Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intraspinal narcotic anesthesia was performed in 180 open heart surgery patients. 0.1 mg/Kg of morphine or 1.5 mg/Kg of meperidine was administered as the primary anesthetic in the subarachnoid space using the barbotage technique. Of the 180 patients scheduled for open heart surgery, morphine was administered to 95 patients, meperidine to 55 and a mixture of morphine and meperidine to 30 patients. From a clinical point of view, there were no significant cardiovascular problems, however, respiratory depression seemed to be most serious after morphine administration. Mild complications such as pruritus (11.1%), voiding difficulty (10.6%), intraoperative awareness (4.4%) and spinal headache were observed, however these were mild, not major clinical problems and were acceptable. Postoperative analgesic effect and respiratory controllability were excellent.
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PMID:Intraspinal narcotic anesthesia in open heart surgery. 326 79

Twenty-three patients with disseminated refractory malignancies each received a tailored combination of adriamycin-conjugated murine monoclonal antibodies. Tumors were typed using a panel of antibodies. Cocktails of up to six antibodies were selected based on binding greater than 80% of the malignant cells as tested by immunoperoxidase and flow cytometry. These monoclonal antibodies were then conjugated to Adriamycin and administered intravenously. Seventeen of 23 patients had reactions to the administration of immunoconjugates, but these were tolerable in all but two patients. Fever, chills, pruritus, and skin rash were by far the most common transitory reactions. All were well controlled with premedication. In several patients there was limited antigenic drift among various biopsies within the same patient over time. This observation confirms the necessity for the use of a cocktail of antibodies if one wishes to cover all tumor cells. Preliminary serologic evidence suggests that the development of an IgM antibody, which is specific against the mouse monoclonal antibody, has the specificity and sensitivity to predict clinical reactions. Selected patients were re-treated. One patient with chronic lymphocytic leukemia had re-treatment on three occasions and demonstrated regression of peripheral lymph nodes. Two patients with breast carcinoma had definite improvement in ulcerating skin lesions and two patients with tongue carcinoma had shrinkage of their lesions. In the course of the study free Adriamycin released from the monoclonal antibodies was discovered to be a limiting factor in the amount of antibody that could be administered. Up to 1 g of Adriamycin and up to 5 g of monoclonal antibody were administered. The limiting factor appeared to be a variable dissociation of active Adriamycin from the antibody that unpredictably caused hemopoietic depression. This study demonstrates the feasibility and reviews technical considerations in preparing immunoconjugate cocktails for patients with refractory malignancies. The major technical hurdle appears to be the selection of an effective conjugation method that can be used to optimally bind Adriamycin to monoclonal antibodies for targeted cancer therapy.
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PMID:Adriamycin custom-tailored immunoconjugates in the treatment of human malignancies. 326 48

To determine the safety, efficacy, and the ventilatory responses to carbon dioxide (CO2) of mini-dose intrathecal morphine, 33 healthy women who underwent cesarean section with spinal anesthesia using 0.75% bupivacaine in 8.25% dextrose were studied. Patients were randomly assigned to receive, in a double-blind fashion, either morphine 0.25 mg (group I, n = 11), morphine 0.1 mg (group II, n = 10), or saline (group III, placebo group, n = 12) in 0.5 ml volume mixed with the bupivacaine. In both groups I and II excellent postoperative analgesia with long duration was obtained (27.7 +/- 4.0 and 18.6 +/- 0.9 hours, respectively, X +/- SEM). All patients in group III required an analgesic (8 mg subcutaneous morphine) within 3 hours of spinal anesthesia. Seven patients in group I and four patients in group II developed mild pruritus that did not require treatment. Ventilatory responses to CO2 showed no evidence of depression attributable to either the 0.25 or 0.1 mg of morphine, but significant depression of the CO2 responses was observed in group III patients after administration of subcutaneous morphine. It is concluded that a dose as low as 0.1 mg of intrathecal morphine gives excellent analgesia with minimal to no side effects and that subcutaneous morphine is associated with marked depression of the ventilatory variables.
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PMID:Mini-dose intrathecal morphine for the relief of post-cesarean section pain: safety, efficacy, and ventilatory responses to carbon dioxide. 327 78

