What about odor in terminal cancer?

Daily care involving proximity with a malodorous patient in the terminal stage of cancer has often proved difficult for the caregiver. Whatever the cause of the primary cancer, three sources of noxious odor can exist or coexist: necrosis, superinfection, and perspiration and/or discharge. The proposed treatment calls for a twofold approach: internal or general and external or local. The internal treatment consists mainly of antibiotics and often involves the combined use of two drugs. Local treatment is applied "à la carte" according to the origin of the odors. Wounds, vomiting, diarrhea, and so on can be treated with specific treatments which will be discussed further.

[Neurotic triad and change in blood platelet number in reaction to stress]. / La triade névrotique et la modification du nombre de plaquettes sanguines en réaction au stress.

Blood platelet count is evaluated three times in reaction to catheterization stress in a group of 21 myocardial infarction patients and a group of 21 non-coronary subjects. Coronary and non-coronary patients are divided in two groups according to their low or high results at the psychological scales (hypochondria, depression, hysteria of the M.M.P.I.). The group of non-coronary patients with low results in hypochondria, depression and in the sum of the three psychological scales presents a lower platelet count than the other groups. The non-coronary subjects with high psychological results have the same platelet count as the coronary patients with high or low values.

[Temporal evolution of neuro-endocrine secretions in reaction to various stressors in coronary and non-coronary subjects (author's transl)]. / Evolution temporelle des variables neuro-endocrines en résponse au stress.

The purpose of this study is a comparison of sequential physiolocical reactions to different stressors in 21 post-myocardial infarction and 21 non-coronary subjects. Two stressful situations are induced in a timespan of 2 hours; the first stress is catheterization, the second is a film implementing either a focused or a diffuse anxiety. Throughout the experiment, the following physiological parameters are assessed six times consecutively: levels of catecholamines, cortisol, TSH, insulin and the ratios: adrenalin/fnor-adrenalin and adrenalin/cortisol. Results indicate that levels of adrenalin and cortisol show specific variations with time and are most sensitive to catheterization. Levels of nor-adrenalin very differently with time among coronary patients, as well as they do in normal subjects. Individuals submitted to focused anxiety show increased levels of catecholamines and cotisol, as well as a lower level of insulin than subjects submitted to diffuse anxiety. The sequential evolution of cortisol differs in coronary patients and normal subjects and in function of the type of film attended. Physiological reactions to stress and far more specific and interdependent than prior studies stated in the past. They vary with the degree and the nature of stress. It is our belief that there is no standardised response to stress.

[Temporal evolution of blood pressure and heart rate reaction to various stressors in coronary and non-coronary subjects (author's transl)]. / Evolution temporelle des variables hémodynamiques en résponse au stress.

The temporal evolution of systolic and diastolic blood pressure and heart rate in reaction to several stresses is measured in a group of 21 post myocardial infarction and 21 non coronary subjects. Heart rate modifications depend essentially upon the nature of stress: catheterization induces tachycardia while a stressing film induces bradycardia. These observations can be connected to environmental intake or rejection. During catheterization stress, the systolic blood pressure is high in both groups but returns to its normal values as soon as the intervention ends. In response to anxiety films, it persists higher in coronary patients than in normal subjects, who do not seem to react to this kind of stress. These results arise the question of either a longer recuperation, or a different reactivity to symbolic stressors (films).

[Temporal evolution of fibrinogen and platelets in reaction to various stressors in coronary and non-coronary subjects (author's transl)]. / Evolution temporelle du fibrinogéne et du nombre de plaquettes en réponse au stress.

Twenty-one postmyocardial infarction patients are compared with twenty-one matching non-coronary subjects. Fibrinogen level as well as whole blood platelet count were measured six times for each subject in a timespan of 2 hours, during which two stress situations are induced. Throughout the experiment, non-coronary subjects show significantly lower levels of fibrinogen and higher blood platelet count. These two variables follow a specific temporal evolution. Stressfull situations are directly related with a significant decrease in the whole blood platelet count. Films inducing a directional anxiety match a lower blood platelet count, as compared to films inducing a diffuse anxiety. A link may be hypothesized between the stress-induced decrease in blood platelet count and the relative thrombopenia of coronary patients.

[Temporal evolution of lipids in reaction to various stressors in coronary and non-coronary subjects (author's transl)]. / Evolution temporelle des lipides en résponse au stress.

