General Well-being Of Patients Research Articles

Sexual functioning in testosterone-supplemented patients treated for bilateral testicular cancer.

To determine the effects of intramuscular injections with testosterone (Sustanon) on sex-hormone levels, sexual functioning and general well-being in patients treated with orchidectomy for bilateral testicular cancer. The study comprised seven men (median age 38 years, range 25-46) who had undergone orchidectomy for bilateral testicular cancer. Patients received intramuscular injections with testosterone every 3 weeks and blood samples for hormone analysis were collected from each patient at three times: one day after testosterone injection (t1), halfway between subsequent injections (t2) and just before injection (t3). Plasma hormone levels were then related to sexual function, as assessed by self-reported data on sexuality and general well-being, measurements of nocturnal penile tumescence and rigidity (NPTR) and erectile function elicited by visual erotic stimulation (VES), determined at t1, t2 and t3. During the 3-week interval between injections, there was a sixfold decrease in plasma testosterone level (mean testosterone 35.8, SD 7.8, and 6.0, SD 2.5 nmol/L, at t1 and t3, respectively). At t1, five of the men had a plasma testosterone level above the upper normal limit (> 35 nmol/L) and at t2 and t3, testosterone levels were below the reference range (< 10 nmol/L) in three and six men, respectively. Oestradiol (E2) levels showed the same pattern: at t1 the mean (SD) E2 level was 0.17 (0.07) nmol/L and at t3 0.07 (0.01) nmol/L. In contrast to follicle-stimulating hormone, luteinizing hormone (LH) mirrored the decline in plasma testosterone after injection, with the lowest levels at t1 and the highest at t3. Other hormone levels remained unchanged. Three patients reported loss of libido, decreased arousal, erectile dysfunction, fatigue and mood depression. However, neither the arousal nor the erectile problems could be verified by VES. There was no relationship between plasma testosterone levels, the reported sexual dysfunctions and the results of NPTR and VES measurements. Although unrelated to a specific testosterone level, three patients reported increased irritability, excessive sweating, hot flushes and heat intolerance at the end of the injection interval. These adverse effects of declining plasma testosterone were related to loss of libido and other sexual problems. In most patients castrated for bilateral testicular cancer and receiving intramuscular injections with testosterone, plasma testosterone levels were outside the normal range. After injection, there was a rapid decline of plasma testosterone to levels below the lower normal limit. With the exception of oestradiol, sex-hormone levels were not correlated to testosterone levels. Sexual functioning was not affected by the fluctuations of plasma testosterone level. However, at the end of the injection interval, adverse psychological and physical effects had a significant impact on libido and arousal.

Quality of Life in Patients with Different Types of Functional Constipation

Glia A, Lindberg G. Quality of life in patients with different types of functional constipation. Scand J Gastroenterol 1997; 32:1083–1089.Background: Little information is available about the health-related quality of life (QoL) in patients with different types of chronic constipation. Methods: We used two self-administered questionnaires, the Psychological General Well-Being (PGWB) index and the Gastrointestinal Symptom Rating Scale (GSRS) to assess QoL and gastrointestinal symptoms in 102 consecutive patients with chronic constipation. The type of constipation was determined from transit time, electrophysiologic investigation of sphincter function, anorectal manometry, and defecography. Results: Overall, our patients with constipation reported low scores for general well-being (mean score, 85.5, compared with 102.9 in a healthy population). Patients with normal-transit constipation (n = 49) reported considerably lower scores in the PGWB than those with slow-transit constipation (n = 35). The symptoms increased frequency of defecation, loose stools, and urgent need for defecation were commoner in normal-transit constipation, which indicates that this group may have a relation to the irritable bowel syndrome. The overall PGWB index was strongly correlated with the total GSRS (P< 0.001). Conclusions: The general well-being of patients with chronic constipation is lower than that of a comparable normal population. Symptom severity correlates negatively with perceived quality of life.

Large-volume paracentesis in the treatment of cirrhotic patients with refractory ascites. The role of postparacentesis plasma volume expansion.

