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)

This analysis indicated that patients with cancer-related pain account for 71.0% in author's material. After the TCM treatment, the effective rate were 91.6% in hepatocarcinoma-related pain; 86.1% in colon-rectal cancer-related pain; 68.2% in malignant lymphoma-related pain; 100% in irradiation-related pain of esophageal cancer, lung cancer, post-operative breast cancer. Results of "four-step analgesic ladder" showed that 52.1% of pain could be relieved by Step I (TCM therapy); if Step II (indomethacin) or III (phenylbutazone) was added, the rate of pain relief reached as high as 96.5%; and only 3.5% need to be treated by Step IV (Opioids). With less side-effects and addiction of opioids and other narcotics, the "four-step analgesic ladder" therapy seems to be more suitable for cancer pain relief in China.
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PMID:[Comprehensive "4-step analgesic ladder" therapy in treating cancer-related pain-analysis of 486 cases]. 130 38

Eight years of experience with endoscopic Nd:YAG laser photocoagulation were analyzed in retrospect in an attempt to identify factors relating to both failures and complications of laser therapy, and to delineate its limits and pitfalls in benign and malignant tumors. Three hundred and seventy-eight patients were studied, including 42 with gastroesophageal cancer, 180 with colorectal adenoma and 156 with colorectal malignancy. Patients with gastroesophageal cancer (n = 42) were referred mainly for obstruction in esophageal cancer and for bleeding in gastric cancer, with successful palliation in 86 and 81%. Hemorrhage was the only complication seen, twice during and twice after treatment. Pain, heat and smoke-induced complaints and sometimes temporary increased dysphagia were mentioned. Two white-surfaced tumors did not react at all. Patients with colorectal adenoma (n = 150) were divided into groups according to the size of the lesion. Definitive, histologically documented eradication of adenomatous tissue was achieved in 43% of the extensive, in 69% of the intermediate, and in 97% of the small adenomas. Major complications, mainly stenosis and hemorrhage, occurred in 6.4%, 7.6% and none of the lesions, respectively, and minor complications were seen in 57.4, 30.8 and 13.8%, respectively. Stenosis appeared to be related only to prior electrocoagulation and to excessive delivery of energy. Post-treatment hemorrhage occurred at about day 7. In familial polyposis (n = 30) surveillance of the rectal stump was successful in 84%, with major and minor complications in 4% and 12%. In colorectal cancers (n = 156) treated for palliation of bleeding and obstruction, success was obtained in 91%. major complications (13%) consisted mainly of stenosis and perforation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Analysis of failures and complications of neodymium: YAG laser photocoagulation in gastrointestinal tract tumors. A retrospective survey of 18 years' experience. 168 58

An improvement of the quality of life by alleviating pain, improving swallowing and increasing weight is achieved in about 80% of patients with esophageal cancer. With survival rates of 41%, 21% and 11% after 1, 2 and 5 years, respectively the curative potential of radiotherapy is considered low. Survival is significantly better in patients with small tumors than with large tumors. Radiochemotherapy must still be considered an experimental modality. Afterloading may be helpful for palliation. Postoperative and postradiation results are relatively positive due to improved local control and patient selection.
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PMID:[Current status of radiotherapy in treatment of esophageal cancer]. 172 90

The combined thoracoabdominal procedure for patients with esophageal cancer is still associated with a high rate of pulmonary complications. Many institutions believe prophylactic postoperative mechanical ventilation to be the most effective measure against pulmonary complications. On the other hand, the duration of mechanical ventilation can have a significant influence on the incidence of pulmonary complications, which are increased after prolonged ventilatory support. Interstitial pulmonary edema is a frequent pathological finding with a poor prognosis after esophageal surgery. Increased water retention in the lung means a greater risk of atelectasis or pneumonia. At the St. Clara Hospital, Basle, patients with esophagectomy were extubated on the day of surgery. Despite early extubation there was a very low rate of minor pulmonary complications. To clarify possible factors contributing to this uncomplicated postoperative course, 20 patients with thoracoabdominal resection of the esophagus were evaluated. All patients were operated upon using a combination of thoracic epidural and light general anesthesia. At the end of the operation all were breathing spontaneously. After a short period of pressure support ventilation and continuous positive airway pressure (CPAP), the mean extubation time was 3 h 10 min postoperatively. Local anesthetics and morphine given by the epidural route and the simultaneous use of nonsteroidal anti-inflammatory drugs made possible an uneventful and pain-free postoperative course. Early extubation, the immediate use of a CPAP mask system 2-3-hourly and an effective cough were the main points of respiratory therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Complication-free early extubation following abdomino-thoracic esophagectomy]. 188 58

