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Biomedical subjects

I Lichter

Publications and source records attributed to I Lichter.

At least 19 recordsLinked to original sources
PubMed1996

Nausea and vomiting in patients with cancer.

Nausea and vomiting in advanced cancer, occurring as a manifestation of the disease process or as a complication of drugs used for symptom control, can be controlled rapidly in most instances using the protocol described. This involves an informed appraisal of the cause or causes of nausea and vomiting, combined with application of knowledge of the mechanisms of emesis and the action of antiemetics. Different mechanisms appear to responsible for emesis after chemotherapy and irradiation and for anticipatory vomiting. Ondansetron combined with dexamethasone appears to be the most effective regimen for post-cisplatin emesis. For less emetogenic agents, dexamethasone alone, or in combination with ondansetron for refractory cases, gives good control. For the control of vomiting induced by single-fraction radiotherapy to the upper abdomen, ondansetron is very effective. Management of anticipatory vomiting should concentrate on prevention, but once vomiting is established, behavioral therapy and the amnesic properties of lorazepam may be used.

Antiemetics↗
PubMed1995

Drug combinations in syringe drivers.

AIMS: Because of widely differing views on the drugs that can be administered in combination, this study was undertaken to record the combination of drugs in syringe drivers that we had found to be compatible. METHODS: The content of syringe drivers in 100 consecutive patients in whom continuous subcutaneous infusion was used, was recorded. The incidence of skin reactions with the different drugs was noted. The efficacy of combinations used was assessed clinically. RESULTS: A wide variety of drugs were used in many different combinations, with no clinical evidence of loss of efficacy. Some drug combinations are incompatible. Drugs known to cause skin reactions were not administered. In this study skin reactions depended on the number of drugs used in combination. CONCLUSIONS: The array of medications that can be used together in syringe drivers enable this method of drug administration to be used successfully in the control of the diverse symptoms that may arise in terminal illness. Further study is needed for quantitative measurement of drug stability.

Anti-Anxiety Agents↗
PubMed1994

Accelerated titration of morphine for rapid relief of cancer pain.

AIM: To reduce the time taken to achieve relief when a strong narcotic is indicated for the control of cancer pain. METHOD: A method of accelerated titration of morphine dosage is described. The time taken to achieve good pain control in 50 consecutive terminally ill cancer patients was recorded. RESULTS: The average time to taken to control pain was 26 hours for patients being cared for at home, and 6 hours for hospice inpatients. CONCLUSIONS: Rapid pain control with morphine can be achieved safely within hours in most cancer patients with morphine responsive pain.

Aged↗
PubMed1993

Biography as therapy.

The feeling that life has had no meaning is an impediment to a peaceful death. Life review enables a person to identify events that have been of worth and so enhances self-esteem. This approach has been extended and formalized by establishing a biographer service to compile oral and written biographies of patients who may be expected to benefit from such a re-examination of their lives. The service is now also being offered to patients whose disability precludes most other forms of activity. The value of biography as therapy is considered and it is concluded that it has much to offer in the circumstances described.

Aged↗
PubMed1993

Results of antiemetic management in terminal illness.

A wide variety of causes may be responsible for nausea and vomiting in terminal illness. The different emetic stimuli reach the vomiting centre by a variety of pathways and can be blocked by specific antiemetics that act at the neurotransmitter receptor sites in these pathways. A knowledge of the neurotransmitter receptor antagonist potency of the different antiemetics allows the choice of the most appropriate antiemetic for the relief of the nausea and vomiting caused by a particular emetic stimulus. To demonstrate the efficacy of this approach to the management of nausea and vomiting in terminal illness, the outcome of antiemetic choice in 100 consecutive episodes is recorded.

Adult↗
PubMed1993

Which antiemetic?

The choice of antiemetic should not be arbitrary, but should be based on knowledge of the different pathways of the various stimuli that lead to nausea and vomiting and the neuroreceptors involved. The steps to be taken in choosing an appropriate antiemetic are described. They are (a) to establish the probable cause of the nausea and vomiting, (b) to consider the afferent pathways involved, (c) to define the neuroreceptors activated at each of these sites, (d) to select the group of antiemetics that antagonizes these neuroreceptors, and (e) to choose the most potent antiemetic with the fewest side effects in that group. Causes for failure to respond to a chosen antiemetic are considered and the action to be taken is described.

Antiemetics↗
PubMed1992

Lacrima mortis: the last tear.

A tear, usually at the moment of death, has been observed in 14% of dying patients. No associated factors have been established and the cause of the "last tear" is not known.

Aged↗
PubMed1990

The last 48 hours of life.

