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Biomedical subjects

Mark J Lema

Publications and source records attributed to Mark J Lema.

6 recordsLinked to original sources
PubMed2002

Anaesthetic team and the role of nurses--North American perspective.

Anaesthesia is an American invention but the development of anaesthesia practice took two paths at its inception. The American-based ether anaesthetic technique allowed for non-physician personnel to administer the drug. As nurses already played a role in assisting surgeons, it was logical for them to assist in the anaesthetic. This article discusses the historical events leading to the development of nurse anaesthesia practice in the USA. The current status of physician and nurse anaesthetist interactions--both harmonious and acrimonious--are presented.

Anesthesiology↗
PubMed2002

Emerging options with coxib therapy.

Future clinical applications of cyclooxygenase (COX)-2-selective inhibitors (coxibs) are likely to extend beyond their current use as oral analgesics in high-risk arthritis patients. The clinical utility of coxibs for the treatment of Alzheimer's disease (AD) is under investigation. Epidemiological surveys, preclinical studies, and preliminary clinical trials with nonsteroidal anti-inflammatory drugs (NSAIDs) have suggested that inflammatory mechanisms play a role in the neurodegeneration of AD. Clinical trials are currently being conducted to determine the effect of coxibs on the rate of AD progression. The use of coxibs as chemopreventive agents in colorectal cancer (CRC) is also under investigation. The chemopreventive benefits of coxibs to promote cell death (apoptosis) and inhibit angiogenesis in CRC have been shown in tumor cell lines and in animal and human models. In addition, palliative care clinicians and oncologists are increasingly including coxibs in their management of cancer pain. Coxibs are utilized for their opioid-sparing effect in the management of cancer pain, without impairing wound healing, or promoting bleeding diathesis (antiplatelet effects) or adverse gastrointestinal effects in patients receiving chemotherapy or radiation treatment.

Alzheimer Disease↗
PubMed1993

Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer.

Twenty-six patients with extensive gynecologic, colorectal or genitourinary cancer who suffered uncontrolled, incapacitating pelvic pain were enrolled in this study during a 1-year period. All the patients receiving oral opioids who developed poor pain response due to the progression of disease or untoward side effects necessitating other modes of therapy were eligible to participate. Bilateral percutaneous neurolytic superior hypogastric plexus blocks with 10% phenol were performed in every patient, 1 day after receiving successful diagnostic blocks using 0.25% bupivacaine (BUP). All patients reported a visual analog pain score (VAPS) of 10 of 10 before the block. Eighteen patients (69%) had satisfactory pain relief (VAPS < 4 of 10): 15 (57%) after 1 block and 3 (12%) after a second block. The remaining 8 patients (31%) had moderate pain control (VAPS 4-7 of 10) after 2 blocks and received epidural bupivacaine-morphine (BUP-MS) therapy with good results. Both groups experienced significant reductions in oral opioid therapy after the neurolytic blocks. No additional blocks were required by patients who had a good response during a follow-up period of 6 months. No complications related to the block were experienced by any patient. In conclusion, neurolytic superior hypogastric plexus block was both effective in relieving pain in 69% of the patients studied (95% confidence interval of 48-85%). Additional neurolytic blocks using higher volumes of the neurolytic agent may be needed in patients with extensive retroperitoneal disease, a group in whom moderate or poor results should be expected.

Adult↗