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

In chronic obliterating arteriopathy the maximum walking distance does not correlate well with the ankle arm index of arterial pressure measured by Doppler ultrasound. Beside reduced macrocirculation and microcirculatory maldistribution in skeletal muscle, pseudoradicular irritation was established as a relevant factor for the onset of pain during walking. The present study investigates the influence of the macrocirculation on hyperalgesia at rest in intermittent claudication. In 35 patients with chronic obliterating arteriopathy of the lower limbs (stage II according to Fontaine) the ankle/arm index of arterial pressure and the walking tolerance, as well as the pain at rest on applying pressure to the calf muscles were determined before and 3 weeks after percutaneous transluminar angioplasty (PTA). All 3 parameters improved after dilatation. Improved macrocirculation leads not only to a decreased production and improved clearance of pain-inducing metabolites in muscle tissue, but also--through a decrease of sympathetic stimulation of the muscle--to an elevation of the pain threshold. Apart from the reduction in pain-inducing metabolites, an absence of booster effects on pseudoradicular irritation and the regeneration of sensitive cutaneous afferents with resultant inhibition of reflex pain development are considered as possible factors in the achievement of pain relief following PTA.
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PMID:[Pain in chronic arterial occlusive disease--the effect of improved macrocirculation on pseudo-radicular irritation]. 183 Apr 37

A gelatin-sealed knitted Dacron graft has been developed which has zero porosity at implantation and does not require preclotting. Its patency rate up to 57 months and effectiveness at saving blood loss have been studied. Gelatin-sealed aortic grafts were implanted into 100 consecutive patients--77 men, 23 women. Surgery was performed for aneurysm in 36 patients (including four with rupture), intermittent claudication in 44, rest pain in 17, and gangrene in three, over an 18 month period. The patients were followed up prospectively for 57 months. Perioperative mortality was 1%. Cumulative primary graft patency was 99%. There was no measurable blood loss at implantation. Forty-seven patients required blood transfusion: mean volume transfused was 430 ml. There were no problems related to the sealant.
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PMID:A prospective study of 100 gelatin-sealed aortic grafts. 183 46

Treating chronic arterial occlusive disease with heparin is controversial because of the risks associated with long-term anticoagulant therapy. Low molecular weight (LMW) heparin (mw about 5000 Dalton), which selectively inhibits the Xa factor with minimal risk of hemorrhage, seems to offer new possibilities in the prevention and treatment of both venous and acute arterial thromboembolism. Therefore, 44 patients with intermittent claudication were recruited to a randomized, double-blind, controlled study. Twenty-two were treated for six months with a single daily subcutaneous dose (15,000 UaXa) of LMW heparin and 22 with placebo administered in the same way over the same period of time. After six months, LMW heparin treatment not only improved walking capacity (by lengthening the pain-free walking time by 25%) but also significantly modified the hemorrheologic pattern (by reducing fibrinogen concentrations and whole blood viscosity at low shear rates). LMW heparin also exerted an antithrombotic and profibrinolytic effect by significantly increasing both the anti-Xa factor and plasminogen activity without markedly modifying activated partial thromboplastin time (+20%). No LMW heparin-treated patient hemorrhaged or reported other noteworthy side effects. These results suggest LMW heparin might be a useful drug in the long-term treatment of chronic arterial occlusive disease of the limbs.
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PMID:Efficacy of low-molecular-weight heparin in the management of intermittent claudication. 184 26

In patients with intermittent claudication and concomitant high hematocrit values a stepwise hypervolemic hemodilution versus isovolemic hemodilution (intravenous infusion of 500ml 10% hydroxyethylstarch solution (HES)(mean molecular weight 200.000/substitution degree 50%) or vensection and subsequent infusion of 10% HES (200/0.5)) were performed intraindividually. Measurements of muscle tissue oxygen pressure (pO2) values using a standardized pedalergometric exercise test as well as the pain free walking distance using a standardized treadmill were performed. Optimal results of muscle tissue oxygen pressure (pO2) behaviour after pedalergometric exercise test as well as muscular performance on the treadmill were found using isovolemic hemodilution at an average hematocrit value of 40.60%. In contrast, hypervolemic hemodilution at a comparable hematocrit level (40.50%) induced a "retarded reactive hyperoxia" and only a moderate increase of painfree walking distance.
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PMID:[Effect of stepwise hypervolemic versus isovolemic hemodilution in patients with intermittent claudication on muscle oxygen pressure during exercise]. 187 29

The effect of a new physical treatment modality, Vacusac, was tested on a group of patients with stable intermittent claudication. Twenty-two patients with a median age of 65 years and a median duration of intermittent claudication of 5 years were randomized to either active or placebo treatments. Seventeen patients completed the study. The effect of treatment was quantified by measurements of systemic and peripheral systolic blood pressures and by measurements of the pain-free and the maximal walking distance on a treadmill. The ankle pressure index (ankle systolic pressure/arm systolic pressure) and toe pressure index (toe systolic pressure/arm systolic pressure) were calculated. After 25 active treatments, administered over a period of 2 months, the patients allocated to this group attained a significant increase in the pain-free walking distance from 54 m (24-107 m) to 99 m (30-420 m) (P less than 0.05) and in the maximal walking distance from 99 m (36-182 m) to 185 m (68-591 m) (P less than 0.05). The patient group receiving 25 placebo treatments did not show any significant changes in either the pain-free or the maximal walking distance. This group then received 25 active treatments over a period of 2 months. This active treatment resulted in a significant increase in the pain-free walking distance from 51 m (14-100 m) to 86 m (18-1000 m) (P less than 0.05) and in the maximal walking distance from 98 m (40-199 m) to 175 m (51-1000 m) (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effects of vacusac in intermittent claudication: a controlled cross-over study. 189 83

