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)

About 160 publications (1978-1992) dealing either directly or indirectly with transcutaneous oxygen partial pressure measurements (tcpO2) in peripheral arterial occlusive disease (PAOD) are reviewed. Thereby, various clinical applications and results are related to the theory and methodology of the tcpO2 technique. In PAOD patients, the tcpO2 reflects local hyperemic skin blood supply. The clinically relevant intersection of the tcpO2-flow hyperbola is of considerably non-linear shape and partially insensitive to flow. In view of macrocirculatory pathology, tcpO2 values depend particularly on PAOD staging, hemodynamic compensation, and calf artery patency. Pathophysiological and pharmacological microcirculatory effects, however, cannot be read unequivocally from corresponding tcpO2 responses due to the heat-induced local vasoparalysis. In daily practice, the tcpO2 does not provide substantial information in patients with asymptomatic obstructions (Fontaine stage I) or intermittent claudication (stage II) but is of clinical impact in limbs with rest pain and skin lesions (stages III and IV). In such a complicated PAOD, diagnostic and prognostic capabilities can be essentially improved by provocational manoeuvres which narrow the flow-insensitive range. A critical limb ischaemia may be assumed if supine and dependent foot tcpO2 values exceed neither 10 mmHg nor 45 mmHg, respectively.
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PMID:Clinical information content of transcutaneous oxymetry (tcpO2) in peripheral arterial occlusive disease (a review of the methodological and clinical literature with a special reference to critical limb ischaemia). 162 28

Intermittent claudication is a symptom triggered from the musculature during walking. The pathogenesis of the pain is unknown. All patients with peripheral vascular disease must abstain from smoking, perform physical exercise and dietary advice is sometime needed. Reconstructive vascular surgery or percutaneous transluminal angioplasty (PTA) are indicated when the occupational pattern and, in some instances, the recreational activities, are threatened. The results of these treatments are good. For various reasons a number of patients, however, cannot be offered these treatments. These patients must be informed of the importance of physical exercise and discontinuation of smoking. Some of these patients can be offered supplementary medical treatment (e.g. pentoxifylline).
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PMID:[Intermittent claudication]. 141 56

Twenty patients with obliterative atherosclerosis in the lower extremities arteries (Fontaine's stage II) were treated with nitrendipine (Bayotensin) given in the dose of 20 mg daily for 6 weeks. This therapy with nitrendipine produced improvement manifested by the prolongation of the distance of intermittent claudication, shortening of pain duration, increase in blood flow in the ischemic extremity, and increase in pressure index. At the same time, nitrendipine decreased ADP-produced platelet aggregation and activated fibrinolytic system. Clinical trials have shown that nitrendipine is effective in the obliterative atherosclerosis in the lower extremities.
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PMID:[Use of nitrendipine in treating patients with obliterative atherosclerosis of arteries in the lower extremities]. 166 21

Kallikrein (Padutin-Depot) was administered to 20 patients with obliterative atherosclerosis of the lower limbs of the II degree (19 patients) and IV degree (1 patient). The drug was given in the daily dose of 40 U i.m. for 28 days. An effect of kallikrein on the distance in intermittent claudication, rate of pain relieve after walking the maximal distance, blood flow in the lower limbs, and on the index of circulating aggregates have been determined. Clinical improvement has been noted after a 4-week therapy with kallikrein. The drug in a single dose of 40 U activates plasma fibrinolytic system for 5 hours and decreases the number of circulating aggregates (2-5 h). The authors explain kallikrein action as the release of endogenous bradykinin, which subsequently releases two epithelial mediators, i.e. PFG1 and EDRF.
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PMID:[Kallikrein in the treatment of patients with obliterative atherosclerosis of the lower limbs and its mechanism of action]. 166 40

Beta-Adrenergic blockers have been considered relatively contraindicated in peripheral arterial disease because of the perceived risk that these drugs could worsen intermittent claudication. Therefore, we conducted a meta-analysis of available randomized controlled trials from the English-language literature to determine whether or not beta-blockers exacerbate intermittent claudication. The primary focus of this analysis was the effect of beta-blockers on exercise duration, measured as walking capacity or endurance time. Outcomes were pooled where appropriate. Of 11 eligible reports, six included 11 individual controlled treatment comparisons that provided data for an analysis of pain-free exercise capacity; no effect size was statistically significant. The pooled effect size for pain-free walking distance was -0.24 (95% confidence interval, -0.62 to 0.14), indicating no significant impairment of walking capacity compared with placebo. Only one study reported that certain beta-blockers were associated with worsening of intermittent claudication. These results strongly suggest that beta-blockers do not adversely affect walking capacity or symptoms of intermittent claudication in patients with mild to moderate peripheral arterial disease. In the absence of other contraindications, beta-blockers can probably be used safely in such patients.
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PMID:Beta-adrenergic blocker therapy does not worsen intermittent claudication in subjects with peripheral arterial disease. A meta-analysis of randomized controlled trials. 167 23

