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)

Out of a regional traumatic spinal cord injury population consisting of 379 individuals, 353 (93.1%) participated in the present study. Subjects were individually interviewed using semi-structured protocols. In addition, previous medical records were available for over 96% of subjects, and were used in all these cases to minimise recall bias. Cause of injury, prevalence of present medical symptoms and occurrence of medical complications in the post-acute, post-discharge phase were recorded. Neurological classification was verified by physical examination according to ASIA/IMSOP standards. Many subjects had experienced complications since discharge from initial hospitalisation, especially urinary tract infections, decubitus ulcers, urolithiasis, and neurological deterioration. Prevalence of medical symptoms was also high. More than 41% of subjects with spastic paralysis reported excessive spasticity to be associated with additional functional impairment and/or pain. Almost two-thirds of subjects reported significant pain, with a predominance of neurogenic-type pain. Bladder and bowel dysfunction were each rated by nearly 41% of subjects as a moderate to severe life problem. As expected, sexual dysfunction was also commonly reported. Prevalence of reported symptoms by general systems review was high, particularly fatigue, constipation, ankle oedema, joint and muscle problems, and disturbed sleep. However, lack of adequate normative data precludes comparison with the general population. The frequent occurrence of reported medical problems and complications support advocacy of comprehensive, life-long care for SCI patients. The commonly reported problems of neurogenic pain and neurological deterioration, in particular, require more attention, as these symptoms are not seldom ominous, either by virtue of their impact on quality of life, or because of underlying pathology.
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PMID:The Stockholm spinal cord injury study: 1. Medical problems in a regional SCI population. 764 55

Interstitial cystitis, a sterile bladder condition, is characterized by urinary frequency, urgency, burning and suprapubic pain. Increasing evidence indicates that interstitial cystitis is a heterogeneous syndrome that reflects an immune response to a variety of triggers. More than 50% of the patients have allergies, 30% have the irritable bowel syndrome and almost 20% suffer from migraine headaches. Increased numbers of mast cells have been reported in interstitial cystitis. Mast cell activation, which is critical if these cells were to be implicated in this syndrome, has been investigated by electron microscopy, which definitively shows mast cell secretion. Recently, methylhistamine, the major metabolite of histamine, and the specific mast cell marker, tryptase, were shown to be significantly elevated in urine of interstitial cystitis patients. Bladder biopsies from 53 patients were analyzed blindly for the number and degree of activation of mast cells using 4 different stains for light microscopy, as well as electron microscopy. Controls included 16 patients with incontinence and chronic bacterial cystitis. Mast cells in controls were less than 10/mm.2 and were all nearly intact. Surprisingly, mast cells from 11 cancer patients averaged 50/mm.2 but almost all were intact. In contrast, mast cells from 26 interstitial cystitis patients averaged 40/mm.2 and more than 90% were activated to various degrees. Therefore, bladder mast cell activation is a characteristic pathological finding in at least a subset of patients with interstitial cystitis.
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PMID:Activation of bladder mast cells in interstitial cystitis: a light and electron microscopic study. 786 1

Literature reports experience using a transurethral prosthetic stent for the treatment of neurogenic bladder in males with spinal cord injury who also have detrusor-external sphincter dyssynergia (DESD). The Urolume prosthesis, a cylindrical wire mesh stent, was inserted in the membranous urethra of 25 spinal cord injured males with DESD and elevated voiding pressure. Patient education regarding care of external condom urine collecting devices was an important preoperative requirement ensuring long-term success. One-year post-stent placement subjects showed a statistically significant decrease in voiding pressure and residual urine volume. Bladder capacity remained constant. All subjects were able to achieve spontaneous reflexive voiding without constant dribbling. There were no complications of bladder stone formation, tissue overgrowth within the stent, untoward effects on renal or erectile function, or pain. Patients reported decreased autonomic dysreflexia symptoms and significant psychosocial benefits such as decreased incontinence and freedom from indwelling catheters. Patient satisfaction, ease of placement, and minimal associated morbidity make sphincter stent placement an effective alternative to external sphincterotomy.
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PMID:Transurethral placement of external sphincter wire mesh stent for neurogenic bladder. 786 17