In order to assess the impact of coronary disease on sequential physiological reactions to stress, this study compares 21 post myocardial infarction patients with 21 matching non-coronary subjects. In each group, levels of phospholipids, triglycerides, cholesterol, FFA, alpha-, beta, pre-beta-lipoproteins and the ratio cholesterol/triglycerides are assessed, six times consecutively in a timespan of 2 hours. Concomitantly, two stressful situations are induced: the first stress is catheterization, the second is a film implementing either a focused-or diffused anxiety. Phospholipids react essentially to catheterization stress. While the ratio cholesterol/triglycerides turns out to be sensitive to psychological stress, neither cholesterol nor triglycerides alter individually when psychological stress is present. Throughout the experiment, levels of beta-lipoproteins very significantly in time and with respect to the theme of the film attended; coronary patients do not show the same sequential variations as normal subjects do. Variations in alpha-lipoproteins differentiate coronary from normal subjects. Levels of FFA vary according to the nature of the film attended and differ in normal and coronary subjects: extreme values are observed in normal subjects rather than coronary patients. Hyperlipidemia, as a reaction to stress, is a process interlinked with many factors, each increasing the liability of coronary disease.

[Psychological links and coronary diseases. I. Physiological correlations of certain psychological variables (author's transl)]. / Liaisons psychophysiologiques et affections coronariennes. I. Corrélats physiologiques de certaines variables psychologiques.

Twenty-one infarct patients were compared with 21 normal subjects regarding several hemodynamic, lipidic and neuroendocrine variables, in various stress situations and at rest. Correlations were tabulated between those bioclinical measurements and various personality patterns drawn from the MMPI. This study shows that the physiological reactions to stress vary in subjects with psychological cardiovascular risk factors as compared to subjects without psychological risk factors. The bearers of psychological risk factors show a higher systolic and diastolic blood pressure, a specific lipids pattern and a lower rate of platelets. In summary, psychological risk factors link with physiological reactions to stress which appear to be by themselves cardiovascular risk factors.

[Psychological links and coronary diseases. II. Psychological correlations of certain physiological variables (author's transl)]. / Liaisons psychophysiologiques et affections coronariennes. II. Corrélats psychologiques de certaines variables physiologiques.

In this study, correlations were tabulated between physiological and psychological measurements drawn from a group of 21 infarct patients and a matching group of 21 normal subjects. The physiological variables taken under consideration are the number of platelets, the beta-lipoproteines and the systolic blood pressure; all these variables were tested under stress and at rest. On the top, fibrinogene at rest, cortisol under stress and heart rate under conditions of "intake" and "rejection" were also measured. The psychological assessment was achieved by the MMPI. Several psychological traits link with physiological parameters to be considered as cardiovascular risks. However, these links are mostly specific; moreover, they vary under different experimental conditions. In other words, different neuro-behavioral patterns seem to operate at rest and under stress. The links between psychological and physiological variables vary also between normal subjects and infarct patients. Normal subjects as well as infarct patients show a relationship between neurotic traits and genuine physiological reactions. However, among the formers, these neurotic traits are in closer relationship with inhibitions as among heart patients. Psychological risk factors in cardiovascular disorders appear to be related with a genuine expression of conflictual affects leading to inadequate physiological responses; when these reactions are repeated in time, functional disorders may induce organic lesions.

[Approach to the personality of the coronary patients with a new modifyed MMPI scale (author's transl)]. / Approche de la personnalité du coronarien à l'aide de nouvelles grilles de correction du MMPI.

In order to set up an instrument for psychologically differentiate normal from coronary subjects, the analysis of 550 items of the MMPI in 40 normal and 40 coronary subjects has been performed. This has allowed to elaborate a questionnaire of 69 items, the Polyvar, and two new MMPI scales, which try to focus on the way conflictual affects are being expressed by coronary patients. Applied to new populations, these two instruments permit to significantly differentiate normal from coronary subjects. The last are characterized by a trouble in the existence and a rigid denial of any weakness. They look like individuals who can not satisfy their fundamental pulsions without risking to confront other requests, and through this, they generate anxiety and guilt.

[Comparison of carotid pulse in normal subjects and coronary patients]. / Comparaison du pouls carotidien de sujets normaux et coronariens

A comparison of the values of R-R, S1S2, QS1, QS2, LVET, PEP, and ICT recorded from the carotid pulse of 40 coronary patients and 40 normal subjects has shown that the coronary group, when compared with the normals, show: --A significant lengthening of the QS2, PEP and ICT values, and a tendency towards lengthening of the S1S2 interval. --A tendency towards shortening of the LVET period. The ratio of PEP/LVET is a particularly good discriminant factor between the two groups. Because of these differences, assessment of the carotid pulse, which is an easy and non-invasive investigation, has become a good means of diagnosing coronary arterial disease. The results of this study have been compared with those from previous studies, and the clinical significance of the different findings has been analysed.

[Stress, psychological characteristics, and respiratory variables]. / Stress, caractéristiques psychologiques et variables respiratoires

This study compares the respiratory reactions of 40 normal subjects and 40 coronary patients. The respiratory measures are taken under stress and under normal situations. The psychological features of the eighty subjects are known; they are drawn from a test battery implementing the MMPI, the ABV and the DS. The study is meant to identify the interaction between the psychological and bioclinical measures. The bioclinical measures comprise several respiratory parameters: they are taken under mental and physical stress.