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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute myocardial infarction is a devastating cardiac clinical event, which is the result of progressive coronary arteriosclerosis. Coronary heart disease is a major health concern that accounts for a significant number of hospitalizations, health care expenditures, and deaths. Recent advancements in the nature and pathophysiology of progressive coronary disease and infarction have allowed us to curb the natural course of the disease, shorten hospital stays, and improve patient outcomes. Focused history taking and physical examination, with the assistance of the appropriate laboratory studies and an electrocardiogram, facilitate the rapid identification of a patient with myocardial infarction. Overall clinical results will be improved by minimizing the time from diagnosis to therapy. Several initial measures are readily available to the physician at the time of the patient's arrival in the hospital emergency room. Consideration regarding relief of pain, anticoagulation, and contraindications for thrombolytic therapy should accompany the initial evaluation. For patients in whom the diagnosis is in doubt, adjunctive confirmatory testing and imaging studies should be urgently sought. Elderly patients have a higher mortality rate from infarction, so an aggressive approach in this group of patients is warranted. Administration of thrombolytic therapy or primary angioplasty will be most efficacious in a majority of patients. The evolution of adjunctive medications will further improve efficacy and avoid reinfarction. Proper dosage and timing of adjunctive medications, along with dosage titration based on hemodynamic response, will facilitate the best possible results. Rapid restoration of flow down a suddenly occluded epicardial coronary vessel is the primary end point in therapy. With this in mind, there has been an increasing trend toward mechanical restoration of flow by means of primary angioplasty in centers where this technologic capability is available. Close attention to the patient's hemodynamic status along with rapid identification and therapy of peri-infarction arrhythmias will help to avoid clinical complications. When peripheral perfusion is compromised, hemodynamic monitoring, inotropic medications, and mechanical assistance may become necessary. Subsequent severe pump failure is usually the result of a devastating mechanical complication. Patients with mechanical complications have a high associated event-related mortality rate. Urgent identification of the nature of the complication with the use of invasive and noninvasive imaging studies, mechanical and inotropic assistance, and emergency surgical correction may be lifesaving.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Current management of acute myocardial infarction. 777 8

Epidural spinal cord stimulation (ESCS) has been suggested to improve microcirculatory blood flow and reduce amputation rates in patients with severe peripheral arterial occlusive disease (PAOD). Pain relief, limb salvage, and skin circulation were studied in 177 patients with ischemic pain caused by nonreconstructible PAOD who were receiving ESCS. Medical or surgical therapy had failed and vascular reconstruction was impossible in all cases. Clinical status was classified as Fontaine's stage III (chronic ischemic rest pain) in 114 patients and Fontaine's stage IV (ischemic pain and ulcers or dry gangrene) in 63 patients. PAOD was essentially due to arteriosclerosis, but 36 patients also had diabetic vascular disease. After a mean follow-up of 35.6 months, significant pain relief (> 75%) with limb salvage was achieved in 110 patients. In 11 patients with limb salvage, pain alleviation was determined to be between 50% and 70%. ESCS was ineffective in reducing pain, leading to major amputation in 56 patients. The cumulative limb salvage rate was 66% at 4 years. The systolic ankle/brachial blood pressure index did not change under stimulation. TcPO2 was assessed on the dorsum of the foot. Clinical improvement was associated with increased TcPO2, with limb salvage improving from 24.2 to 48.1 mm Hg in stage III (p < 0.02) and from 16.4 to 37.2 mm Hg in stage IV (p < 0.03) disease. A TcPO2 increase of more than 50% within the first 3 months after implantation was predictive of success. TcPO2 changes are correlated with the presence of adequate paresthesias in the painful area during the trial period.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Epidural spinal cord stimulation in the treatment of severe peripheral arterial occlusive disease. 781 84

Subsequent to cardiac arrest, a 58-year-old man with intractable dysrhythmia and severe arteriosclerosis developed flaccid paraplegia, depressed deep tendon reflexes, and showed no pain or temperature sensation caudal to Th-7 in spite of completely intact proprioception and vibration sensation. An echocardiogram showed no clots or vegetation on the prosthetic valve and no thrombus in the left atrium or left ventricle. The patient's paraplegia was permanent, at least through a follow-up period of 2 years. These findings suggest that the etiology was spinal cord ischemia due to blood supply in the area of the anterior spinal artery (ASA); however, magnetic resonance T2-weighted imaging demonstrated signal abnormalities throughout the gray matter and in the adjacent center white matter. Somatosensory-evoked potentials (SEP) measure neural transmission in the afferent spinal cord pathway, which is located in the lateral and posterior columns of the white matter; these showed a delay in latency between Th-6 and Th-7. The spinal cord is as vulnerable to transient ischemia as the brain. Spinal cord ischemia after cardiac arrest results from principal damage in the anterior horn of the gray matter, the so-called ASA syndrome; however, the pathways of SEP and pathogenesis of the spinal cord ischemia need further investigation.
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PMID:Spinal cord ischemia after cardiac arrest. 788 98

