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)

Clinical and instrumental (ECG, PCG, ultrasonic cardiography and polycardiography) examination of cardiac activity in 98 breast cancer patients treated at the Center after Cooper established the cardiotoxic effect of 5-fluorouracil, vincristine, methotrexate, cyclophosphamide and corticosteroids. 46% of them suffered pain in the region of the heart, tachycardia, extrasystole, atrial flutter and deranged conduction function. Congestive heart failure was observed in 7% only. In 24%, myocardial lesions could be detected by instrumental means only. They were identified on the basis of an increase in terminal diastole and systole volume and mass of the myocardium matched by a decrease in stroke volume, PCG amplitude, % delta S and VCF. Cardiac disorders did not persist and were hardly detectable during medication course intervals or one-two months after treatment.
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PMID:[Cardiotoxic effect of cytostatics in patients with breast cancer]. 384 Mar

Prostaglandins are ubiquitous biologically active compounds that are involved in inflammatory reactions, hemostasis, and, under certain circumstances, the maintenance of renal function. NSAIDs, which inhibit PG synthesis, are used therapeutically most often as antiinflammatory agents in conditions of inflammation and pain, mostly of a nonurologic nature. However, since NSAIDs inhibit systemic PG synthesis, administration of NSAIDs can lead to adverse side effects. For example, the gastrointestinal irritation caused by NSAIDs probably reflects removal of a cytoprotective effect of gastrointestinal PGs. Similarly, the kidney may be especially susceptible to adverse effects of NSAIDs. In diseases such as peptic ulcers, diabetes, hypertension, congestive heart failure, liver disease with ascites, and renal insufficiency, PGs seem to play a protective role in the kidney. This protective role, which results from increased synthesis of vasodilator PGs in the face of elevated vasoconstrictors, is diminished in the presence of NSAIDs. Other side effects include the antagonism by NSAIDs of the action of diuretics, such that the dose of the diuretic must be adjusted accordingly. The diuretic triamterene should not be used in conjunction with indomethacin due to several reported cases of toxicity. Another drug interaction involves the salicylates, which have been shown to diminish the uricosuric effects of probenecid and sulfinpyrazone. Likewise, since corticosteroids increase the renal clearance of salicylates, it is important to monitor the patient carefully following termination of steroid treatment in patients receiving large doses of salicylates, since this change in elimination can precipitate toxicity. In addition, the NSAIDs bind to plasma proteins and, as such, can displace or be displaced by other drugs that bind in the same manner and can result in either decreased efficacy or toxicity. Despite the fact that the kidney may not be the target of NSAID therapy, renal function may be adversely affected by NSAID treatment. It has therefore been proposed that a renal-sparing NSAID would be a very useful therapeutic agent. Sulindac (Clinoril) has been suggested to be such an agent, eg, able to inhibit systemic PG synthesis (usually monitored by measuring serum thromboxane synthesis) without an apparent effect on renal PG synthesis (monitored by measurement of urinary PGs). However, recent data have suggested that Sulindac does inhibit renal PG synthesis and does not exhibit selectivity. The reasons for the discrepancy are not clear, but may relate to the doses or time intervals examined.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Indications and contraindications for the use of nonsteroidal antiinflammatory drugs in urology. 393 61