Long-term use of spinal opioids to treat chronic severe pain is widely established. However, the indications, shortcomings and complications of the method have not been completely described. Experience with spinal opioids was analysed for the period 1979-1984 in a nationwide Swedish survey. Out of 93 anaesthesia departments, 69 used the method. Approximately 750 patients were treated with epidural morphine for an average duration of 124 days (3-450). Eighteen patients were treated with intrathecal morphine for an average period for 47 days (3-90). The intrathecal approach was used in all clinics because of failure of the epidural route. In only one department was the intrathecal approach used as the primary route of therapy, depending on the mechanism of pain. The highest daily morphine dose was 480 mg and 50 mg for epidural and intrathecal routes, respectively. The patients given the highest dosages were not necessarily those subjected to the longest treatment. The need for increased dosage seems to be related not only to changes in receptor sensitivity but also to changes in pain mechanisms. No case of threatening ventilatory depression was reported. Thirty-two departments had treated a few patients with chronic non-cancer pain conditions. Initial results were considered "excellent" in 11 departments, but at follow-up results were excellent in only one department. In addition to dislocation, occlusion of the catheters or leakage, injection pain was an obstacle to successful treatment. Pruritus urinary retention, and local infections were not reported as significant problems, but one case of meningitis was reported.
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PMID:Clinical experience of long-term treatment with epidural and intrathecal opioids--a nationwide survey. 336 50

The short duration of epidural fentanyl has limited its direct comparison with epidural morphine in previous reports. The following study was performed of continuous postoperative epidural infusions at 5 ml/hr fentanyl 10 micrograms/ml (n = 59) or morphine 0.1 mg/ml (n = 48), both with bupivacaine 0.1%, in patients having cesarean sections. Postoperative evaluations included the frequency and magnitude of clinically evident respiratory depression, the adequacy of analgesia, nausea, pruritus, the ability to ambulate, and other side effects for 24 hours. Analgesia and the number of supplemental narcotic injections needed were similar in both groups. The incidence of nausea and pruritus was significantly less in the patients receiving fentanyl. No patient developed respiratory depression in either group. Patient and staff acceptance of the continuous epidural technique was excellent because there were only minor catheter-related problems associated with its use. It is concluded that continuous epidural fentanyl combined with bupivacaine offers excellent postoperative analgesia with minimal side effects.
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PMID:Comparison of continuous epidural infusion of fentanyl-bupivacaine and morphine-bupivacaine in management of postoperative pain. 337 11

Among 82 inpatients with psoriasis, 67% (55 patients) reported moderate or severe pruritus. The degree of depressive psychopathology discriminated between the mild, moderate, and severe pruritus groups at admission. Prospectively, the change in depression scores correlated with the change in pruritus pretreatment to posttreatment. Pruritus severity did not correlate significantly with stress due to life events, age at onset, ethyl duration of psoriasis, age, sex, marital status, and average reported daily alcohol (ethanol) consumption. Among the objective dermatologic measures, including extent and severity of lesions, only the degree of perilesional irritation discriminated between the mild, moderate, and severe pruritus groups at admission, and prospectively, change in this measure correlated with the change in pruritus pretreatment to posttreatment. This finding was most likely related to the self-excoriation associated with pruritus. Intrapsychic factors (eg, the severity of depression) rather than external psychosocial or well-defined dermatologic factors, were the most significant correlates of pruritus in psoriasis.
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PMID:Pruritus in psoriasis. A prospective study of some psychiatric and dermatologic correlates. 338 49

Since its introduction to North America in 1942, the use of epidural catheter analgesia has increased dramatically. Improved equipment, methods and medications have broadened its application to include among others, surgical anesthesia, chronic pain relief and the management of postoperative pain. Numerous techniques for epidural puncture and insertion of the catheter have been described. Although complications have been associated with placement of an epidural catheter, these are rare when performed by an experienced anesthesiologist. Epidural analgesia was first accomplished by blockade with local anesthetics. Bupivacaine has been called the local anesthetic of choice for epidural infusion. Bolus administration of epidural local anesthetics gives effective analgesia; however, its use is limited by brief duration and occasionally severe hypotension. Epidural local anesthetics have been administered by continuous infusion in an attempt to minimize side effects. Nevertheless, hypotension, as well as motor block, numbness, nausea and urinary retention have occurred. Epidural analgesia with local anesthetics is effective in relieving postoperative pain, but its safety and feasibility have been questioned because of the frequent, potentially serious side effects. These problems led to trials of epidural narcotics for postoperative pain management. The exact site of action of epidural narcotic analgesics is debatable; however, the bulk of evidence supports a direct spinal action. Epidural narcotics appear to specifically inhibit nociceptive stimuli. The prolonged and profound analgesia that occurs with epidural narcotics relative to parenteral administration is due to a higher concentration of drug reaching the CSF through the epidural route. Since nervous transmission is not completely blocked this technique cannot provide anesthesia during operation. Morphine has been the most frequently used narcotic for epidural analgesia. Results of several recent, randomized double-blind studies have shown that epidural narcotics give adequate analgesia comparable with that observed with epidural bupivacaine. Epidural morphine provides a greater duration of analgesia and may cause fewer side effects. Improved analgesia has been reported when epidural narcotics are used in combination with local anesthetics. Continuous administration of low dosage epidural narcotics has been shown to have less frequent side effects than bolus administration. Nevertheless, pruritus, urinary retention, hypotension and severe respiratory depression have been reported with both methods.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Epidural catheter analgesia for the management of postoperative pain. 351 98

