1/12. Theatres of the psyche.Fragments of the analytic voyage of a forty year old patient, haunted by the idea of her death since infancy when confronted with the anguish that accompanies the discovery of a potentially death dealing illness. In three years of intensive analytic work, her way of functioning psychically changed dramatically (her flight from imaginative life, total disaffectation of her emotional life, psychic deafness regarding her body and its messages...). These discoveries led to my analysand's resuming her psychoanalytic voyage in these words: 'Even if I am destined to die of this cancer, at least I shall have lived'.- - - - - - - - - - ranking = 1keywords = cancer (Clic here for more details about this article) |
2/12. A suspected case of proximal diabetic neuropathy predominantly presenting with scapulohumeral muscle weakness and deep aching pain.A 48-year-old man with a 14-year history of type 2 diabetes with proliferative diabetic retinopathy and distal symmetrical diabetic polyneuropathy visited our hospital. Eight months later, he subacutely developed difficulty in both shoulder movement and trouble standing up from a squatting position. This was accompanied by severe bilateral shoulder and thigh pain. magnetic resonance imaging of the brain, cervical and lumbar spine, computed tomography of the shoulder and X-ray films of the cervical spine and shoulder revealed no abnormality. cerebrospinal fluid showed a mild elevation of protein (0.93 g/l) without cell infiltration. Antiganglioside antibodies and point mutation of mitochondrial dna at position 3243 were not found. Neuropathology of the sural nerve showed a moderate myelinated fiber loss, active axonal degeneration, but onion-bulb formation, endoneurial or epineurial vasculitis were not observed. electromyography revealed neurogenic changes in the proximal upper limb muscles. Nerve conduction studies revealed mild bilateral slowing in nerve conduction velocity in both of the upper and lower limbs. The diagnosis of this patients was suspected to be a proximal diabetic neuropathy (diabetic amyotrophy). The pain and muscle weakness had persisted more severely in the shoulder than in the thigh throughout the clinical course. His unbearable symptoms could be partially alleviated by an administration of a selective serotonin reuptake inhibitor, fluvoxamine maleate. Proximal diabetic neuropathy is a rare disabling type of neuropathy, which is characterized with subacute bilateral muscle weakness and wasting in the proximal part of the lower limbs. The involvement of the scapulohumeral region observed in this case is very unusual in proximal diabetic neuropathy.- - - - - - - - - - ranking = 0.32444843572882keywords = muscle (Clic here for more details about this article) |
3/12. adrenal insufficiency and testicular failure secondary to megestrol acetate therapy in a patient with cystic fibrosis.We present a case report of adrenal insufficiency and testicular failure in an adult cystic fibrosis (CF) patient due to megestrol acetate therapy. This is followed by a review of the literature on the use of megestrol acetate in the treatment of weight loss in CF, AIDS, and cancer, with particular emphasis on the adverse effects that should be looked for in CF patients.- - - - - - - - - - ranking = 1keywords = cancer (Clic here for more details about this article) |
4/12. University of Miami Division of Clinical pharmacology Therapeutic Rounds: medications used to treat anorexia in the frail elderly.weight loss and anorexia are common problems that are associated with increased morbidity and mortality in the growing frail elderly population. Orexigenic agents are often prescribed in an attempt to improve appetite and lean muscle mass. Much of the data regarding their benefit comes from studies involving younger patients with illnesses such as acquired immunodeficiency syndrome or cancer. This article reviews the use and potential adverse events associated with these medications in frail elderly patients. This article also discusses the effects of the different antidepressants and antipsychotics on weight gain and appetite.- - - - - - - - - - ranking = 1.0463497765327keywords = cancer, muscle (Clic here for more details about this article) |
5/12. The last 48 hours of life: a case study of symptom control for a patient taking a Buddhist approach to dying.Caring for a patient dying of cancer can, at times, be extremely difficult. Sarah was 39 years old when she died, survived by her husband and two children aged 6 and 4 years. During the weeks leading up to her death, Sarah held extensive discussions with family and the multidisciplinary team. Her goal was to live the remainder of her last few hours as comfortable as possible and to die a "peaceful death". terminal care is an important phase of life, one in which individuals have the right to expect quality of care to ensure that their death occurs with dignity. Sarah practised buddhism on a daily basis. Issues of spirituality, serenity and peacefulness in dying were very important to her to ensure a good rebirth.- - - - - - - - - - ranking = 1keywords = cancer (Clic here for more details about this article) |
