patients, with an average of 1.5 interventions per patient. The most common intervention types were giving general therapeutic advice, starting of a drug for an uncontrolled symptom and stopping a drug that was given as prophylaxis. When comparing the contribution of the hospital pharmacist and the outpatient pharmacist, their interventions overlapped with regard to starting drugs, choice of drugs and side-effect management. However, interventions on parenteral drugs or optimising the route of administration mostly came from the hospital pharmacist, whereas the outpatient pharmacist more often intervened in increasing adherence and stopping drugs. Conclusion The palliative pharmacist team adds expertise to the palliative treatment team, with an active contribution in 76% of patients.

Electrochemotherapy is a new therapeutic option for patients with locally spread melanoma. It is based on the phenomenon of reversible electroporation, i.e. a transient increase in permeability of cell membranes under the influence of an appropriately modulated electric field. This allows multiplication of toxicity of a cytostatic agent entering the tumour cell. It is highly effective, especially in the palliative treatment of cancers located in the integument of the human body (skin and subcutaneous tissue). Available literature provides a mandate both for the application of this method in the aforementioned cases as well as for further work on its development. This paper focuses on reviewing the literature concerning the use of electrochemotherapy in the treatment of melanoma.

// In-Hye Jung 1 , Sang Min Yoon 1 , Jungwon Kwak 1 , Jin-Hong Park 1 , Si Yeol Song 1 , Sang-Wook Lee 1 , Seung Do Ahn 1 , Eun Kyung Choi 1 , Jong Hoon Kim 1 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea Correspondence to: Sang Min Yoon, email: drsmyoon@amc.seoul.kr Keywords: hepatocellular carcinoma, bone metastasis, palliative treatment, radiotherapy, dose-response relationship Received: June 15, 2016 Accepted: January 16, 2017 Published: January 27, 2017 ABSTRACT We evaluated the pain and radiologic response, time to progression, and dose-response relationship after palliative radiotherapy for bone metastasis from hepatocellular carcinoma. We retrospectively reviewed the medical records of 91 patients between January 2004 and August 2012. The reviewed medical records included data on changes in pain, local tumor progression, and radiologic response evaluated via follow-up images. The radiologic response was assessed based on the Response Evaluation Criteria In Solid Tumors. The pain response was defined according to the International Bone Metastases Consensus Working Party palliative radiotherapy endpoints. Median radiation dose was 40 Gy (range, 20–66 Gy), with various fraction sizes (range, 2.0–6.0 Gy). Pain response rate was 81.4%. During the follow-up periods, radiologic local tumor progression was found in 42 patients (46.2%). The median time to progression was 14.1 months. When the patients were divided into two groups according to their radiation dose (< 55 Gy 10 vs. ≥ 55 Gy 10 ), the pain response rates of the high- and low-dose groups did not differ significantly ( p = 0.728). However, the radiologic response rate and the time to progression showed significant differences between the two groups ( p = 0.009 and p = 0.018, respectively). With dose escalation, higher radiologic response rates and a longer time to progression were achieved in patients with mass-forming bone metastases from hepatocellular carcinoma.

Cancer incidence and mortality depend on a number of factors, including age, socio-economic status and geographical location, and its prevalence is growing around the world. Most of cancer treatments include external beam radiotherapy or brachytherapy. Brachytherapy, a type of radiotherapy with energy from radionuclides inserted directly into the tumor, is increasingly used in cancer treatment. For cervical and skin cancers, it has become a standard therapy for more than 100 years as well as an important part of the treatment guidelines for other malignancies, including head and neck, skin, breast, and prostate cancers. Compared to external beam radiotherapy, brachytherapy has the potential to deliver an ablative radiation dose over a short period of time directly to the altered tissue area with the advantage of a rapid fall-off in dose, and consequently, sparing of adjacent organs. As a result, the patient is able to complete the treatment earlier, and the risks of occurrence of another cancer are lower than in conventional radiotherapy treatment. Brachytherapy has increased its use as a radical or palliative treatment, and become more advanced with the spread of pulsed-dose-rate and high-dose-rate afterloading machines; the use of new 3D/4D planning systems has additionally improved the quality of the treatment. The aim of the present study was to present short summaries of current studies on brachytherapy for the most frequently diagnosed tumors. Data presented in this manuscript should help especially young physicians or physicists to explore and introduce brachytherapy in cancer treatments.

The course of untreated localized prostate cancer after 10 years of follow-up is at large unknown. As curative treatment is usually only offered patients with a life expectancy exceeding 10 Years, the expected course of the disease if left untreated is of the utmost interest. This paper aims to describe the outcome for patients who survive for more than 10 years when treated without curative intent. The results indicate that cancer specific mortality in patients with localized prostate cancer increases steadily over time and is approximately 50% after 15 years. This is a much higher figure than in reported series on radical prostatectomy. Even if many deaths occur at an old age, prostate cancer death is shown to be associated with a significant morbidity, need for palliative treatment, hospital care and cost. Preventing prostate cancer death is therefore not only a matter of saving year of life but also to prevent suffering caused by the disease. Modern diagnostic tools, such as prostate specific antigen, seem to detect clinically significant cancers in the vast majority of patients. Over diagnosis seems to be uncommon if diagnostic procedures are restricted to patients with a long life expectancy. Localized prostate cancer is a slow-growing but progressive neoplastic disease. When diagnosed in a man with a longer life expectancy it should be handled as such.

Background: Lymphocytes were reported to play a significant part in host anticancer immune responses and influence tumour prognosis. Few studies have focused on the prognostic values of aspartate aminotransferase (AST) to lymphocyte ratio (ALRI), aspartate aminotransferase to platelet count ratio index (APRI) and systemic immune-inflammation index (SII) in hepatocellular carcinoma (HCC) treated with palliative treatments. Methods: Five hundred and ninety-eight HCC patients treated with palliative therapies were retrospectively analysed. We randomly assigned patients into the training cohort (429 patients) and the validation cohort I (169 patients). Receiver operating characteristic (ROC) curves were used to identify the best cut-off values for the ALRI, APRI and SII in the training cohort and the values were further validated in the validation cohort I. Correlations between ALRI and other clinicopathological factors were also analysed. A prognostic nomogram including ALRI was established. We validated the prognostic value of the ALRI, SII and APRI with two independent cohorts, the validation cohort II of 82 HCC patients treated with TACE and the validation cohort III of 150 HCC patients treated with curative resection. In the training cohort and all the validation cohorts, univariate analyses by the method of Kaplan-Meier and multivariate analysis by Cox proportional hazards regression model were carried out to identify the independent prognostic factors. Results: The threshold values of ALRI, APRI and SII were 86.3, 1.37 and 376.4 respectively identified by ROC curve analysis in the training cohort. Correlation analysis showed that ALRI>86.3 was greatly associated with higher rates of Child-Pugh B&C, portal vein tumor thrombosis (PVTT) and ascites (P < 0.05). Correspondingly, ALRI level of HCC patients with Child-Pugh B&C, PVTT and ascites was evidently higher than that of HCC patients with Child-Pugh A, without PVTT and without ascites (P < 0.001). In the training cohort and the validation cohort I, II, III, the OS of patients with ALRI >86.3 was obviously shorter than patients with ALRI ≤86.3 (P

Pancreatic cancer is one of the most aggressive and deadly malignancies. Despite better understanding of its biology and pathogenesis, contemporary treatment regimens are still insufficient. Along with the introduction of new treatment agents and combination therapy, the response rates are increasing, but these scores do not go with overall survival, and results are frequently conflicting. Therefore, contemporary medicine faces the challenge of expanding the knowledge base and practice on all grounds - pathology, factor risk, diagnosis, and finally surgical and palliative treatment of this disease. This paper provides a review of current adjuvant and neoadjuvant regimens and the role of experimental therapies in pancreatic ductal adenocarcinoma.

