BACKGROUND:Pain is a common symptom in palliative care and affects patients' quality of life considerably. Standard analgesics are sometimes insufficient and are associated with substantial side effects. Neurolysis, the targeted destruction of nerves using thermal or chemical agents, offers an additional option for managing localized pain in palliative care. Phenol, a widely available chemical neurolytic agent known for its painless injection and hyperbaric properties when dissolved in glycerin, can effectively relieve refractory cancer pain. METHODS:A literature review was conducted on the pharmacology, toxicology, and indications of phenol in interventional pain and palliative medicine. RESULTS:Despite its use as a neurolytic agent for nearly a century, our current understanding of phenol's pharmacological properties, toxicity, and efficacy stems mainly from case series and small studies, often published decades ago. To date, no uniform guidelines exist, nor is there consensus on the optimal application of phenol in clinical practice, resulting in variability among practitioners. Chronic pain syndromes affect up to 30% of the global population, prompting the expansion of phenol neurolysis to new applications, such as joint denervation and sympathetic blocks in non-cancer pain. Understanding the mechanism of action of phenol and standardizing its clinical use are crucial for integrating this technique into broader pain management strategies. CONCLUSION:This review provides a comprehensive overview of the mechanisms, indications, benefits, and safety of phenol neurolysis in pain and palliative medicine, aiming to support its evidence-based use in clinical practice.
Both [18F]PSMA-1007 PET/CT and [18F]fluciclovine PET/CT scans are commonly used for prostate cancer (PCa) staging. To the best of our knowledge, no head-to-head comparison of these 2 scans for detection of intraprostatic clinically significant PCa (csPCa) has been published. Methods: A multicenter prospective histopathologic validation study was conducted from October 2020 to February 2023. Patients with newly diagnosed biopsy-proven intermediate- or high-risk PCa scheduled for robot-assisted radical prostatectomy (RARP) were consecutively included. Before RARP, patients underwent both [18F]PSMA-1007 PET/CT as well as [18F]fluciclovine PET/CT. The diagnostic accuracy of [18F]PSMA-1007 PET/CT and [18F]fluciclovine PET/CT for intraprostatic PCa detection and localization was established by histopathologic examination of the prostate specimen as reference. Sensitivity, specificity, positive predictive value, and negative predictive value were compared. Results were based on per-lesion analysis and per-segment analysis. The focus was set on csPCa, defined as the International Society of Urological Pathology grade group 2 or higher. Results: In total, 77 patients were included of whom 57 underwent both PET/CT scans before RARP. Histopathology of the prostate specimen found a total of 88 lesions, of which 68 (77.3%) were qualified as csPCa. Using [18F]PSMA-1007 PET/CT, lesion-based sensitivity for csPCa was 86.8% (95% CI, 75.9%-93.4%), and with [18F]fluciclovine PET/CT, it was 73.5% (95% CI, 61.2%-83.2%). Sensitivity for segment-based csPCa localization was 46.6% (95% CI, 42.4%-50.8%) for [18F]PSMA-1007 PET/CT and 37.3% (95% CI, 33.3%-41.5%) for [18F]fluciclovine PET/CT. Whereas [18F]PSMA-1007 PET/CT has a significantly higher accuracy in the detection and localization of csPCa, [18F]fluciclovine PET/CT visualized all 5 non-[18F]PSMA-1007-avid index tumors. Conclusion: Compared with [18F]fluciclovine PET/CT, [18F]PSMA-1007 PET/CT demonstrated higher sensitivity for csPCa detection. However, in non-[18F]PSMA-1007-avid tumors, the [18F]fluciclovine PET/CT can visualize csPCa and has therefore a potential role in the diagnostic work-up and the clinical decision-making process.
Background and study aims Esophagogastroduodenoscopy is a widely used medical examination. Despite the short duration of this procedure, many patients experience anxiety, pain, and discomfort. The aim of this study was to examine effects of virtual reality (VR) distraction on anxiety, pain, and discomfort during unsedated gastroscopy. Patients and methods Thirty-nine patients in the intervention group wore VR glasses 10 minutes before and during the gastroscopy. Fifty patients in the control group received care as usual. Anxiety and pain levels were measured with the STAI-DY and NRS before, during, and after the procedure. Moreover, comfort level was reported by an accompanying nurse during the procedure. The last outcome was self-reported willingness to undergo unsedated vs. sedated gastroscopy in the future. Results The VR and control non-VR groups were comparable in terms of age, gender, education level, and self-reported general health, anxiety, and pain levels. No significant differences were observed in levels of anxiety, pain, and discomfort during the endoscopy. There was no difference in medical outcome and willingness to undergo unsedated vs. sedated gastroscopy in the future. Conclusions VR distraction did not objectively reduce patient anxiety, pain, or discomfort before, during, or after the procedure. Moreover, willingness to undergo the same procedure without sedation was the same for the VR and control groups. Future research is needed to explore whether selected groups of patients may benefit from VR distraction.
Perioperative abnormalities presenting in patients with inherited primary disorders of skeletal muscle can share similar characteristics to those in a malignant hyperthermia crisis. These patients are often referred to malignant hyperthermia units for perioperative advice as clinicians are accessing conflicting and non-current literature. To address this, the European Malignant Hyperthermia Group (EMHG) has conducted a review of the current literature and used a formal consensus process, with review at annual EMHG meetings and workshops, to provide guidelines for the perioperative management of patients with these myopathies. The guidelines include general recommendations and suggestions applicable to all patients with myopathy requiring anaesthesia or procedural sedation and additional specific recommendations, suggestions and main concerns for patients with specific primary myopathies (ICD-11-CM) with inheritable pathology distal to the neuromuscular junction, including congenital, mitochondrial and metabolic myopathies; muscular dystrophies; myotonias; and familial periodic paralyses.
Prostate cancer is a common diagnosis and is usually established by PSA-driven diagnostics. The disease is often asymptomatic and does not affect the patient's life expectancy. Prostate cancer may follow an aggressive course with substantial mortality. Curative treatment options include robot-assisted radical prostatectomy and radiotherapy, sometimes in combination with hormonal therapy. Although these treatments are effective, they may be associated with urinary incontinence, erectile dysfunction, and urinary and gastrointestinal symptoms. Hormonal therapy has a broad spectrum of side-effects. The treatment of metastatic disease consists of hormonal therapy, in combinations or sequentially, and chemotherapy. Mortality in metastatic prostate cancer is high.
