Annals of oncology : official journal of the European Society for Medical Oncology
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Little information is available about the diagnosis and management of acute methotrexate (MTX)-induced encephalopathy. ⋯ Acute MTX toxicity often manifests as fluctuating neurologic symptoms with alternating hemispheric involvement. Restricted diffusion on DWI is a reliable early sign of acute MTX encephalopathy and resolves as clinical status improves, despite the persistence of subtle abnormalities on MRI.
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Morphine and other opioids are the mainstay of cancer pain management, yet considerable fears surrounding them present barriers to pain control. Research in groups already using opioids has examined their concerns, but there is little evidence about how patients react when first offered opioids. We explored the factors influencing the decision to accept or reject morphine when first offered to patients with cancer. ⋯ Among cancer patients the idea that opioids represent a comfort measure for the dying and not legitimate analgesics may represent a greater barrier to their uptake than concerns about tolerance or addiction.
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The aim of this systematic review is to critically evaluate cytoreductive surgery combined with heated intraoperative intraperitoneal chemotherapy in the treatment of ovarian cancer. A systematic review of all manuscripts published in the English literature that met predetermined inclusion criteria was carried out. Data concerning cytoreductive surgery, method and agents for administration of heated intraoperative intraperitoneal chemotherapy, morbidity, mortality, hospital stay and survival were extracted, critically reviewed and tabulated. ⋯ The median mortality was 3% (range 0%-10%). Cytoreductive surgery combined with heated intraoperative intraperitoneal chemotherapy is a treatment option for patients with ovarian cancer that is worthy of further investigation. Selection criteria for patients most likely to benefit need to be defined.