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Biomedical subjects

K J Egan

Publications and source records attributed to K J Egan.

At least 19 recordsLinked to original sources
PubMed1996

Chronic pelvic pains represent the most prominent urogenital symptoms of "chronic prostatitis".

OBJECTIVES: To refine and standardize evaluation of current symptoms in men with "chronic prostatitis." METHODS: We reviewed the literature, developed a symptom index, and evaluated the clinical utility of this tool in 50 patients with chronic prostatitis and 75 control patients (25 with benign prostatic hyperplasia [BPH] and 50 with sexual dysfunction). RESULTS: Patients with prostatitis reported more perineal, lower abdominal, testicular, penile, and ejaculatory pain than patients with BPH (P < 0.05 for each symptom) or sexual dysfunction (P < 0.01 for each symptom). Ejaculatory pain was also more common among men with prostatitis than among men with BPH (P = 0.07) or among men with sexual dysfunction (P < 0.01). Although described as characteristic of prostatitis in the literature, low back or rectal pain did not distinguish patients with prostatitis from those with BPH. Patients with prostatitis were intermediate between patients with BPH and sexual dysfunction on the voiding scale and similar to the BPH group on the sexual dysfunction scale. CONCLUSIONS: Pain symptoms were the predominant urologic manifestations of chronic prostatitis. The symptom index may prove valuable for evaluating patients and describing clinical results.

Adult↗
PubMed1996

A multidimensional comparison of morphine and hydromorphone patient-controlled analgesia.

Although patient-controlled analgesia (PCA) pumps have been in use for more than a decade, the optimal PCA analgesic has yet to be identified. Many drugs are used; however, morphine remains the "gold standard" of opioid analgesics worldwide. The present study evaluated morphine and hydromorphone (Dilaudid) PCA with respect to analgesic efficacy, side effects, mood, and cognitive function. Sixty-one opioid naive patients undergoing lower abdominal surgery participated in the double-blind protocol. Verbal rating scores, use of medication, and side effects for the two medications were recorded. Cognitive functioning was assessed by computation of Digit Symbol and Trails Making B Tests. Self-reported affective state (mood) was measured by Profile of Mood States (POMS) inventory. Both medications provided adequate analgesia without a difference in side effects. Cognitive performance was poorer in the hydromorphone group (P < 0.05). Patients receiving hydromorphone reported less anger/hostility (P < 0.01) and generally better mood elevations on the other subscales than those receiving morphine. A similar incidence of side effects and dose medication can be anticipated with morphine and hydromorphone. When considering cognitive effects, morphine had less adverse consequences, while hydromorphone appeared to result in improved mood. We conclude that hydromorphone may provide a suitable alternative to morphine.

Abdomen↗
PubMed1995

Intraoperative complications of revision hip arthroplasty using a fully porous-coated straight cobalt-chrome femoral stem.

The operative complications of a consecutive series of 135 cementless revision total hip arthroplasties using a fully porous-coated straight cobalt-chrome femoral stem were reviewed. Intraoperative complications occurred in 59 cases (44%), 22 of which (37%) involved more than one complication. Three categories of intraoperative complications were recorded: eccentric reaming, femoral perforation, and femoral fracture. Complications were noted to decrease throughout the period of the study. Surgical approach did not affect the complication rate. Stem length, stem diameter, and host-bone quality all affected the complication rate. Femoral perforations and fractures were more numerous with femoral stems longer than 200 mm. Larger-diameter femoral stems (> or = 18 mm) were associated with a higher complication rate (55%). Complications were also more numerous with poorer-quality host-bone. In cases of multiple complications, eccentric reaming often predisposed bone to perforation and subsequently to fracture. There was also greater blood loss in patients with intraoperative complications. Intraoperative complications may be avoided with the use of implants, as well as reaming no longer than absolutely necessary, and the use of intraoperative radiographs or flexible reamers early in femoral canal preparation.

Adult↗
PubMed1994

Patient satisfaction with intravenous PCA or epidural morphine.

