Showing papers by "Churchill Hospital published in 1981"

Unexpected complication of successful nerve block. Morphine induced respiratory depression precipitated by removal of severe pain.

Abstract: A case is reported of a 76-year-old man with a right-sided mesothelioma who required large doses of oral narcotics to control his severe chest pain After a successful chlorocresol intrathecal nerve block, respiratory failure was induced by doses of oral morphine at the same level as those used before the block, and also by substantially smaller doses A considerable reduction in analgesic requirements may be possible following non-drug intervention to relieve pain and may be essential in patients with compromised respiratory function This observation emphasises the importance of pain as a potent stimulator of the respiratory centre in patients with reduced respiratory reserve who are receiving narcotic drugs

The Urodynamic Characteristics of Multiple Sclerosis

Abstract: Summary— Urodynamic assessment was performed in 52 patients with urinary symptoms positively diagnosed as suffering from multiple sclerosis. Fifty-one patients had unequivocal bladder instability on filling cystometry the exception had inappropriate relaxation of the urethral sphincter at a small bladder capacity and low bladder pressure. Results of sphincter electromyography and synchronous cineradiography of voiding in a number of our patients led to the conclusion that many of these patients also suffer detrusor sphincter dyssynergia. There was no correlation between any measurable urodynamic parameter and the severity of the physical disability.

CONTROLLED-RELEASE MORPHINE TABLETS A double-blind trial in dental surgery patients

Abstract: We report a randomized double-blind comparison of controlled-release morphine tablets (MST-1; 2 x 10 mg) and oral morphine sulphate in solution (20 mg) in 28 patients (20 females) who had undergone removal of impacted lower third molars or a dental clearance under general anaesthetic The response in both groups was very poor: eight of 15 patients in MST-1 group and six of 13 patients in the standard group required "rescue" analgesics and were withdrawn from the study within the first 2h No threshold plasma concentration of morphine corresponding to a particular analgesic effect was apparent MST-1 produced significantly greater plasma concentrations at 8h compared with the standard preparation Controlled-release morphine, or any oral formulation of morphine, may not be suitable for the treatment of acute pain after operation

Pleural effusion in allergic bronchopulmonary aspergillosis: two case reports.

Abstract: Two cases of pleural effusion associated with allergic bronchopulmonary aspergillosis are described. This association has not previously been reported. In one case the effusion cleared with prednisolone. It is suggested that the effusions were directly related to the aspergillosis.

Rehabilitation in terminal cancer patients.

Abstract: Good terminal care may be described as rehabilitation of the dying, and is exemplified in the modern hospice. The aim is to help the individual patient to do his best, given his illness, his symptoms, and his cultural, familial and personal background and beliefs. Comfort is the primary objective, not prolongation of life. The patient and his family should be regarded as the unit of care. Sixty per cent of patients with far-advanced cancer experience pain. In the majority of patients it is not difficult to control pain provided certain basic principles are adhered to: 1. Careful evaluation of cause(s) of pain. 2. Realization that pain is a somatopsychic experience. 3. Use of an appropriate analgesic on a time-contingent basis. 4. Recognition that the effective dose of a narcotic analgesic varies widely. 5. Use of both non-drug and drug treatments. 6. Continuing surveillance of all patients, particularly those receiving a narcotic analgesic. A comparable analytical and systematic approach is necessary also in the management of other symptoms. Patients need professional friendship and support if they are to adjust to declining physical health and a poor prognosis. Gentle openness in matters of communication is fundamental; evasion and deceit are essentially destructive. Thed family too need much help if they and the patient are to become mutually supportive. Terminal care cannot be done by individuals, only by individuals working together as a team.

Atropine responsiveness in asthma in relation to steroid aerosol therapy

Abstract: The observation by Altounyan 1964 that atropine responsiveness in allergic subjects diminishes with increasing severity of airflow obstruction implies, as a corollary, that atropine responsiveness should improve if airflow obstruction improves either spontaneously or as a result of treatment. Thus, in a study comprising 60 patients with allergic airways disease, he showed that a course of treatment with prednisolone resulted not only in an overall improvement in symptoms and lung function, but also in a change from a low to a high degree of atropine responsiveness. In a study where 17 subjects with allergic airways disease were treated solely with Intal Compound (disodium cromoglycate and isoprenaline) he noted that even in the absence of a significant change in basal FEV 1 , an improvement in atropine response did occur (Altounyan 1969). There have been no reports of atropine responsiveness in subjects treated solely with steroid aerosols and we therefore describe a study in eight subjects with reversible airflow obstruction associated with features of allergy. All had atropine response tests before and during treatment with steroid aerosols.