Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0016382 (flushing)
 6,387 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A patient is described with a 17-year history of intractable left-sided facial pain. The pain occurred daily in 5 sec spasms to a maximum of one every 2-3 min and was restricted to the left upper face. It was associated with rhinorrhoea on the left and often with ipsilateral facial flushing. Conventional therapy, including carbamazepine, baclofen and three posterior fossa explorations, had not provided lasting relief. Local facial stimulation by tapping a painful trigger point led to both pain and flushing of the face ipsilaterally. During this flushing, blood was collected and assayed using sensitive radioimmunoassays for several neuropeptides (neuropeptide Y, substance P, vasoactive intestinal polypeptide and calcitonin gene-related peptide). A marked (119%) increase in calcitonin gene-related peptide was noted in the external jugular vein blood ipsilaterally during the flushing with no change in the other peptides measured. To quantitate the effect of calcitonin gene-related peptide on human extracranial vessels, standard pharmacological procedures were used to examine the potency of the peptide as a vasodilator of human facial artery. The IC50 of calcitonin gene-related peptide for the prostaglandin F2 alpha-precontracted human facial artery was 10(-9) mol/l. The relevance of these observations to the clinical problem of migraine is considered.
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PMID:Cutaneous sensory stimulation leading to facial flushing and release of calcitonin gene-related peptide. 155 59

Carbetocin, a long-acting oxytocin analog, was administered by intravenous and intramuscular injection to 40 women 24 to 48 hours postpartum. Intravenous injection of 8 to 30 micrograms produced a tetanic uterine contraction within 2 minutes, lasting about 6 minutes, followed by rhythmic contractions for a further 60 +/- 18 minutes. Intramuscular injection of 10 to 70 micrograms also produced tetanic contraction in less than 2 minutes, lasting about 11 minutes, and followed by rhythmic contractions for an additional 119 +/- 69 minutes. The prolonged duration of activity after intramuscular compared with the intravenous carbetocin was significant (p = 0.020). Carbetocin produced mild lower abdominal cramping in most patients and severe pain in three patients who received 50 or 100 micrograms intravenously or 70 micrograms intramuscularly. Approximately half of the patients also experienced flushing and warmth. Although carbetocin has not yet been studied immediately postpartum, its prolonged uterine activity suggests that carbetocin may offer advantages over oxytocin in management of the third stage of labor.
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PMID:Effect of carbetocin, a long-acting oxytocin analog on the postpartum uterus. 162 93

The efficacy of iloprost, a stable prostacyclin analog, was investigated in a placebo-controlled trial in 109 diabetics with ischemic lesions. 56 patients were randomly allocated to iloprost and 53 patients to placebo. Iloprost was intravenously applied for 6 hours daily on 28 consecutive days at an individually tolerated dose up to 2 ng/kg/min. The control group received identical solvent volumes. In addition all patients had an intensive basic, mainly local, therapy. At the end of the treatment in the iloprost group 31 of 50 patients (62%) showed partial (greater than 30%) or total healing of the lesion(s). In the placebo group this was the case in 12 of 51 patients (22.5%). The difference of 38.5% was statistically significant (p less than 0.05, chi 2-test, alpha = 0.05, beta = 0.1). The percentage of patients who were free of pain increased from 23% to 42% (+19%) in the iloprost group and from 38% to 48% (+10%) in the placebo group. After dose-titration iloprost was well tolerated. Flush, headache and abdominal complaints were the most frequent side effects. Heart rate and blood pressure were not influenced and the control of diabetes was not altered.
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PMID:[Iloprost in the treatment of ischemic tissue lesions in diabetics. Results of a placebo-controlled multicenter study with a stable prostacyclin derivative]. 169 72

