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)

Eight patients with severe lower limb ischaemia, aged 65-80, received defibrotide intravenously for periods from 5 to 21 days (mean 13 days). All patients had intractable rest pain. Five had ischaemic ulcers and 3 had minor gangrene. Five had previous arterial surgery and 6 lumbar sympathetic ganglion injections. Pretreatment ankle pressure indices ranged from 0 to 0.5 (mean 0.19). Rest pain, sleep disturbance and analgesic requirement were assessed on a nominal scale. Rest pain improved in 4 and sleeping pattern in 2 patients. One patient showed a diminution in analgesic requirement. Pressure indices improved in 5 patients. Amputation was performed in 4 patients. Adverse reactions included vomiting and diarrhoea (2), thrombophlebitis at infusion site (3) and generalized skin reaction (1). All patients had 'end-stage' peripheral vascular disease but some showed symptomatic benefit. Further evaluation of defibrotide is indicated.
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PMID:Preliminary experience with defibrotide in severe lower limb ischaemia. 375 38

Peripheral vascular disease of the extremities causes ischemic pain and, at times, skin ulcerations and gangrene. It has been suggested that epidural spinal electrical stimulation (ESES) could improve peripheral circulation. Since 1978 we have used ESES in 34 patients with severe limb ischemia; all had resting pain and most had ischemic ulcers. Arterial surgery was technically impossible. Twenty-six patients had arteriosclerotic disease, one had Buerger's disease, and seven had severe vasospastic disorders. Ninety-four per cent of the patients experienced pain relief. ESES healed ulcers in 50% of those with preoperative nonhealing skin ulcerations. Seventy per cent of the patients showed improved skin temperature recordings. Only 38% of the stimulated arteriosclerotic patients underwent amputations during a mean followup period of 16 months, as compared to 90% of a comparable group of unstimulated patients. ESES is very promising in severe limb ischemia where reconstructive surgery is impossible or has failed.
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PMID:Epidural electrical stimulation in severe limb ischemia. Pain relief, increased blood flow, and a possible limb-saving effect. 387 10

Many epidemiological studies have shown up the frequent association of arterial hypertension (HT) with atherosclerosis of different localizations. However, many of the drugs used to treat HT are contraindicated in patients with peripheral vascular disease (PVD), because they cause unfavorable metabolic changes or vasoconstriction. The aim of the present study was to assess the effect of a proven hypotensive drug, captopril, on the peripheral circulation. The drug appeared to be effective in improving blood flow to lower limbs, prolonging the pain. Free interval and increasing the angle/arm arterial pressure index.
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PMID:Captopril for the treatment of patients with hypertension and peripheral vascular disease. 389 45

Pain ist not the major early symptom of peripheral vascular disease; often there is no pain at all or only with extreme physical load. Other frequently described symptoms are not characteristic. Thus even the most careful anamnesis is not entirely reliable. The simplest and quickest diagnosis is by the Doppler Ultrasonic method. The reactive hyperemia values obtained by venous occlusion plethysmography and tissue clearance with 133Xenon are also valuable in the diagnosis of beginning peripheral blood flow disturbances. Here the pulse curve analysis of the linear blood flow deserves special mention, important parameters being the peak-flow, the catacrote areal index, the peak delay, and the sum of pulse peak and pulse peak delay. The evaluation of cut-off values allows in a simple way to differentiate between normal, beginning pathological and clearly pathological conditions. However B-scanning and digital subtraction angiography will possibly be valuable supplementary procedures in future.
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PMID:[Peripheral arteriosclerosis. Early diagnosis]. 390 26

The physiological effects of local anaesthetic (bupivacaine), neurolytic (phenol) blockade and surgical ablation of the lumbar sympathetic chain were assessed in patients with peripheral vascular disease or sympathetic dystrophy. Local anaesthetic blockade in 49 patients resulted in significant decrease in pain, plantar sweating and in the vasoconstrictor ice response of the foot, as well as a significant increase in skin temperature and foot blood flow. Subsequent neurolytic blockade in 31 of these patients achieved an effective denervation as assessed by the same physiological measurements. The magnitude of changes in blood flow and sympathetic activity were similar for local anaesthetic and neurolytic blockade as well as in six patients who underwent surgical sympathectomy.
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PMID:Blood flow, sympathetic activity and pain relief following lumbar sympathetic blockade or surgical sympathectomy. 397 62