Ascites is a common complication of cirrhosis and has a major clinical impact on the patient's general well-being. Approximately 10% of patients with cirrhosis can develop diuretic-resistant, tense ascites that requires other therapeutic interventions. In recent years, there has been a renewed interest in large-volume paracentesis (LVP) as a safe, simple, and inexpensive method to substitute for other more complicated and costly therapeutic interventions for refractory ascites. In this article, we review the latest literature supporting the use of LVP for the treatment of refractory, tense ascites. We also address the role of intravascular volume expansion after LVP, note that usually no postparacentesis volume expansion is necessary, and compare, when used, the different plasma volume expanders in terms of efficacy, safety, and cost.

The Influence of an Inhaled Steroid on Quality of Life in Patients With Asthma or COPD

Relatively little is known about the influence of inhaled corticosteroids on general well-being (quality of life) in patients with asthma or COPD. In a 4-year prospective controlled study, we examined the influence of beclomethasone dipropionate (BDP), 400 micrograms, two times daily, on quality of life in 56 patients with asthma or COPD in comparison with the effects of BDP on symptoms and lung function. During the first 2 years, patients received only bronchodilator therapy with salbutamol or ipratropium bromide. During the third and fourth years, additional treatment with BDP was given. Fifty-six patients (28 with asthma, 28 with COPD) with an annual decline in the forced expiratory volume in 1 s (FEV1) of at least 80 mL/yr in combination with at least two exacerbations per year during bronchodilator therapy alone participated. Quality of life was assessed at the start and after 2 and 4 years by means of the Inventory of Subjective Health (ISH) and the Nottingham Health Profile (NHP). Although BDP significantly improved the course of lung function (FEV1)(p < 0.0001), it did not improve the ISH score or the six dimensions of the NHP neither in asthma nor in COPD. Beclomethasone dipropionate temporarily decreased respiratory symptoms during months 4 to 6 of BDP treatment in patients with asthma (p < 0.01) and during months 7 to 12 in patients with COPD (p < 0.05). A weak correlation was found both cross-sectionally and longitudinally between (change in) symptoms and quality of life on the one hand, and the (change in) FEV1 on the other. It was concluded that BDP did not improve the general well-being of patients with asthma or COPD as measured by these generic health instruments. However, BDP significantly improved the course of lung function and temporarily decreased the severity of symptoms. It seems probable that changes in quality of life would have been better detected by use of a disease-specific health instrument. Such an instrument was not available at the start of the study. Another possible explanation for these observations is that patients soon get used to different levels of lung function and learn to live with their disease. It is advised that disease-specific health instruments are used in future intervention studies and that quality of life is measured frequently during the early phase of the intervention, eg, once every month.

Effects of felodipine extended release on quality of life—an analysis of four clinical trials

The effect of treatment with felodipine extended release (ER) in monotherapt or in combination with either a beta-blocker or an angiotension-converting enzyme (ACE) inhibitor on the quality of life are summarized. A total of 452 patients (men and women with mild-to-moderate hypertension) were included in the four trials, which had been primarily designed to evaluate drug efficacy in terms of blood pressure control. Quality of life was assessed using the Subjective Symptom Assessment Profile and the Psychological General Well-Being index. The observed changes in quality of life were generally very small and consistent throughout the four studies despite the comparatively small number of patients in each group. Although expected class-specific side-effect symptoms occurred, felodipine ER was well tolerated and did not compromise patient general well-being. It is concluded that felodipine ER, as monotherapy or in combination with either a beta-blocker or an ACE inhibitor, maintained the quality of life in hypertensive patients.