Twelve patients with critical ischaemia of the lower limbs were treated with iloprost. The purpose of this study was to investigate for a possible iloprost-digoxin interaction and to evaluate the clinical benefit provided by short- or long-term iloprost therapy. The pharmacokinetics of digoxin were studied before and during iloprost treatment. Under iloprost the absorption of digoxin was delayed by about one hour, but the area under the plasma digoxin concentration curve remained unmodified. In 11 of our 12 patients the clinical effect of iloprost was satisfactory both immediately and after 6 months. Pain vanished in 6 patients and diminished in 6 patients. All skin ulcers were healed. In most cases this improvement persisted beyond the study period: 2 patients treated at the beginning of the study and who are still followed up have remained improved after 2 1/2 years. Two patients with pain relapse received iloprost in repeated 10 days' courses with successful results. The treatment was relatively well tolerated (headaches, flushing, abdominal pain). Thus, iloprost can avoid amputation in severe arteritis unsuitable for revascularization and for which there is no effective treatment. Patients under digoxin may continue to take this drug in the same doses during treatment with iloprost.
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PMID:[Treatment with iloprost of critical ischemia of the lower limbs associated with cardiac insufficiency. Study of the interaction with pharmacokinetics of digoxin]. 172 24

We have treated with intravenous iloprost twelve patients suffering from cardiac insufficiency compensated under oral digoxin (NYHA class II) associated with severe limb ischaemia due to arterial insufficiency. Our aim was to study its possible interaction on digoxin levels and to evaluate the long-term efficacy of iloprost. Although iloprost slowed the digoxin absorption by approximately one hour, we found no clinically significant difference between the digoxin pharmacokinetic data before and during treatment by iloprost. Moreover, 11 out of the 12 patients had a good clinical fate after the treatment, which persisted at 6 months. The pain disappeared in 4 and diminished in 7; and all skin ulcers healed. This improvement has lasted up to two and a half years in two patients. The clinical tolerance of iloprost was acceptable despite frequent headache and flushing associated with hypotension and nausea. We conclude that iloprost seems to be a very promising treatment of severe limb ischaemia when no intervention on the proximal arteries is possible. The patients on digoxin can continue their treatment without dose alteration while starting on iloprost.
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PMID:[Treatment with iloprost of critical ischemia of the lower limbs associated with cardiac insufficiency. Study of interaction with the pharmacokinetics of digoxin]. 172 27

A 47 year old man with episodes of attacks of pain, redness and mild blurring of vision was investigated for narrow angle glaucoma in view of shallow anterior chambers and a cupped optic disc. The history was reviewed following a spontaneous attack in hospital, which had features other than acute glaucoma. A diagnosis of cluster headache was made on the basis of tests. Cluster headache has been defined as unilateral intense pain, involving the eye and head on one side, usually associated with flushing, nasal congestion and lacrimation; the attacks recurring one or more times daily and lasting 20 - 120 minutes. Such attacks commonly continue for weeks or months and are separated by an asymptomatic period of months to years. This episodic nature, together with unilaterality and tendency to occur at night, closely mimics narrow angle glaucoma. Further, if patients have shallow anterior chambers and disc cupping, the differentiation becomes more difficult yet critical. Resource to provocative tests is often the only answer as the following case report demonstrates.
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PMID:Cluster headache or narrow angle glaucoma? 181 Aug 83

A portable, battery-driven, programmable drug infusion system which administers up to four different drugs through a single i.v. line is described ("IntelliJect I.V. Drug Delivery System"). The IntelliJect System can be used for a wide range of simple and complex regimens, including cytostatic therapy, antibiotic therapy, antiemetic therapy or pain control. If the actual drugs are not compatible, one channel can be programmed for flushing with sodium chloride. The system assures infusion of the right drug at the right time, while allowing delivery of preferred regimens in all settings--hospital, outpatient and home. A central venous access is necessary when used in an outpatient setting. The system needs minimal nurse or patient manipulation. Chemical stability and questions concerning microbiological contamination must be clarified, because drugs will be in the pump from several hours to several days. Applications of the system for cancer treatment are described, and documentation of patient preference of such a system is demonstrated. "IntelliJect I.V. Drug Delivery System" has the potential of optimizing cancer therapy, with regard to both quality of life and scheduling of cytotoxic drugs which can reduce toxicity and thereby possibly allow dose escalation.
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PMID:[Programmable and portable infusion pump for advanced cytostatic multidrug treatment]. 200 90