130 muscle biopsies were taken from the gastrocnemius of 82 patients with different degrees of peripheral vascular disease (PVD) and 19 normal controls for histochemical analysis, and 30 patients and 7 controls for biochemical analysis of "aerobic" and "anaerobic" enzymes. The results showed that the gastrocnemius of patients with PVD did not adapt by increasing its "aerobic" potential as previously suggested. Histochemical studies showed that the cross-sectional area of both Type 1 and Type 2 muscle fibres became smaller than those from age-matched controls in the presence of PVD, and in some cases biopsies from both legs confirmed that this trend was greater in those limbs with increasing evidence of PVD. There is also some evidence to suggest a decrease in absolute capillary numbers per muscle fibre. The biochemical assays confirmed decreased levels of aerobic enzymes with increasing evidence of PVD as judged by ankle systolic pressure, and those patients with intermittent claudication showed some evidence of increased anaerobic enzyme levels in comparison to both the normal controls and those with rest pain. Patients with PVD do not adapt to ischaemia/anoxia by increasing their aerobic capability, but show signs of muscle atrophy probably due to reduced mobility. Training regimes may benefit patients with intermittent claudication by reversing these changes.
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PMID:Calf muscle adaptation to peripheral vascular disease. 404 17

The advantages and disadvantages of an arterial sheath to introduce catheters percutaneously through the femoral artery were prospectively studied in 184 consecutive patients without peripheral vascular disease undergoing routine diagnostic left heart catheterization and coronary arteriography. The arterial sheath was used randomly in 91 patients (sheath group) and the standard Seldinger technique in 93 (control group). There were no differences in age or sex between the two groups. All patients were studied with no premedication and had the same dose of lidocaine local anesthesia and heparin. No major complication occurred in any of the patients in the sheath or control groups. There were no significant differences in groin hematomas between the two groups. The patients in the control group more commonly had severe or moderately severe discomfort requiring additional local anesthesia. We conclude that the use of an arterial sheath percutaneously for introduction of catheters for left heart catheterization and coronary arteriography is advisable, particularly for anxious patients who have a low pain threshold.
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PMID:Percutaneous left heart catheterization and coronary arteriography with and without an arterial sheath in patients without peripheral vascular disease. 406 10

One hundred and twenty four elderly patients with peripheral vascular disease were seen by a geriatrician over a period of just under 4 years. Half of them presented with critical ischaemia and had not been previously known to have peripheral vascular disease. Two-thirds were shown to have bilateral disease; 14.5% of the series developed manifestations of the condition during the course of acute systemic illnesses and in 5 cases this was almost certainly, and in several more probably, due to haemodynamic crises. A third were dead within 3 months and so far a further 18.5% are known to have died within 2 y of first encounter. Of those who survived 3 months, at least 37% required treatment for persistent rest pain or had skin ulceration or necrosis, or had developed gangrene or come to amputation. Only 5 patients, after investigation, underwent successful limb salvage procedures. Peripheral vascular disease in old people is common, is likely to continue to be so, carries a dismal prognosis, and appears on the evidence presented here to be under-suspected until an advanced stage in the disease. Those dealing with the aged must be constantly on the alert for it since it calls for scrupulous care of the feet and for especial vigilance during acute systemic illness.
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PMID:Peripheral vascular disease--the geriatrician's tale. 409 47

Six patients are described in whom gangrene of one or more toes occurred as the presenting feature of essential thrombocythaemia. Spontaneous platelet aggregation was observed in platelet-rich plasma from four patients and platelet aggregation after the addition of adenosine diphosphate and collagen was highly abnormal in samples from all six. All of the patients described dramatic relief of pain within six hours of ingestion of aspirin and this coincided with disappearance of the spontaneous platelet aggregation and collagen-induced platelet aggregation. Treatment with phosphorus-32 corrected the platelet count and there were no further recurrences of peripheral vascular disease. Platelet function tests performed at the time all gave normal results. It is concluded that essential thrombocythaemia is an important and treatable cause of peripheral vascular disease.
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PMID:Essential thrombocythaemia and peripheral gangrene. 447 3

An open and a double-blind study were undertaken on patients with leg ulcers caused mainly by venous (VI) or arterial incompetence (AI). They were treated with intravenous infusions or injections of prostaglandin E1 (PGE1). Eight of 10 patients in the open study experienced relief of pain and a complete or almost complete healing of their ulcers. In the double-blind study (20 patients) 4 out of 5 patients with a history of leg ulcers due to VI for more than 5 year responded to the PGE1 treatment, compared with one of 5 treated with saline. In the saline group 3 more patients with VI of shorter duration improved. In 3 of 5 patients of PGE1 with ulcers due to AI the original ulcer area was reduced by 78--65% after 70 days, while in the 2 remaining cases healing occurred later on. No effect was noted in the 2 patients with ulcers due to AI who received saline infusions. The results indicate the beneficial effect of PGE1 on pain and healing in leg ulcers caused by peripheral vascular disease.
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PMID:Prostaglandin E1 treatment of leg ulcers caused by venous or arterial incompetence. 616 14


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