Though patients usually die peacefully, problems may arise in the last period of a terminal illness. In the final days new symptoms may arise or there may be exacerbation or recurrence of symptoms previously well controlled. Two hundred consecutive hospice patients were studied. The incidence was noted of pain, dyspnea, moist breathing, nausea and vomiting, confusion, restlessness, jerking and twitching, difficulty in swallowing, incontinence and retention of urine, sweating, moaning and groaning, and loss of consciousness. Each symptom is considered and the results of the management employed are noted. Many of the features appearing in the last days of a terminal illness, especially cancer, can be attributed to organic brain disease consequent to metabolic disorder associated with multi-organ failure. An awareness of the nature of the problems that may arise in the last 48 hours of life makes it possible to keep the patient comfortable to the end.

Aged↗
PubMed1986

Differential effects of atenolol and enalapril on memory during treatment for essential hypertension.

A randomized single-blind study was designed to compare the performance on memory tests requiring recall of information relevant to everyday life of two groups of hypertensive patients. One group of 13 patients were taking a beta-adrenoceptor blocker (atenolol) and the other group of 12 patients received the angiotensin-converting enzyme inhibitor (enalapril). The results suggested that when compared with placebo the group of patients treated with enalapril showed no changes in memory function, whilst there was a mild, but consistent deficit in the group taking atenolol.

Adult↗
PubMed1978

Motor disorder in pharyngoesophageal pouch.

Patients with a pharyngoesophageal pouch studied by esophageal manometry were shown to have premature relaxation of the upper esophageal sphincter. Postrelaxation contraction of the sphincter was therefore already in progress while pharyngeal contraction was taking place. This motor disturbance creates a physiological obstruction at the upper esophageal sphincter so that high pressures are built up in the pharynx. These conditions are conductive to herniation of the pharyngeal mucosa through any weak area in the muscle wall of the pharynx.

Diverticulum↗
PubMed1976

Localized pulmonary Wegener's granuloma simulating lung cancer: report of four cases.

Clinical features suggesting lung disease in three patients and a chance chest radiograph in the fourth led to films showing localized lung lesions with some characteristics of neoplasms. Two were heavy smokers, two were non-smokers. In two the lesion was peripheral, in one lobar (RUL), and in the fourth it crossed the interlobar fissure (apical and posterior segments LUL and apical LLL). Malignant cells were not seen on sputum cytology examination in any, but in one, atypical cells were reported. All four patients had lung resection for suspected cancer, two by pneumonectomy, one by lobectomy, and one lingulectomy. All patients recovered, and their clinical course has so far been uniformly benign. Two have been followed long term (16 and 10 years), one 2 1/2 years, and one a year. Pathologically, the lesions appeared to be strictly limited without extra-pulmonary involvement, except that the patient followed for one year has developed hyporegenerative anaemia responsive to prednisone therapy. The pathological features of focal necrosis, granulomatous inflammation, and vasculitis were sufficiently striking, although often focal, to suggest that incisional biopsy from frozen-section histological diagnosis could be useful to prevent extensive lung resection for lesions not positively diagnosed before thoracotomy.

Aged↗
PubMed1975

Surgical management and problems of heart pacing.

Experience with 40 patients and 150 pacemakersss is reviewed. In 13 patients the initial pacing was by epicardial electrodes and in 27 by transvenous catheter electrodes. When epicardial systems were used, two electrodes were always fixed to the heart, the additional electrode being provided for temporary pacing and as a spare in case of future need. The battery unit was usually buried behind the rectus abdominis muscle. Vacuum drainage of the pacemaker pocket was used and was considered helpful in avoiding some complications. The right cephalic vein was preferred for transvenous pacing but existing venous abnormalities sometimes required use of the external jugular vein. Five patients had epicardial systems changed to transvenous ones, and in 5 the reverse procedure was needed. Pacemaker battery problems included inadequate soft tissue protection for the unit, epoxy resion fracture, titanium case leak and problems relating to design change and the special needs for overseas travel. While the danger from diathermy and radiofrequency is now recognized, similar dangers exist for those paced by 'demand' units in large electromagnetic fields.

Abdominal Injuries↗
PubMed1975

The pattern of swallowing during sleep.

The pattern of swallowing during sleep was investigated by means of a study in 10 normal subjects. Sleep was staged by means of EEG, EOG and EMG, and swallowing was monitored by means of an external sensing device attached to the neck. It was found that during sleep, swallowing is episodic, with long swallow-free periods. Swallows occur almost exculusively in association with movement arousals which are most frequent during Stages REM, 1 and 2 of sleep.

Adult↗
PubMed1975

Serial measurement of plasma cortisol in lung cancer.

Serial plasma cortisol estimations were carried out in 81 male lung cancer patients and in a control group of 50 male subjects with conditions other than lung cancer. It was found that group mean plasma cortisol levels, both in the morning and in the afternoon, were greater in the lung cancer patients than in the no-cancer control group. However, long-term assessment four years after the beginning of the study showed that high plasma cortisol levels were found predominantly in cancer patients within six months of death. If such patients are excluded from the study, there is no significant difference in group mean plasma cortisol levels between male lung cancer patients and a male control group.

Female↗