This randomized, double-blind study investigated the effect of ciprostene, a stable epoprostenol (prostacyclin) analog in patients with peripheral vascular disease (PVD) characterized by ischemic ulcers. A total of 211 patients (106 ciprostene, 105 placebo) received IV infusions of ciprostene (120 ng/kg/min in 8-hour daily infusions for 7 days) or placebo. The two groups were comparable with regard to demographic data. Only 45% of the patients receiving ciprostene and 55% of the placebo patients completed the trial. The groups were similar in frequency of amputations, vascular surgery, and development of new ulcers. Among those who completed the trials an insignificantly higher percentage of patients receiving ciprostene had all ulcers heal completely. The reduction of ulcer size by at least 50% was higher in the ciprostene-treated group at month 4 (P = .005). Both ciprostene and placebo reduced the severity of a patient's rest pain. There was no difference in the ankle brachial index between the groups. Ciprostene induced a higher incidence of headache, nausea, and flushing during infusion when compared with the placebo group. The results confirmed inherent problems with studies in PVD, namely, scarcity of patients with ischemic ulcers, inclusion of severely ill patients leading to a high dropout rate, and a high placebo effect. Good tolerance and safety of ciprostene was documented in this patient population, and the therapeutic benefit was limited to partial reduction of ulcer size. Selection of patients with less advanced disease and a longer infusion of ciprostene may improve the clinical benefit of this agent.
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PMID:The effect of ciprostene in patients with peripheral vascular disease (PVD) characterized by ischemic ulcers. The Ciprostene Study Group. 204 33

Decisions regarding the use of and reimbursement for new medical technologies frequently involve complex cost-quality trade-offs. Among physicians, hospital administrators, and insurers, interindividual variation in the value of benefits attributable to these technologies often leads to conflicting opinions about their appropriate use. Although society now encourages patient involvement in such decisions, few methods for obtaining patient valuations have been developed and systematically applied. In order to assess patient valuations of a particular new technology, low osmolality contrast media (LOM), a survey of 100 outpatients was conducted. Participants were asked about their willingness to pay (WTP) for the benefits of this expensive medical technology. Of the 95 subjects who completed the study questionnaire, a majority were unwilling to pay the minimum extra per procedure cost of LOM ($50) in return for a reduced risk of minor side effects alone (pain, nausea, hives, and flushing). For a reduced risk of both major side effects (death, renal insufficiency, severe allergic reaction, and cardiac arrhythmia) and minor side effects, the median WTP was $50; patient income and education were directly associated with WTP $50 or more. We conclude that similar WTP surveys may be helpful in addressing other difficult cost-quality issues.
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PMID:Risk reduction from low osmolality contrast media. What do patients think it is worth? 210 85

To overcome the technical limitations which have precluded noninvasive Doppler ultrasound in investigation of rapid cerebral haemodynamic responses in two cerebrovascular beds at the same time, we have modified a commercial 2 MHz pulsed Doppler instrument with online spectrum analysis. Two probes are activated intermittently, recording eight averaged Doppler-shifted spectra from each probe sequentially. Concurrent recordings of blood velocity in both middle cerebral arteries were performed during 25 selective iohexol carotid angiography runs in 13 patients with near normal cerebral vasculature. The technique permitted the differentiation between the specific responses confined to the recipient vascular bed, and the general responses occurring in remote brain areas as well. The specific response to iohexol was biphasic; a significant decrease in blood velocity occurred less than 4 s after the bolus entry, probably due to the high viscocity of iohexol. Between 4 and 12 s. blood velocity was significantly increased, reflecting the cerebrovascular response to hypertonic solutions. The blood velocity on the opposite side increased from less than 4 s through 45 s after iohexol. This concurs with studies using electromagnetic flowmetry, and suggests that these general responses are elicited by anxiety, discomfort and pain. Thus, no general responses were seen during angiography under general anaesthesia. Eight patients investigated during catheter flushing with normal saline showed a biphasic specific response reciprocal to that due to iohexol. A significant blood velocity peak occurred less than 4 s after the bolus entry, followed by a decrease between 4 and 60 s. The saline injections produced no pain and evoked no significant general response.
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PMID:Haemodynamic aspects of clinical cerebral angiography. Concurrent two vessel monitoring using transcranial Doppler ultrasound. 212 5


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