Intestinal and extraintestinal complications of Crohn's disease: Predictors and cumulative probability of complications

Of 238 patients with Crohn's disease seen at our clinics from April 1973 to August 1988, 203 patients were selected for this study, since they fulfilled the following criteria: they had been followed up for more than 6 months as outpatients or had been treated as inpatients for more than 1 month. They were studied to elucidate: (a) the different types and incidence of various complications, (b) the factors related to complications present at the time of diagnosis, (c) predictors of new complications arising after diagnosis, and (d) the cumulative incidence of complications occurring during the course of the disease from the times of onset and diagnosis. Of the intestinal complications, perianal fistula was most common (33%), followed by strictures with dilatations of the proximal bowel (21%), and internal fistula (14%). Of the extraintestinal complications, menstrual disturbance was the most common (18% of the female patients), followed by arthritis (10%), and aphthous stomatitis (10%). As for the factors influencing complications present at the time of diagnosis, the pattern of bowel involvement was significantly correlated with the presence of intestinal stricture, while the erythrocyte sedimentation rate was significantly correlated with the presence of perianal fistula. A significant predictor of new complications arising after diagnosis was the general well-being of patients at the time of diagnosis. Patients who, at diagnosis, already have complications such as stricture, abdominal abscess, internal or external fistula, massive hemorrhage, and free perforation or anal lesions are more likely to develop new complications in addition to those present at diagnosis, compared with patients without any complications at diagnosis (P = 0.055).

Behavioral changes following chronic myocardial infarction in rats

Myocardial infarction evokes major physiological changes because of the acute loss of functional cardiac tissue, resulting in more or less severe symptoms of congestive heart failure. In addition, general well-being of patients, their quality of life, is reduced. This includes anxiety/depression, loss of interest in environment and social interactions, sexual problems, and sleep disturbances. Postinfarction treatment is aimed mainly at improving life expectancy, whereas less attention is paid to the quality of that life. The aim of the present study was to determine behavioral changes after myocardial infarction in a (otherwise proven as clinically relevant) rat model for heart failure after myocardial infarction. We have chosen four behavioral tests based upon certain aspects of quality of life in patients. Anxiety/depression, interest in environment, and mobility, tested in an open field, revealed that infarcted rats are more anxious (as inferred from a higher preference for the safe corner area and less visits to the middle area), have less interest in a new environment [as indicated by less exploratory behavior and a longer time before they go into the new area (free exploration)], and showed less mobility (as indicated by reduced distance walked and less time spent on walking). In a test on social interaction, infarcted rats spent less time on social behavior and displayed even somewhat more walking away, suggesting active avoidance of social interaction. The observed behavioral changes in infarcted rats match very well with the aspects of reduced quality of life in postinfarct patients. Therefore, we conclude that the presented behavioral tests, in combination with our previously described functional hemodynamic measurements, could provide a new basis to study treatment that improves hemodynamic state as well as the quality of life.

Orally administered N-acetylcysteine may improve general well-being in patients with mild chronic bronchitis

Oral N-acetylcysteine (NAC) exerts a beneficial action in chronic bronchitis by reducing the number of exacerbations. There have been few studies of the effect of NAC (or of any other drug) on general well-being in chronic bronchitis. We used an established psychiatric instrument (General Health Questionnaire; GHQ) and a visual analogue scale (VAS) to measure well-being in a 22-week, placebo-controlled, double-blind, parallel-group study of NAC administered as sustained release tablets 600 mg b.i.d., including during the winter months, to patients with mild chronic bronchitis. One hundred and fifty-three patients were accepted for randomized treatment, 129 finished the study (59 NAC, 70 placebo), and well-being was measured in 105 (46 NAC, 59 placebo). The number of observed exacerbations was unexpectedly low in both groups. The number was lowest in the NAC group, however, the difference did not reach statistical significance in the present study (P = 0.08). There were no statistically significant differences between NAC and placebo in subjective symptom scores, FEV1 or FVC. The distribution of GHQ score at baseline was uneven, but NAC was significantly superior to placebo in terms of a favourable effect on GHQ score. GHQ score correlated with the number of exacerbations, and VAS correlated with GHQ score. This study therefore demonstrates the validity of measuring general well-being in patients with mild chronic bronchitis. Future studies of the treatment of chronic bronchitis should use a battery of more specifically adapted instruments which are now becoming available to measure well-being.