Advanced squamous cell carcinoma of the oesophagus and gastroesophageal junction usually requires palliative treatment, and the method of choice is stenting. There are several types of stents currently available, including: self-expandable metallic stents (fully or partially covered); self-expandable plastic stents; biodegradable stents. Each of the mentioned stents has its advantages and limitations, and requires a proper, patient-tailored selection. Due to the close anatomical relationship between the oesophagus and bronchial tree, some patients may require bilateral stenting. Oesophageal stenting may not only be considered as a palliative procedure, but can also be implemented to alleviate dysphagia during preoperative chemotherapy and/or radiotherapy.

WOS: 000391457100008, PubMed ID: 27780164, Objective: To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms. Subjects and Methods: This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the. 2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis. Results: The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled. Conclusion: In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey. (C) 2016 S. Karger AG, Basel

Intraluminal brachytherapy plays an important role in the treatment of oesophageal tumours. This article aims to define this role in the curative as well as in the palliative treatment settings drawing on data from the literature, and also emphasizing its potential for harm when used inexpertly. It also provides a short introduction to practical aspects of the treatment procedure and treatment planning.

Assessment of parenchymal blood volume (PBV) of primary and secondary pulmonary malignancies by using a C-arm CT, regarding its role in detecting early functional response to transpulmonary chemoembolization (TPCE) and clinical practicability.21 patients with a mean age of 56.77 years, who were assigned to TPCE during their palliative treatment, were included. PBV and the diameter of tumours were analyzed. PBV maps were calculated from three-dimensional CT-angiographic (3D-CTA) data sets. Imaging was performed on a flat detector, C-arm CT. Groups of response were classified according to the criteria of the response evaluation criteria in solid tumours. Statistically significant differences were determined and Pearson's regression analysis correlated PBV and diameter as parameters of response to treatment.During 4.91 sessions, median diameter increased 18.18% (p 0.05) and PBV reduced 39.62% (p 0.05). Functional and imaging response per tumour was statistical significantly different (p ≤ 0.05). Correlation coefficient was r = 0.058. 2/41 tumours showed partial response; 31/41 tumours showed stable disease; and 8/41 tumours showed progressive disease. The highest pre-treatment PBV values were measured in decreasing tumours (206.93 ml l(-1)), and the lowest values were measured in increasing tumours (60.17 ml l(-1); p 0.05). The lowest values were also measured in lung cancer (53.02 ml l(-1)) that was significantly different to uterine leiomyosarcoma (103.31 ml l(-1)) and renal cell cancer (113.14 ml l(-1); p ≤ 0.05).Assessment of PBV maps by using 3D-CTA image data is feasible in the clinical routine. PBV shows a stronger response to TPCE treatment than measurement in diameter and should be considered as a response parameter for early detection.Assessment of PBV using C-arm CT during TPCE is a feasible technique. Assessment of PBV might be useful in assessing response to treatment.

Introduction: Pancreatic tumours are a crucial medical issue. The majority of patients report sick in the late stage of carcinoma clinical advancement, which considerably limits the possibility of surgical treatment. Pancreatic cancer patients with no other alternative but palliative treatment constitute a large group. Aim: To assess pain intensity levels and quality of life of pancreatic cancer patients after videothoracoscopic splanchnicectomy. Material and methods: Between 2001 January and 2010 November in the Department of Thorax, General Surgery and Oncology of the Medical University of Lodz 262 patients with pancreatic tumours were hospitalized. In 121 cases grade 3 and grade 4 tumours were observed. Hundred and twenty-one videothoracoscopic procedures of sympathetic trunk and ganglion excision were performed in 89 patients. Results: Before the procedure the pain intensity level according to VAS was 5.66 (3.9-7.2; SD 1.24) in the trial group and 5.46 (4.1-7.1; SD 1.15) in the control group. The quality of life average assessment in both groups did not differ statistically (p = 1.07) and was 46.3 (32-66; SD 0.92) in patients before the operation and in the control group 50.3 (41-63; SD 0.75). On the 7 th postoperative day the pain intensity on average was 2.33 (1.2-3.9; SD 0.78) and 4.57 (3.6-5.5; SD 0.69) respectively. One week after the procedure the quality of patients’ life was estimated at 64.1 (39-83; SD 1.38) and in the control group at 52.2 (42-65; SD 0.71); the differences are significant (p < 0.05). Thirty days after the procedure 12 patients did not t ake any painkillers (13.5%), and in the others a considerable decrease of the taken drugs was observed. On average, the pain intensity was estimated at 1.78 (0.6-3.6; SD 0.68). The quality of life, on the other hand, improved considerably in relation to the state prior to the procedure, but increased insignificantly in relation to the state on the 7 th postoperative day to 70.9 (52-88; SD 1.14). Conclusions: Splanchnicectomy is a safe method of cancer pain treatment in patients with advanced pancreatic tumours. Videothoracoscopic excision of visceral nerve thoracic section contributes to the statistically significant decrease of cancer pain intensity and considerably improves the quality of patients’ lives.

Preparation of site of radiation delivery is an important process in radiation treatment planning and plays a crucial role during a course of radiotherapy to achieve reproducibility of set-up and accuracy of treatment delivery. The preparation of treatment area is done by markings of field center, field edge or other reference point of planned field. Both non-invasive (marker pen, henna) and invasive methods (tattoo) are available for marking with limitations of each. Tattoo with a needle pricked at angle of 30° to 1-2 mm depth to create tattoo 2-3 mm diameter in size is an ideal procedure. Visibility, permanent nature, social-religious belief, and mobility of skin are one of the main concerns about tattoo. Tattoo removal can be done performed if desirable by patients by various modern ways, which will be esthetically available. Dermabrasion, cryotherapy, surgery, QSRL (Q-switched ruby laser) are common methods of tattoo removal. Esthetic dissatisfaction, allergy, dermatoses, keloids, infection, fanning/fading of tattoo are associated problems. In IMRT and IGRT treatment, delivery dependence on tattoo in reduced and use of surrogate markers including particularly for bony set-up and implanted markers (e.g. gold seeds) for tumor localization and treatment verification is increasing. However, these are complex procedures and require an expertise. Ease of set-up and less time required for tattooing are one of the main advantages of tattoo as compared to external or internal marker set-up. Tattoo still remains a crucial method of positioning, especially in developing countries and in palliative treatment settings.

