Methadone treatment in the pediatric intensive care unit.
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Child↗
Biomedical subjects
D E Weissman
Publications and source records attributed to D E Weissman.
Wisconsin physicians' knowledge and attitudes about opioid analgesic regulations.
This pilot study was designed to evaluate physician knowledge of the controlled substance regulations that govern the prescribing of opioids and whether concerns about regulatory scrutiny affect reported prescribing practices. Two hundred Wisconsin physicians were surveyed, and 90 (45%) of the questionnaires were evaluable. Approximately 50% of the responses to questions about controlled substance regulations were incorrect. Concern about regulatory scrutiny ranked low compared to concerns about addiction and other opioid side effects. However, 54% of the respondents indicated that, due to concern of regulatory scrutiny, they will do one of the following: reduce drug dose or quantity, reduce the number of refills, or choose a drug in a lower schedule. These results indicate that many physicians have poor knowledge of controlled substances regulations and that the perceived risk of regulatory scrutiny can alter physician prescribing practice. Implications for patient care, policy and further research are discussed.
Analgesics, Opioid↗
A case of large cell CNS lymphoma associated with a systemic small cell lymphocytic lymphoma.
A case is reported of a 59 y/o woman with a large cell CNS lymphoma and a small cell lymphocytic lymphoma in the bone marrow. The brain tumor underwent spontaneous regression and subsequent regrowth while there was slow progression of the systemic small cell lymphoma. The CNS lymphoma regressed rapidly following treatment with prednisone and cyclophosphamide. We hypothesize that the small cell lymphoma in this patient may represent an underlying immunodeficiency disorder.
Brain Neoplasms↗
Early diagnosis of spinal epidural metastases using out-patient computed tomographic myelography.
Twenty patients with known malignancies, back pain, abnormal roentgenograms of the spine, and normal neurological examinations were evaluated by outpatient computed tomographic (CT) myelography to determine the presence and extent of epidural tumor. Spinal CT following the intrathecal administration of low doses of water soluble contrast agents provided high quality diagnostic information. Three patients experienced adverse effects from this procedure which were mild and easily managed in the outpatient setting. Epidural tumor was identified in 15 of 20 (75%) patients. Patients were followed for 9-27 months following myelography. The 14 patients with epidural tumor treated with local radiation experienced pain relief and only one of these patients developed signs or symptoms of recurrent epidural tumor in the treated site. This study documents the high incidence of epidural tumor in selected patients without neurological deficits and the excellent palliative results of non-emergent, carefully planned radiation therapy. It also demonstrates that high resolution CT myelography can be performed safely in an outpatient setting in patients at high risk for epidural tumor. Outpatient myelography facilitates the early diagnosis of epidural tumor and provides needed information on the extent of the tumor for radiation treatment planning while conserving health care resources. For these reasons, outpatient CT myelography should be considered in selected patients with cancer who are at high risk for epidural metastases.
Adult↗
Attitudes about cancer pain: a survey of Wisconsin's first-year medical students.
A brief questionnaire was administered to 317 first-year students at Wisconsin's two medical schools to assess their attitudes about cancer pain prior to their entry into medical school. Although the students had a realistic perspective of the prevalence and severity of cancer pain, they displayed a number of negative attitudes that if unchanged would contribute to future inadequate pain treatment. Students (a) greatly exaggerated the incidence of psychological dependence (addiction) in patients treated with opioid analgesics, (b) inappropriately timed maximal analgesic therapy to the duration of life expectancy, (c) felt that a majority of patients with cancer currently receive adequate or excessive analgesic therapy, and (d) believed that increasing pain was invariably related to the development of drug tolerance rather than to progression of the disease. Curricular efforts need to be directed at bringing about changes in students' negative attitudes about cancer pain and its management.
Attitude of Health Personnel↗
Changing physician attitudes about cancer pain management.
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Attitude of Health Personnel↗
Primary lymph node presentation of angiocentric lymphoma associated with features of a hemophagocytic syndrome.
The spectrum of post-thymic T-cell neoplasia includes the angiocentric immunoproliferative lesions, a group of disorders histologically exhibiting vascular infiltration and destruction; included among these disorders is angiocentric lymphoma. In contrast to the typical extranodal presentation seen in the angiocentric immunoproliferative lesions, this report describes a case of angiocentric lymphoma presenting as primary lymph node disease with clinicopathologic findings mimicking a hemophagocytic syndrome. Rearrangement of the T-cell receptor beta chain documents this case to be a clonal T-cell neoplasm. The association of this distinct histologic type of T-cell malignancy with hemophagocytic syndromes is reviewed.
Adult↗
Complete remission of paraneoplastic sensorimotor neuropathy: a case associated with small-cell lung cancer responsive to chemotherapy, plasma exchange, and radiotherapy.
A 61-year-old man was found to have small-cell lung cancer following a 1-year history of a progressive peripheral sensorimotor neuropathy. The neuropathy initially improved following chemotherapy, but subsequently progressed to the point of respiratory failure. Treatment with plasma exchange, additional chemotherapy, and radiotherapy resulted in a sustained complete tumor remission and neurologic recovery. The role of plasma exchange is unclear, but its use should be considered in cases of severe sensorimotor neuropathy unresponsive to antineoplastic treatment.
Antineoplastic Combined Chemotherapy Protocols↗
Assessment of pain during head and neck irradiation.