Social functioning and general well-being in patients treated with clean intermittent catheterization

Social role function, health perceptions and general well-being were studied longitudinally over 1 yr in 149 males and 153 females performing clean intermittent catheterization (CIC). The evaluation included urological assessments and self-rating instruments (Revised Physical Battery, General Health Questionnaire—28 items, State Anxiety Inventory and CIC Pain and Discomfort Scale). Twenty-six percent reported major improvement in their overall quality of life, while 7% reported a wish to be dead and away from it all. Females with infranuclear lesions and detrusor myopathies scored higher on unpleasant health perceptions, state anxiety and physical discomfort by performing CIC than males. In males, the social role function 1 yr later was predicted by initial anxiety and urinary tract infections, whereas in females by initial anxiety only. Discomfort by CIC was predicted by initial infection in males, and by none or moderate medical comorbidity, initial depression and infection in females.

Irritable bowel syndrome: Assessment of psychological disturbance and its influence on the response to fibre supplementation

This study describes the effect of fibre supplementation on the gastrointestinal symptoms and general wellbeing of patients with constipated irritable bowel syndrome. In a single centre, double blind, placebo controlled trial of 3 months duration, a daily supplement of 4.1 g fibre produced no greater change in gastrointestinal symptoms than placebo. Pretreatment constipation was related to baseline fibre intake. Overall outcome was the same in treated and control groups; a considerable placebo response was evident. This level of fibre supplementation is not a useful treatment; improving neither constipation nor other symptoms. At the outset pain severity correlated with depression score on psychometric testing. Those who felt better at the end of the study scored significantly lower for depression at outset than those who felt no better. In irritable bowel syndrome a depressive emotional state profile is a powerful determinant of outcome, shaping the response to treatment, which includes a considerable placebo element.

Well‐being (quality of life) in connection with hypertensive treatment

Quality of life is often considered to equate how the medical treatment is subjectively perceived by the patient, but ought to include the total impact of the disease/treatment on the patient's emotional, physical, and social well-being. Recently, a proposal for a generally applicable definition of quality of life in health care was put forward. This definition includes general well-being, health, and welfare (external factors), as three fundamental components, and the definition is based on both objective and subjective judgments. General well-being is exclusively and expression of the individual's subjective experience and is based on his or her own qualitative evaluation of well-being in relation to condition, treatments, and experiences. Health is according to the proposed definition, judged both objectively (signs) and subjectively (symptoms). Apart from health and well-being, there is also reason to include objectively registrable factors at the welfare level (external factors) such as the consumption of medicines, number of days in hospital, length of sick leave, need of in-home care, etc. This review is an attempt to elucidate the effects of antihypertensive pharmacotherapy on the patient's general well-being. The topic will be discussed from several points of views (e.g., aims of antihypertensive treatment, occurrence of symptoms in the population, compliance with prescribed treatment, symptom inventories, the concept of quality of life.

Beneficial effects of dietary carbohydrate restriction in chronic cor pulmonale

To explore the effects of moderate and severe reductions in carbohydrate intake on abnormal pulmonary physiology in chronic hypercapneic respiratory failure, spirometric, metabolic, arterial blood gas tension, and oximetric studies were carried out in eight patients who took, in random order daily for a week, either 50 g or 200 g of carbohydrate in an isocaloric diet. At the end of a week's daily intake of an isocaloric diet containing 200 g of carbohydrate, all patients experienced a subjective improvement; the mean body weight was 55.5 ± 15.4 kg (1 SD) compared with 56.0 ± 16.0 kg during the control dietary period, the arterial carbon dioxide tension decreased from a mean of 56.9 ± 6.7 to 50.9 ± 6.2 mm Hg (p <0.005), and the arterial oxygen tension increased from a mean of 50.6 ± 7.3 to 62.0 ± 14.5 mm Hg (p <0.02). After a week's intake of 50 g of carbohydrate in an isocaloric diet, the body weight and arterial oxygen tension did not change significantly, but the arterial carbon dioxide tension decreased still further to 48.0 ± 7.8 mm Hg (p <0.05). Mouth pressure at 100 msec after the start of inspiration, as a measure of respiratory center output, was significantly higher during both the low carbohydrate intakes compared with the control dietary period. The spirometric data, ventilation-perfusion distribution measurements, oxygen consumption, and carbon dioxide production did not change significantly during various dietary periods. It is concluded that, under these short-term, hospital-controlled conditions, a reduction in the carbohydrate intake to 200 g a day improves the general well-being of patients with chronic hypercapneic respiratory failure, increases arterial oxygen tension, and decreases arterial carbon dioxide tension. A further reduction in the carbohydrate intake to 50 g a day provides further beneficial effects, and such a diet may be used in patients with intractable respiratory failure.