The clinical usefulness of prostaglandin derivatives was reviewed for the treatment of peripheral vascular diseases such as arteriosclerosis obliterans, Buerger's disease, Raynaud's disease, and collagen disease etc. PGE1 was initially used for this purpose, however, it had to be infused intra-arterially or intravenously for hours. PGE1 incorporated in lipid microsphere (Lipo PGE1) was made for one-shot use and the targeting drug delivery because the lipid microsphere is easily taken up by some inflammatory cells. Lipo PGE1 was revealed to be effective to improvement of considerably large ischemic ulcer and pain. Beraprost sodium (PGI2 derivative) was produced for oral use, and has been widely used. The effectiveness was similar to Lipo PGE1, but the complications such as hypotension, headache, and numbness were more common in PGI2.
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PMID:[Treatment of the peripheral vascular diseases with prostaglandin]. 793 9

Approximately 50% of diabetic hospital admissions in the United Kingdom are for foot problems. These relate primarily to neuropathic and vascular disease, often presenting as separate entities. Added to these problems is an impairment of the inflammatory response to intercurrent infection. Arterial lesions are those of arteriosclerosis, occurring at a young age. The lesions are more prominent in the calf vessels and distal profunda artery than across the adductor canal or the aorta-iliac segment. Surprisingly, microangiopathy does not present a major problem in digital vessels. Classification of foot problems is based on foot deformity and the degree of ulceration, infection and gangrene. Management is most effectively directed at educating doctors, nurses, patients and their carers, on foot care. Established foot lesions are best managed by a team, including chiropodists, orthotists, physicians and surgeons. This combined approach ensures optimal treatment of the diabetes and associated risk factors, such as hypertension. Patients usually have sufficient autonomic neuropathy to negate any advantages of sympathectomy, but temporary improvement of severe ulceration and pain may be obtained by prostaglandin E2 infusions, allowing time for angiographic assessment. Angioplasty provides the first line of vascular reconstruction. Surgical reconstruction may involve bypass to the level of the shin and ankle. Such revascularisations may reduce foot surgery to local amputation and debridement. Major amputation should not be delayed if it provides the most effective means of rehabilitation and return to community life.
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PMID:Vascular management of the diabetic foot--a British view. 812 56

Angina pectoris is a pain syndrome caused by coronary arteriosclerosis but also by a number of other disorders, including microvascular angina, gastroesophageal reflux (GER), and esophageal dysmotility. The relationship between abnormal physiology and pain in these conditions is complex. Simultaneous ambulatory monitoring of esophageal pH and motility has demonstrated that patients may have identical episodes of chest pain with acid reflux, dysmotility, both types of events, or neither. Patients may have anginal chest pain with inflation of an esophageal balloon, and patients with microvascular angina may have pain with catheter manipulation in the right atrium. Recent evidence suggests that disorders of visceral pain perception may play a role in both chest pain of esophageal origin and microvascular angina. The physiology of visceral pain is reviewed, including concepts of convergence of somatic and visceral afferent input, descending modulation of pain perception, and sensitization of visceral pain afferents. An approach to evaluation and treatment of chest pain in patients with angiographically normal coronary arteries is outlined.
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PMID:Southwestern Internal Medicine Conference: the syndrome of angina pectoris: role of visceral pain perception. 816 Jul 26

In patients affected by unbearable pain secondary to peripheral vascular disorders beyond surgical repair such as thromboangitis obliterans, diabetic microangiopathy, arteriosclerosis obliterans, there is a need to establish the degree of micro-circulation functionality before proceeding with invasive pain therapy, such as Spinal Cord Stimulation (SCS). From our series some cases of refractory ischaemic pain subjected to nuclear medicine techniques assessment before and after SCS implant will be presented; these data suggest that the use of radionuclides for quantifying regional perfusion, in view of the information it offers us both in the dynamic angiographic phase and in the later static phase, constitutes a very valid aid in the diagnosis and treatment of chronic pain conditions of ischaemic origin. Cutaneous, musculoskeletal and bone flow scintiscan is a non-invasive procedure which allowed us to make an objective selection of patients who are candidates for prolonged conservative treatment thus limiting the incidence of ineffective permanent SCS implants.
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PMID:Cutaneous, musculoskeletal and bone flow scintiscan by intravenous infusion of 99mTc-MDP (Diphosphonate) in the evaluation and control of patients treated with spinal cord stimulation for ischaemic pain. 820 32

