Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011206 (delirium)
 5,996 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case of life-threatening adverse effects following intravenous administration of a non-ionic contrast medium is reported. The patient, a 68-year-old diabetic hypertensive male with dyspnoea and cough had an abnormal chest radiograph, revealing congestive heart failure and an enlarged right hilum. Computed tomography (CT) of the chest was performed using 100 cm3 of intravenous iopamidol. Within half an hour the patient developed abdominal cramping, vomiting, and diarrhoea, followed by hypotension, tachycardia, fever to 40 degrees C, and delirium. His course was complicated by disseminated intravascular coagulation, rhabdomyolysis, renal failure, respiratory arrest, and atrial fibrillation. There was no evidence of infection, neoplastic disease, or myocardial infarction. Over the next month the patient slowly recovered. One other case report implicates a contrast agent with a similar syndrome. The features of this case fulfil the criteria for a probable adverse drug reaction of a type and severity rarely encountered.
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PMID:Case report: multisystem failure following intravenous iopamidol. 139 88

The lack of control of physical suffering among cancer patients in the last days or hours of life is a common medical problem but it is rarely discussed in an open fashion. We carried out a prospective study of the dying of 120 terminal cancer patients assisted by a home care team. We documented how long it was before death that physical symptoms, unendurable to the patient and controlled only by sedation-inducing sleep, appeared. In 63 patients (52.5%), unendurable symptoms due to tumor progression or irreversible acute organic phenomena appeared, on average two days before death. Of the 63 patients, 47 had only one uncontrollable symptom, 15 had two symptoms and one patient had three symptoms. The most common symptoms included dyspnea (33 patients), pain (31), delirium (11), and vomiting (5). The most frequent symptoms were dyspnea in lung and head and neck disease; pain in breast, gastrointestinal tract, colon-rectum, and male genitourinary tract cancer; and vomiting in female genitourinary tract malignancies. Data reported emphasize the clinical relevance of physical symptoms in the last days of life in terminal cancer patients and how these serve to indicate imminent death. More than 50% of these patients die with physical suffering that is controllable only by means of sedation.
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PMID:Symptom prevalence and control during cancer patients' last days of life. 171

A recent report suggested that more than 50% of terminal cancer patients have physical suffering that requires sedation in the last days of life. To evaluate this finding on our 14-bed palliative care unit, a retrospective analysis of 100 consecutive patients admitted for 6 days or more was carried out. Information was collected on major symptoms requiring treatment, symptom control at admission and during each of the last 7 days of life, medications used, and changes that may have contributed to sedation. Of the 100 patients, 99 had pain, 46 had dyspnea, 71 had nausea, and 39 experienced delirium. Visual Analogue Scores (VAS) were done twice a day in all patients; mean pain showed a change from 31 +/- 24 on Day 6 to 24 +/- 19 on day of death (DOD) (p less than 0.05); nausea from 19 +/- 18 on Day 6 to 13 +/- 9 on DOD (p less than 0.01); drowsiness from 51 +/- 28 on Day 6 to 85 +/- 45 on DOD (p less than 0.001); symptom distress score from 49 +/- 11 on Day 6 to 52 +/- 9 on DOD (p less than 0.01). On the day of admission (DOA), 69% of VAS were done by the patient and 28% by the nurse as compared to 8% by the patient and 90% by the nurse on DOD. Level of consciousness on DOA was alert (72%), drowsy (28%), unresponsive (0%) and by DOD was alert (2%), drowsy (41%), unresponsive (57%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Symptom control during the last week of life on a palliative care unit. 204 96

An investigation has been made with regard to the clinical picture of 87 terminally ill patients with lung cancer. It has yielded the following points. 1) Seven patients had been informed of their diagnosis. 2) Intravenous hyperalimentation was administered in 78 cases (90%), oxygen therapy in 68 cases (78%), and morphine in 35 cases (40%). 3) The most frequent cause of death in these patients was respiratory failure, due to progress of cancer, then infection, pleural, or pericardial effusion, or interstitial pneumonitis. 4) Psychic disturbances involved anxiety over breathing, depression, and delirium. In only 12% of the patients did the mental condition seem normal until death. 5) To deal with the dying patient's needs, it is necessary to establish proper treatment for the control of sensory dyspnea and for psychosocial support by a psychiatrist and other professionals for members of the family.
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PMID:[The clinical picture of terminally ill patients with lung cancer]. 250 34

