Biomedical subjects
M Michaud
Publications and source records attributed to M Michaud.
Patient-controlled subcutaneous hydromorphone versus continuous subcutaneous infusion for the treatment of cancer pain.
Twenty-five patients with pain due to advanced cancer were randomized to receive patient-controlled sc injections (PCIs) of hydromorphone (HM) versus continuous sc infusion (CSCI) of HM by means of a Pharmacia 5200 pump. Each self-injection of HM during PCI was equivalent to 4 hours of CSCI. After 3 days, a crossover occurred, and patients received the alternate treatment for 3 days. During both phases of the study, patients could request extra doses of HM from their nurses. In 22 patients able to be evaluated, pain intensity (visual analogue, 0-100 mm) at 9:00 a.m. and 4:00 p.m. was 31 +/- 23 and 28 +/- 18 mm, respectively, on PCI versus 28 +/- 18 and 27 +/- 17 mm, respectively, on CSCI [P = not significant (NS)]. The total dose of HM was 168 +/- 197 and 181 +/- 234 mg on PCI and CSCI, respectively (P = NS). No significant difference was found in nausea, drowsiness, or number of hours of sleep. The total number of extra doses of HM was 6 +/- 7 on CSCI versus 2 +/- 3 on PCI (P = .007). At the end of the study, patients chose PCI and CSCI in seven and 10 cases, respectively (P = NS; 5 patients expressed no preference). We conclude that both methods were similar in regard to effectiveness and toxic effects in short-term hospital use.
Use of the subcutaneous route for the administration of narcotics in patients with cancer pain.
From February 1985 until January 1987, 108 consecutive patients with pain due to advanced cancer requiring parenteral narcotics were treated with a subcutaneous infusion of morphine (62 patients) or hydromorphone (46 patients). Mean maximal daily dose of morphine and hydromorphone was 305 mg (range, 80-3000 mg) and 310 mg (range, 40-4024 mg), respectively. The infusion was maintained for a mean of 31 +/- 16 days (range, 2-156). Seventy patients were treated with a portable pump. Of these patients, 33 (45%) were discharge home for a mean of 29 +/- 20 days. Eighty-six of one hundred eight (86/108, 80%) patients experienced adequate pain control (less than two extra doses of analgesics per day). The duration of the site of the infusion was 7 days (range, 2-31). The mean daily increase in those was 2.4 +/- 1.6% of the initial dose (only 15% of patients needed an increase more than or equal to 5% per day). Systemic toxicity consisted of respiratory depression in two patients, severe sedation in six, and confusion in three; all patients improved upon reduction of the daily dose of narcotics. Local toxicity consisted in infection in two patients, bleeding in one, and chemical irritation in six. Cost analysis shows that subcutaneous infusion reduced costs by either allowing home discharges, or replacing intravenous infusion. The authors conclude that this method is safe and effective in patients admitted and at home, and should be considered the first choice when parenteral analgesia is required.
Muscle electrophysiology in patients with advanced breast cancer.
Sixty-one consecutive patients with advanced breast cancer (defined as metastatic disease) and 20 normal age- and sex-matched controls were admitted to a prospective study designed to assess muscle electrophysiology. Nutritional status, lean body mass, and ultrasonographic measurement of the triceps brachialis, sternomastoid, and adductor pollicis muscles were determined in patients and controls. In addition, tumor mass and performance status were determined in the patient group. Electrophysiology of the adductor pollicis muscle was assessed during isometric voluntary maximum effort and during electrical stimulation via the ulnar nerve (80-120 V, 50-100 msec). Nutritional status, lean body mass, and ultrasonographic measurements of the triceps brachialis, sternomastoid, and adductor pollicis were not significantly different between patients and controls. Maximum strength after supramaximal stimulation at 50 Hz was 34 +/- 15 N in patients, versus 40 +/- 9 (P less than .01) N in controls. Relaxation velocity was 336 +/- 149 N/sec in patients, versus 507 +/- 251 (P = .02) N/sec in controls. Fatigue (% of initial strength after 30 sec of stimulation) was 67% +/- 22% in patients, versus 79% +/- 17% (P = .03) in controls. Muscle electrophysiology did not correlate with tumor mass or performance status. It was concluded that patients with advanced breast cancer have abnormal muscle electrophysiology that is not due to abnormal nutritional status or decreased muscle mass. More research is needed to better characterize this disorder and to better define its cause.
