1/88. Revision hip arthroplasty in patients with a history of previous malignancy.BACKGROUND AND OBJECTIVES: The potential association between implants and malignancy has been discussed in the literature, but never as a cause of loosening of joint arthroplasty. methods: The records of all patients who underwent revision arthroplasty at our institution between 1992 and 1995 were reviewed. RESULTS: Among 93 patients who underwent revision hip arthroplasties, 11 (11.8%) had a history of previous malignancy. At surgery, in 2 of these patients, metastasis was found to be the cause of loosening in the affected hip. CONCLUSIONS: When revision hip arthroplasty is considered, patients with a history of malignancy require attenuated pre-, intra-, and postoperative workup. Management algorithm in such cases is proposed.- - - - - - - - - - ranking = 1keywords = affect (Clic here for more details about this article) |
2/88. Successful antidepressant treatment for five terminally ill cancer patients with major depression, suicidal ideation and a desire for death.In the debate on euthanasia and physician-assisted suicide, we have to exclude terminally ill patients in whom the desire for death is caused by major depression. However, it is still not clear to what degree major depression can be treated by psychiatric intervention in this setting. We evaluated the effect of antidepressant treatment in terminally ill cancer patients. Six cancer patients with suicidal ideas thought to be due to major depression were treated with tricyclic antidepressants. Three had requested terminal sedation to relieve them from their suffering. The median survival of five of these patients was 4 weeks after diagnosis; one was lost to follow-up. The efficacy of the antidepressant treatment was assessed using the Hamilton Rating Scale for depression (HRSD). One week after the start of treatment with antidepressants, five of the six patients showed a marked improvement in their mood and showed no further suicidal thoughts or requests for terminal sedation. The average reduction in the HRSD score was 23.4 points (14-38; SD = 9. 9). Antidepressant treatment can be effective in alleviating the desire for death due to major depression, even in terminally ill cancer patients.- - - - - - - - - - ranking = 8.8669042600945keywords = mood (Clic here for more details about this article) |
3/88. Urinary continence issues in oncology.urinary incontinence may occur with many types of cancer and cancer therapies. Symptoms of urinary incontinence negatively may affect patients' lifestyles, self-esteem, and quality of life. Although urinary incontinence is not a new problem, nurses often underestimate its impact on patients. knowledge of the physiology of micturition and causes of urinary incontinence in patients with cancer may help nurses identify patients at risk and provide a framework for conducting targeted assessments of urinary function.- - - - - - - - - - ranking = 1keywords = affect (Clic here for more details about this article) |
4/88. Managing addiction in advanced cancer patients: why bother?The management of addiction in patients with advanced cancer can be time-consuming, labor-intensive, and difficult. Some clinicians believe that it is not worth the effort, due in part to a failure to appreciate the deleterious impact of addiction on palliative care efforts and a view of addiction as intractable in any case. Indeed, it is possible that some clinicians perceive addiction not only fatalistically but, because of common misconceptions, believe that managing or attempting to decrease the patient's use of alcohol or illicit substances would be tantamount to depriving a dying patient of a source of pleasure. In this paper, we argue that managing addiction is an essential aspect of palliative care for chemically-dependent and alcoholic patients. The goal of such efforts is not complete abstinence, but exerting enough control over illicit drug and alcohol use to allow palliative care interventions to decrease suffering. To illustrate this view, we describe two patients with chemical-dependency. We highlight the impact of unchecked substance abuse on patients' perpetuation of their own suffering, the complication of symptom management, the diagnosis and treatment of mood/anxiety disorders, and the effect on the patients' family and caregivers.- - - - - - - - - - ranking = 8.8669042600945keywords = mood (Clic here for more details about this article) |
5/88. Difficulties in diagnosing neuropsychiatric complications of corticosteroids in advanced cancer patients: two case reports.Because of their variety of uses, corticosteroids are frequently prescribed in advanced cancer patients. Two patients who developed neuropsychiatric complications on corticosteroids and their subsequent management are described. The first patient, who had a known history of steroid-induced psychotic depression, required corticosteroids to treat recurrent brain edema from a malignant meningioma. The patient was managed by using low-dose corticosteroids and concomitant haloperidol. The second patient was prescribed corticosteroids for a constellation of symptoms, including pain and nausea from a possible bowel obstruction, and developed a severe delirium that required discontinuation of the corticosteroids. The difficulties of diagnosing steroid-related cognitive and mood changes in advanced cancer patients who often have multisystem disease are discussed, as well as strategies for minimizing the effects of corticosteroids' neuropsychological complications.- - - - - - - - - - ranking = 8.8669042600945keywords = mood (Clic here for more details about this article) |
