Although haloperidol is mainly used for the medical treatment of delirium in cancer patients, there are no universally accepted guidelines for its usage. We accordingly assessed the usefulness in managing delirium of a haloperidol treatment regimen in ten delirious cancer patients. The results of this preliminary study suggest that, in the management of delirium, appropriate usage of haloperidol on the first day is important as it affects the dosage thereafter.
To clarify the psychiatric liaison issues in Japan, this paper briefly introduces a survey of physician attitudes and practices regarding cancer care in Japan and preliminarily reports on an "active" liaison program developed at one Japanese general hospital. The survey of physicians from 31 teaching hospitals, including all cancer centers, revealed that 56% of physicians do not inform patients of a diagnosis of cancer. Thus, actual psychiatric consultation referrals were very few due to the physician's fear of harming his relationship with the cancer patient. One medical unit, in which about one-quarter of the cancer patients were told their diagnoses by the unit chief physician, showed significantly higher rates of psychiatric consultation after the introduction of an "active" liaison program in that hospital. These results suggest that the liaison program can positively influence the rate of psychiatric consultation referrals for cancer patients when the physician discloses the diagnosis to the patient. Consultation-liaison psychiatry in cancer care is expected to develop in Japan, because most physicians report a trend toward informing patients of their cancer diagnosis.
In this report, we investigated the relationship between depressive symptoms and plasma interferon (IFN)-α-like immunoreactivity, cyclic GMP (cGMP) and soluble interleukin-2 receptor (sIL-2R) levels during IFN therapy. An altered mood state was observed in 5 of 26 patients. IFN-α-like immunoreactivity in the depressed group tended to be elevated. cGMP levels of depressed patients were significantly greater than those of control subjects before and 6 weeks after IFN therapy. However, sIL-2R levels were not different between the two groups. These results suggest that a number of patients suffered from depression during IFN therapy and that patients had greater concentrations of cGMP levels.
Previously, we quantified reabsorption of interstitial pulmonary edema liquid into the pulmonary circulation during recovery from hydrostatic edema. To determine whether the bronchial circulation also reabsorbs edema liquid, we induced very-low-protein interstitial edema in seven sheep lungs by perfusion of the pulmonary circulation with diluted blood and 1% albumin in Krebs-Henseleit buffer containing 125I-labeled albumin for 70 +/- 40 min. In eight control sheep we perfused the lungs with diluted blood and 5% albumin in Krebs-Henseleit buffer containing 125I-albumin without causing significant edema formation. Subsequently, we washed the intravascular tracer from the pulmonary circulation with buffered saline and then perfused the bronchial vessels via the bronchoesophageal artery with whole or diluted blood (normal protein osmotic pressure). We measured flow, hematocrit, and 125I-albumin concentration in the venous outflow into the left atrium and into the azygos vein for 2 h. We calculated the volume of liquid reabsorbed on the basis of the change in hematocrit and 12I-albumin concentration in the outflow. On the basis of hematocrit dilution, the net clearance of interstitial liquid (edema minus control) averaged 21 ml (15% of the induced edema). One the basis of 125I-albumin reabsorption, the net clearance of interstitial liquid was 12 ml. We conclude that the bronchial circulation may be a clearance route for interstitial liquid and protein during recovery from low-protein hydrostatic edema.
The lung lymph flow was unexpectedly large under the conditions of the study, and our data suggest that the drainage effect of lymphatics is significant as a safety factor against pulmonary oedema formation.
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