Introduction: The aim of this study was to find out if Y-90 could form a stabile complex with meso-2,3-dimercaptosuccinic acid (DMSA) and if Y-90-DMSA may have potential for tumor therapy in the palliative treatment of bone metastases. Methods: The preparing of Y-90-DMSA was carried out by varying experimental parameters, such as ligand concentration, pH, time, and temperature of the reaction, in order to maximize the labeling yield. Analysis of the complexes enclosed the radiochemical quality control (instant thin-layer chromatography, paper chromatography, and high-performance liquid chromatography), determination of pharmacokinetical parameters as well as biodistrbution study in health male Wistar rats. In vitro stability of the complexes was tested too. Results: Y-90-DMSA could be prepared in high yields ( GT 95%) under optimized conditions of reaction. Stability studies in saline and human serum in vitro showed no significant release of activity from the ligand over 24 hours and 10 days, respectively. The preliminary biodistribution results in rat at 2 hours indicated that Y-90-DMSA, at both pH levels, was significantly retained into bone. The uptake in the kidneys was lower for Y-90-DMSA at pH 8.0 then at pH 3.0. The retention in other organs was negligible. Conclusions: Y-90 complexes could be made with ease with DMSA. Y-90-DMSA was obtained in good yield and was found to be very stable. A promising biodistribution result of this complex pointed at potential in the palliative treatment of bone metastases.

In the examination of the several modes of treating urinary concretions, the question of their indications and contraindications is worthy of special attention, since adherence to a single procedure belongs to the medicine of a remote past. Modern medicine demands that preventive measures be taken in threatened calculous affection at the first sign of coming of hyperlithaemia; that when hyperlithuria exists, medicinal treatment be resorted to; that when calculi are formed, mechanical means be promptly applied for their removal; that when the calculi have been removed, the cure be accomplished by suitable after-treatment; and that when mechanical treatment is contraindicated, a judicious course of palliative treatment be adopted. Therefore the treatment of urinary concretions is now arranged into the preventive, medicinal, palliative, mechanical and post-mechanical treatment. The preventive treatment embraces hygienic, medicinal and mechanical means. The needed hygienic observances comprise diet, exercise, ablutions and raiment. The medicinal means of prevention

Background The European Society for Medical Oncology (ESMO) 2021 conference provided a high number of randomized phase III trial reports, many of which were claimed to be practice changing. Given the short time available for conference presentations, results and conclusions tend to have greatest priority with less time remaining for study background and study methodology. Purpose On behalf of the ESMO Practicing Oncologists Working Group, 11 potentially practice-changing reports were selected and screened for three main questions: (i) Did the investigators provide sufficient details with regard to Patients and Methods to make the results comprehensible? (ii) Were there any reasons to consider bias? (iii) To which extent did the results presented translate to clinical benefit? Results In 2 out of 11 trials, the study design presented differed considerably from the study design described at ClinicalTrials.gov. Allocation concealment was not carried out in 6 out of 11 trials. In none of the trials reporting progression-free survival was informative censoring considered an issue. In none of the trials reporting overall survival was desirable crossover considered an issue. Defined trial outcome measures depicted at ClinicalTrials.gov, which could boost or weaken the ESMO-Magnitude of Clinical Benefit Scale score, were often lacking in the presentation. Study success was claimed in a heterogeneous manner, which was often not clearly linked to overall clinical benefit. Conclusion ESMO conference presentations can inform the scientific community and catalyze further research but cannot replace the full papers in peer-reviewed journals, which are needed to estimate the thoroughness of the results, the overall impact on clinical benefit and the consequences for future treatment guidelines., Highlights • An oncological peer-reviewed paper is lengthy and well structured. • An oncological conference presentation is short and less structured, but its impact can be high. • ESMO 2021 conference encompassed many possibly practice-shaping phase III trial reports. • A survey of 11 selected reports to ascertain if the conclusions made were adequately underlined by the provided information.

Background/aim Electrochemotherapy (ECT) is a predominately palliative treatment for cutaneous metastases where an electric field is used to increase the intracellular accumulation of a chemotherapeutic drug (bleomycin or cisplatin). ECT induces a strong anti-vascular effect and endothelial cells seem especially vulnerable. To date, almost no neurological and/or cerebrovascular complications after ECT treatment have been published. In this paper two such cases are reported. Case report A seizure in a man treated with ECT for a basal cell carcinoma in the temporal region and a fatal ischemic stroke in a woman treated for cutaneous metastases in the neck are reported. In both cases a causal relationship to ECT treatment was strongly suspected. Conclusion ECT in the head and neck can potentially cause severe neurological complications. Ultrasound is recommended for ECT treatment in the neck.

Background: Palliative care and dignity at patients’ end-of-life are nursing competences. Many therapies and guides have been developed to assure the preservation of dignity in patients with life-threatening illnesses and in the last stages of these ones. In 2002, Harvey Max Chochinov developed the Dignity Therapy with the aim of promoting end-of-life dignity. Aim: Analyse the effectiveness of Dignity Therapy on the improvement of patients with advanced life-threatening diseases and establish if its use in the clinical practice should be recommended. The specific objectives are: analyse the effectiveness of Dignity Therapy to improve psychological distress, anxiety, depression and psychological fatigue; analyse its effectiveness in improving physical distress and symptomatology; know the effectiveness of Dignity Therapy to increase the palliative patient’s sense of dignity; analyse the benefits of Dignity therapy in the treatment of psychosocial and existential distress; and assess the feasibility of Dignity Therapy focusing on both patients and family relatives acceptability and satisfaction. Methodology: Conduction of a bibliographic review. PUBMED, COCHRANE, CINAHL and CUIDEN databases were queried during the first half month of March 2019. The selection of articles was limited to the use of Dignity Therapy in adult patients admitted to palliative care units with the sufficient physical and mental capacity to undergo the intervention. Data extracted was synthesised and analysed following the study objectives. Results: Fourteen papers encountered the selection criteria and were assessed for eligibility. The results obtained demonstrate that the Dignity Therapy is an effective instrument for the treatment and improvement of patients with life-limiting illnesses especially in the last stages of it. Therefore, its use in palliative care is recommended. Results on psychological distress lead to controversial conclusions. Four studies suggested benefits on physical distress. The overall light turns out to be positive in terms of sense of dignity, psychosocial distress and existential distress. Finally, in terms of feasibility, both patient and family’s opinion in relation to acceptability and satisfaction have been found to be positive. Conclusion: The results found throughout this review conclude firmly and affirm Dignity Therapy’s effectiveness in terms of patients’ dignity and consequently overall status. In palliative care settings, where de defence and preservation of patients’ dignity is an undeniable obligation, patients could clearly benefit from Dignity Therapy. Dignity Therapy has demonstrate to be a useful instrument for patients to solve, close or clear out their personal believes and questionable issues before leaving. This paper emerges a positive light for future research and the application of the Dignity Therapy in palliative care settings

Liver metastases development in colon rectal cancer has a strong impact on patient overall survival, with a 5-years survival of 5% with palliative treatment. Surgical resection combined with pharmacological treatment can achieve a 5-year overall survival of 31–58%. However, in only 20% of patients with colon rectal liver metastases (CRLM) liver resection is feasible. In highly selected patients, recent trials and studies proved that liver transplantation for non-resectable CRLM is a surgical option with an excellent long term overall survival. The aim of this paper is to review the indications and outcome of liver transplantation for CRLMs, with a special focus on the immunosopressive therapy and the management of local and extra hepatic recurrence after liver transplantation.