Thirty-one patients with recurrent pericarditis were observed for periods of 2 to 19 years. Twenty-four had idiopathic pericarditis; four had postoperative or posttraumatic pericarditis, two had postinfarction pericarditis and one had recurrent pericarditis after anticoagulant-induced intrapericardial bleeding. In 24 patients (Group I), recurrences were documented by electrocardiographic changes, echocardiographic evidence of pericardial fluid or a pericardial rub as well as chest pain. In seven patients (Group II), recurrences were documented only by increased white blood cell count, increased erythrocyte sedimentation rate or fever in addition to pain. In 19 patients, the duration of the active or recurrent process was 5 years or more; in 7, it was 8 years or more. Three patients had cardiac tamponade in the initial attack; none had tamponade during recurrences. No patient developed congestive heart failure, constrictive pericarditis or cardiac arrhythmias with recurrences. Immunoelectrophoresis showed normal findings or minor deviations in 11 patients studied; B cell and T cell lymphocyte counts were normal in 10 patients and showed minor deviations in 3. Antinuclear antibody studies were normal in 19 of 22 patients and positive in low titer in 2. Most patients required adrenal steroid therapy for pain relief; steroid withdrawal was often difficult. Pericardiectomy was done in nine patients; in only two was this followed by clear-cut relief. In this group of 31 patients, 22 of whom were observed for 5 years or more, recurrent attacks of chest pain were the only major disabling feature of their pericarditis.
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PMID:Recurrent acute pericarditis: follow-up study of 31 patients. 394 48

Between 1963 and 1983, 55 patients presented to our hospital with a clinical picture that suggested aortic dissection but with aortograms that were interpreted as negative for that entity. In 4 patients, the aortographic findings subsequently proved to be false negative. The remaining 51 patients had the following diagnoses: myocardial infarction in 9 patients; aortic regurgitation in 5; thoracic nondissecting aneurysm in 4; musculoskeletal pain in 4; mediastinal tumor in 4; pericarditis in 3; acute coronary insufficiency in 3; cholecystitis in 2; miscellaneous in 3; and unknown in 14. The clinical features in these patients were compared with those of 125 patients with true aortic dissection. Three features were significantly more prevalent in patients with than without dissection: prior systemic hypertension, pain for 24 hours or less, and migratory pain. Patients without dissection were younger than those with distal dissection and had significantly less systemic hypertension, posterior thoracic pain and migratory pain. Patients without dissection had significantly less frequent congestive heart failure, pulse deficits and aortic regurgitation, and more frequent hypertension and pain for more than 24 hours than patients with proximal dissection. This study defines the actual differential diagnosis of aortic dissection at our hospital, the frequency of false-negative aortographic findings and contrasts the clinical features of patients with and without dissection.
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PMID:Spectrum of conditions initially suggesting acute aortic dissection but with negative aortograms. 394 23

In 698 patients with suspected and definite acute myocardial infarction we tried to predict the severity of the infarction from clinical history and simple bedside evaluation soon after arrival in hospital. The severity of the infarction was judged from serum enzyme activity, 2-year survival, incidence and severity of congestive heart failure and incidence of severe ventricular arrhythmias during initial hospitalization. Entry characteristics which were positively associated with the severity of the infarction were intensity of pain, sign of congestive heart failure, high heart rate, ECG signs of acute myocardial infarction and presence of Q waves. Elderly patients and those with a history of hypertension also had a more severe clinical course.
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PMID:Prediction of the severity of acute myocardial infarction. 405 14

A prospective clinical study is reported of the initial attack of acute rheumatic fever in 210 children seen in Kuwait over a period of four years. The main presenting feature was pain in the joints, caused by arthritis in 79% of our patients and by arthralgia in 15%. Five per cent presented with chorea alone and 1% with congestive heart failure alone. Carditis was detected in 46.2%, cardiomegaly in 10%, pericarditis in 1.4% and congestive heart failure in 4.8%. The incidence of chorea was 7.6%, of erythema marginatum 1% and of subcutaneous nodules 0.5%. The mortality rate was 0.5%. Data from this study reflect the mild nature of acute rheumatic fever in Kuwait, in contrast to the aggressive nature of the disease described from neighbouring and developing countries.
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PMID:Acute rheumatic fever during childhood in Kuwait: the mild nature of the initial attack. 618 40

