Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Narcotic analgesics and related drugs act as agonists on several receptors that are responsible for their effects on pain perception, mood and feeling state, and respiration, as well as other pharmacologic actions. Naloxone is the first discovered antagonist that is devoid of agonistic activity and appears to be a competitive antagonist at several receptors. The ability of naloxone to displace or prevent the binding of agonistic narcotics is partly responsible for its antagonistic effects. The ability of naloxone to rectify narcotic-depressed homeostats and precipitate abstinence is also related to its antagonistic activity. Certain cautions and principles apply in the use of naloxone in treating narcotic overdose, reversing surgical analgesia, and the treatment of neonates and children. Unapproved uses of naloxine include reversing the psychotomimetic effects of certain agonists-antagonists, terminating narcotic-induced convulsions and coma, reversing non-narcotic depression, diagnosing physical dependence, and treating narcotic addicts.
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PMID:Naloxone. 18 95

Forty-two adults in deep coma due to uncomplicated overdosage with barbiturates or tricyclic antidepressants were studied to determine the effects of the drugs and the depth of coma on ventilation and acid-base balance. All the patients were breathing spontaneously. The usual acid-base disturbance was a mixed respiratory and metabolic acidosis. No differences in effects of barbiturates and tricyclic antidepressants could be demonstrated in either grade of coma studied. Patients who were completely unresponsive to painful stimuli were significantly more acidemic (arterial [H+] 51.4 nmole/liter c.f. 44.4 mole/liter) and hypoxic (PaO2 6.6 kPa c.f. 10.5 kPa) than those who showed a minimal response to pain. These findings could not be explained by differences in alveolar ventilation, and it is suggested that they are due to ventilation/perfusion imbalance.
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PMID:Ventilation and acid-base changes in deep coma due to barbiturate or tricyclic antidepressant poisoning. 58 53

It is estimated that every year about 500 000 people around the world are bitten by poisonous snakes. Between 30 000 to 50 000 persons die due to snake-bites; the highest frequency is reported from Southern Asia. Clinically three types of snake-bites can be distinguished: 1. Bites with local damage (extreme pain, edema, necrosis), 2. Bites followed by generalized hemorrhagic symptoms and 3. bites with neurotoxic effects of the poison (no local pain, paralysis of cerebral nerves, coma). For tropical snake-bites snake-venom is live-saving. As in many cases the biting animal cannot be identified it is advisable to use polyvalent sera. These are heterologous sera which contain antitoxins against several poisonous snakes of a certain area. Often there is some delay until the snake-venom becomes available. Therefore local and symptomatic treatment is valuable: cleaning of the wound, superficial incision to remove poison, venous congestion, oral and intravenous fluid-therapy, antihistaminic drugs, steroids and prophylaxis of shock. Tourists are only rarely endangered by poisonous snakes, they do not need to carry anti-snake venom; this is recommended for scientific excursions in areas with dense vegetation and for persons living in warm countries.
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PMID:[Poisonous-snake bites. Therapy and preventive measures]. 62 Sep 95

In severe Reye's syndrome, with nonspecific intensive supportive therapy, the mortality rate approaches 75%. In many instances, death is due to uncontrolled cerebral edema and elevated intracranial pressure. (ICP). Pentobarbital therapy, sufficient to maintain a blood barbiturate level between 2.5 mg% and 4.0 mg%, was used to control ICP in seven patients with metabolic coma complicated by intracranial hypertension (intracranial pressure greater than 30 mm Hg for 30 min). The nadir of their neurological function was characterized by no response to deep pain, absent or abnormal oculocephalic responses, bilaterally dilated, unreactive pupils, and markedly irregular or absent respirations. Before barbiturate administration hyperventilation, steroids, mannitol, and other supportive therapies commonly used in Reye's syndrome were begun. After institution of pentobarbital therapy, the daily mannitol dose required to maintain the intracranial pressure below 20 mm Hg was significantly reduced (p less than 0.001), from 3.7 +/- 0.3 to 0.5 +/- 0.2 g/kg/day. All the patients survived, and six have no obvious neurological sequelae. Pentobarbital is a useful adjunct for intracranial pressure control in advanced metabolic coma.
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PMID:Pentobarbital therapy for intracranial hypertension in metabolic coma. Reye's syndrome. 63 24

An analysis has been made of 2144 consecutive cases of latrodectism (envenomation by the red-back spider, Latrodectus mactans hasselti) reported to the Commonwealth Serum Laboratories. In the last eight years, notifications have averaged 240 cases per annum. Bites, usually on the extremities (74%), occurred most frequently in the summer months, and in the afternoon or evening. Most victims (79%) were aged between 18 and 50 years and 64.4% of them were males. Males are still often bitten on the genitals or buttocks (9.7% of cases). Local pain, redness and swelling were the most common symptoms, although significant pain was felt at other sites in 39% of the cases. The regional lymph nodes often became swollen and tender within 30 minutes. General effects included nausea, vomiting and sweating, but coma and respiratory failure were very uncommon, probably because of use of specific antivenom. This was administered within 24 hours of the bite in 92% of cases, and within two hours in 70%. Although 11 anaphylactic reactions (0.54%) were reported, no deaths resulted either from the venom or from reactions to the antivenom. Few delayed serum reactions (1.7%) were recorded. The action of the venom is described and the management of red-back spider bite is outlined.
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PMID:Survey of 2144 cases of red-back spider bites: Australia and New Zealand, 1963--1976. 73 70

