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Biomedical subjects

T D Walsh

Publications and source records attributed to T D Walsh.

At least 37 records · Page 2Linked to original sources
PubMed1990

Continuing care in a medical center: the Cleveland Clinic Foundation Palliative Care Service.

Approximately 500,000 people die of cancer in the United States each year. Most attention has focused on curative approaches to cancer management. Despite the fact that 80% of persons with advanced cancer suffer from chronic pain and an equal number have a major problem with anorexia and weight loss, little systematic evaluation of these problems has been conducted, although they have a high medical, psychological, and socioeconomic impact. The need for a palliative care service (PCS) at the Cleveland Clinic Foundation was originally identified by physicians within the Department of Hematology and Medical Oncology. During 1987, a pilot study was conducted to evaluate the service, define its potential patient base, and assess its impact on patient care. It is astonishing that so little attention has been paid to this area by the major institutions and organizations involved in care of patients with advanced cancer, despite the hundreds of thousands dying of the disease each year. A dedicated palliative care service would therefore seem appropriate in any major medical institution dealing with significant numbers of cancer patients. It also seems appropriate that the provision of a PCS should be part of the requirements for a comprehensive cancer center, if a center is to claim to provide the entire spectrum of services, from diagnosis until death.

Cancer Care Facilities↗
PubMed1990

Pseudohypoproteinemia and multiple myeloma.

Paraproteinemia is an important diagnostic feature of multiple myeloma. The M-protein level reflects tumor burden and helps to determine the response to chemotherapy. A case is described that illustrates the phenomenon of reversible in vitro gelification of an M-protein. Paraprotein IgG1-kappa formed a concentration- and temperature-dependent gel, which was reversed by agitation. Measurement of paraprotein without previous vortexing of the specimen can erroneously lower the apparent M-protein level as well as reduce serum viscosity levels. This phenomenon can downstage the disease at diagnosis, produce inappropriate assessment of treatment response, or lead to premature withdrawal of chemotherapy. In addition, misdiagnosis of hyperviscosity syndrome can occur with serious clinical consequences.

Aged↗
PubMed1990

Metastatic carcinoma of the prostate with hypercalcemia.

A patient presented with advanced cancer of the prostate and underwent bilateral orchiectomy. After 2 years, hypercalcemia developed and was managed successfully with saline diuresis, furosemide, and oral glucocorticoid therapy. It is believed that the patient's hypercalcemia was caused by a metabolic complication of progressive, advanced disease.

Adenocarcinoma↗
PubMed1987

Phase I and clinical pharmacology study of trimetrexate administered weekly for three weeks.

Trimetrexate, a new antifolate compound, was administered by 30-min infusions weekly for 3 weeks to 29 patients with solid tumors in a Phase I study. Thrombocytopenia was dose limiting, but highly variable among patients at a given dose level; other toxicity was mild and uncommon. Twenty-three patients participated in pharmacokinetic studies and five patients participated in a study of the effects of trimetrexate on [6-3H]-deoxyuridine incorporation into hematopoietic cell DNA. The median total body clearance of trimetrexate for each dose level was independent of dose but the total body clearance varied widely among patients at a given dose level. The magnitude of the fall in platelet count in individual patients correlated well with the amount of exposure to trimetrexate, but not with the extent of prior therapy. The amount of [6-3H]deoxyuridine incorporation into hematopoietic cell DNA at 72 h after drug administration correlated with the total body clearance of trimetrexate. The total body clearance of trimetrexate was reduced in patients with impaired hepatic synthetic function, as judged by low pretreatment serum albumin concentrations. The recommended Phase II starting dose on this schedule is 130 mg/m2 weekly for 3 weeks; patients with hypoalbuminemia should be treated at lower doses.

Adenocarcinoma↗
PubMed1987

Control of pain and other symptoms in advanced cancer.

In the patient with advanced cancer, effective symptom control requires a multidisciplinary, multimodal approach. Considerations involved in the control of pain can serve as a model for management of other symptoms, such as anorexia and dyspnea, as well.

Analgesics↗
PubMed1984

Oral morphine in chronic cancer pain.

Extensive clinical experience has been obtained in the use of opiates during the last decade in special units devoted to symptom control in advanced cancer. Important contradictions have emerged with the clinical pharmacological literature on opiates calling into question its relevance to the treatment of chronic pain. Specifically in the case of morphine it is clear that: it is a very effective analgesic given orally, dosage must be individualized, parenteral use or exotic analgesic 'cocktails' are usually unnecessary, and tolerance, dependence and respiratory depression are rarely common or serious problems which prevent effective pain control provided morphine is used appropriately in accordance with its pharmacological characteristics. Heroin is a suitable alternative to morphine (particularly for intramuscular administration) if differences in milligram potency are taken into account, but has no advantages in terms of either analgesic efficacy or side effects. This paper summarizes clinical experience in the use of oral morphine for cancer pain at St. Christopher's Hospice, any data from clinical investigations which support this approach, and comments on the areas of controversy which have emerged.

Administration, Oral↗
PubMed1984

Hypoglycaemia and septicaemia.

A patient with severe hypoglycaemia complicating staphylococcal septicaemia is reported. No recognized cause of hypoglycaemia was detected during life or at autopsy. This case adds to the existing evidence that through several possible mechanisms septicaemia can give life-threatening hypoglycaemia.

Aged↗
PubMed1984

Malignant ureteric obstruction relieved by dexamethasone.

A case is described where dexamethasone relieved tumour-induced ureteric obstruction with improvement in the biochemical abnormalities and clinical features of post-renal failure. Such intervention is not always appropriate but may be of great value in symptom control. Because of this and similar applications, corticosteroids are finding increasing favour in the palliative care of patients with advanced cancer.

Aged↗
PubMed1983

Antidepressants in chronic pain.

ADs have achieved popularity in the treatment of chronic pain syndromes associated with organic and psychogenic illness. This is surprising as there is little evidence from controlled studies that they are of value other than in the treatment of depression. There is good evidence for an intimate relationship between the neurotransmitters involved in the regulation of pain and mood and the mode of action of both opiates and antidepressants. There are also similarities in the clinical pharmacology of both groups of drugs, including evidence of a co-analgesic action when ADs are used in conjunction with opiates. Uncontrolled studies suggest that, when ADs have been reported to relieve pain when used alone, this is consequent on relief of depression. Their reported effectiveness in neuralgic pain appears to be dependent on being used in conjunction with a phenothiazine. Controlled studies do not support their use in chronic pain other than for relief of depression. Overall, it may be said that they have a useful opiate-potentiating role in pain due to cancer, are valuable in treatments of neuralgia when given with a phenothiazine, and, in other conditions, may relieve depression-associated pain by their AD action. New AD drugs with specific effects on MA metabolism may reveal if ADs have an analgesic action independent of their AD effect and suggest its biochemical basis. This would have important implications for improving knowledge of pain biochemistry and physiology. Few areas of modern therapeutic endeavour allow prescription of drugs in the absence of objective evidence of benefit. Current practice in chronic pain reflects the problems associated with psychological assessment in chronic physical illness, the complexity of chronic pain syndromes, and the natural desire to explore every avenue to relieve patients' symptoms.

Antidepressive Agents↗