6/88. A new homeopathic approach to neoplastic diseases: from cell destruction to carcinogen-induced apoptosis.Neoplastic diseases are now among the most commonly seen conditions. Orthodox, non-surgical approaches, including chemotherapy and radiotherapy, have variable results, but many adverse affects that limit their use. These are sometimes the direct cause of death. More patients are choosing alternative treatments, mainly the homeopathic and herbal-nutrition approach. homeopathy does not have highly effective remedies for cancer in its literature, and has been limited to palliating the adverse effects of chemo/radiotherapy. research into substances that can produce neoplastic diseases (carcinogens), may lead to them being used to treat the cancer they cause, according to the principle of similarity. I have used ultra-low doses (1 x 10(-10) to 10(-12) molar) of chemical carcinogens for 3-24 months, which have been given to cancer patients, usually in conjunction with conventional treatment. Using this procedure, complete remission or life extension has been achieved for some cancer cases. Three clinical cases are presented: a man with undifferentiated lung cancer; a child with an astrocytoma and a woman with leiomyosarcoma.- - - - - - - - - - ranking = 1keywords = affect (Clic here for more details about this article) |
7/88. An unfortunate family: terminal illness and the altering of the attachment bond.This article emphasizes the value of a therapeutic presence in terminal death situations. An unusual clinical case illustrates the point. The presenting issue was aggression between an adult son and father. It soon became apparent, however, that this son was profoundly enmeshed with his mother. During the course of family therapy the father died, and then the mother was diagnosed with cancer. The therapist changed therapeutic goals and attended to the relationship between mother and son. He made home visits to the mother and the surviving son. She seemed to die peacefully and the son moved on with his life, which prior to the death of his mother would not have appeared likely because of his profound dependence on her. Resolving pathological attachment is not easy. Attachment theory refers to the affectional bonds or attachments, initially between child and parent and later between adult and adult. It is suggested that terminal illness and death can, with help of a therapist, alter this attachment bond, even though the literature on adult dependency and attachment does not refer to death in this manner.- - - - - - - - - - ranking = 1keywords = affect (Clic here for more details about this article) |
8/88. Variegated aneuploidy related to premature centromere division (PCD) is expressed in vivo and is a cancer-prone disease.We present three patients with variegated aneuploidy and premature centromere division (PCD), a rare chromosomal abnormality in humans. Comparison of these three and eight other patients with variegated aneuploidy related to PCD demonstrates a phenotype comprising most frequently microcephaly, CNS anomalies (with cerebellar affection and migration defects), mental retardation, pre-and postnatal growth retardation, flat and broad nasal bridge, apparently low-set ears, eye and skin abnormalities, and ambiguous genitalia in male patients. The occurrence of wilms tumor in three patients, rhabdomyosarcoma in two others and acute leukemia in a fifth characterizes this condition as a chromosome or genome instability disorder with a high risk of malignancy. FISH studies in uncultured blood and buccal smear cells demonstrate that the random aneuploidies are not limited to cultured cells, but also occur in vivo.- - - - - - - - - - ranking = 1keywords = affect (Clic here for more details about this article) |
9/88. Assessment and management of pain in palliative care patients.BACKGROUND: pain affects more than 70% of cancer patients but is often undertreated. methods: The authors review and present methodologies to maximize proper palliative approaches to this symptom for the majority of patients. RESULTS: The world health organization's stepwise guide to pain control serves as an excellent basis for management. Around-the-clock dosing, using adjuvant treatments, and using noninvasive routes of administration provide good pain control for 80% of patients. CONCLUSIONS: Barriers to effective pain control will be reduced as new JCAHO standards regarding pain control are implemented.- - - - - - - - - - ranking = 1keywords = affect (Clic here for more details about this article) |
10/88. breast cancer genetics and cancer control. Tumor association.Verified breast cancer was present in a father, his mother, and his daughter. His sone had a brain tumor (by history) and his grandson, (ehs sone of the affected daughter), had a histologically verified rhabdomyosarcoma. This familial aggregation of cancers (except for leukemia, which is absent) is consistent with a newly described familial breast cancer syndrome. A single pleiotropic, dominantly transmitted gene, possibly interacting with carcinogenic factors, such as an oncogenic virus, may be the cause. A cancer-control potential exists for tumor associations such as those exhibited in this kindred, as well as for other cancer genetic syndromes where careful consideration is given to all histologic varieties of cancer.- - - - - - - - - - ranking = 1keywords = affect (Clic here for more details about this article) |
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