Esophageal prothesis (EP) is a palliative treatment for inoperable neoplastic stenosis. Ninety-one patients were candidates for EP placement between 1978 and 1983. EP placement was successful in 77 patients. Of these: 85% had primary esophageal cancer; 15% had bronchial or mediastinal carcinoma; 83% had stenosis in the middle third. Dysphagia was the main symptom in 84%, and tracheoesophageal fistulae in 16%. The observed median survival was 3.2 months +/- 1.9 (2 standard deviations [SD]), and the survival rate at 1 year was 7%. With the single-factor analysis method, not one of 12 factors presented any significance (age, sex, general status, anterior treatment, lesion site, endoscopic feature, stenosis diameter, histologic features, metastasis, tracheal involvement, symptoms, and type of prothesis). Two factors had a P value approaching significance: there were slightly longer survival rates in patients with a stenosis diameter less than 7 mm (P less than 0.07), and with stenosis located in the lower third and cardia (P less than 0.07). By multivariate analysis (Cox model), prognostic significance was found in only one factor: the location in the lower third and cardia (P = 0.002, relative risk = 3). The quality of life after EP placement was briefly improved: 80% of 73 evaluable patients had improvement in dysphagia for a mean duration of 3.7 months +/- 2 (2 SD), especially patients with a good general status (0 and 1; P less than 0.01); and 45% of patients had improvement of their general status for a mean duration of 4.1 months +/- 2 (2 SD). Minor complications related to EP placement were observed in 40% of patients (pain, obstruction, and mobilization), and severe complications were observed in 20% (perforation, 11 cases; fistulae, 5 cases, with death in 3 cases; hemorrhages, 4 cases). In conclusion, EP is a good palliative treatment, although complications are frequent, and evaluation of patient comfort is required to compare this procedure with other available techniques.
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PMID:Esophageal prothesis for neoplastic stenosis. A prognostic study of 77 cases. 241 40

Surgical palliation of advanced gastrointestinal malignancy is often accompanied by high morbidity and limited success. To evaluate the role of ablative laser therapy in palliation, we reviewed our experience with 30 consecutive patients who presented with symptoms of obstruction, bleeding, or pain from unresectable tumors of the esophagus (20), Stomach (4), or rectum (6). Overall, 97 laser treatments were administered endoscopically with a Neodymium Yttrium Aluminum Garnet (Nd:YAG) laser using average energy per treatment of 4525 joules. Forty per cent of the patients received their therapy as outpatients and all were given only light intravenous sedation. The symptomatic response was good to excellent in 70 per cent of patients but five (16.7%) subsequently developed recurrences requiring further laser ablation. Performance status was improved in 19 of 20 patients with esophageal cancer. Few of the gastric or colorectal cancer patients noted changes in performance status since concomitant medical illnesses often limited their overall function. There was one mortality within 30 days from esophageal tumor cachexia and two patients experienced moderately severe visceral pain. No perforation or fistulizations occurred. This experience confirms that a Nd:YAG laser photo-ablation is safe and effective when palliation is indicated for advanced cancers of the gastrointestinal tract.
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PMID:Laser palliation for gastrointestinal malignancy. 244 6

The purposes of this study were (a) to determine the applicability of endoscopic palliation for patients with esophagogastric cancer strictures in a referral center, and (b) to compare the efficacy and safety of the BICAP tumor probe with the neodymiumyttrium-aluminum-garnet (YAG) laser for such palliation. Forty-two consecutive patients with weight loss and obstructive symptoms from an unresectable, malignant esophageal stricture were referred for endoscopic palliation. Fourteen patients did not meet the criteria for YAG laser or BICAP tumor probe treatment and other therapies were recommended. Twenty-eight patients were treated, the first 14 with low-power YAG laser and the last 14 with BICAP tumor probe. All patients had coagulation of malignant strictures in one session. Treated patients were similar in background variables and stricture lengths but twice as much thermal energy was needed for the YAG laser as the BICAP tumor probe treatment. Treatment results were not statistically different during the median follow-up and survival of 16 wk. As minor complications, either pain or edema requiring dilatation was more common in the YAG laser-treated group than the BICAP tumor probe group. Treatment-related esophageal strictures developed in 21% of patients treated with YAG laser. A fistula developed in 1 patient with noncircumferential cancer in the BICAP tumor probe group. Compared with only the intake of liquids before treatment, 86% of patients could eat a soft or solid diet after initial treatment with BICAP tumor probe or YAG laser. Our conclusions were that for BICAP tumor probe and YAG laser, endoscopic palliation efficacy and safety for circumferential esophageal cancer strictures were similar. The advantages of using the BICAP tumor probe were portability, lower equipment costs, and the ability to treat submucosal, long, or high esophageal cancer strictures in one session. Treatment with YAG laser was safer than BICAP tumor probe for exophytic, noncircumferential cancers because the laser could be directed endoscopically. Use of the BICAP tumor probe is not recommended for noncircumferential esophagogastric cancer strictures.
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PMID:Comparison of low-power YAG laser and BICAP tumor probe for palliation of esophageal cancer strictures. 245 15

