Seventy-five patients with brain metastases from solid tumours were treated with whole-brain irradiation at our institution between 1990 and 1993. The primary cancers included 35 cases of lung cancer, 19 cases of breast cancer, nine cases of renal-cell cancer, six cases of melanoma and six cases of other primary sites. In each case the total dose to the whole brain was at least 25 gray (Gy). The primary site, age, performance status, number of brain metastases and the presence of extracranial disease were studied as prognostic factors for survival. The median survival for the whole population was 4 months (range 1-62 months). The patients with the brain as the only metastatic site had significantly better survival (P = 0.019) than those with both intracranial and extracranial metastatic sites. Poor performance status at the time of diagnosis of brain metastases was also related to short survival (P = 0.001). None of the other studied variables had prognostic significance. Four of the 75 patients with primary tumour sites in the breast (two patients) and the kidney (two patients) survived for more than 2 years. In general, patients with breast cancer had better survival than patients with other primary cancers. Our study confirms the generally poor prognosis of cancer with brain metastases, although individual patients may survive several years after whole-brain irradiation. Approximately two-thirds of the patients experienced a relief in symptoms allowing a reduction in the dose of corticosteroid medication, which clearly supports the use of whole-brain radiotherapy as a palliative treatment.

SummaryThe time course of changes in breathing pattern in opioid-induced respiratory depression was characterised for two opioids. Intravenous morphine (0.039 mg.kg À1 bolus 0.215 mg.kg À1 .h À1 infusion) and oxycodone (0.05 mg.kg À1 bolus 0.275 mg.kg À1 .h À1 infusion) were administered to six healthy male volunteers for 2 h in a random, double-blind and cross-over fashion. Monitoring included pulse oximetry and noninvasive respiratory-inductive plethysmography for the measurement of breathing pattern. The total amounts of drugs given were 35.1 (0.0) mg [mean (SD)] morphine and 41.3 (8.0) mg oxycodone. Four of the six oxycodone infusions had to be stopped at 99 (14) min because of respiratory depression as judged by pulse oximetry. No morphine infusions were stopped. The ®rst changes in breathing pattern were a decrease in respiratory rate and an increase in the contribution of the rib cage to tidal volume, while the compensatory increase in tidal volume became evident later. A decrease in minute ventilation and inspiratory duty cycle were also found. Opioids are known to decrease both hypoxic and hypercapnic respiratory drive [1]. However, little is known about opioid-induced changes in breathing pattern. The aim of this study was to describe the time, dose and concentration dependence of changes in breathing pattern for two m-agonist opioids, morphine and oxycodone and, if possible, to ®nd an ideal parameter for detecting early respiratory depression. MethodsSix healthy male volunteers, aged 21±30 years and weighing 68±80 kg, participated in this double-blind, randomized cross-over study. The subjects were non-smokers and had no medication or history of drug or alcohol abuse. The study protocol was approved by the Institutional Ethics Committee of Turku University Hospital and written informed consent was obtained from all participants. The subjects participated in two study sessions at least 10 days apart. After fasting for at least 12 h (only a glass of juice was allowed), the volunteers were admitted to the laboratory. The radial artery and an antecubital vein were cannulated. In the second session, the radial artery of the contralateral hand was used. After attaching the sensor bands of the respiratory-inductive plethysmograph, breathing and haemodynamics were allowed to settle over 20 min in the supine position before baseline measurements were taken.The drugs were diluted with saline to 50 ml by an independent anaesthetist. An intravenous bolus dose of oxycodone (Oxanest 10 mg.ml À1 , Leiras, Finland) 0.05 mg.kg À1 or morphine (Morphin 20 mg.ml À1 , Leiras, Finland) 0.039 mg.kg À1 was given in 1 min followed by an infusion of 0.275 mg.kg À1 .h À1 or 0.215 mg.kg À1 .h À1 , respectively lasting 115 min. If arterial oxygenation was seriously impaired, determined by an oxygen saturation under 90% over 30 s, the infusion was stopped. After stopping the infusion, the measurements were continued for 60 min, after which naloxone 0.8 mg was given.

VRS and RWS were the most applicable scales, unlike VAS, which appeared to be an unreliable pain scale in perioperative hip fracture patients. In patients with other lower limb trauma, all four scales provided excellent applicability. Our results are in accordance with the accumulating evidence suggesting that VAS is not an ideal tool for pain measurement in the elderly.

Sixty-five women (aged 32 - 54 yrs) were assessed at 2 months before to 8 months after total abdominal hysterectomy on four separate occasions. Beck's Depression Inventory (BDI), Taylor's Manifest Anxiety Scale (TMAS), the Buss-Durkee Hostility Inventory (BDHI), Measurement of Masculinity-Femininity (MF), Likert scales and semantic differentials for psychological, somatic and sexual factors varied as assessment tools. High-dysphoric and low-dysphoric women were compared with regard to hysterectomy outcomes. Married nulliparae suffered from enhanced depression post-surgery. Pre-surgery anxiety, back pain and lack of dyspareunia contributed to post-surgery anxiety. Pre-surgery anxiety was related to life crises. Pre- and post-surgery hostility occurred in conjunction with poor sexual gratification. Post-hysterectomy health improved, but quality of sexual relationship was impaired. Partner support and knowledge counteracted hysterectomy aftermath. Post-hysterectomy symptoms constituted a continuum to pre-surgery signs of depression, anxiety or hostility.