Patients with hypertension requiring therapy frequently present with concurrent peripheral vascular disease (PVD). This situation must be taken into account for an optimum antihypertensive treatment. In general, in patients with PVD only a cautious and gradual lowering of the blood pressure is recommended, since the decrease in poststenotic perfusion pressure may accentuate the symptoms of occlusive disease. In intermittent claudication--the most frequent manifestation of occlusive disease beta--receptor blockers today are no longer considered to be contraindicated. In the presence of critical ischemia of the legs (pain at rest and/or necroses) beta blockers should only be given with extreme caution. The agents of choice are calcium antagonists, ACE -inhibitors as well as alpha blockers and some newer vasodilating substances (e.g. Carvedilol). Conventional diuretics show disadvantages. An slightly elevated blood pressure in critical leg ischemia helps to improve the poststenotic perfusion of the affected limb. Antihypertensive treatment should not be instituted in patients whose systolic blood pressure is lower than 160 mmHg.
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PMID:[Antihypertensive therapy in arterial occlusive disease]. 168 38

Haemodilution is often recommended for peripheral arterial disease, yet little data is available to support its clinical efficacy. This study was designed to prove or disprove the effectiveness of Dextran-haemodilution in intermittent claudication. Twenty claudicants with long, well-collateralized arterial occlusions were randomized into groups 1 and 2. Group 1 received isovolemic haemodilution with Dextran 40 (500 ml per session) during 3 weeks, which was followed by a wash-out period, followed by placebo treatments for 3 weeks. In group 2 this sequence was reversed. Pain-free and maximal walking distances were measured by standardized treadmill tests along with plethysmographic blood flow, Doppler pressures, haematocrit, blood and plasma viscosity as well as fibrinogen. Walking distances increased significantly by about 50% during haemodilution in both groups. This was paralleled by a fall in haematocrit and blood viscosity. All other variables remained constant. During placebo treatments there were no significant changes of any variable. The treatment was tolerated without complications. Thus Dextran-haemodilution seems safe and effective in selected peripheral occlusive arterial disease (POAD) patients. Potential responders might be identifiable before the start of therapy by angiographic investigations. The clinical effectiveness of Dextran 40 is comparable to that of hydroxyethyl starch 200 as reported in the literature.
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PMID:A double-blind trial of Dextran-haemodilution vs. placebo in claudicants. 168 13

The symptom of intermittent claudication indicates a generalised arteriosclerosis. The high mortality of these patients is due to myocardial infarction, cerebrovascular events and rupture of aortic aneurysms. Prognostic factors for the progression of peripheral occlusive arterial disease to rest pain and trophical lesions are persistent nicotine consumption, arterial occlusions on more than one extremity, brachiopedal pressure quotient less than 0.5 and diabetes mellitus. Therapy of choice in most cases is the walking exercise. When the claudication distance remains very short or decompensation of peripheral circulation is imminent, reopening procedures like percutaneous transluminal angioplasty should be performed. If they are successless a prostanoid therapy is able to relief the complaints.
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PMID:[Intermittent claudication]. 175 Jan 57

A 74-year-old woman with peripheral vascular disease suffered from rest pain in the right big toe and intermittent claudication. Because of concomitant venous congestion, a chemical lumbar sympathectomy was considered to carry an increased risk of leg edema. A continuous lumbar sympathetic block with local anesthetic abolished the pain in the toe without side effects. After this reversible block, a chemical lumbar sympathectomy was performed producing pain relief for 4 weeks when the patient was last seen.
Clin J Pain 1991 Sep
PMID:Continuous lumbar sympathetic block. 157 23

This study assessed the efficacy and safety of once-daily doxazosin in the treatment of patients (n = 19) with mild or moderate essential hypertension (sitting diastolic blood pressure [DBP] 95 to 114 mm Hg) and concomitant intermittent claudication (Doppler ankle/arm ratio of less than 0.80 and walking tolerance of less than 700 m on the treadmill). After 14 weeks of treatment with doxazosin, a significant (p less than 0.05) reduction in systolic blood pressure and DBP was observed. Mean blood pressures were reduced from 170/100 mm Hg at baseline to 161/93 mm Hg at the end of treatment. Minor changes in heart rate occurred, which with continued treatment were not statistically significant from baseline. In 12 of 16 (75.0%) efficacy-evaluable patients blood pressure was normalized (DBP to less than or equal to 90 mm Hg with an greater than or equal to 5 mm Hg reduction from baseline) with a mean daily dose of 7.6 mg/day. Doxazosin improved the hypertension severity category in 13 of 16 (81.3%) patients. The blood pressure ratios between both the thighs and arms and ankles and arms showed no statistically significant changes after treatment with doxazosin. Thigh blood flow at rest and the reactive hyperemia after 3 minutes of arterial occlusion did not change statistically. There was a tendency for pain-free distance to improve. Laboratory data were not significantly changed after treatment with doxazosin. Of the 19 patients studied, 5 reported mild or moderate side effects that were either tolerated or disappeared with continued treatment. No patient had therapy withdrawn and no patient required a dose reduction.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A multicenter study of doxazosin in the treatment of patients with mild or moderate essential hypertension and concomitant intermittent claudication. 182 63


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