Elemental diets in treatment of acute Crohn's disease.

Twenty-seven patients with 32 acute exacerbations of Crohn's disease were treated for four weeks with an elemental diet. At the end of treatment 29 of the exacerbations had remitted both clinically and biochemically. After six months six patients had relapsed. These findings suggest that the elemental diet is effective in treating acute Crohn's disease, but the reasons are not clear. The diet may be effective because it provides nutritional support, is hypoallergenic, acts as a medical bypass from the affected area, or alters bowel flora. The patient's general wellbeing is improved by the supply of adequate energy and essential foodstuffs in a form easily available without further digestion and given in a safe, simple, non-toxic way.

Hysterectomy. Indications and technics.

Certain benign and malignant conditions often require hysterectomy. Among the benign conditions are inflammatory disease, neoplasm, structural and physiologic incompetence, accidents of pregnancy, and hemorrhage. The malignant diseases may be gynecologic or nongynecologic. Whenever possible, the physician should attempt to preserve uterine integrity, particularly if the patient is less than 35 years old and has not yet completed her family. However, this should not be done at the expense of the patient's general well-being.

Home care of cancer patients.

A program of home care was organized in 1950 to provide the services of physician, nurse, and social worker for cancer patients who did not require hospitalization yet were too ill for treatment at the clinic. Under the direction of a physician, the program coordinated the resources of hospital, clinic, medical school, and community. This team concept has benefited all participating groups. In nine years of operation this program has achieved a plateau, with a patient load of 15 to25 patients and about 4,500 patient-days of care per year. It demonstrates that care in the home, when practical, is less expensive and more conducive to the patient's general well-being than is hospital care.

FOLIC ACID IN THE TREATMENT OF PERNICIOUS ANEMIA

Abstract 1. Folic acid in daily doses of 15 to 50 mg., orally, or 20 mg. intramuscularly, usually produced a submaximal reticulocytosis in patients with pernicious anemia. 2. In 3 patients the hemoglobin and red cells rose to a level of about 12.0 Gm. and 4.3 million respectively without further rise after 3 months of therapy. 3. Folic acid in the above doses failed to prevent the development or progression of neurological symptoms indicative of subacute combined sclerosis. 4. In 5 patients folic acid in doses of 5 or 10 mg. orally daily combined with ½ unit of liver extract injected intramuscularly daily produced a reticulocytosis greater than that anticipated from adequate liver extract therapy alone. 5. With combined liver extract and folic acid therapy there was evidence of improvement in the symptoms and signs of subacute combined sclerosis in 3 patients. 6. Folic acid, combined with ½ unit of liver extract, was found to produce a complete hematological remission. 7. Folic acid, alone or in combination with small doses of liver extract, produced an improvement in appetite and general well-being in patients with pernicious anemia. 8. The possible enhancing effect of liver extract when combined with folic acid cannot be due to the folic acid content of the former since 1 unit of liver extract contains only 0.38 micrograms of folic acid.31 9. Folic acid administered to a patient with macrocytic anemia due to faulty postoperative intestinal digestion and absorption, produced a complete remission in the blood picture and a marked improvement in signs and symptoms.