In many institutions postoperative patients may receive morphine for analgesia administered into the epidural space, epidural opioid analgesia (EOA), or through intravenous self-administered patient-controlled analgesia pumps (PCA). Although a number of studies have compared the two approaches with regard to efficacy and side effects, there is less known with regard to patient satisfaction and its sources. In this study, 711 patients using PCA morphine and 205 patients receiving epidural morphine following a variety of gynaecological, urological, orthopaedic, and general surgical procedures rated their satisfaction with the method they used on a 0-10 verbal analogue satisfaction scale (0 = very dissatisfied; 10 = very satisfied). A consecutive subset of 100 patients (50 from EOA group and 50 from the PCA group) underwent further evaluation to identify advantages and disadvantages of the technique used which contributed to their satisfaction and/or dissatisfaction. Overall satisfaction (mean +/- SD) in the two large groups was 8.6 +/- 1.8 for PCA and 9.0 +/- 1.5 for EOA (P < 0.01). In the subset of 100 patients, there were differences between the EOA and PCA groups with regard to the advantages and disadvantages selected. Patients in the PCA group identified "personal control" and "method worked quickly" as advantages whereas patients receiving EOA selected "clear mind," "effective relief resting," and "effective relief while moving or coughing." The single disadvantage identified more frequently by PCA patients was "pain immediately after surgery before method became effective." Disadvantages identified more frequently by EOA patients were "side effects" and "poor pain relief." We conclude that overall patient satisfaction was high whether patients received PCA or EOA.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1994

Evaluation of intravenous ketorolac administered by bolus or infusion for treatment of postoperative pain. A double-blind, placebo-controlled, multicenter study.

BACKGROUND: Ketorolac is a nonsteroidal analgesic that may provide postoperative analgesia without opioid-related side effects. This double-blind, randomized, multicenter study evaluated the analgesic efficacy and safety of intravenous ketorolac in 207 patients during the first 24 h after major surgery. METHODS: Subjects were assigned to receive one of three analgesic regimens: a ketorolac infusion, ketorolac boluses, or placebo. All subjects had access to intravenous morphine via patient-controlled analgesia (PCA). Evaluations included PCA morphine used, pain assessment (categorical pain intensity scores and visual analogue pain scores), pain relief (categorical pain relief scores), sedation, presence of adverse events, and overall rating of regimens by study observers and patients. RESULTS: Patients in the ketorolac infusion group (but not the ketorolac bolus group) used less morphine (average 33 mg) than did the placebo group (44 mg) (P = 0.009). Significant differences favoring both ketorolac groups were seen in the pain intensity and the categorical pain relief scores at various time points during the study. At the termination of the study, compared with the placebo group, categorical pain intensity scores were lower in the ketorolac bolus group; visual analogue pain scores were lower in both ketorolac groups; and pain relief scores were higher in the ketorolac bolus group. The incidence of vomiting was significantly greater in the placebo group (27%) than in the ketorolac infusion group (12%) or bolus group (9%) (P = 0.032 and P = 0.005, respectively). The incidence of postoperative fever was 10% in the ketorolac bolus group and 25% in the placebo group (P = 0.013). Study observers noted less nursing difficulty while caring for patients in the ketorolac infusion group (P = 0.015). Study observers and patients in both ketorolac groups reported statistically significant overall drug superiority compared with placebo. CONCLUSIONS: It is concluded that intravenous boluses or infusions of ketorolac in conjunction with PCA morphine provide effective, safe analgesia after major surgery and improve on the response to PCA morphine alone.

Adult↗
PubMed1994

Psychological problems in chronic prostatitis patients with pain.

OBJECTIVE: Men with chronic prostatitis are frequently seen in urological practice and are difficult to treat with standard antimicrobial medications. This pilot study was designed to take a different perspective in assessing chronic prostatitis patients with pain by evaluating them using a standard chronic pain clinic psychological approach. DESIGN: Twenty men, 27% of the referred group of patients with chronic prostatitis and pain, completed the MMPI and a structured psychological interview. Their findings were compared to age- and education-matched men seeking treatment for chronic low back pain. SETTING: Data were collected at the Pain Clinic within the Department of Anesthesiology at the University of Washington Medical Center. PATIENTS: Patients were 20 men referred from a urology-based Prostatitis Clinic and 20 men referred to the Pain Clinic for chronic low back pain. RESULTS AND CONCLUSIONS: The two groups differed in the impact of their pain problem on their lives. Prostatitis patients were employed but reported that their symptoms greatly interfered with their sexual/romantic relationships. Back pain patients reported that their pain interfered primarily with work; most of these patients had long-term marital relationships, whereas few prostatitis patients did. Half of the prostatitis patients met criteria for major depression, but back pain patients were more somatically focused, depressed, and anxious. The constellation of relationship problems, disruptions in sexual functioning, levels of depression, along with failure of multiple previous medical treatments in men with chronic prostatitis indicates that continued antimicrobial therapy is unlikely to provide the "cure" these patients seek. Psychological evaluation, couples' counseling, individual counseling, and medications for depression all may play a role in a comprehensive approach to these patients. These results must be considered as preliminary and as representative of a possibly skewed sample of prostatitis patients since only those men who accepted the referral to a pain clinic psychologist for an evaluation were assessed. Clearly, they are likely to be among the patients who are most psychologically and sexually impaired by the chronic prostatitis and associated pain. A further study with less self-selection is indicated.