Radiation therapy for patients with head and neck malignancies frequently results in painful mucositis, which is usually poorly controlled with standard analgesics or topical anesthetics. To better understand the temporal development of radiation-induced pain and the effects of this pain on activities of daily living, 14 patients undergoing radiation therapy for a newly diagnosed head and neck malignancy completed daily pain diaries during the course of irradiation. All patients developed painful mucositis, usually beginning during the second or third week of radiation. Despite the use of analgesics/anesthetics, pain was rated as moderate or severe on 37% of treatment days and was noted to be constant or present throughout most of the day on 58% of treatment days. Eating and sleep disturbances related to pain occurred on 55% and 34% of treatment days, respectively. Eight patients had greater than a 2-kg weight loss. Radiation induces a predictable pattern of pain and comorbidity, which may be amenable to earlier and more aggressive analgesic treatment.
Activities of Daily Living↗
Educational role of cancer pain rounds.
Lack of appropriate physician education is one of several reasons for the recognized deficits in cancer pain management. This article describes the educational role of a weekly meeting, "Cancer Pain Rounds," attended by a multidisciplinary team of health professionals skilled in cancer pain management and student physicians caring for inpatients with cancer. Educational benefits occur in three spheres including factual information concerning assessment, treatment, and attitude issues, legitimization of the cancer pain problem, and role modeling. This type of educational experience will hopefully improve cancer pain management.
Analgesia↗
Experimental drug therapy of peritumoral brain edema.
Four drugs with potential anti-peritumoral brain edema activity were studied using the VX2 rabbit brain tumor model. Meclofenamate and indomethacin were tested in an attempt to confirm recent reports of anti-edema activity in non steroidal anti-inflammatory drugs (NSAID's). The 'angiostatic' steroids 17 hydroxyprogesterone and epicortisol were tested because of their lack of glucocorticoid and mineralocorticoid effects and their structural similarity to glucocorticoids. The protein and water component of brain edema were indirectly quantitated. None of the test drugs demonstrated significant anti-edema activity. This work does not confirm reports that NSAID's have anti-edema activity and suggests that there may be no correlation between 'angiostatic' and anti-edema activity in certain steroid compounds.
17-alpha-Hydroxyprogesterone↗
A model for quantitation of peritumoral brain edema.
A model system is described which is suitable for quantitation of peritumoral brain edema. The temporal development of peritumoral brain edema in dexamethasone-treated rabbits and untreated controls was evaluated following the implantation of VX2 carcinoma cells into the frontal lobe of New Zealand White rabbits. A colorimetric assay of Evans blue (EB) extravasation was used to quantitate edema. Animals receiving a sham tumor injection contained an equal amount of EB compared to control animals. Dexamethasone was found to significantly reduce the extravasation of EB in rabbits with VX2 brain tumors and to delay the onset of neurologic deficits. These results are consistent with events occurring in patients with brain tumors. Studies of new drugs or physiologic aspects of peritumoral edema can be conducted with this model system.
Animals↗
Cancer pain education: a call for role models.
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Education, Medical↗
Glucocorticoid treatment for brain metastases and epidural spinal cord compression: a review.
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Brain Edema↗
Direct-implantation model of metastatic and ocular tumors.
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Animals↗
Corticosteroid toxicity in neuro-oncology patients.
Hospital charts from 59 patients with intracranial malignancy or epidural spinal cord compression were reviewed to establish the frequency of clinically important corticosteroid toxicities and to determine treatment or patient characteristics which were predictive for toxicity. Thirty patients (51%) developed at least one steroid toxicity and eleven (19%) required hospital admission for diagnosis and/or management of steroid-related complications. In this retrospective analysis the duration of steroid therapy and the total administered dose predicted for toxicity. Patients with toxicity also had a significant fall in the serum albumin level. Important corticosteroid toxicity occurs frequently in neuro-oncology patients. Further research should be directed at developing non-toxic alternatives to corticosteroids.
Adrenal Cortex Hormones↗
Simultaneous leptomeningeal and intramedullary spinal metastases in small cell lung carcinoma.
A patient with small cell lung carcinoma and simultaneous intramedullary spinal and leptomeningeal metastases is described. A review of the literature revealed that 28 cases of intramedullary spinal metastases have been reported in small cell lung carcinoma patients since 1978. Fifteen of these were in patients who had coexisting carcinomatous meningitis. The pathogenesis of intramedullary spinal metastases is discussed and a potential mechanism is proposed to explain the simultaneous occurrence of intramedullary and leptomeningeal metastases. Therapy for leptomeningeal metastases should be considered in patients with small cell lung carcinoma and intramedullary spinal metastases.
Antineoplastic Combined Chemotherapy Protocols↗
The use of computed tomography of the spine to identify patients at high risk for epidural metastases.
The usefulness of spinal computed tomography (CT) in predicting the presence of epidural tumor was evaluated in cancer patients undergoing CT myelography for suspected epidural tumor. Two hundred ninety two vertebral levels were evaluated in 30 patients. Spinal CT demonstrated cortical disruption surrounding the epidural space from metastatic cancer in 109 vertebrae. Eighty-five (78%) of these vertebral levels had tumor extension into the adjacent epidural space. The incidence of epidural tumor adjacent to vertebrae which had normal spinal CT or metastatic tumor without cortical disruption was 11%. Eighty-six percent of the epidural tumor adjacent to these vertebrae were a result of craniocaudal tumor extension in the epidural space from adjacent vertebral levels with cortical disruption. Twenty-one of 23 patients (91%) with cortical disruption at more than one vertebral level on spinal CT had epidural tumor. Synchronous noncontiguous epidural lesions were observed in 38% of patients with epidural tumor. Spinal CT is an important diagnostic test in determining which patients are at high risk for epidural tumor. Myelography should be performed in all patients with suspected epidural tumor to accurately define the full extent of tumor.
Adult↗