In this Article, which draws primarily on continental West European views on death and dying, the author contends that the Harvard criteria for irreversible coma (1968) are not reliable for diagnosing death in comatose patients under resuscitation treatment. The Article suggests that use of the Harvard Criteria to diagnose death leaves such patients legally unprotected against surgical assaults such as organ removal and biomedical experiments while they still may be living and capable of perception, possibly including the perception of pain and the spoken word. An alternative to the Harvard Criteria--angiography--is offered, and several additional issues related to the definition and diagnosis of death are discussed. Finally, the author suggests that even prior to death, termination of resuscitation treatment of irreversibly comatose patients, though followed by death, should be lawful.
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PMID:Diagnosis of death in comatose patients under resuscitation treatment: a critical review of the Harvard report. 97 24

Four cases of acute or subacute subdural hygromas in the posterior fossa were reported. All showed suboccipital skull fractures radiologically. Two cases of acute subdural hygromas were encounteded during the fiscal year from 1972 to 1973 at Toritsu Toshima Hospital. In the same period 254 patients with head injuries were admitted here and 106 demonstrated skull fractures. Among these 24 exhibited fractures in the suboccipital region. Among these 24 cases 8 showed signs and symptoms of space-occupying lesions in the posterior fossa and were confirmed later surgically (7 cases) or by autopsy (1 case), namely; three extradural hematomas, two acute subdural hygromas as mentioned above, three subdural hematomas with cerebellar contusions. Preoperative courses in these three acute subdural hygomas as well as three subdural hematomas were summarized as follows:lucid interval was followed by severe nuchal pain and rapid downhill course and finally by coma and panea. Retrograde brachial angiographies were performed in cases. The findings were not contributary to locate mass lesions, in three cases, partly because of delayed or faint filling of vessels caused by compression with hematoma or acute subdural hygroma. In short, differential diagnosis between subdural hematoma and subdural hygroma was difficult preoperating. Postoperatively, courses of subdural hematomas were poor or even fatal. On the contrary, patients of acute subdural hygromas showed rapid clinical improvement after evacuation of xanthochromic fluid. The authors stressed that suboccipital craniectomy should be performed as soon as possible to the patients with sugoccipital fractures when vital signs became progressively worse even if little findings were obtained by carotid angiographies. Subdural hygromas in the posterior fossa may have been present in those fatal cases where autopsy finds neither contusion nor hemorrhage but only brain edema or swelling.
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PMID:[Acute subdural hygroma in the posterior fossa (author's transl)]. 123 91

The management of the final 24 hours of life of 100 patients, dying in Our Lady's Hospice is reviewed. This review suggests that management might be improved by better contact between general hospitals and hospice/home care teams concerning the timing of patient transfer. The frequency of symptoms in the dying patient, even where many are semi-comatose, is highlighted. The main distressing symptoms are pain, excessive respiratory secretions and agitation. Our review confirms reliance on standard palliative medications such as morphine, however identifies the benefit of such newer preparations as hydromorphone and midazolam. Management might be improved by the earlier usage of hyoscine subcutaneously and stopping the use of intramuscular diazepam. Attention to potential hyoscine toxicity and untreated pyrexia may ease pre-terminal agitation. The dying patient's family also needs attention to complete the optimal management of the final 24 hours.
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PMID:Management of the final 24 hours. 138 75

To evaluate the usefulness of routine pelvic x-ray films in the resuscitation of blunt trauma victims, 1395 patients were prospectively evaluated over a 13-month period. Of these, 810 (58%) were awake with Glasgow Coma Scale scores greater than or equal to 13 and were enrolled into the study. A history, with directed questions regarding pelvic pain, a clinical examination of the pelvis, and an anterior-posterior pelvic x-ray film (APPX) were obtained for each patient. Thirty-nine patients (5%) had fractures identified on the x-ray films. Of these patients with radiographically identified fractures, 34 (87%) complained of pain and had positive results on clinical examination, two (5%) either complained of pain or had positive results on examination and three (8%) had neither complaint of pain nor positive examination results. Of the 771 patients without fractures 743 (96%) lacked pain complaints or positive examination results. The likelihood of fracture was greatest in patients with complaints of pain and positive examination results (65%) followed by patients with either complaint of pain or positive examination results (16%). Only three (0.4%) of the 743 patients having no complaints of pain and a negative clinical examination had fractures diagnosed roentgenographically. These were minor fractures that did not affect the clinical course. Total charges incurred to diagnose pelvic fractures in this low-yield patient group were $88,028. We conclude that the practice of obtaining a screening APPX is not necessary or cost-effective in the management of awake blunt trauma patients who do not complain of pain and who have normal pelvic physical examination results.
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PMID:Routine pelvic x-ray studies in awake blunt trauma patients: a sensible policy? 2083 51

In the dying patient, coma is preceded by either progressive sedation or the development of the organic brain syndrome of delirium. More than one-third of dying patients experience some difficulties during the last 48 hours of life with noisy and moist breathing, pain, and agitation and restlessness the most common. The great majority of these terminal symptoms can be managed by reassurance or drug intervention. Sublingual lorazepam and continuous subcutaneous infusion of midazolam can be effective in controlling terminal restlessness.
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PMID:The last few days. 145 27


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