Adult↗
PubMed1994

Acute pain management of the chronic pain patient on opiates: a survey of caregivers at University of Washington Medical Center.

OBJECTIVE: The provision of acute pain management for the chronic pain patient can pose a challenge. We sought to characterize management issues. SUBJECTS/SETTING: An anonymous survey was distributed to 270 physicians and 212 nurses at University of Washington Medical Center (UWMC) in an attempt to characterize management issues. DESIGN: Caregivers were queried regarding treatment modalities, efficacy of anxiolysis, patient attributes, concern of the quantity of medication, criteria for patient evaluation, and other management issues. RESULTS: Of the respondents, 61.8% were physicians, and 38.2% were nurses. The mean duration in practice was 7.7 years. The responses from the two groups were similar. Seventy-five percent reported using different pain-evaluation techniques for chronic pain patients than those utilized for the "average" patient. Pain scores were used frequently in the average patient, whereas ability to perform activities was used more commonly in the chronic pain patient (p < 0.0001). Half of the respondents expressed concern regarding the amount of medication used and level of sedation. The same proportion found anxiolysis to be a helpful adjunct. The use of a time-contingent "pain cocktail" as an oral medication was a useful strategy for 88% of respondents. The least labor-intensive modality reported was patient-controlled analgesia (PCA) for 84.5% of respondents; intravenous opiate fusion, 5.3%; and epidural analgesia, 11.2%. CONCLUSIONS: The survey describes caregiver concerns regarding this patient population, including medication use, sedation, length of hospital stay, and evaluation techniques.

Academic Medical Centers↗
PubMed1992

Self-administration of midazolam for postoperative anxiety: a double blinded study.

Anxiety is almost inevitably present in patients facing surgery. The optimal management of postoperative pain requires the acknowledgement of perioperative anxiety and the inclusion of pharmacological and/or non-pharmacological means of alleviating the fear and worry inherent in the surgical experience. In a double-blind randomized design, 39 patients undergoing total abdominal hysterectomies were given postoperative access to a standard patient-controlled analgesia (PCA) morphine pump for pain and a PCA pump dispensing either low-dose midazolam or saline for anxiety. Measures of anxiety and pain were completed pre-operatively and for 2 days postoperatively. Utilization of morphine and 'anxiolytic agent' were recorded. Analysis of covariance was applied to the data to control for the imbalance of cancer patients between the 2 groups. While both groups of patients chose to utilize their 'anxiety pump' throughout the study, those patients receiving midazolam had significantly lower postoperative Spielberger State Anxiety scores and visual analogue scale anxiety scores. Patient-controlled midazolam in doses used in this study were safe and effective in managing anxiety but did not influence pain scores or the amount of PCA morphine patients used. Pre-operative levels of depression were significantly associated with postoperative pain levels independent of treatment group or cancer diagnosis.

Adult↗
PubMed1991

Self-reported symptoms of stress with temporomandibular disorders: comparisons to healthy men and women.

Replies on a self-report measure of symptoms of stress obtained from men and women patient samples with diagnosed temporomandibular disorders were compared with similar replies on this test obtained from healthy men and women. On most (six of 10) of the symptoms of stress subscales, the temporomandibular disorder patients' scores were elevated relative to the symptoms of stress averages of the healthy nonpatient samples. There were several statistically significant group differences. There were no statistically significant gender differences nor any gender group interactions. These data are seen as essentially supporting and extending prior studies, which have indicated that, on the average, temporomandibular disorder patients report more psychologic and somatic symptoms. Furthermore, current findings indicate that male temporomandibular disorder patients and female temporomandibular disorder patients report more numerous and/or frequent somatic, psychologic, and behavioral symptoms of stress compared with their healthy counterparts.

