Trofm. Elena. G.P. Bacau, Romania

Aim of investigation: Enderlein, founded a new medical branch leaving aport Pasteur's monomorphism and creating the basis of pleomorphism (show that health represent the perfect symbiosis between the human organism and a number of microorganisms living permanently with it), endobionts and simbionts which have an important part in what we call being healthy.

Methods: Enderlein developed effective methods to diminish or stop the grawing of the valencies of the microorganism in the fluids of the body and in its cells. He cleared up scientifically the leading part of a correct feeding of the organism, explaining the importance of living food, which contains a great quantity of bioregulators which act like medicine, regulating the sanguineous pH besides synthesizing the vitamins and enzymes.

Results and conclusions: In order to understand the isopathy we must get rid of the idea that a shape if strange object or obsession which should be fought against or extirpated. The means of extirpation both isopathic are procedures of transformation without aggressi vity and represent undistructive actions. Tumours are part of us. a kind of evoluting neighbours, which grew us. Because of the reactions of the conjunctiv tissue are so weak alt the appearence of the cancerous tumour that it can't be identified as a foreign body. The true therapy to heal cancer has as a central aim the transformation of metabolism destroyed by fermentation.

CLINICAL EXPERIENCE AND A POSTAL SURVEY OF PROPOFOL-ANESTHESIA DURING PAINFUL PROCEDURES AT THE PEDIATRIC ONCOLOGY WARD

 Margareta von Heijne'. Stefan Soderhall², Gunnar L. Olsson'

Karolinska Inst., 'Pediatric Anesth, Pediatric Oncology, Astrid Lindgren Children's Hosp, Karolinska Hosp, S-171 76 Stockholm, Sweden

Aim of investigation: To evaluate if light propofol-anesthesia at the ward could improve the management of procedure pain and anxiety in children with cancer, when the combination of EMLA cream, local anesthetics (l.a.) and midazolam had been unsuccessful or was impossible to perform.

Methods: Anesthesia routines and a pilot-questionnaire were developed. The questionnaire was mailed to parents of 23 children that after EMLA application were anesthetized with propofol (19) or midazolam and alfentanil sedation (2) during lumbar puncture andYor bone marrow aspiration, at the pediatric oncology ward.

Results: 57 anesthesia were performed success-fully in 23 patients. The return of questionnaire compliance was 91% (21), age range 2 to 16 years. All reported advantages with anesthesia at the ward compared to at the operating room (OR). In the list of stated advantages, 86% marked familiar nurses and doctors, 81% familiar environment, 81% closer to the own room, 71% the child more calm, 67% shorter waiting-time, 62% faster recovery, 48% shorter fast and 48% parents more calm, as benefits. For eventual future procedures requiring pain relief and anesthesia, 90% of the parents/ patients wanted these procedures performed at the ward.

Conclusion: If painful procedures in children with cancer can not be performed with EMLA, l.a. and midazolam our clinical experience and a postal survey suggest that light propofol-anesthesia performed at the ward might be advantageous and preferred by parents/patients compared to anesthesia at the OR.

Acknowledgements: Timmermansorden, Sweden.

TREATMENT OF THE PAIN IN CANCER PATIENTS. AN EPIDEMIOLOGIC STUDY.

L Copel(l) M Esteve(2) S_Barthier( 1) S Carayon(l) B Asselain(3), J Vedrenne(2)
(1)Palliative and Supportive Care Unit
(2)Anaesthesiology department
(3)Statistic Department
Institut Cune 75005 Pans FRANCE

Aim of Investigation: to realise an epidemiological transversal study about pain among our cancer patients in our Comprehensive Cancer Centre

Methods: Dunng a day on December 1999, a questionnaire was given to every patient (day care and hospitalised) asking them specific questions related to pain Out of the 731 questionnaires given 471 were analysable

