Search PubMed⌕ Search

Biomedical subjects

R Twycross

Publications and source records attributed to R Twycross.

17 recordsLinked to original sources
PubMed1996

Midazolam for intractable hiccup.

We describe two terminally ill cancer patients severely distressed by intractable hiccup. Commonly recommended treatments were ineffective. Intravenous midazolam 5-10 mg rapidly relieved the hiccup. Maintenance treatment comprised midazolam 40-120 mg/24 hr by continuous subcutaneous infusion.

Aged↗
PubMed1995

Euthanasia.

Explore the source record for details and available documents.

Attitude to Death↗
PubMed1994

The risks and benefits of corticosteroids in advanced cancer.

Corticosteroids are extensively prescribed in advanced cancer for various specific indications (e.g. spinal cord compression), for pain relief, as hormone therapy and to stimulate appetite and wellbeing. Choice of corticosteroid is dictated largely by local fashion, and times of administration are more traditional than pharmacological. Corticosteroids have many potential disadvantages, some life-threatening (e.g. masked septicaemia). Others are seriously debilitating (e.g. myopathy, avascular bone necrosis). Oropharyngeal candidiasis is a common complication. Corticosteroids are withdrawn in about 5% of patients because of unacceptable adverse effects, including moon-face and diabetes mellitus. Corticosteroid hypersensitivity occurs, and the succinate salts have been associated with bronchospasm. Steroid pseudorheumatism may occur with high dose therapy or when tailing off after a prolonged course. Important drug interactions with corticosteroids relate to salt and water retention, and decreased glucose tolerance. Some anticonvulsants cause an increased clearance of corticosteroids and, with dexamethasone, up to a 50% reduction in the anticipated effect. The benefit of corticosteroids in terms of increased appetite, mood and activity has been demonstrated in several controlled trials. The effect may well be time-limited in most patients. In several studies, corticosteroids have resulted in an analgesic-sparing effect. Some centres use very high doses of dexamethasone in cases of spinal cord compression, although the justification for these is not obvious. Corticosteroids are used to help relieve nerve compression pain and in symptomatic raised intracranial pressure. Corticosteroids are also injected locally into or around bone metastases, particularly ribs and the sacro-iliac joints. Epidural injections are used for patients with troublesome intractable low back pain. Corticosteroids are now used less often in hypercalcaemia because of poor response rates. More benefit is obtained, however, if high dosages are used, e.g. prednisolone 60 to 80 mg/day. Dexamethasone is widely used as an antiemetic in association with chemotherapy. Some centres use dexamethasone by continuous subcutaneous infusion in selected patients when the oral route is not feasible. The choice of starting dose of a corticosteroid is largely arbitrary. It is important, however, not to miss a possible treatment benefit by prescribing too low a dose. For most patients, an initial dosage of prednisolone of 30 to 60 mg/day (dexamethasone 4 to 8 mg/day) is appropriate. In patients with anorexia, there are several alternative options that should be considered. There is evidence to suggest that patients with advanced cancer receiving a corticosteroid are not as closely monitored as other patients. There is a need to state clearly in writing the reason(s) for prescription and to review after 1 or 2 weeks.(ABSTRACT TRUNCATED AT 400 WORDS)

Adrenal Cortex Hormones↗
PubMed1983

[Use of oral morphine in incurable pain].

Oral morphine sulphate is the strong narcotic of choice at most hospices. Administered in simple aqueous solution (e.g. 10 mg in 10 ml). No advantage in giving as "Brompton Cocktail." Usual starting dose 10 mg every 4 h. If patient has previously only had a weak narcotic analgesic, 5 mg may be adequate. If changing to morphine from alternative strong narcotic, such as dextromoramide, levorphanol, methadone, a considerably higher dose may be needed. With frail elderly patients, it may be wise to start on sub-optimal dose in order to reduce likelihood of initial drowsiness and unsteadiness. Adjust upwards after first dose if not more effective than previous medication. Adjust after 24 h "if pain not 90% controlled." Most patients are satisfactorily controlled on dose of between 5 and 30 mg 4 hourly; however, some patients need higher doses, occasionally up to 500 mg. Giving a larger dose at bedtime (1,5 or 2 x daytime dose) may enable a patient to go through the night without waking in pain. Use co-analgesic medication as appropriate. Eigher prescribe an antiemetic concurrently or supply (in anticipation) for regular use should nausea or vomiting develop. Prescribe laxative. Adjust dose according to response. Suppositories may be necessary. Unless carefully monitored, constipation may be more difficult to control than the pain. Write out regimen in detail with times to be taken, names of drugs and amounts to be taken. Warn patient of possibility of initial drowsiness. Arrange for close liaison and follow up.

Administration, Oral↗
PubMedDate not supplied

Volume reduction of arm lymphoedema.

Most of the volume reduction in an 11-day course of compression bandaging for severe cancer-related arm lymphoedema appeared to occur in the first few days. This study therefore compared the volume loss during days 1-4 with 5-11. Fifteen consecutive courses of bandaging were studied. Arm volume was estimated on days 1, 5 and 11. The volume reduction during days 1-4 was compared with days 5-11 using the Wilcoxan Ranked Pairs Test. Seventy nine per cent of the total median volume reduction occurred during days 1-4. The difference between the two periods was highly significant (p < 0.001). The duration of compression bandaging has therefore been reduced to 4 days for severe cancer-related arm lymphoedema in this clinic.

Bandages↗
PubMedDate not supplied

A pain-free death.

Explore the source record for details and available documents.

Analgesia↗