Is HLA class II allogenotyping universally applicable?
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Continuous subcutaneous (CS) infusion of metoclopramide (MCP) using a plastic disposable infusor for the treatment of chemotherapy-induced emesis.
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Managing chemotherapy-induced emesis.
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Absolute scattering probabilities for subexcitation electrons in condensed H2O.
Absolute elastic and inelastic collision probabilities per unit length for subexcitation electrons scattering in condensed water were determined by analysis of electron energy loss and transmission data for electron energies between the vacuum level (zero incident kinetic energy) and 3.2 eV. Highly disordered solid films were deposited on a metal substrate with thickness varying between 1 and 50 layers. Analysis by an N-channel model of hot electron transport provides values of 0.017 and 0.068 per layer for the elastic and total inelastic collision probabilities, respectively.
Total cross sections for slow-electron (1-20 eV) scattering in solid H2O.
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Absolute vibrational excitation cross sections for slow-electron (1-18 eV) scattering in solid H2O.
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Opening of new decay channels for core-excited resonances.
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Near-threshold electronic excitation by electron impact of multilayer physisorbed N2 and CO.
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Local toxicity during the subcutaneous infusion of narcotics (SCIN). A prospective study.
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Continuous sc infusion of narcotics using a portable disposable device in patients with advanced cancer.
Fifty-six patients with chronic pain due to advanced cancer were treated with an sc infusion of morphone (34 patients) or hydromorphone (22 patients) using a portable disposable infusor. The infusion was maintained for 26 +/- 14 days. Twenty-five patients (45%) were discharged to the home for a mean period of 18 days (range, 2-138). The mean daily increase in dose was 2.6% +/- 1.4% of the initial dose. The sc site needed to be changed every 8 days (range, 2-31). Local toxicity consisted of infection in two patients (3%), chemical irritation in three (5%), and bleeding in one (2%). After 48 hours of treatment, 54 of 56 patients (96%) preferred the sc infusion to their previous parenteral treatment. We conclude that this is a safe and simple method for the administration of narcotics to inpatients and outpatients.
Continuous Sc infusion of metoclopramide for treatment of narcotic bowel syndrome.
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[What is your diagnosis? Scleroderma type II].
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Muscular compensatory mechanism in the presence of a tendinitis of the supraspinatus.
The aim of this study was to assess the electromyographic (EMG) activity of the middle part of the deltoid and of the supraspinatus muscles in subjects suffering from supraspinatus tendinitis. This experimental group (N = 10) was compared to a control group (N = 10). Each subject performed three isometric contractions for each of four pre- determined levels (5, 20, 35 and 50%) of their maximal voluntary contraction (MVC) during shoulder abduction. These contractions were carried out at angles of 0 degree and 45 degrees of abduction. The EMG signals obtained for each subject were integrated and normalized in a Z score form. Trend analysis, performed on the data of each of the two groups, revealed the existence of a significant (p less than 0.001) linear relationship between the integrated EMG (IEMG) and torque levels for each muscle investigated, at both angles of abduction. Furthermore, in the control group, similar EMG amplitudes were obtained for each muscle at these two angles of abduction. However, in the experimental group, the IEMG of the deltoid muscle showed a significant decrease in activity relative to the activity of the supraspinatus at an angle of 45 degrees of abduction (ANOVA, p less than 0.05). It is suggested that this inhibition of the deltoid reflects a compensatory mechanism. The purpose of this mechanism could be to prevent the compression of the affected supraspinatus tendon between the humeral head and the acromion that could occur while abducting the arm.