• Title/Summary/Keyword: Pain Palliation

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End Stage Palliative Care of Head and Neck Cancer: a Case Study

  • Shishodia, Nitin Pratap;Divakar, Darshan Devang;Al Kheraif, Abdulaziz Abdullah;Ramakrishnaiah, Ravikumar;Pathan, Akbar Ali Khan;Parine, Narasimha Reddy;Chandroth, Santhosh Vediyera;Purushothaman, Binu
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.3
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    • pp.1255-1258
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    • 2015
  • Background: Locally advanced head and neck cancer is generally incurable and has a short survival rate. This study aimed to evaluate symptom relief, disease response, and acute toxicity after palliative hypo-fractionated radiotherapy and long-term survival in affected patients. Materials and Methods: Between January 2011 to December 2011, 80 patients who were histopathologically diagnosed as having stage III or stage IV head and neck squamous cell carcinoma based on Eastern Cooperative Oncology Group (ECOG) performance status 1-3, were offered palliative radiotherapy (20 Gy/5Fr/5 Days). Later these patients were evaluated on 30th day after completion of treatment for disease response based on World Health Organisation (WHO) criteria and palliation of symptoms using symptomatic response grading and acute toxicities by the Radiation Therapy Oncology Group (RTOG). Many patients were given post radiation therapy (RT) palliative chemotherapy for appropriate palliative care and a few patients were selected for further curative RT. The overall survival was also evaluated among this group of patients with last follow up date of 1st May, 2014. Results: The most common presenting complaint was pain followed by dysphagia. Most patients (60-70%) had appreciable relief in their presenting symptoms. A good response was observed in the majority following palliative RT; a few patients had progressive disease and some had stable and regressed disease. None of the patients experienced radiation toxicity that required hospital admission. Almost all showed grade one and two acute skin and mucosal toxicity one month after completion of treatment. The mean survival days for patients given only hypofractionated palliative RT was 307 days, those with post palliative RT and palliative chemotherapy was 390 days and patients who went on to receive further palliative RT and curative RT dose had significantly overall survival of 582 days. Conclusions: Advanced head and neck cancer should be identified for suitable palliative hypofractionated radiotherapy to achieve acceptable symptom relief in a great proportion of patients and should be followed by palliative chemotherapy or curative RT in suitable cases for long-term symptom-free survival.

Philosophic Investigation of the 'Ghi(氣)' Phenomena ('기(氣)' 현상에 대한 철학적 고찰)

  • Lee, Hyun-Ju
    • Journal of East-West Nursing Research
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    • v.3 no.1
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    • pp.50-67
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    • 1998
  • When recognition of the Ghi(氣) which exist in all things, is changed on the aspects of the science of nursing, the view of health and nursing will be more efficient and can be developed as the proper concept for Korean culture. I think it is nessary to confirm which philosophical basis of the will be applicable to nursing and how to it has to be developed. Therefore I can for the research of the Ghi phenomena to attain the Thoughts of philosophy that is appropriate to expound those phenomena. And I attempt to induct "the fusion of horizons" to unify the view of the I world between Korea and the West. The Ghi is very energetic and omnipresent among the universe, Nature, and the human being. So it can organize all the primary elements of mental and I physical function of human as like life, mind, breath, feeling, energy, etc. A general concept of the Ghi is described as follows ; (1) The Ghi is the origin and essence to organize the universe, Nature, and the human being. (2) It is the perpetually movable thing. (3) And there are continuous transmission between the Ghi of the universe and the human through 'body, mind, and soul. For review on the philosophic basis of the Ghi, I studied out the identity of the doctrine of Li and Ch'i(理氣論) in the field of philosophy of Korea and the West. In Korea, the concept of the Vigor is based on Ch'i monolism(기일원론) and Li Ch'i dualism (이기이원론) of Yul-gok Lee's, Toi-kye Lee's, Hwa-dam's, and/or Hekang's. These are indispensable for the view of the world of Korea as Metaphysical ideology, Concrete science, Materialism, Ontology, and Epistemology. From the viewpoint of the philosophy of the West, the doctrine of Li and Ch'i(이기론) of Korea is identical with the doctrine of Li and Ch'i(이기론) of Joo-ja, Idea of Plato, Metaphysics of Aristotle, World Spirit(Weltgeist) of Hegel, and Existentialism of Heidegger. In the nursing theory of the West, some of them referred to the Ghi as like Energy field theory of Rogers and Energy exchange of Neuman. Though there are different in terminology, "energy" and the "Ghi" are induced comparable therapeutic action between the human and the environments. With the nursing theory of Korea, I have made an attempt to compare the Ghi with metaparadigm of nursing-the human being, the environment, the health, and the nursing. For the most part, the alternative therapy is resonable to the frame of the nursing theory of Korea. It is easy to apply alternative therapy on the every spot of nursing. So this therapy could be a kind of forms as nursing therapy in the nursing centers where take the duties of supporting in local societies. In result, independent nursing intervention will be activated by the nurse who puts up with the major parts. It is available to apply this therapy to palliation of pain, insomnia of infant, Sanhujori (산후조리), pain of menstruation, arthritis. And the alternative therapy makes it possible to propose the nursing model which represent originality, tradition, and history of the nursing of Korea. Additionally, in the field of the nursing, it is indispensable to choose a suitable methodology which is considered whether it is matched with a theory of philosophy in the boundary and object of the research. Because there are many way to get the knowledge of nursing related to the Ghi. In the science of nursing, context of sociocultural background and frame are required to understand the person who need to take care of (nursing client). But the value systems of the West and the East are distinctive each other as well as the behavior of health persuance. Therefore it is the basic research data of great worth to review philosophical the Ghi phenomena which is well known to Korean.

