Cases reported "Neoplasms"

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11/31. Successful treatment of wernicke encephalopathy in terminally ill cancer patients: report of 3 cases and review of the literature.

    Although wernicke encephalopathy has been reported in the oncological literature, only one terminally ill cancer patient with wernicke encephalopathy has been reported. wernicke encephalopathy, a potentially reversible condition, may be unrecognized in terminally ill cancer patients. In this communication, we report three terminally ill cancer patients who developed wernicke encephalopathy. Early recognition and subsequent treatment resulted in successful palliation of delirium. Two of the three patients did not show the classical triad of Wernicke encephalopathy. Common clinical symptoms were delirium and poor nutritional status. Intravenous thiamine administration dramatically improved the symptoms of delirium in all three patients. In terminally ill cancer patients, clinicians must remain aware of the possibility of wernicke encephalopathy when patients with a poor nutritional status present with unexplained delirium. Early intervention may correct the symptoms and prevent irreversible brain damage and the quality of life for the patient may improve.
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12/31. Difficult cases in pain management: use of methadone in a multifactorial approach.

    Cancer pain management is a crucial aspect of patients' quality of life. During the course of the disease, patients with cancer may develop difficult pain management problems that do not respond to interventions that use the basic principles of pain management. Ongoing assessment, multiple approaches, and excellent communication among all care management team members are critical. pain management goals must be continually evaluated, reestablished if necessary, and negotiated by patients and the team. Difficult pain management cases demand the involvement of all team members, especially patients, to assist in determining acceptable approaches. nurses must recognize the challenge, advocate for better management, and provide ongoing assessment. Ultimately, pain management outcomes are determined by nursing advocacy. Through nurse leadership, suffering is minimized and quality of life is improved for this patient population.
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13/31. survivors of childhood sexual abuse diagnosed with cancer: managing the impact of early trauma on cancer treatment.

    The incidence of survivors of childhood sexual abuse (CSA) diagnosed with cancer is unknown. It is estimated that one in three women and one in six men in the united states are survivors of CSA. survivors of CSA diagnosed with cancer are presented with multiple and potentially accumulating traumas. The re-traumatizing nature of a cancer diagnosis and treatment affects all elements of the CSA survivor's care and may impede her/his treatment. To date, the impact of CSA on the medical treatment of people with cancer has been unexplored with the existing studies on female survivors of CSA with cancer focusing on the post-treatment experience and their higher incidence of sexual dysfunction. This article describes the impact of CSA on the cancer treatment of 18 survivors of CSA and the clinical interventions used to address the unique psychosocial needs of this population. Anecdotal information suggests that the survivors of CSA may find aspects of the cancer experience reminiscent of their history of abuse. All 18 survivors of CSA experienced distressing memories of their abuse during their cancer treatment. Fifteen CSA survivors presented traumatic memories that were inaccessible to conscious thought processes prior to their cancer diagnosis. Psychodynamic interventions address issues of disruption in the cancer treatment, non-adherence, and difficulties in relationships with the health care team. Containment of intense affect and distressing thoughts rather than exploration improved CSA survivors' adherence with cancer treatments. The acquisition of self-comforting skills helped CSA survivors feel less re-victimized by their cancer experience. The establishment of an environment of internal and external safety improved communication with the health care team. health care/psychosocial clinicians' awareness and use of appropriate interventions can minimize the affects of re-traumatization and enhance the CSA survivor's treatment experience.
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14/31. Case report: topical DMSO for mitomycin-C-induced skin ulceration.

    mitomycin-C is a commonly used anticancer drug for patients with advanced anal, breast, colorectal, gastric, lung, or pancreatic cancers. mitomycin-C can cause severe necrosis and ulceration when extravasated inadvertently into skin and soft tissues following IV drug administration. Local applications of heat, ice, and common antidotes such as glucocorticosteroids and hyaluronidase or sodium thiosulfate have failed to reduce the experimental toxicity of these vesicant reactions in mice. Plastic surgery with split-thickness skin grafting may be required to palliate local pain symptoms and loss of function, although some extravasations heal without any local treatment. This brief communication summarizes two case reports of the treatment of severe mitomycin-C venous extravasations using topical applications of dimethylsulfoxide (DMSO). Although the authors' experience represents the results of DMSO interventions in only two patients, the response to treatment in both patients was so pronounced that others may find this useful in their practice.
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15/31. psychotherapy by telephone. A therapeutic tool for cancer patients.