Introduction. Synchronous metastases of gastric cancer to the liver occur in 3–14% of patients with this cancer, and metachronous lesions in 37% of patients after radical gastrectomy. Liver resections due to metastases of gastric carcinomas represent only 5–9% of resections due to metastases other than colorectal cancer. Until recently, patients with gastric carcinoma metastases to the liver were classified in the IV stage of cancer and the therapy was limited to chemotherapy or palliative treatment only. Material and methods. The paper presents a current review of literature and the authors’ own experience with liver resection due to gastric cancer metastases into this organ. During 34 months, 488 patients with liver metastases were treated in the Department of General, Transplant and Liver Surgery, of the Medical University of Warsaw, in whom 426 surgical procedures were performed (87.3%). The types of surgical procedures are as follows: minor liver resections in 204 patients (47.9%), hemihepatectomies in 102 patients (23.9%), thermoablations in 86 patients (20.2%) and laparotomies in 34 patients (8.0%). Among patients treated for liver metastases there were 4 patients with metastases from gastric cancer (0.8%), which constituted 1% of patients operated on, but 6.8% of patients with liver metastases from organs other than colorectal cancer. The postoperative course and direct results in all patients operated because of gastric cancer metastases into the liver were very good. Conclusions. In some patients (single metachronous metastasis, no extrahepatic lesions, no peritoneal lesions, with subsequent chemotherapy) liver resection due to metastases from gastric cancer provides a chance for a longer survival.

The efficiency of electroporation (EP) has made it a widely used therapeutic procedure to transfer cell killing substances effectively to the target site. A lot of researches are being done on EP-based cancer treatment techniques. Electrochemotherapy (ECT) is the first EP-based application in the field of drug administration. ECT is a local and nonthermal treatment of cancer that combines the use of a medical device with pharmaceutical agents to obtain local tumor control in solid cancers. It involves the application of eight, 100µs, pulses at 1 or 5000 Hz frequency and specified electric field (V/cm) with a median duration of 25 minutes. The efficacy of chemotherapeutic drugs increases by applying short and intense electrical pulses. Several clinical studies proposed ECT as a safe and complementary curative or palliative treatment option (curative intent of 50% to 63% in the treatment of Basal Cell Carcinoma (BCC)) to treat a number of solid tumors and skin malignancies, which are not suitable for conventional treatments. It is used currently for treatment of cutaneous and subcutaneous lesions, without consideration of their histology. On the contrary, it is also becoming a practical method for treatment of internal, deep-seated tumors and tissues. A review of this method, needed instruments, alternative image-guided procedures (IGP) approaches, and future perspectives and recommendations are discussed in this paper.

Objectives: Pain appearance is one the most common complication of spastic hip disease in children with cerebral palsy (CP). It determines child and caregiver quality of life and life priorities. Reconstruction hip surgery should be considered as a treatment of choice. Some clinical conditions give the inability to perform such a procedure. In our paper, we would like to present four palliative methods of spastic hip dislocation treatment in children with CP.Material: We analyzed four groups of patients treated because of hip pain. Inclusion criteria were pain appearance (visual analog scale-11 or numeric rating scale-11) and hip joint dislocation (migration percentage >80%). All patients were admitted to our department between 2008 and 2018. In the first group, patients were treated only by steroid injections to hip joints; in the second group, patients were recruits after hip interposition arthroplasty with shoulder spacer; in the third group, they were patients after valgus subtrochanteric osteotomy (Schanz); and in the fourth group, these were patients after proximal femoral resection (Castle procedure). The minimal follow-up time was 2 years. The first group consisted of 15 patients (15 hips) with a mean age of 15.5 (8–17) years; the second group, 20 patients (24 hips) with a mean age of 14.2 (9–22.6) years; the third group, 22 patients (24 hips) with a mean age of 13.5 (7–20.5) years; and the fourth group, 10 patients (15 hips) with a mean age of 12.9 (7–17.6) years.Methods: Radiological evaluation was based on a standardized anteroposterior X-ray of the hip joints. Pain severity before surgery and at the last follow-up time was measured by visual analog scale-11. Parents or caregivers were asked about their child's pain during sitting, perineal care, and rest. During the visit, all caregivers were asked about treatment satisfaction (no 0 to max 10) and if they would decide again for the same surgery.Results: In all groups of patients, we observed a decrease in pain complaints. The observed reduction of pain in the first group was from 7.88 (4–10) to 3.08 (0–8) (p = 0.05), but results of injection were observed only for 4 months (2–8), and it has to be repeated (average: two times). In the second group, level of pain was reduced from 4.93 (1–10) to 0.93 (0–5) (p < 0.001); in the third group, from 6.22 (3–10) to 0.59 (0–6) (p < 0.001); and in the fourth group, pain reduces from 5.43 (2–10) to 2.13 (0–5) (p < 0.001). Observed changes concerned mostly sitting position and perineal care. The complication rate was in the second group, 6 of 24 cases of extraarticular ossification; in the third group, 2 of 24 cases with extraarticular ossification, two cases of revision surgery. In the fourth group, two cases needed another femoral resection. In the first group, five patients died during follow-up time, so they were excluded from the study. In the steroid injection group, parents' treatment evaluation was 6.83 (0–10), and only in three cases that they would resign from the treatment. In the hip interposition arthroplasty group, caregivers' evaluation was 7.41 (0–10), and in five cases, parents did not accept the surgery. In the Schanz osteotomy group, parents' evaluation was 5.9 (0–10), and in eight cases, caregivers would not repeat surgery. In the proximal femoral resection group, satisfaction was the highest, 8.3 (3–10), and only two parents would not decide for surgery again.Conclusion: All procedures can be considered as palliative treatment options for pain complain in a spastic hip joint dislocation in children with CP. Steroid injections to the hip joint need to be repeated, and with the follow-up time, it becomes less effective. Steroid injection seems to be the treatment of choice for patients with general anesthesia contraindications. Interposition arthroplasty of the hip joint seems to give better final results, but the highest parents' satisfaction surprisingly was observed in the proximal femoral resection group, but differences were not statistically significant.

