ABC of palliative care. Nausea, vomiting, and intestinal obstruction.
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Humans↗
Biomedical subjects
M J Baines
Publications and source records attributed to M J Baines.
Intestinal obstruction in patients with advanced malignant disease.
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Humans↗
On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far? A reply.
Patients who are dying of cancer usually give up eating and then stop drinking. This raises ethical dilemmas about providing nutritional support and fluid replacement. The decision-making process should be based on a knowledge of the risks and benefits of giving or withholding treatments. There is no clear evidence that increased nutritional support or fluid therapy alters comfort, mental status or survival of patients who are dying. Rarely, subcutaneous fluid administration in the dying patient may be justified if the family remain distressed despite due consideration of the lack of medical benefit versus the risks. Some cancer patients who are not imminently dying become dehydrated from reversible conditions such as hypercalcaemia. This may mimic the effects of advanced cancer. These conditions should be sought and fluid replacement therapy should be given along with the specific treatments for the condition.
Brain Diseases↗
Management of intestinal obstruction in patients with advanced cancer.
Intestinal obstruction is a common and distressing complication for patients with advanced abdominal or pelvic cancer. Palliative surgery has an inevitable high mortality and morbidity rate in these patients who are often very ill. Conservative treatment, using intravenous fluids and nasogastric suction, has not been shown to cause resolution of the obstruction and it involves hospitalisation, immobility and discomfort. Pharmacological treatment, using drugs to control the symptoms of colic, continuous abdominal pain and vomiting, is effective in the majority of patients. They can therefore be cared for at home or in a hospice. A small group of patients, mainly with high obstruction, will benefit from a nasogastric tube or venting gastrostomy and fluids can be given, if needed, by intravenous or subcutaneous infusion.
Abdominal Neoplasms↗
Intestinal obstruction.
Intestinal obstruction is a common and distressing complication for patients with advanced abdominal or pelvic cancer. Many of these patients are unfit for surgery due to extensive local disease or poor general condition. There are now many drug regimens available that will relieve obstructive symptoms in most patients, although a few, mainly with high obstruction, will require a venting procedure.
Abdominal Neoplasms↗
Management of bowel obstruction in advanced and terminal cancer patients.
BACKGROUND: Bowel obstruction is a common and distressing outcome in patients with abdominal or pelvic cancer. PATIENTS AND METHOD: Patients may develop bowel obstruction at any time in their clinical history, with an incidence ranging from 5.5% to 42% in ovarian carcinoma and from 10% to 28.4% in colorectal cancer. The causes of the obstruction may be benign postoperative adhesions, a focal malignant or benign deposit, relapse or diffuse carcinomatosis. The symptoms which are almost always present are intestinal colic (reported in 72%-76% of patients), abdominal pain due to distension, hepatomegaly or tumor masses (in 92% of patients) and vomiting (68%-100%) of cases. CONCLUSION: While surgery must remain the primary treatment for malignant obstruction, it is now recognised that there is a group of patients with advanced disease or poor general condition who are unfit for surgery and require alternative management to relieve distressing symptoms. A number of treatment options are now available for the patient with advanced cancer who develops intestinal obstruction. In this review of the literature, the indications for surgery will be examined, the use of nasogastric tube and percutaneous gastrostomy evaluated and the place of drugs for symptom control described.
Abdominal Neoplasms↗
A new family of mathematical models describing the human growth curve.
A new family of mathematical functions to fit longitudinal growth data is described. All members derive from the differential equation dh/dt = s(t). (h1-h) where h1 is adult size and s(t) is a function of time. The form of s(t) is given by one of many functions, all solutions of differential equations, thus generating a family of different models. Three versions were compared. All were superior to previously described models. Model 1, in which s(t) was defined by ds/dt = (s1 - s)(s - s0) was especially accurate and robust, containing only five parameters to describe growth in stature from age two to maturity. Derived "biological" parameters such as Peak Height Velocity were very consistent between these three members of the family but, in some cases, differed signficantly from previous estimates.
Body Height↗