Pravastatin is a new lipid-lowering drug belonging to the class of 3-hydroxy-3-methylglutaryl CoA (HMG-CoA) reductase inhibitors. Since 1986, more than 15,000 patients have received pravastatin in sponsored clinical research trials with more than 21,000 cumulative patient-years of exposure to the drug. Analysis of long-term follow-up data from 1142 patients participating between 1986 and 1990 in six core randomized clinical trials in the United States confirms the favorable safety profile of pravastatin. Rash, gastrointestinal complaints, musculoskeletal pain, and elevations in liver transaminase levels, whether or not attributed to treatment, were the most common reasons for patients withdrawing from these trials. Ophthalmologic monitoring revealed no adverse effects on the crystalline lens. Safety assessments continue for two core trials in more than 400 patients with up to 7 years of continuous follow-up. The effects of pravastatin on serum cholesterol levels are not influenced by the age, sex, weight, or initial cholesterol level of the patient. Vitamin E, A, and D metabolism remain normal during treatment. Combination therapy with pravastatin and bile-acid-binding resins or niacin is well tolerated, with additive effects on low-density lipoprotein cholesterol. There is limited experience with the combination of pravastatin and gemfibrozil or cyclosporine. An ongoing arteriosclerosis research program with more than 21,000 patients enrolled will further define the long-term safety of pravastatin and its effects on atherosclerosis progression, as well as its role in the primary and secondary prevention of coronary heart disease.
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PMID:Long-term experience with pravastatin in clinical research trials. 845 55

Twenty-eight patients of arteriosclerosis obliterans (ASO) complaining of intermittent claudication or pain at rest underwent symptom limited exercise leg perfusion scintigraphy using 201TlCl (Tl). Regions of interest (ROI) were drawn around each buttocks, thighs, calves and feet in whole body image, and we calculated Lesion/Normal Index (LNI) which was the divided value of the average count per pixel of each ROI of the affected side by that of the normal side. The average LNI of the foot was 0.81 and was smaller than other regions (p < 0.05). Other region except foot showed Tl high uptake in affected side in some cases. Fifteen patients were compared after percutaneous transluminal angioplasty (PTA) with before PTA, and LNI of the foot was statistically improve after PTA (p < 0.005). The period suffer from disease of the group of Tl high uptake in the affected leg was statistically shorter than that of the group of Tl non-high uptake (p < 0.05). We supposed that the Tl uptake of the foot reflects ischemia of the leg sensitively, and high uptake of Tl in affected leg is concerned with compensatory change of microcirculation of ischemic leg in subacute period. This scintigraphy was thought to be useful to detect the ASO and to evaluate the effect of PTA, and was able to avail diagnosis and observation of the course of ASO patient.
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PMID:[Usefulness of the 201TlCl exercise leg perfusion scintigraphy inarteriosclerosis obliterans (ASO)--with evaluation of leg perfusion comparing before and after PTA]. 852 41

The axillary brachial plexus block is a well-known technique for intra- and postoperative analgesia and sympathetic blockade in hand and microsurgery. The aim of this study was to show the influence of the axillary brachial plexus block on the blood flow as a side effect. METHODS. We used a colour-coded sonography unit (Toshiba) with a 7.5-MHz transducer. A total of 12 patients with no clinical signs of vascular diseases were enrolled in this study. We measured the peak blood flow velocity and the peak flow at the bifurcation of the brachial artery and vein and the proximal and distal radial artery before and after the plexus block. In addition, we were able to take the morphological aspects of the analysed vessels into consideration as we also used conventional sonography. This was done to detect any early signs of vascular malformation or arteriosclerosis, either of which might have affected the measurements. RESULTS. The average arterial peak blood flow after the plexus block was 1.9 times that before. On the venous side, the block effect caused an average increase of the blood flow to 8.6 times than before the block. In general, an additional and immediate effect of the block was a significant rise in blood flow velocity with an increase in cross-section area. CONCLUSIONS. The brachial plexus block combines two advantages: pain relief and pain management plus temporary sympathectomy. In conclusion, it prevents vasospasms and improves the circulation of the hand in patients undergoing reimplantation of limbs and those with nutritional disorders.
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PMID:[Quantification of variations in arm perfusion after plexus anesthesia with color doppler sonography]. 859 60


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