    Medically ill patients who cannot come to the psychotherapist's office on a regular basis frequently are encountered in consultation-liaison settings. For these individuals the telephone becomes the only link to psychological counseling. The two cases presented in this article of successful telephone therapy with cancer patients exemplify and highlight the effect of this mode of interaction on the therapeutic process and relationship. telephone communication also differs from face-to-face interaction in areas of therapist-patient accessibility, control, formality, and anonymity, which make it an especially effective psychotherapeutic tool for the medically ill patient.
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16/31. Continuity of care for the cancer patient with chronic pain.

    The care of patients with cancer and chronic pain, often complicated and demanding, strains the resources of a single physician. Continuity of care programs, such as that developed by the Pain Service of Memorial Sloan-Kettering Cancer Center (new york), with good communication and liaison work between hospital and community, add a much needed dimension to the pain management of these patients in the home. Although continuity of care programs resemble hospice programs in philosophy, there are major differences in admission criteria: the program is not restricted to dying individuals; patients may live alone; they may receive active therapy with a focus on cure or remission; and they continue to receive their care, including pain management, within a standard medical system under the supervision of their primary physician and nurse.
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17/31. Group therapy for families facing a cancer crisis.

    The impact of the cancer diagnosis and its effects on the lives of patients and family members can put a serious strain on intra-family relationships. This paper describes how to initiate, lead and analyze supportive group therapy meetings for families of individuals with cancer based on our experiences in conducting more than 600 group sessions over the last 12 years. We have found that most families can benefit from multiple-family therapy sessions and that highly-stressed families can benefit significantly from both multiple- and single-family therapy meetings. Discussed is the need for therapists to be alert to non-verbal as well as verbal communications of families and the need for different interacting techniques for each type of therapy group. The meetings aim to overcome family members' resistance to discussing the emotional distress caused by the disease and to encourage them to bring into the open conflicts from the past, anxieties about the present, and fantasies regarding the future.
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18/31. The general practitioner and information to cancer patients.

    Information to cancer patients is a continuous process, and a considerable personal undertaking is usually needed. The general practitioner is in an unique position because of his contact with the cancer patient and his family during all stages of the disease. This gives him both opportunities and the responsibility for this information. The basis for cancer patient information can briefly be given in the "three c's": communication, Coordination and Cooperation--communication both to patient and family and coordination and cooperation between the multitude of professionals, who often taken care of the cancer patient right through his illness.
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19/31. Cancer pathomimicry: a report of three cases.

    Three cases of alleged and feigned cancer are presented. The diagnostic and management problems presented are discussed through a review of the literature of feigned illness. This ranges across a spectrum from benign use of feigned or alleged symptoms, malingering, conversion reactions and hysterical manifestations to the severe and flamboyant clinical presentation of the munchausen syndrome. The cases presented mainly fit the criterion for malingering (conscious prevarication and simulation), although some elements of the Munchausen dynamics were present in two of the three. Also noteworthy was the fact that the "cancers" were presented to administration and lay people as an initial communication. The psychiatric consultation was with the lay people initially and the events of each episode were reconstructed through multiple sources of information including clinical interviews in two of the cases.
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20/31. Psychological support of oncology nurses: a role for the liaison psychiatrist.

    This paper describes the working of an oncology nurses coping group which functioned under the guidance of a consultation-liaison psychiatrist at the Toronto General Hospital. nurses were helped to deal more effectively with the many and varied stresses which they face in treating patients with cancer. As a result ward atmosphere, patient care and inter-staff communication improved. The success of the group was due to a number of factors that included the high motivation of the staff, the high level of stress on the ward, the support of the head nurse and the consistent relationship of the consulting psychiatrist. A series of cases are presented to illustrate these points.
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