El objetivo del articulo es analizar la forma en que profesionales de cuidados paliativos -disciplina médica especializada en la atención de pacientes con enfermedades terminales-definen, proyectan y comunican el estatuto de "terminalidad" de pacientes con enfermedades oncológicas avanzadas. El articulo se basa en observaciones etnográficas y en entrevistas a profesionales de un servicio de cuidados paliativos de la ciudad de Buenos Aires. Se analizan las tareas de definición y proyección del proceso de morir y la forma en que los profesionales manejan la información sobre el pronóstico de la enfermedad. El análisis de estas prácticas evidencia la forma en que el "final de la vida" es construido en un doble sentido: como una etapa de preparación psicológica para pacientes y familiares -y, por ende, en un objeto de intervención profesional-, y como un proceso gradual que culmina en la muerte. The aim of this paper is to analyze how professionals of palliative care -a branch of medicine specialized in the care of dying patients- define, plan and disclose the "terminal" status of patients with advanced cancer diseases. The article is based on ethnographic observations and interviews with professionals in a palliative care service in the Buenos Aires city. The paper analyzes the tasks of definition and projection of the dying process and the way professionals disclose information about the dying prognosis. The analysis of these practices shows how the "end of life" is constructed in two ways: as a stage of psychological preparation for patients and families (and therefore an object of professional intervention), and as gradual process culminating in death. O artigo aborda a maneira em que os profissionais de cuidados paliativos -disciplina médica especializada no tratamento de doentes terminais- definen, projetan e comunican o estatuto de "terminalidade" de pacientes com doenças oncológicas avançadas. A partir de observações etnográficas e entrevistas com profissionais da saúde de um serviço de cuidados paliativos da cidade de Buenos Aires, o artigo analisa as tarefas de definição e projeção do processo de morrer e do manejo das informações sobre o prognóstico da doença por parte dos profissionais. A análise dessas práticas mostra como o "final da vida" é construído em um duplo sentido: como um estágio de preparação psicológica para pacientes e familiares (e, portanto, como um objeto de intervenção profissional), e como um processo gradual que culmina com a morte.

Endoscopic placement of biliary stent is a well-established palliative treatment for biliary obstruction. However, duodenobiliary reflux after stent placement has been a common problem which may lead to dreadful complications. This paper designed a novel anti-reflux biliary stent with a cone spiral valve. Fluid-Structure Interaction (FSI) simulations were established to evaluate the efficiency of the anti-reflux stent comparing with a clinically applied standard stent. According to the stress distribution of the valve, the fatigue performance in the stress concentration area was analyzed. The results show that when the antegrade flow through the valve, the cone spiral valve could stretch and open to realize adequate drainage under the normal physiological pressure of biliary tract; When the duodenal reflux through the valve, the valve would be compressed and close with a result of nearly zero at the outlet flow rate. Furthermore, the anti-reflux stent achieved improved radial mechanical performance with 2.7 times higher radial stiffness than standard stent. Finite element analysis (FEA) also indicates that compared with the standard stent, the addition of the anti-reflux valve had little negative effect on flexibility of the stent. Fatigue analysis results showed that the valve was reliable. This research provides the new stent with a cone spiral valve and proves that it is technically feasible and effective for preventing the duodenobiliary reflux while ensuring the antegrade bile flow without compromising the other biomechanical performances.

Màster Oficial de Psicogerontologia, Facultat de Psicologia, Universitat de Barcelona, curs: 2019-2020, Tutora: Rosa Baeza Lanuza, Introducción: Encontrarse con la muerte es algo inseparable para las auxiliares de geriatría, dado que va asociado al desarrollo de su profesión. Su implicación en el cuidado de los residentes en situación de últimos días representa una experiencia emocional muy impactante e intensa bajo unas condiciones laborales donde escasea el tiempo y el personal y debiendo contener las propias emociones. Todos estos factores predisponen y generan síntomas del síndrome del cuidador quemado en el equipo sanitario. Objetivo: Se propone una intervención psicoeducativa desde la perspectiva de la psicología en el campo de los cuidados paliativos. El programa tiene como objetivo dotar a las auxiliares de geriatría de conocimientos y habilidades sobre el proceso de morir y estrategias para detectar y manejar sus propias emociones. Metodología: Se plantea una intervención de modalidad grupal, de 10 sesiones con una duración de 2 horas y periodicidad semanal. La estructura de cada sesión incluye una primera parte de contenidos teóricos en formatos audiovisuales y/o impresos en papel y una segunda parte donde se realizarán dinámicas y ejercicios que servirán para afianzar y aplicar lo aprendido. Resultados: Se espera que, al finalizar el programa de intervención, los participantes logren varios objetivos; por un lado, que los participantes amplíen sus competencias sobre el acompañamiento durante el proceso de morir y la agonía, y por el otro, que aumenten y desarrollen herramientas y estrategias para la detección y el manejo emocional. Conclusiones: El programa Cuidar cuando no es posible Curar espera llenar un vacío en la formación de las auxiliares de gerontología, un colectivo muchas veces olvidado. Además, este proyecto aspira a ser precursor de una nueva concepción de los cuidados en situación de últimos días sirviendo como ejemplo para psicogerontólogos y profesionales de la salud interesados en humanizar las tareas de cuidado en las personas mayores al final de la vida y dando voz a un acontecimiento vital como es la muerte., Introduction: Encountering death is inseparable for geriatric assistants, since it is associated with the development of their profession, Her involvement in care residents at the end of life, represents a very shocking and intense emotional experience under working conditions where time and staff are scarce and her own emotions must be contained. All of these factors lead professional caregivers down the path of burnout. Objective: A psychoeducational intervention is proposed from the perspective of psychology in the field of palliative care. The intervention aims to provide gerontology assistants with knowledge about the dying process and skills to detect and manage their emotions. Methods: A group modality intervention of 10 sessions with a duration of 2 hours and weekly periodicity is proposed. The structure of each session includes a first part of theoretical contents in audiovisual formats and/or printed on paper and a second part where activities and tasks will be carried out and will serve to strengthen and apply what has been learning. Results: At the end of the program is it expected that participants accomplish a set of goals. On the one hand, it is expected that they will expand their skills about the accompaniment during the process of dying and the agony, and on the other, they will increase and develop tools and strategies for detection and emotional management. Conclusions: The program Cuidar cuando no es posible Curar looks forward to filling and essential gap in the training of gerontology assistants, a group that is often forgotten. The program aspires to be a precursor of a new conception of care in last-day situations, serving as an example for psychogerontologists and health care professionals interested in humanizing care tasks in the elderly at the end of life and giving voice to a vital event such as death.

SummaryIn the early days of transplantation most organs were procured from donors after circulatory death. Later on, as a result of a wide acceptance of the concept and diagnosis criteria of brain death, donation from donors after brain death replaced donation after circulatory death, which finally became the standard (except for several countries). Renewed interest in donation after circulatory death started in the 1990s, resulting from the persistent organ shortage from donation after brain death and the need to bridge the gap between the need for transplantation and the number of available organs. Presently, in many countries donation after circulatory death accounts for even up to 30-40% of organ procurement activity. However, the lack of unified guidelines on donation after circulatory death has challenged the medical, ethical, legal and transplant community on several grounds. Issues concern problems like end-of-life palliative treatment and its withdrawal phase, or the definition of circulatory death and its irreversibility. Both legislation on and the practice of donation after circulatory death differ significantly in different countries. In parallel with the development of this type of donation, new terms, criteria and recommendations have arisen, resulting in constantly changing and unceasingly emerging terms and definitions used in the literature, at scientific conferences and symposiums, or between countries and institutions. A need has emerged for a consensus and clear guidelines to deal with the ethical, legal, organizational, and technical challenges. Te compilation of a classification of donors after circulatory death has been envisaged to serve this purpose. This paper presents and discusses different classifications of donors and donation after circulatory death.