37 patients aged 80 or over underwent cardiac surgery during an 11-year period. Operative indications included angina, dyspnea and syncope. The majority of patients (n = 32) had a left ventricular ejection fraction greater than 0.5. There were 28 aortic valve procedures, of which seven were combined with coronary artery bypass grafts (CABG), and 2 with mitral valve repair; in addition, 7 isolated CABG procedures and one isolated mitral valve repair were performed. 36-day mortality was 5.4% (2 patients); 9 patients died at a later date (2.5 to 118 months after surgery). The most frequent postoperative complications were atrial fibrillation, pulmonary infection or atelectasis, transient delirium and atrioventricular conduction disturbances. Mean hospital stay was 14.5 days. 1- and 5-year actuarial survival rates were 83% and 57%. In a control group of patients aged 60-69 matched for preoperative characteristics, there were no in-hospital fatalities and 1- and 5-year survival were, respectively, 100% and 82%. Among complications, only conduction disturbances and transient delirium were significantly more frequent in the octogenarian group. At follow-up, the proportion of severely symptomatic octogenarians had diminished to 24% from 84%. In conclusion, cardiac surgery can be performed on octagenarians with adequate myocardial reserve, exposing them to a perioperative mortality that is in the range of younger age groups while offering an equivalent prospect for functional improvement.
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PMID:[Cardiac surgery in octogenarians]. 750 8

Jumping is the most common reported means of suicide in general hospitals. There have been no published reviews of suicides of nonpsychiatric inpatients since 1980. We describe 12 subjects who, between January 1980 and January 1992, jumped from a large general teaching hospital. Eight of them succumbed, providing a rate of suicide of 1.7 per 100,000 admissions. There were three clinical subgroups: those admitted after suicide attempts, the acutely delirious, and the chronically medically ill. Factors appearing frequently in the third subgroup were pain, dyspnea, transient confusion, poor prognosis, and recent adverse news. When we compared the hospital jumpers with 30 nonfatal jumpers who attended our Emergency Department, the medical and psychiatric profiles differed in the frequency of medical illnesses, advancing age, male gender, and absence of preexisting psychiatric illness. Proximity and ease of access to balconies and windows appeared to be highly relevant to the prevention of hospital jumping.
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PMID:Jumping from a general hospital. 764 65

A 36-year-old man was stung by a wasp OD. He became delirious and had dyspnea, ocular pain, and severely decreased visual acuity OD. A broken stinger was found in the central deep cornea. Additional ocular findings were keratitis, iritis, cataract, secondary glaucoma, and unrecordable electroretinographic responses.
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PMID:Wasp sting-induced retinal damage. 848 60

A middle aged man who inhaled sarin in a train in a subway station in Tokyo in 1995 and showed a variety of symptoms including psychiatric symptoms was reported. He experienced muscle weakness, dyspnea and unconsciousness of sudden onset immediately after exposure to sarin. Marked miosis was observed on admission. Plasma cholinesterase activity was remarkably decreased at that time. He also experienced delirium consisting of visual hallucination, insomnia and irritability at mid-night for more than seven days. These psychiatric symptoms gradually improved without any medication. To date there is no detailed description of such psychiatric symptoms in sarin poisoning.
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PMID:[Psychiatric symptoms following accidental exposure to sarin--a case report]. 852 73

We reviewed the circumstances surrounding the use of sedation for symptom control in a Japanese hospice. Of 143 inpatients, 69 (48.3%) received sedation and died an average 3.9 days after sedation was begun. Symptoms requiring sedation included dyspnea, pain, general malaise, agitation, and nausea. In 83% of cases, those symptoms were escalating as death approached. In about one-half of the cases, sedation was carried out intermittently until the patient died. Sedation was gained by such sedatives as midazolam, morphine, and haloperidol. Side effects included suppression of the respiratory and/or circulatory system in nine cases (in four cases it caused death), and delirium in one case; tolerance and dependence were also observed in two cases. We also examined the explanation to and understanding of the patients and their family members about sedation. This experience suggested the type of communication methods that are likely to be useful in Japan. It stresses the importance of intermittent use of sedation and communication with family members. We propose criteria for sedation to improve symptom control that would be acceptable in Japan.
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PMID:Sedation for symptom control in Japan: the importance of intermittent use and communication with family members. 871 14

Pulmonary thromboendarterectomy under circulatory arrest and deep hypothermia is presently a curative treatment for pulmonary hypertension secondary to chronic pulmonary artery thromboembolic occlusion, but is still not frequently performed around the world. We report here the first successful pulmonary thromboendarterectomy under circulatory arrest performed in Chile. The patient was a 37 year old white man, high school teacher, with a 5 months history of effort dyspnea and cough. Pulmonary hypertension secondary to chronic pulmonary thromboembolism was confirmed by angiography and echocardiography. The patient was operated on April 27, 1995. After the operation the patient had an immediate and maintained normalization of his pulmonary hemodynamics. He presented periods of delirium that postponed mechanical ventilation disconnection until the 7th postoperative day, after which he had an uneventful neurological recovery. Before hospital discharge a control angiography showed complete patency of the pulmonary artery system with no evidence of residual thrombi. Presently he is enjoying a normal life and back to his teaching activities.
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PMID:[Pulmonary thromboendarterectomy: a case of surgical treatment of chronic pulmonary thromboembolism under circulatory arrest with deep hypothermia]. 913 74


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