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Biomedical subjects

R H Adler

Publications and source records attributed to R H Adler.

At least 55 records · Page 3Linked to original sources
PubMed1988

Differential diagnosis of pain in cancer patients.

The differential diagnosis of pain in cancer patients and in patients in whom cancer is suspected can be best attained using a technique of anamnesis that 1. Follows the associations of the patient 2. Accepts biological, psychological, and social factors without prejudice 3. Comprehends the symptom "pain" in its seven dimensions. The list of possible pains includes pain of neoplastic origin, pain due to cancer therapy, somatic pain of nonneoplastic origin, cancer pain increased by psychic factors, and psychogenic pain. The last category includes pain due to conversion and pain as an accompanying sign of the "flight-fight" reaction.

Adult↗
PubMed1987

The development of a German language (Berne) pain questionnaire and its application in a situation causing acute pain.

The adjectives used in the McGill Pain Questionnaire were translated into German. Nine of the 76 adjectives could not be translated satisfactorily. Accordingly, 10 new German adjectives were added by 22 physicians and psychologists, who were also asked to judge the grouping of the words and how adequately they express pain. Concordance of grouping was reached by more than 82% of the raters. The adjectives were assigned to 20 groups. In a next step 80 subjects assessed the words in each group on a visual analogue scale (VAS) with respect to intensity: for 3 of the 20 groups we found no difference in intensity between the adjectives within a group. They were not retained in the final version tested. Additionally each group was reduced to 3 adjectives by dropping the least discriminating words of each group; 17 groups of 3 words each were retained. In a third step a comparably composed group of 82 subjects rated the words in each group on VAS with respect to intensity: for each of the 17 triads there was a significant overall difference between the 3 adjectives on the VAS. In all but 4 of the 17 triads all 3 possible pairwise differences were significant as well. In spite of the significant differences of mean values there was considerable disagreement in individual intensity rankings of the 3 adjectives within the 17 groups. The validity of the German language (Berne) pain questionnaire (BPQ) was tested together with a verbal rating scale (VRS) and a VAS in a double-blind, complete cross-over study. A low osmolar (LO), a high osmolar (conventional) (HO) compound and 0.9% NaCl (placebo) (PL) were injected intra-arterially in patients with arteriovascular disease. We expected the LO compound to cause much less pain than the HO compound. The 3 conditions HO, LO and PL had significantly different effects on all 4 scales: VAS, VRS, RaW (scale of rank of words), and NoW (scale of number of words). The pairwise comparisons of PL with HO and LO resulted in significant differences also. The square of the correlation r for VAS/VRS was 0.64, for RaW/NoW 0.61, all other possible correlations were not significant. Our conclusions are: the translation of the MPQ into German was successful, and its validity could be shown. In our experiment, it differentiated acute, short lasting pain as well as the visual analogue and the verbal rating scales. The BPQ is a tool worth being examined in the laboratory and in studies of clinical pain syndromes.

Evaluation Studies as Topic↗
PubMed1982

Stage fright in musicians: a model illustrating the effect of beta blockers.

Stage fright was used to investigate the mode of action of beta blockers in acute anxiety and on the technical-motor performance of 22 performing string players. They received 100 mg of atenolol or placebo 6.5 hr before performing either in the presence or absence of an audience. Continuous heart rate, stage fright (especially devised rating scale), technical-motor performance (runs of fast notes, trills, vibratos), and urine catecholamine levels were assessed. Before an audience the placebo group showed a significant impairment of technical-motor performance (increase in the relative variance of repeated fast elements of movements: + 25.68%, p less than 0.01) as compared to performance with no audience present; there was a slight but not significant improvement under beta blockade (- 7.48%). Heart rate was significantly lower under beta blockade than under placebo (p less than 0.001). Urine catecholamine levels increased twice as much under beta blockade as under placebo before an audience (p less than 0.01). Beta blockade did not influence stage fright measured before performing, but reduced it (measured immediately after the concert) during the concert. We conclude that the drug was at least partially effective as shown by an improvement in technical-motor performance, and that the beneficial effects of beta blockade in stage fright only involve a peripheral site of action.

Adrenergic beta-Antagonists↗
PubMed1982

Dyspnea proneness to CO2 stimulation and personality (neuroticism, extraversion, MMPI factors).

The relationship between extroversion (E), MMPI factors on the one hand and the ventilatory response to CO2 on the other was examined in order to extend and clarify earlier studies. 30 male nonsmokers were studied using the method of Read (delta VE/PaCO2 as index of readiness to react with dyspnea upon CO2 stimulation). Extroversion (E) and neuroticism (N) was assessed by the Eysenck Personality Test. The panic-fear (PF) and the ego-strength (Es) scales were extracted from the MMPI. The correlation between E, N, MMPI values and delta VE/PaCO2 was measured with Pearson's correlation. Reliability between the first and second respiratory test was obvious, r = 0.66 (p less than 0.001). The correlation between the psychological parameters and the readiness to respond to CO2 was very low in the first test. In the second test, the r for hypochondriasis, depression and PF was 0.25, 0.28 and 0.29, respectively (p less than 0.1; 2-tailed), for N the r was 0.33, for psychastheny 0.33, and for Es -0.40 (all p less than 0.05). In agreement with Saunders and co-workers, we found no correlation for E. Our results indicate that readiness to react to CO2 is related to anxiety (positive correlations for N, Hs, Pt and PF, and negative for Es). This corresponds to clinical observations.