Nuclear theranostics functions as a bridge which connects targeted diagnosis to targeted therapy, just like Turkey functions as a geographical bridge which connects Asia to Europe. This unique geographical site of the country plays an important role with regard to introduction of novel scientific and technologic improvements, which originate from one continent to another, in the era of accelerated information. The first nuclear medicine practice in Turkey started in the beginning of 1950s with the first radioiodine treatment, which actually was a debut for nuclear theranostics in Turkey, years before many other countries in the world. For the time being, along with radioiodine treatment, many other theranostic applications such as I-131 MIBG treatment, Lu-177/Y-90 DOTA peptide treatment, Lu-177 PSMA treatment, Y-90 microsphere treatment, and bone palliative treatment are being performed in many centers countrywide. As science and technology improves, novel theranostic applications are eagerly awaited to be introduced in near future. This paper summarizes the story of nuclear theranostics in Turkey and aims to give an overview on the current status of theranostic applications in Turkey.

Peritoneal carcinomatosis (PC) from colorectal cancer (CRC) is a disease with a poor prognosis, often thought to be a terminal illness with no hope except for palliative treatment. New therapeutic modalities combining cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have shown favorable outcomes and may provide a significant survival benefit in a selected group of patients. The main rational for CRS is to remove all visible tumor burden to allow for the chemotherapeutic agent (HIPEC) to eradicate any microscopic residual disease. The Amsterdam statement formulated at the 9th International Congress on Peritoneal Surface Malignancies supports the use of CRS with HIPEC as a standard of care for selected patients with small-to-moderate volume PC from CRC. Selecting appropriate patients who would benefit from CRS/ HIPEC is paramount to derive the maximum oncological outcomes while minimizing the risks of postoperative complications and mortality. In this paper, we will review the role for CRS/HIPEC in the management of PC from CRC.

Therapeutic use of cannabis as a palliative treatment for certain medical conditions has been hotly debated in Britain in recent months. The weight of public opinion is behind a reform of the law; reform would legalise the possession and use of cannabis for therapeutic ends. This paper will endorse that argument by concentrating on a central contradiction within the law: while the law meticulously categorises the drugs which it regulates and prohibits, it is unwilling divide users of particular drugs into recreational and therapeutic groupings. This paper argues that the traditional arguments against making such a change in the law are unable to hold water, particularly when viewed in comparison with developments in Germany. We will also propose that the medical practitioner fulfil an existing traditional function as gate keeper in order to ensure supply and quality are both kept to a certain minimum standard. This policy will serve the ends of patients for whom this treatment is effective and cheap and which is justified in the public interest.

We read with great interest the papers by Perrone et al and Corrado et al evaluating the role of electrochemotherapy with intravenous infusion of bleomycin as a palliative treatment for vaginal and vulvar cancers not amenable to standard treatments.[1 2][1] In our experience, both skin and mucosal

Background: Patients who play musical instruments (especially wind and stringed instruments) and vocalists are prone to particular types of orofacial problems. Some problems are caused by playing and some are the result of dental treatment. This paper proposes to give an insight into these problems and practical guidance to general practice dentists. Method: Information in this paper is gathered from studies published in dental, music and occupational health journals, and from discussions with career musicians and music teachers. Results: Orthodontic problems, soft tissue trauma, focal dystonia, denture retention, herpes labialis, dry mouth and temporomandibular joint (TMJ) disorders were identified as orofacial problems of career musicians. Options available for prevention and palliative treatment as well as instrument selection are suggested to overcome these problems. Conclusions: Career musicians express reluctance to attend dentists who are not sensitive to their specific needs. General practitioner dentists who understand how the instruments impact on the orofacial structures and are aware of potential problems faced by musicians are able to offer preventive advice and supportive treatment to these patients, especially those in the early stages of their career.

Aim To describe 20 years of experience with corpus callosotomy at Great Ormond Street Hospital for Children, London and the Children's Hospital at Westmead, Sydney. Method Records of patients who underwent corpus callosotomy between January 1995 and December 2015 were reviewed. Complications of surgery and changes in seizure type and frequency, injuries, and use of antiepileptic drugs were recorded. Drop attacks were analysed using Kaplan–Meier event-free survival curves. Multivariable regression analysis was used to assess the effect of clinical characteristics on outcome at last follow-up. Results Inclusion criteria were met for 55 patients younger than 18 years of age. Median follow-up length was 36 months. At the last follow-up, 26 out of 55 patients (47%) had rare or no drop attacks. In those without a good outcome at final follow-up, 26 out of 29 (90%) had drop attacks return within 12 months of surgery. There were no preoperative predictors of developing drop attacks postoperatively. The median number of antiepileptic drugs significantly reduced from three to two. Transient neurological complications were experienced by 11 out of 55 patients (20%) and 6 out of 55 patients had surgical complications (11%). Interpretation Corpus callosotomy is a well-tolerated procedure that is effective at reducing the severity of drop attacks in paediatric patients. Drop attacks that do return are likely to do so within 12 months and the number of antiepileptic drugs can be significantly reduced. What this paper adds Corpus callosotomy is an effective palliative treatment and well tolerated in children. Good outcomes for the first 12 months after surgery were likely to continue. The number of antiepileptic drugs can be significantly reduced after corpus callosotomy. Patients with fewer than three types of seizure had better outcomes. There were fewer injuries from drop attacks after surgery.

Treballs Finals de Grau Antropologia Social i Cultural, Facultat de Geografia i Història, Universitat de Barcelona, Curs: 2016-2017, Tutor: Mariona Rosés Tubau, El present article tracta d’il·lustrar les maneres en què la musicoteràpia pot ajudar als malalts terminals de la unitat de pal·liatius del Centre-Fòrum Hospital del Mar. La recerca vol mostrar la importància de la dimensió emocional i comunicativa que envolta tota pràctica musical, imprescindible per donar peu a la socialització entre els presents durant les sessions de la teràpia. Aquestes pràctiques permeten elevar la categoria del pacient a la de protagonista del moment vital en el qual es troba. Sense aquest tipus de teràpies, que busquen fer possible la comunicació entre els participants d’aquest procés, el paper del malalt terminal quedaria relegat a un segon pla esperant la mort de forma passiva. En front de la incapacitat d’oferir ajuda als qui estan morint, de mostrar afecte en el moment del comiat, trobem alternatives com la musicoteràpia.

This chapter shows, how the notion of “euthanasia medica” and the belief that it was the physician’s task to provide a “good” death resonated more and more in contemporary medical culture and reached a climax in the late eighteenth and early nineteenth century. Numerous authors devoted chapters or entire books to the topic, detailing how torments of dying patients could be alleviated and their particular needs satisfied. This went along with widespread criticism of futile therapeutic zeal that risked leading to a “kako-” or “dysthanasia”, to a bad death rather than to a good one. The second part of the paper traces how this widespread appreciation of palliative medicine rapidly receded into the background from about 1850 onwards, due to a growing – and in retrospect largely unfounded − belief in the virtually unlimited possibilities of modern medicine.