The clinical profile of acute rheumatic fever below the age of five years was studied prospectively in 53 children seen over a period of seven years. The majority presented with pain in the joints, manifested as arthritis in 81% and arthralgia in 15%. Four per cent presented with congestive heart failure. Carditis developed in 42%, with a high incidence of pericarditis (6%) and congestive heart failure (15%) and a mortality of 2%. The incidence of Erythema marginatum was 2%, while chorea and subcutaneous nodules were not seen. Data from this prospective study, when compared with those of other prospective studies of acute rheumatic fever throughout childhood, clearly show a similar incidence of arthritis and carditis with a slightly more aggressive nature of carditis in children under five years. These findings are in marked contrast to recent reports describing the clinical profile of acute rheumatic fever in this age group.
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PMID:Acute rheumatic fever below the age of five years: a prospective study of the clinical profile. 620 72

Rheumatic diseases are prevalent in the elderly population, resulting in high morbidity caused mainly by lack of mobility. Consequently, the use of antirheumatic drugs in older persons is extensive. This review outlines some of the hazards encountered in the use of antirheumatic drugs in the elderly. Analgesics such as propoxyphene and acetaminophen are useful adjuncts to the treatment of arthritic pain, but propoxyphene has been associated with respiratory depression, and renal clearance of acetaminophen is reduced in elderly subjects. Salicylates may cause deafness, and like the other nonsteroidal anti-inflammatory drugs, may cause salt and water retention resulting in congestive cardiac failure. Phenylbutazone should not be used because of the risk of blood dyscrasia, and indomethacin has been reported as interfering with the antihypertensive effect of beta-blockers. Chloroquine levels may be raised in patients with impaired renal function, and there is increased risk of retinal damage with the drug in elderly subjects. Injectable gold compounds and penicillamine are not contraindicated in the elderly, because they are just as efficacious as in younger persons for the treatment of rheumatoid arthritis. Toxicity due to gold compound is not increased in the elderly, but skin rashes and abnormalities of taste do occur more commonly in elderly patients treated with penicillamine. Corticosteroids do not affect disease progression and therefore should be used only in acute severe disease for short periods of time. As in the younger population, treatment of gout in the elderly is dependent on renal function.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Problems of antiarthritic therapy in the elderly. 636 34

In a double blind study of metoprolol in the treatment of suspected acute myocardial infarction 698 patients (study group) received metoprolol and 697 a placebo (control group). Metoprolol was given in an intravenous dose of 15 mg as soon as possible after admission to hospital followed by 50 g by mouth four times a day for two days and thereafter 100 mg twice a day for three months. A placebo was similarly given. Congestive heart failure occurred in a similar percentage of patients in both the study (27%) and the control groups (30%). Its severity was estimated by calculating the total dose of frusemide given during the first four days in hospital. Less frusemide was given to patients treated with metoprolol compared with those given a placebo in the total series. An appreciably lower total dose of frusemide was given to patients included in the trial less than or equal to 12 hours after the onset of pain and treated with metoprolol compared with a placebo, while no difference was seen among patients treated later. The initial heart rate, systolic blood pressure, and infarct site affected the results.
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PMID:Development of congestive heart failure after treatment with metoprolol in acute myocardial infarction. 637 39

We conducted a retrospective chart review on 50 patients under age 65 (average age 52.9 years) and 55 patients over 65 (average age 75.6 years). The older patients were much more likely to have atypical pain or no pain (38% vs 4%, P less than .0001). They were less likely to have electrocardiographic QRS changes (47% vs 72%), but more likely to have congestive heart failure (44% vs 16%, P less than .01). In 25% of the older patients, no diagnosis was made in the first 24 hours, as compared to 8% of the younger group. The increased mortality in the older group (16% vs 4%) approached statistical significance (P = .08). We conclude that the manifestations of acute myocardial infarction are more subtle in the elderly, with a higher proportion of atypical chest pain and nondiagnostic electrocardiograms, but the elderly are more likely to have congestive heart failure.
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PMID:Acute myocardial infarction in elderly patients. 648 79


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