The purpose of this study is to analyze the causes of elevation of plasma antidiuretic hormone (ADH) level during surgery and the relationship between urinary volume and plasma ADH level by measuring plasma ADH level of patients undergoing operation for esophageal cancer. The results obtained were as follows: The plasma ADH level was 4.0 pg/ml before surgery, 59 pg/ml after skin incision, 190 pg/ml after thoracotomy, and 276 pg/ml after vagotomy (right esophageal branch). Elevation of the plasma ADH level was partially suppressed by epidural analgesia combined with GOF anesthesia. The main factors that elevate plasma ADH level during surgery were pain at the skin incision, the manipulation of the pleura and vagotomy. The plasma ADH level was high (114 pg/ml) just after surgery and decreased to a normal level (4.3 pg/ml) in the morning of the 2nd postoperative day. Urinary volume was 74 ml/h before surgery, 95 ml/h just after surgery and 40 ml/h in the morning of the 1st postoperative day, and then, continued to gradual increase. There was no correlation between urinary volume and plasma ADH level during surgery until the 1st postoperative day. Elevation of plasma ADH level was not a primary factor of oliguiria during and just after surgery.
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PMID:[Fluctuation in plasma ADH levels during and after surgery of esophageal cancer]. 378 29

A combination of bleomycin, in a 12 h infusion, and radiotherapy was applied in 25 patients with untreated inoperable esophageal cancer. Bleomycin was administered 15 mg/m2 twice weekly, concurrently with irradiation (total dose 3600-4000 rad). Such combined treatment produced 3 complete remissions of the esophageal tumor, 10 partial remissions (response rate 52%--13/25), 3 stable disease cases, while in 9 cases the disease progressed in spite of therapy. The median duration of remissions was 8.7 months in complete responders, 6.0 months in partial responders, and 3.0 months in stable disease cases. Similarly, median survival was the longest in complete remission cases (10.3 months). Patients who did not respond to therapy had a median survival of only 2.8 months. Adverse treatment reactions were of a milder character, except retrosternal pain and burning caused by irradiation mucositis, which occurred in 80% of patients. The trial showed that the combination of bleomycin applied in the form of 12 h infusion and irradiation can produce remissions in 50% of inoperable esophageal cancer cases, i.e., a rate of remission which is similar to that achieved by irradiation and bleomycin applied in the form of rapid (push) i.v. injections.
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PMID:Bleomycin infusions combined with radiotherapy in the treatment of inoperable esophageal cancer. 616 59

The antitumor activity of 5-fluorouracil (5-FU), combined either with bleomycin or adriamycin plus radiation, was studied in a controlled randomized clinical trial. Sixty-one previously untreated inoperable esophageal cancer patients entered the study and 56 have been evaluated: 58 male and 3 female patients with a mean age of 57 years (range 37-74). Concerning localization of the tumors in the esophagus, 2 were in the upper third, 36 in the middle third and 18 in the lower third. The length of the filling defects in the esophagogram (X-ray) was in 9 patients less than 5 cm, in 31 5-8 cm, and in 16 patients greater than 8 cm. Squamous cell carcinoma was found in 51 patients, adenocarcinoma in 3, and anaplastic (squamous cell) carcinoma in 2 patients. Modality A consisted of a combination of 5-FU (10 mg/kg i.v. 2 X weekly, 4 weeks) and bleomycin (10 mg/m2 i.v., 2 X 4 weeks) which was given concurrently with radiation (3600-4000 rad - 1000 rad weekly). In modality B the combination of 5-FU (same dose) and adriamycin (30 mg/m2 i.v. day 1, 2, 23 and 24) was applied with the same schedule and dosage of radiation. Seventy-five percent of the patients (21/28) have responded to treatment (CR + PR) in modality A, with 11 complete and 10 partial responses. In arm B, response was recorded in 64% of patients (18/28), with 2 complete and 16 partial responses. The difference in complete responses (39% vs 8%) was statistically significant (P less than 0.05). The median remission duration in complete responders was 12 months in modality A (range 6-18 months), and 6.8 months in modality B (range 3-10 months). All the responses occurred in patients with squamous cell carcinoma, except one partial response in a case of adenocarcinoma. As far as the age is concerned (less than 55 vs greater than 55 years), no significant difference in response rate was found (67% vs 71%). More favorable results were observed in the group of patients with less than 10% weight loss (79% vs 63%). Toxicity was moderate (myelosuppression, cardiotoxicity), but one treatment-related death (pulmonary fibrosis, cardiac failure) was recorded in arm A, as well as one death (rupture of aorta) in group B. Approximately 60% of patients in both modalities suffered from severe mucositis and retrosternal pain. The results of the study showed that the combination of 5-FU with adriamycin and particularly with bleomycin, given concurrently with lower radiation dosage, is an effective palliative treatment for inoperable esophageal cancer.
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PMID:The value of two combined chemoradiotherapy approaches in the treatment of inoperable esophageal cancer. 620 Sep 79


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