Oesophageal cancer is the ninth leading cause of malignant cancer death and its prognosis remains poor, ranking as the sixth most frequent cause of death in the world. This research work aims to adopt an Auxetic (rotating-squares) geometry device, that had previously been examined theoretically and analysed by Grima and Evans (J Mater Sci Lett 19(17):1563-1565, 2000), to produce a novel Auxetic oesophageal stent and stent-grafts relevant to the palliative treatment of oesophageal cancer and also for the prevention of dysphagia. This paper discusses the manufacture of a small diameter Auxetic oesophageal stent and stent-graft. The oral deployment of such an Auxetic stent would be simplest if a commercial balloon dilatational catheter was used as this obviates the need for an expensive dedicated delivery system. A novel manufacturing route was employed in this research to develop both Auxetic films and Auxetic oesophageal stents, which ranged from conventional subtractive techniques to a new additive manufacturing method. Polyurethane was selected as a material for the fabrication of Auxetic films and Auxetic oesophageal stents because of its good biocompatibility and non-toxicological properties. The Auxetic films were later used for the fabrication of seamed Auxetic oesophageal stents. The flexible polyurethane tubular grafts were also attached to the inner luminal side of the seamless Auxetic oesophageal stents, in order to prevent tumour in-growth. Scanning electron microscopy was used to conduct surface morphology study by using different Auxetic specimens developed from different conventional and new additive manufacturing techniques. Tensile testing of the Auxetic films was performed to characterise their mechanical properties. The stent expansion tests of the Auxetic stents were done to analyse the longitudinal extension and radial expansion of the Auxetic stent at a range of radial pressures applied by the balloon catheter, and to also identify the pressure values where the Auxetic stent fails. Finite element models of both Auxetic film and Auxetic stent were developed, and the results were compared with experimental results with a good agreement. The tensile testing of the Auxetic polyurethane films revealed that the Poisson's ratio of the sample ranged between -0.87 and -0.963 at different uniaxial tensile load values. From the stent expansion test, it was found that the Auxetic oesophageal stent radially expanded from 0.5 to 5.73 mm and longitudinally extended from 0.15 to 1.83 mm at a range of applied pressure increments (0.5-2.7 bar) from the balloon catheter.

Les cures pal·liatives pediàtriques milloren la qualitat de vida dels infants i adolescents; i fins i tot de les famílies. D’aquesta manera, tot i estar en risc la vida del pacient, s’alleugereix el patiment i s’afavoreix la identificació dels símptomes proporcionant una mort digna. A Espanya cada any 2000 nens han de rebre cures pal·liatives, dels quals un 40% estan diagnosticats de càncer. El projecte de guia de pràctica clínica (GPC) va dirigit a les infermeres que treballen a l’àmbit hospitalari de les cures pal·liatives pediàtriques i que tracten dia rere dia amb aquets infants i adolescents, d’entre 0 i 18 anys. Per l’elaboració del projecte de guia s’ha realitzat una recerca bibliografia sobre els principals símptomes que pateixen els nens, com afecten tant psicològicament com físicament, i la millor forma d’abordar-los i el paper de la infermeria alhora de tractar-los. Seguint aquest passos es millora l’autonomia del pacient i es dóna la oportunitat de viure la vida amb plenitud fins al final. També s’ha desenvolupat la metodologia i el disseny que es requereix per elaborar la guia. L’objectiu és realitzar un projecte de GPC enfocat a la homogeneïtzació de les cures pal·liatives pediàtriques i oferir una eina als professionals per proporcionar les millors cures als nens i com a conseqüència, evitar el patiment i dignificar l’últim tram de la vida dels infants. PARAULES CLAU : Cures pal·liatives pediàtriques, oncologia, càncer, símptomes, infermeria Pediatric palliative cares improves the life quality of children and adolescents; even families’ lives too. By this way, although patient lifes are in the final part of it, the suffering will decrease and the symptoms identification will be faster providing a dignified death. In Spain, 2000 children are receiving palliative cares every year, concretely the 40% of these cases are attributed to cancer. Clinic practice guide project (GPC is the Catalan abbreviation of it) is addressed to nurses who are working in hospitals in pediatric palliative cares area and treats every day with children and adolescents between 0 and 18 years. For the elaboration, the guide project has been a research about the mainly suffered symptoms, how they affect the children, and which is the best way to address it. Following these steps, child independence will be improved and bring them the opportunity of high and full life until the last moment. It has also developed a methodology and design that is required to produce the guide The objective is to realize a GPC project focused on standardization of pediatric palliative cares and provide a new tool that will help professionals to treat children. This must alleviate children suffering and must dignify the last moments of their short life. KEY WORDS : Pediatric palliative care, oncology, cancer, symptoms, nurse Grau en Infermeria

This paper is designed to provide an introduction to music therapy in the continuum of cancer care. The value and use of music therapy during diagnosis and treatment, palliation, hospice, actively dying, and bereavement have been well documented. The music therapy process will be identified, research will be shared, and the importance and role of music therapy in palliative medicine and supportive cancer care discussed. Music therapy is invaluable throughout the entire cancer treatment process.

There has been much discussion regarding the acceptable use of sedation for palliation. A particularly contentious practice concerns deep, continuous sedation given to patients who are not imminently dying and given without provision of hydration or nutrition, with the end result that death is hastened. This has been called ‘early terminal sedation’. Early terminal sedation is a practice composed of two legally and ethically accepted treatment options. Under certain conditions, patients have the right to reject hydration and nutrition, even if these are life-sustaining. Patients are also entitled to sedation as palliation for intolerable, intractable suffering. Though early terminal sedation is thought to be rare at present, the changing nature of palliative medicine suggests its use will increase. Arguments regarding early terminal sedation have failed to recognize early terminal sedation as a distinct legal and ethical entity. It can be seen as both the simple sum of treatment refusal and sedation for palliation, analogous to terminal sedation. It can also be seen as an indivisible palliative treatment, more analogous to assisted suicide or euthanasia. But ultimately, it is wholly analogous neither to terminal sedation given when death is imminent, nor to assisted suicide or euthanasia. This paper contends that early terminal sedation should be considered as a distinct entity. Such a reconception promises to provide a way forward in the debate, practice and policy regarding this contentious area of palliative medicine.

We read with great interest the paper by van Rijen et al. on the psychosocial functioning of adults with congenital heart disease,1but feel that the importance of their paper has been underplayed. It is estimated that 1% of all live births have congenital heart disease,2and that in the United States alone, there are 500000 adults with congenital heart disease.3Because medical intervention is continuously improving, the long-term outlook of these patients who have had either curative or palliative treatment is getting better, and many of these patients are followed up regularly. Nonetheless, their psychological problems and psychological functioning have …

Ofrecer Cuidados Paliativos de calidad a un paciente con un Trastorno Mental Severo es uno de los retos más difíciles para los profesionales del campo asistencial. En los últimos años, se ha detectado un incremento en el número de personas que padece una o múltiples afecciones orgánicas junto a una enfermedad mental grave. Asimismo, dentro de esta misma clasificación, se ha cuantificado otro subgrupo a destacar, el de los individuos que cuentan con un pronóstico vital irreversible. Con el fin que los profesionales puedan ofrecer unos Cuidados Paliativos adecuados a sus necesidades reales, es esencial, que éstos dispongan de nociones respecto a cuáles son las enfermedades mentales consideradas como severas, sobre los distintos síntomas psiquiátricos que podrían interferir en la atención normal al proceso de muerte y respecto a las estrategias de cuidado y comunicativas más aconsejables. Es por ello que el objetivo de este trabajo es realizar una revisión bibliográfica sobre los cuidados paliativos a personas con Trastorno Mental Severo. Providing quality palliative care to a patient with Severe Mental Disorder is one of the most difficult challenges for assistance professionals. An increase in the number of people suffering from one or multiple organic diseases with severe mental illness has been detected in the last few years. Also, within this classification, another subgroup has been highlighted, the individuals that have an irreversible prognosis. So that professionals can offer them palliative care appropriate to their actual needs, it is essential that they have notions about which are considered severe mental illnesses, on various psychiatric symptoms that may interfere with normal attention to the process of death and about the most desirable strategies of care and communication. That is why the aim of this paper is to review the literature on palliative care to people with severe mental disorder. Grau en Infermeria

