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Biomedical subjects

D P Todd

Publications and source records attributed to D P Todd.

8 recordsLinked to original sources

Prolonged stellate block in treatment of reflex sympathetic dystrophy.

Prolonged continuous stellate ganglion blockade has been found useful in treatment of post-traumatic reflex sympathetic dystrophy under the following circumstances: 1) When conservative treatment with outpatient physical therapy, tranquilizers and mild analgesics has failed. 2) When conservative therapy plus intermittent stellate blocks (q.l to 4 weeks) has failed. A three-year average follow-up of a group of 26 unselected patients has shown 25% relapse rate and 75% marked to complete improvement.

Autonomic Nerve Block↗

The treatment of upper extremity reflex sympathetic dystrophy with prolonged continuous stellate ganglion blockade.

Twenty-nine consecutively treated patients over a 5-year period with upper extremity reflex sympathetic dystrophy were admitted to Massachusetts General Hospital for prolonged continuous stellate ganglion blockade. Diagnosis was based on the presence of pain, decreased joint motion, trophic changes, and vasomotor disturbances. Selection for blockade was made on the failure to improve with outpatient physical therapy, tranquilizers, and mild analgesics. Treatment consisted of indwelling-catheter injections of bupivacaine hydrochloride every eight hours to the stellate ganglion for an average of 7 days, supplemented with vigorous physical therapy. Improvement during treatment was documented in all but two patients with regard to pain and decreased joint motion and in two-thirds with regard to trophic and vasomotor changes. Long-term follow-up demonstrated a relapse rate of 25%, but marked improvement persisted in the rest and normal status was attained in four of 26 patients at an average of 3 years later.

Adult↗

Cancer pain relieved by long-term epidural morphine with permanent indwelling systems for self-administration.

Clinical trials for abatement of intractable pelvic cancer pain were conducted in two patients, each electing surgical implantation of one of two indwelling catheter systems for administration of morphine into the spinal epidural space. Both systems, one consisting of a partially indwelling Broviac catheter, and the other, completely indwelling, consisting of a morphine reservoir connected to a shunt pump and on-off Hakim valve assembly, permitted the patients to return home where they could self-administer epidural morphine. Each patient reported that 2 mg of epidural morphine provided 8 to 12 hours of pain relief at a level of superior to their previous narcotic medication. On a regimen of 2 mg of epidural morphine administered twice daily, both patients experienced analgesia for 6 months, unaccompanied by alterations in sensory, motor, or cognitive functioning, and with a little drug tolerance reaction.

Carcinoma↗