6/12. The last 48 hours of life.This paper arosefrom a personal nursing reflection in which I was given the privilege of working with and nursing a patient in her last 48 hours of life. Caring for a patient dying of cancer can, at times, be extremely difficult. Sarah was 39 years old when she died, survived by her husband and two children aged 6 and 4. During the weeks leading up to her death, Sarah held extensive discussions with family and the multi-disciplinary team. Her goal was to live the remainder of her lastfew hours as comfortably as possible and to die a 'peaceful death'. terminal care is an important phase of life, one in which individuals have the right to expect quality of care to ensure that their death occurs with dignity. This paper provides an insight into the remaining few hours of Sarah's life discussing psychological and psychosocial support as well as management of symptoms as they arose. Sarah practiced buddhism on a daily basis. Issues of spirituality, serenity and peacefulness in dying were very important to her to ensure a good rebirth. The last days of life are uniquefor each person. They are very personal and private. Dying people are usually less interested in the outside world and they want the closeness of only a few people--to comfort them. I felt extremely privileged to be a part of Sarah's dying expeience.- - - - - - - - - - ranking = 1keywords = cancer (Clic here for more details about this article) |
7/12. Palliative and shared care concepts in patients with advanced colorectal cancer.Approximately 50% of patients with colorectal cancer (CRC) will eventually die of metastatic disease. Effective palliative management can be used within a shared care model in CRC to provide optimum symptom control, psychological well-being and maintenance of quality of life for patients, their families and carers, including bereavement support. maintenance of realistic hope and early goal setting are equally important in end-of-life discussions with patients and families. palliative care should be incorporated early in the course of the illness, concurrent with disease-modifying therapies. Within shared care, the palliative medicine specialist, surgeon and other members of the multidisciplinary team can each bring their own expertise to provide a patient-centred approach. A case is presented that incorporates some of these principles and exemplifies the benefits of contemporary palliative care for patients with advanced CRC.- - - - - - - - - - ranking = 5keywords = cancer (Clic here for more details about this article) |
8/12. Diabetes management at the end of life: transitioning from tight glycemic control to comfort.Tight glycemic control has become the standard of care for prevention of the long-term side effects of diabetes mellitus. When individuals with diabetes approach the end of life from advanced cancer or another chronic illness, they often become anorexic. The result is an increased risk for hypoglycemic episodes. It is appropriate to shift the goal of therapy from tight control of blood sugar to maintaining comfort and enhancing quality of life.- - - - - - - - - - ranking = 1keywords = cancer (Clic here for more details about this article) |
9/12. psychotherapy during radiotherapy: effects on emotional and physical distress.The authors determined the effects of ongoing weekly individual psychotherapy on the symptoms of patients undergoing a 6-week course of radiotherapy for cancer. Forty-eight patients were given weekly psychotherapy sessions for 10 weeks; another 52 patients served as control subjects. A statistically significant reduction was found in both emotional and "physical" manifestations of distress in the patients receiving psychotherapy compared with the control group. This was true regardless of gender, ward or private patient status, or knowledge of diagnosis. Patient gender and knowledge of diagnosis did affect the pattern and magnitude of the response to psychotherapy.- - - - - - - - - - ranking = 1keywords = cancer (Clic here for more details about this article) |
10/12. Whole body protein turnover, synthesis and breakdown in patients with colorectal carcinoma.As a basis for assessing protein metabolism in cancer patients, whole body protein turnover, synthesis and breakdown were measured preoperatively using a constant rate infusion of L-(1-14C) leucine in patients with differing stages of colorectal carcinoma. The levels of protein synthesis and breakdown were correlated with the extent of disease as measured by the percentage incorporation of the labelled amino acid into plasma protein (1) and the subsequent modified Dukes' classification (2). Eleven apyrexial patients were divided into two groups; 6 of whom had normal appetites while 5 were anorectic. Protein synthesis increased with advancement of disease in both groups, as did protein breakdown. Protein synthesis and breakdown were lower in the anorectic group, suggesting some degree of starvation adaptation. All patients were in positive balance, despite anthropometric data to support loss of host body protein. This suggests translocation of protein stores from muscle to areas of more rapid protein synthesis such as tumour. Remodelling of body protein is an important facet of metabolism in cancer patients.- - - - - - - - - - ranking = 2.0463497765327keywords = cancer, muscle (Clic here for more details about this article) |
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