Adolescent↗
PubMed1991

Comprehensive evaluation and treatment of 75 men referred to chronic prostatitis clinic.

We investigated the role of genitourinary tract infections, structural and psychologic abnormalities in 75 men referred to a "chronic prostatitis" clinic. Patients had had symptoms for an average of eighty-three months and had received an average of ten weeks of antimicrobial treatment during the three months prior to evaluation. Specific infectious diseases, structural or functional causes were identified in 34 (45%) of the 75 patients. Genitourinary tract pathogens were isolated from 26 patients and inflammation was documented in urethral or prostatic secretions of 24 patients. Structural or functional abnormalities that merited treatment were identified in 8 cases. In addition, major criteria for depression were documented in 9 of 17 patients who agreed to this evaluation. Overall, a comprehensive approach to diagnosis led to specific treatment for 37 (49%) of the 75 men with chronic prostatitis, despite longstanding symptoms and failure of multiple prior courses of therapy.

Adolescent↗
PubMed1988

Self-management of hypertension: predictors of success in diastolic blood pressure reduction.

The purpose of this study was to determine which borderline hypertension subjects could succeed in self-regulating blood pressure, and to distinguish the psychologic and physiologic variables that predicted success. Thirty-four white, male, unmedicated, borderline hypertensive subjects participated in a 14-session biofeedback/cognitive self-management training program. Of these, 22 exited with diastolic pressure below 90 mm Hg; 12 exited equal to or above 90 mm Hg. Both groups exited with scores markedly lower on the Symptoms Checklist-90 (SCL-90). The successful group began and ended on all cognitive/affective subscales at a lower level than the unsuccessful group. A discriminant analysis revealed that lower scores on the SCL-90, lower systolic blood pressures, and higher heart rates during a mental task at the beginning of treatment distinguished those who succeeded in self-regulation from those who could not succeed. The possible mechanisms for blood pressure control/change as a consequence of biofeedback are discussed.

Adult↗
PubMed1987

Response to symptoms in healthy, low utilizers of the health care system.

From the literature, it is clear that a small proportion of people account for an inordinately high number of health care visits. Conversely, there exists a group of individuals who rarely seek professional medical intervention and, yet, who remain healthy. This study examines a sample of adults who have not received remedial treatment for any symptom in the previous year, who consider themselves as healthy and who pass a comprehensive physical examination. A gender and age balanced group of healthy low utilizers was administered the Symptom Response Questionnaire, an instrument designed to elicit response tendencies to thirteen standardized symptoms. There were significant differences between age groups in response to symptoms with the older individuals more likely to seek professional help. There were few gender differences within the healthy sample. This sample of healthy low-utilizers was not without symptoms, reporting an average of 20 symptoms occurring in the previous week as measured by the SCL-90. A clinical headache group was also administered the SRQ to provide information about their response tendencies to symptoms. This preliminary study suggests that response to illness may be significantly influenced by age and patient status and that reported gender differences in health care utilization may need to be examined more carefully. It is proposed that behavior patterns of healthy, low utilizers may have direct implications for intervention with high utilizers of the health care system.

Adaptation, Psychological↗
PubMed1986

Hysterical paralysis in the upper extremity of chronic pain patients.

The patient with chronic pain who develops the conversion symptom of hysterical paralysis in the upper extremity can be treated successfully by rehabilitation medicine services, using a shaping behavioral program. Four case reports illustrate the management of this condition and the basic ingredients for such a program are outlined. The approach is based upon learning principles and experience with conversion reactions affecting gait. Treatment outcome often is related directly to the care and skill with which psychological assessment is performed and to the coordinated effort of the various team members.

Adult↗
PubMed1984

The effect of alexithymia on morbidity in hypertensives.

Alexithymic and nonalexithymic hypertensives were assessed for severity of hypertension using a weighting system based on diastolic blood pressure, optic fundi, ECG, chest X ray, renal studies, and patient history. Outpatient hypertensives (diastolic blood pressure greater than 95 mm Hg) were selected as subjects because they are largely asymptomatic; thus, focusing on somatic ills to the exclusion of thoughts about emotions is not likely to be due to their hypertensive pathology but rather reflects psychological constitution. Controlling for age differences, it was found that alexithymics manifested more severe hypertensive sequelae than did nonalexithymics ; there was, however, no difference in severity of atherosclerosis. The results suggest that alexithymia is not only correlated with hypertension but may also play a role in its etiology.

Adult↗