Adult↗
PubMed1981

[Disregard of feelings - an impediment for the development of patient-oriented medicine].

Medicine which considers psychological and social factors to be just as serious as somatic factors meets with obstinate resistance even if "psychosomatics" is part of the official curriculum of many medical schools. Classical psychosomatic studies with a justified claim to be of scientific value, have not changed this situation. Observations of psychosomatics in institutions and in the author's own practice suggest that disdain for emotionality is the basis for rejection of a bio-psychosocial concept. This rejection of emotions finds its unequivocal expression in the physicians' conduct towards patients: the physician showed scant esteem for "soft data". He defines pain for which no organic etiology can be found as "as real" pain and embryos antidepressant medication instead of allowing the patient to "work through" his or her perfectly natural feelings of sorrow, etc. In the light of an example and the literature on "education" it is demonstrated that the childhood of a physicians is held in a state of suppression by the kind of pedagogy which smothers emotions and throttles emotional independence. The future physician then learns to pay attention neither to his own emotions nor to those of his patients. The subsequent lack of respect and empathy towards the patient as an impediment to the development of psychosomatics is discussed, together with possible ways of overcoming these negative influences.

Affect↗
PubMed1981

Differential diagnosis of pleural effusions: clinical usefulness of cell marker quantitation.

Carcinoembryonic antigen (CEA), orosomucoid beta 2 microglobulin, and alpha fetoprotein were quantified in the pleural fluid and serum of 58 hospitalized consecutive patients in order to differentiate malignant from non-malignant effusions. Cytologic examination of the effusions was also performed. The orosomucoid assay was the most helpful in identifying malignant effusions; higher values (greater than 100 mg/100 ml) were found in 74 percent (26/35) of malignant effusions. Quantitation of carcinoembryonic antigen had a high specificity (95 percent) but a low sensitivity (36 percent) for the detection of malignant pleural effusions. The parallel quantitation of CEA and orosomucoid had a higher sensitivity (86 percent) which increased when associated with cytologic examination. The sensitivity of cytology was only 46 percent. The concentrations of orosomucoid in pleural effusions correlated well with serum concentrations. Alpha fetoprotein and beta 2 microglobulin quantitations were of no clinical value for diagnosing malignant effusions. It is suggested the cytologic examination combined with orosomucoid and CEA quantitation in pleural fluid have a considerable clinical value for the diagnosis of pleural effusions.

Adult↗
PubMed1981

Penetrating bullet wound of chest with bronchoscopic removal of bullet.

A case history is presented of a patient with a penetrating bullet wound of the chest in whom the 0.38 caliber bullet was unexpectedly found entirely within the lumen of the right lower lobe bronchus at bronchoscopy. A second bullet penetrating the abdomen necessitated an extensive abdominal operation and delayed removal of the intrabronchial bullet by 1 day. During the 1 day interval, distal migration of the intrabronchial bullet caused technical problems in removal which are discussed. The bullet was successfully removed with a rigid bronchoscope without subsequent complications. The limited literature on this rare occurrence is reviewed, and suggestions are made concerning management.

Abdominal Injuries↗
PubMed1979

Diagnostic value of biochemical analysis of pleural effusions. Carcinoembryonic antigen and beta 2 microglobulin.

Pleural effusions from 105 patients with malignant and nonmalignant diseases were examined for tumor cells, content of CEA, beta2 microglobulin, ceruloplasmin, alpha2 macroglobulin, orosomucoid, lysozyme, and hexosaminidase. Only CEA and beta2 microglobulin determinations were of diagnostic value. CEA concentrations greater than 11 ng/ml were found only in malignant effusions. Beta 2 microglobulin values were increased in pleural effusions due to lymphoma or immune diseases. Measurement of CEA and beta2 microglobulin in addition to the cytologic examination could increase the diagnostic significance of the analysis of pleural effusions.

Beta-Globulins↗
PubMed1978

Psychotropic agents in the management of chronic pain.

In recent years some psychotropic drugs have become useful aids in the management of chronic pain. In this paper these agents will be reviewed with respect to their mode of action, their indications and dosages. Problems in the assessment of their analgesic effects will be discussed.

Antidepressive Agents, Tricyclic↗
PubMed1978

Persistent chylothorax. Treatment by talc pleurodesis.

Two patients with persistent chylothorax resistant to therapy by special diet, thoracenteses, and tube thoracostomy drainage were successfully treated by talc pleurodesis. In one patient with advanced lymphosarcoma involving pleura and mediastinal nodes, the chylothorax was managed by open thoracotomy and talc powder. The other patient developed chylothorax following resection of a thoracic aortic aneurysm. She was successfully treated by talc suspension introduced through a thoracostomy tube. Pleurodesis with talc should be considered only when the chylothorax persists after an adequate period of medical treatment and pleural decompression. Intrapleural instillation of talc through a thoracostomy tube should be successful if the chylothorax can be evacuated and the underlying lung fully expanded.

Chylothorax↗