In situ ablation of colorectal liver metastases is frequently assessed for palliative treatment only. The establishment of clinically relevant lesion size and a lack of long-term survival data were regarded as main limitations to using them with curative intention. In contrast to surgical liver resection, whose oncological findings seem to have remained unchanged over the years, the in situ ablation methods have considerably changed technically and clinically in the last few years.The aim of the paper was to point out experimental and clinical data underlining the impact of in situ ablation for potentially curative treatment of colorectal liver metastases.On the basis of experimental data, the aim of complete local tumor control (R0 ablation) can only be obtained if additional energy is applied after reaching the tumor-adapted maximal coagulation volume. Analogous to the oncological safety margin in surgical resection, we defined this decisive energy difference as the "energy safety margin" for in situ ablation. The energy safety margin is the energy that must be additionally applied after reaching the plateau in the energy/volume curve to achieve complete tumor coagulation. In addition to that, in situ ablation should be combined with temporary interruption of hepatic perfusion whenever possible to prevent intralesional recurrences. In this way, the thermoprotective mechanism of hepatic perfusion can be effectively eliminated. With restrictions, the survival data after ablation in specialized centers is comparable to surgical resection with concomitantly lower morbidity and mortality. Based on recent findings and with the corresponding expertise in the field of ablation and state-of-the-art equipment, ablation is, thus, an alternative to surgical resection. The combined application of surgical resection and ablation is also a suitable method for increasing the R0 rate and thus helps improve the prognosis of treated patients. In summary, it can be said that in situ ablation is a useful expansion of the therapeutic spectrum of liver metastases and can be applied as an alternative to or in combination with surgical resection.

Summary The head and neck area includes a multitude of small, complexly arranged anatomic structures; intimate knowledge of normal spatial relationships and variations is necessary to plan and implement appropriate therapy. Lesions often lie near vital structures, complicating diagnostic and therapeutic procedures. Improved visualization using MRI during such procedures can therefore provide the physician with critical information and is permitting innovative procedures. However, palliative treatment options for recurrent head and neck cancer are limited by the proximity of vital vascular and neural structures and the aggressive nature of these tumors. Depending from the localization of the recurrent tumor a minimally invasive treatment modality such as interventional MR-guided laser-induced thermotherapy offers a potential treatment benefits. This paper is describing the indications and technique of MR-guided LITT using a Nd:YAG laser (1064 nmm) for the treatment of recurrent head and neck tumors.

Summary Backround The aim of palliative treatment of advanced malignant tumours involving the hilus of the liver is to decompress mechanical jaundice. In some cases, percutaneous drainage of biliary ducts is the only possible effective treatment. The aim of this paper is to evaluate the results of palliative percutaneous drainage of biliary ducts. Materials and methods Percutaneous drainage of biliary ducts was carried out under ultrasound and x-ray control with a picture channel. A PIGTAIL catheter (9F diameter, 45 cm length) was installed by entering its end-part into intrahepatic billiary ducts and bile diversion. In 5 patients bile was inserted in back to the gastrointestinal tract by simultaneous endoscopic microgastrostomy. In 1996–2003, 52 percutaneous drainages of biliary ducts were installed in 38 patients. All of them suffered from mechanical jaundice with the bilirubin level of 170–510 umol/l caused by neoplasm constricting biliary ducts. The neoplastic disease in all cases was histologically confirmed. The quality of life was evaluated one month after installing percutaneous drainage of biliary ducts. Regression of symptoms connected with mechanical jaundice, independence and self-service when using a catheter and the physical and mental state of patients were taken into consideration. Results In all patients a decrease in the bilirubin level below 170 umol/l was observed 14 days after the procedure. In 20 patients jaundice regressed completely 4 weeks after the drainage. In a later period increased bilirubin levels were connected with temporary impairment of catheter patency or with infection of biliary ducts. Despite the advanced neoplastic disease patients showed total independence and selfservice. However neoplastic cachexia and the necessity to take analgesics deteriorated their quality of life. Conclusions 1) Percutaneous drainage of biliary ducts decompresses mechanical jaundice and decreases ailments typical of cholestasis. 2) Percutaneous drainage of biliary ducts requires specialized long-term care and cooperation with the patient and or his or her family. 3) Deterioration in the quality of life in return for its prolongation is accepted by patients and their families.

The paper first defines palliative treatment and distinguishes it from symptomatic treatment. Then, the palliative situation is delineated as inseparably linked to the finitude of human life. Given the objectives of palliative treatment — responding to symptoms, damage to the patients' self-image, and the proximity of death — a subjective concept of disease is described, that is regarded as the focus of palliative treatment. The essence of the concept of disease is analysed as the patient's experience with a tendency of reduction of her or his vitality. Palliative medicine is shown not to be symptom-oriented, but disease — directed as other domains of medicine. Implications and practical consequences, especially the status of objective findings, of this concept are discussed and therapeutic opportunities in the palliative situation reconsidered.

Purpose Brachytherapy is a highly valued and effective palliative treatment for lung cancer, especially as it reduces intensity of dyspnoea and other symptoms arising from tumours inside the respiratory tract. In some cases, due to the location of the lesion brachytherapy is a treatment of choice. However, its curative role is unclear. A combination treatment of brachytherapy and an external beam irradiaton may play a significant role when the mediastinal lymph nodes are involved. The paper presents the results of treatment of advanced lung cancer patients by external beam irradiation and brachytherapy, and the role of this palliative treatment is discussed. Material and methods Between May 1999 and March 2000 at the Greatpoland Cancer Centre fifteen patients with advanced lung cancer were treated by HDR brachytherapy and palliative external beam irradiation using the method of hypofractionation. The patients’ age ranged between 39 to 80 years, mean: 54.3 years. The treatment consisted of external beam irradiation (total dose of 20–30 Gy), and a weekly high dose rate (HDR) brachytherapy (three fractions of 7.5 or 10 Gy, at 1 cm from the source). In three cases the treatment was started with external irradiation, whereas in 12 cases the first stage was brachytherapy. During the patients’ clinical and endobronchial follow-up of 1, 3 and 6 months, local remission and regression of difficulties in breathing, cough, pain and haemoptysis were assessed. Results In all our patients subjective improvement (regression of all symptoms) was found on the first check-up following treatment. In one case complete remission of the tumour lasted for over 6 months, in 9 cases partial remission and in two cases progression were found. Severe complications due to the high total local dose were not observed. Conclusions Combined palliative treatment (intraluminal brachytherapy and external beam irradiation) in advanced lung cancer was an efficient method that led to regression of symptoms and improvement of well-being in many patients.