Neurosurgical Procedures for the Relief of Pain in Advanced Cancer

Rarely should a defeatist attitude toward intractable pain be entertained without an investigation of the possibilities of relief by means of surgery. This applies especially to patients with incurable cancer because to them the actual and potential penalties involved are insignificant when compared with the relief of pain which they may expect from surgical treatment. In this country alone, cancer takes 160,000 lives each year. Of this number of patients passing through the terminal stages of the disease, comparatively few require neurosurgery. Local treatment of the growth, together with other measures such as x-ray therapy and the administration of analgesic drugs, tides the majority of patients over until there are complications causing rapid failure or until cerebral metastases occur which may not only raise the threshold of pain but also make the patient indifferent to his condition. It is in those patients with intractable pain, whether this comes early or late in the course of a malignant neoplasm, that neurosurgery has a wide field of usefulness. When pain becomes unbearable, relief by surgical means should be considered before allowing the patient to become addicted to opiates. At present, the number of patients being treated in this manner is small, but when the possibilities and advantages of surgery are more widely appreciated, a greater number will be benefited. Opiates may control pain for a brief period, but this interval is shortened as tolerance to the drug is increased. Furthermore, gastro-intestinal disturbances are common and may be as disquieting as the pain itself. The general well-being of patients relieved of pain by surgical means is far better. Often they are able to pursue a gainful occupation for months or years. Moreover, treatment of the formerly painful areas can be pushed to the limit. Chordotomy and Tractotomy Any operation for relief of pain due to cancer should not only produce anesthesia, preferably analgesia, well beyond the limits of the tumor area, but also render insensitive, so far as possible, that part of the body to which pain is apt to spread. For the most part, section of the pain-conducting tracts in the spinal cord (chordotomy) answers these requirements. For many years, following its introduction by Spiller and Martin (1) in 1912 and subsequent refinement by Frazier, chordotomy was applied only for relief of pain below the diaphragm—mainly in the pelvis and lower extremities. There remained unsolved the problem of pain in the chest, upper extremities, neck, and head, except for such procedures as posterior root section, which left much to be desired. Stookey (2), in 1931, introduced high cervical chordotomy to raise the level of analgesia to include the upper chest and arm, mainly for the purpose of relieving pain resulting from carcinoma of the breast. In more recent years, other significant contributions have been made.

ANTISYPHILITIC TREATMENT

The problem expressed in the title of this paper has been given little consideration in modern syphilologic literature. Among the modern textbooks only that by Stokes 1 gives adequate consideration to a discussion of the paramount necessity of rest as an adjunct to specific treatment, while others have little or nothing to say. Even less can be found about the general effect of specific treatment on the patient. Yet the distinct influence which antisyphilitic treatment has on the patient's general well-being must be apparent to every experienced syphilologist. To a certain extent this influence can be objectively evaluated, for example, by the increase in the patient's weight. There is, however, a less tangible, but none-the-less important, change which can be observed in the majority of the patients, namely, a distinct improvement in the subjective feeling of well-being. In cases of latent syphilis the difference between the way the patient

DIABETES MELLITUSTHE LIMITATIONS OF ITS DIETETIC TREATMENT.

Over 100 years ago Rollo pointed out the supreme importance of diet in diabetes, and demonstrated that by restriction of the carbohydrate principles of food sugar could be made to disappear from the urine and a general improvement in the patient's nutrition result. In elaboration of this principle, Bouchardat laid down in their minutest details the rules of the dietetic regimen, and ever since, and until a very recent date, discussion has only been on points of minor importance, such as the eligibility of certain foods or beverages for introduction into the various dietaries, strict or moderate. This, our most valuable means of combating the diabetic dystrophy, was conceived in empiricism, and, until comparatively recent times, was practiced empirically, the only guide being the results obtained—the fluctuations of the glycosuria and the state of the patient's general well-being. It may be said that these indications, to a large extent, still govern our procedure, but, thanks