The natural history of intermittent claudication is generally benign. Clear indications for revascularization in patients with intermittent claudication are rest pain and necrotic tissue. Disabling claudication in patients who are at low operative risk is another acceptable indication for surgical treatment. Young patients with intermittent claudication from aortoiliac occlusion constitute a subset of patients in whom a more aggressive approach is justified. Nevertheless, in most patients, the management of intermittent claudication should be conservative.
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PMID:Intermittent claudication. 192 71

The authors studied muscular blood flow (F), oxygen consumption rate (R), and oxygen extraction fraction (E) in 5 patients suffering from severe intermittent claudication (stage II). They applied the bolus technique of H2150 and 1502 with a detection by positron emission tomography (PET). Tomograms were recorded at the greatest diameter of the calves, at rest and ten minutes after a treadmill walk test leading to the development of ischemic pain in the affected extremity. F and E data were compared with the values obtained by more usual methods, namely occlusive venous strain gauge plethysmography and femoral venous blood sampling. During the study, these patients received naftidrofuryl, a vasodilatator drug, in an intravenous dose of 600 mg diluted in 250 mL saline infused over a six-hour period in a placebo-controlled, double-blind, crossover protocol (two consecutive experiments, a week apart). The results showed that all blood flow values measured at rest and after exercise by PET were in close correlation (r = 0.71) with the plethysmographic findings. The agreement between the two methods of measuring blood flow was less obvious with an Altman's presentation of the data: there was a tendency to measure higher values with PET scan. Concerning E, the correlation was poor at rest. After exercise, the values were more elevated with PET and no correlation was found with blood samples. The authors found no significant effect of naftidrofuryl either on flow or metabolic data.
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PMID:Assessment of flow and oxygen delivery to the lower extremity in arterial insufficiency: a PET-scan study comparison with other methods. 195 68

The study included 18 patients suffering from intermittent claudication before (stage 1) and after (stage 2) 3 months of rehabilitative training and after 2 years of follow-up (stage 3) during which patients undertook regular exercise (walking for 1 hour 3-4 days a week) and antiplatelet aggregating therapy with indobufen (200 mg x 2/day). A comparison of the data revealed that:a) there was a significant and gradual increase in the claudication pain distance (CPD) and maximal walking distance (MWD), and a reduced recovery time between stages 1 and 3 (parameters were assessed during and after walking on a treadmill (rolling mat) at a speed of 3.2 Km/h on a 12% slope); b) the resting ankle/arm pressure ratio was unchanged, but a significant increase was observed when the ratio was measured after exercise between stages 1 and 3; c) fibrinogenemia was significantly reduced between stages 1 and 2. Out of 18 subjects studied, 8 exceeded an MWD of 640 metres (maximum limit of exercise test which was suspended after 12'), 3 became asymptomatic, and 1 showed a significantly reduced capacity to walk. The paper concludes that, although it is necessary to obtain a confirmation from controlled studies, indobufen therapy and regular physical exercise represent an efficacious therapeutic approach, even over a long-term period, to stage II chronic arteriopathies of the lower limbs.
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PMID:[Effects of physical exercise and indobufen in patients with intermittent claudication. Results after a 2-year follow-up]. 196 41

The durability and the eventual complication rate of endovascular therapy (percutaneous transluminal angioplasty, laser-assisted angioplasty, and atherectomy) are not yet entirely clear, especially with respect to the treatment of atherosclerotic lesions in the femoropopliteal or distal arterial segments. Therefore, the indications for its use have not been firmly established and must take into consideration the natural history of the occlusive disease itself. Although some type of procedural intervention clearly is warranted in the presence of ischemic rest pain or tissue necrosis, intermittent claudication is the only complaint in approximately 70% of patients who present with either aortoiliac or femoropopliteal involvement. Most nondiabetic patients experience substantial symptomatic improvement with a daily exercise program, and their long-term risks for either abrupt deterioration (20-25%) or amputation (less than 10%) are relatively low. In comparison, the 5-year mortality rate ranges from 20-40% even in claudicants, and as many as 40% of those with clinical indications of associated coronary artery disease have been shown angiographically to be candidates for myocardial revascularization. These observations suggest that traditional indications for surgical treatment (truly disabling claudication and/or limb salvage) also should be applied to endovascular therapy until its success is confirmed beyond speculation, and that incidental coronary disease deserves particular attention in patients with lower extremity ischemia.
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PMID:The natural history of peripheral vascular disease. Implications for its management. 199 93

Indobufen--an inhibitor of platelets aggregation--has been used in 306 patients with intermittent claudication due to peripheral vascular disease. Patients were treated and followed up for one year. One patient of every 3 treated with indobufen was treated with ASA, and a control group of patients receiving no treatment was also followed up. The authors studied by means of a treadmill exercise test the pain-free walking distance (PFWD), the global walking distance (GWD), and the recovery time after exercise. The treatment period was completed by 290 patients: 204 claudicants, 51 claudicants with diabetes, and 35 with a short PFWD and GWD (greater than 150 m). Indobufen was more effective than ASA in improving the PFWD and GWD in all groups. There were also fewer side effects with indobufen, and cardiac morbidity and mortality was also reduced. In conclusion indobufen showed its activity and safety in chronic treatment of patients with peripheral disease, and we suggest that it may be used for long periods without side effects.
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PMID:Long-term evaluation of indobufen in peripheral vascular disease. 199 62


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