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Combined Radiotherapy and Hyperthermia for Nonresectable Hepatocellular Carcinoma (절제 불가능한 원발성 간암의 온열 및 방사선 병용 요법)

  • Seong Jin Sil;Juhn Juhn Kyu;Suh Chang Ok;Kim Gwi Eon;Han Kwang Hyub;Lee Sang In;Roh Jae Kyung;Choi Heung Jai;Kim Byung Soo
    • Radiation Oncology Journal
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    • v.7 no.2
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    • pp.247-257
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    • 1989
  • Thirty patients with nonresectable hepatocellular carcinoma (HCC) due to either locally advanced lesion or association with liver cirrhosis, treated with combined radiotherapy and hyperthermia between April 1988 and July 1988, at Dept. of Radiation Oncology, Yonsei university College of medicine, were analysed. External radiotherapy of a total dose of 3060cGy/3.5 wks was given. Hyperthermia was given twice a week with a total of 6 treatment sessions using 8MHz radiofrequency capacitive type heating device, i.e., Thermotron RF-8 and Cancermia. In all cases hyperthermia was given within 30 minutes after radiotherapy for 30~60min. Temperature was measured by inserting thermocouple into the tumor mass under the ultrasonographic guidance only for those who had not bleeding tendency. As a result, partial response (PR) was achieved in 12 patients (40%), and symptomatic improvement was observed in 22 patients (78.6%) among 28 patients who had suffered from abdominal pain. The most significant factor affecting the tumor response rate was the type of tumor (single massive: 10/14, 71.4%; diffuse infiltrative: 2/10, 20%; multinodular:0/6, 0%; p<0.005). There were not any significant side effects relating to combined treatment. The overall 1 year survival rate was 34%, with 50% in the PR group and 22% in the no response group (NR), respectively. Median survival was 6.5 months and longer for those of PR than of NR (11 mos. vs 5, p<0.05). In conclusion, combined radiotherapy and hyperthermia appeared to be effective in local control and symptomatic palliation of HCC. Further study including a larger number of the patients to confirm its effect in survival and detrimental side effect should be urged.

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The Effect of Percutaneous Bilateral Metalic Stent for Hilar Cholangiocarcinoma (간문부 담관암 환자에서 경피경관 양측성 금속 배액관의 효과)

  • Kim, Kum-Rae;Kim, Joo-Hyung;Park, Won-Kyu;Jang, Jay-Chun;Cho, Jae-Ho;Kim, Tae-Nyen;Kim, Jun-Hwan;Jang, Byeng-Ik
    • Journal of Yeungnam Medical Science
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    • v.22 no.2
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    • pp.211-220
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    • 2005
  • Background: The purpose of this study was to determine the effectiveness of a percutaneously placed self-expanding metallic stent for the relief of biliary obstruction in patients with hilar cholangiocarcinoma. Materials and Methods: From November 2001 to December 2004, 48 patients with hilar cholangiocarcinoma were prospectively studied. After percutaneous placement of bilateral selfexpanding, uncovered metallic stents, follow-up evaluation was carried out until July 2005. Results: There were 4 cases of Bismuth type II, 21 cases of Bismuth type IIIa, 8 cases of Bismuth type IIIb and 15 cases of Bismuth type IV. Stent placement was technically successful in all patients. All patients had satisfactory biliary drainage, resulting in one week drainage rate of 72.8% and final drainage rate of 91.1%. There were 12 cases (21.3%) of abdominal pain requiring analgesics and 1 case (7.1%) of cholangitis; both were successfully managed with conservative treatments. Late complications occurred in four patient (8.3%), including two patients with cholangitis, one patient with liver abscess, and one patient with biloma; all were appropriately managed by percutaneous drainage. The average length and median durations of stent patency and median survival time were 303 days (range, 60~815) and 338 days (range, 60~1175), respectively. Conclusion: Placement of a percutaneous metallic stent is an effective and safe method for palliation of patients with hilar cholangiocarcinoma.

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