Results: 40% of the outpatients complained of pain at least one time during the last 2 weeks (142) versus 81% of the hospitalised patients (94) In 70% of the cases, they blamed the cancer for the pain The cause of the pain was different from the outpatients to the hospitalised patients respectively due to the treatment in 63% versus 55 4%, due to the progression of cancer in 185% versus 277% and both causes in 3 3% versus 9 2% other cause in 15 2% versus 7 7% Among the outpatients, only 8% were painful for more than one month, versus 20% among the hospitalised patients On a Verbal Category Scale, the intensity of the pain was about the same in both groups 314% of the outpatients had an important ' pain and 10% had a "very important' pain, versus 30 2 and 11 6 among the hospitalised patients Surprisingly, this pain provoked less insomnia among the hospitalised patients (38 6%) than among the outpatients (50%)

Conclusion: These results show that pain is more frequent than usually thought and had to be searched to a better care and a better quality of life of our patients

BACK PAIN IN CANCER PATIENTS: SPECIFICS IN DIAGNOSIS AND TREATMENT

 DALIA SKORUPSKIENE MD. PhD
ONCOLOGY CLINIC KAUNAS UNIVERSITY OF MEDICINE, KAUNAS 3007, LITHUANIA

Aim of investigation. To determine better diagnostic and treatment algorhitm for cancer patients with back pain

Methods.The data was collected about 86 cancer patients (seen in Kaunas Medical University Hospital, 1998 1999), who suffered from back pain All patients were formerly diagnosed having cancer Back pain intensity varied (VAS 5 10) Diagnostic X rays were performed for all patients osteoscmtigraphy (Tc 99m) for 57 CT for 36, MRI- 6 patients After determining the cause of the back pain treatment was revised

Results. The causes of back pain were metastases in vertebral bodies (71 patient 82 5 %) metastases in suprarenal glands (3 cases 3 5%) sarcoma in pelvis bones (lease 1 2%) metastases in the lower nbs - 4 cases (4,6%), non malignant pain 7 cases 8,1% X rays for vertebral metastases were highly informative only in 25 cases, 30 showed some low possibility of metastases, 16 were absolutely umnformative In these cases osteoscintigraphy strongly advised metastases in vertebral bodies and CT confirmed the diagnosis (in 2 cases only MRI) The pharmacotherapy was performed according to the WHO analgesic ladder' 65 patients with bone lesions received palliative radiotherapy It allowed lowenng drugs doses for 60 patients (92%) Heat and some other physiotherapy procedures were urgently discontinued (14 cases)

Conclusions. The presence of back pain calls for a very thorough examination of the cancer patient While suspecting metastatic lesion in bones the negative X ray cannot reject this possibility The palliative radiotherapy for vertebral or bone metastases is beneficial Some physiotherapy modalities must not be used for cancer patients

PAIN AMONG PATIENTS WITH CANCER: AN EPIDEMIOLOGIC STUDY

L Copel, M Esteve', S Barthier, S.Carayon, B Asselain, J Vedrenne
(1) Palliative and Supportive Care Unit
(2) Anaesthesiology department
(3) Statistic Department
Institut Curie; 75005 Paris-FRANCE

Aim of Investigation: to realise an epidemiological transversal study about pain among our cancer patients in our Comprehensive Cancer Centre.

Methods: Dunng a day on December 1999, a questionnaire was given to every patient (day care and hospitalised) asking them specific questions related to pain. Out of the 731 questionnaires given, 471 were analysable.

Results: 40% of the outpatients complained of pain at least one time during the last 2 weeks (142) versus 81% of the hospitalised patients (94).

In 70% of the cases, they blamed the cancer for the pain. The cause of the pain was different from the outpatients to the hospitalised patients' respectively due to the treatment in 63% versus 55 4%, due to the progression of cancer in 18.5% versus 27.7% and both causes in 3.3% versus 9.2%; other cause in 15.2% versus 7.7% Among the outpatients, only 8% were painful for more than one month, versus 20% among the hospitalised patients On a Verbal Category Scale, the intensity of the pain was about the same in both groups: 31.4% of the outpatients had an "important" pain and 10% had a "very important" pain, versus 30.2 and 11.6 among the hospitalised patients. Surprisingly, this pain provoked less insomnia among the hospitalised patients (38.6%) than among the outpatients (50%).

Conclusion: These results show that pain is more frequent than usually thought and had to be searched to a better care and a better quality of life of our patients.

Pain in Europe III. EFIC 2000, Nice, France, September 26-29, 2000. Abstracts book, p. 282, 296, 299, 309, 355