Symptoms due to estrogen deficiency begin in the perimenopausal years and progress as serum levels of this hormone decrease Vasomotor instability, manifested by hot flushes or night sweats, may persist for several months to a few years. Psychologic symptoms include anxiety, tension, depression, insomnia, palpitations, and headaches. Atrophy of the genital epithelium may result in senile vaginitis with symptoms of irritation, burning, pruritus, dyspareunia, and even vaginal bleeding. Even the lower urinary tract mucosa is dependent upon estrogen. Postmenopausal osteoporosis affects 25 to 50% of older women and increases the risk for vertebral, hip, and other fractures. Estrogen therapy for menopausal complaints has received adverse publicity because several reports have indicated that unopposed estrogens increase the risk of endometrial cancer. Added progestogen not only negates this risk but reduces the incidence of endometrial adenocarcinoma in estrogen-progestogen users to less than that observed in untreated women. Estrogen replacement therapy does not increase the risk of breast cancer; the incidence of this malignancy, however, was also less in the estrogen-progestogen users when compared with either the untreated women or from that expected from the national cancer surveys. In evaluating postmenopausal women for hormone replacement, the benefits of estrogen-progestogen therapy must be weighed against possible risks.
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PMID:The menopause. 351 23

The anesthetic effect of 2 ml of 5% lidocaine in 7.5% glucose (LG) or 5% meperidine in water were evaluated and compared in 40 ASA class 1 or 2 patients. Patients were randomly assigned to one of the two groups (20 patients in each) according to the anesthetic agent, which was injected into the lumbar subarachnoid space in the sitting position. The patients remained sitting for 5 min before being placed in the supine position. Times of onset of sensory and complete motor blockade were significantly more rapid with LG. The extent of maximum cephalad spread of analgesia and the time to maximum height of analgesia in the two groups were not different. Duration of analgesia at the T-7 (48.96 +/- 6.64 min with LG, 44.74 +/- 6.14 min with meperidine; means +/- SEM) and L-1 (94.37 +/- 7.42 min with LG, 76.19 +/- 5.64 min with meperidine) dermatomes was not different in the two groups but was statistically longer at the T-10 dermatome with LG (66.83 +/- 6.72 min) than with meperidine (46.66 +/- 6.26 min). The duration of complete motor blockade was also significantly longer with LG (66.44 +/- 7.05 min) than with meperidine (42.67 +/- 4.47 min). Complications in both groups included decrease in blood pressure and nausea and vomiting intraoperatively, and urinary retention, nausea and vomiting, and mild headache postoperatively. Complications that occurred only in the meperidine group were intraoperative drowsiness, respiratory depression, bronchospasm, and itching. The frequency of complications was greater wit meperidine.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Meperidine as a spinal anesthetic agent: a comparison with lidocaine-glucose. 354 85

A prospective randomized trial was conducted to evaluate the effectiveness of epidural morphine for pain relief after lumbar laminectomy. Thirty-three male patients were studied in two groups. At the end of surgery, Group 1 patients (15) received 2 mg morphine in 5 ml saline through an epidural catheter. Doses were repeated on demand. Group 2 patients (18) received 10 mg morphine intramuscularly on request in the postoperative period. Pain was assessed at 2, 6, 12, and 24 hours postoperatively by the linear analog of pain scale. There was significantly greater pain relief in Group 1 than in Group 2 after 2, 6, and 12 hours, respectively. Furthermore, Group 2 received larger doses of morphine than Group 1. There was no respiratory or cardiovascular depression detected in patients in either group. Nine patients in Group 1 and five patients in Group 2 had transient postoperative urinary retention that required catheterization. Only one patient in Group 1 had mild pruritus and three patients in Group 2 had nausea.
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PMID:Epidural morphine for pain relief after lumbar laminectomy. 355 53


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