Interstitial cystitis is a syndrome of urinary urgency, frequency and suprapubic pain. We investigated the role of inflammatory mediators in 96 patients with histories and symptoms consistent with interstitial cystitis, and 13 controls from The New York Hospital-Cornell Medical Center, University of Washington and University of California at San Diego. Patients were classified into either group A (meets all criteria of the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases for inclusion in research studies), group B (meets all of these criteria but without glomerulations) or an "other" group. A small number of group A patients had detectable interleukin-6 in the urine. Urinary concentrations of tumor necrosis factor, prostaglandins E2, D2 and F2 alpha, and thromboxane B2 were not different among either patient groups or controls. Urine specimens contained inhibitors of the bioactivity of interleukin-6 and tumor necrosis factors but no differences between patients or controls were found. No factors chemotactic for human neutrophils were detected in a small patient sample. Bladder wash fluid concentrations of prostaglandins E2, D2 and F2 alpha, and thromboxane were much lower than urinary levels. Bladder wash fluid interleukin-6 and tumor necrosis factor were not detectable. The results suggest that while a small subset of patients may have elevated levels of interleukin-6 the majority of patients do not appear to have elevated levels of inflammatory mediators in the urine or bladder wash fluid. Evaluation of patient bladder tissue may indicate changes not detectable in urine or bladder wash fluid. Alternatively, other etiologies must be considered in those patients.
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PMID:Inflammatory mediator profile in urine and bladder wash fluid of patients with interstitial cystitis. 801 71

The intrathecal application of the GABA-B agonist baclofen has become more and more popular for severe spinal spasticity. Since it was first introduced in 1984 more than 1000 patients worldwide have been treated by this method, using an implantable drug administration device. Clinical data from 48 patients are presented, as well as further experience from a multicentre trial conducted in Europe, in conjunction with a literature overview. The method is now generally accepted as a powerful treatment for spasticity due to spinal lesions of whatever aetiology; improvement in mobility and function as well as relief of spastic pain are the most obvious benefits for the patient. Bladder function is improved in terms of increased bladder volume and lowered residual volume. In patients with supraspinal lesions causing muscle hypertension, where several mechanisms usually contribute besides hyper-reflexia (spasticity), the response has been less pronounced, but intrathecal baclofen still seems to have clinical effects that are superior to those of any oral drug treatment. The initial technical and methodical problems have been solved and today the procedure is generally assessed as safe.
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PMID:Intrathecal baclofen. 814 75

A 52-year-old female with the chief complaint of miction pain was referred for the examination of a urethral nodule. Physical inspection revealed the meatus to be reddish and swollen. The painless nodule (1 x 1 x 2 cm) was situated between the urethra and vagina on transvaginal examination. Chest X-ray, drip infusion pyelography (DIP) and urethrocystography (UCG) showed no evidence of tuberculosis. Bladder mucosa was normal on cystoscopy. Mycobacterium tuberculosis was not detected from urine or sputum. The nodule was resected along with a portion of the urethra. Histopathological examination revealed tuberculous granuloma of the urethra.
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PMID:[Tuberculosis of the female urethra: a case report]. 826 67

Case reports are presented on 3 patients who sustained severe chemical cystitis from the inadvertent insertion of a nonoxynol-9-containing vaginal contraceptive suppository into the bladder. A treatment schedule is suggested, and the toxicity of nonoxynol-9 is discussed. In Case 1, a 23-year-old woman had marked urinary urgency following inadvertent insertion of a vaginal contraceptive suppository into the bladder via the urethra. Emergency cystoscopy revealed severe chemical hemorrhagic cystitis with pain. The bladder was irrigated copiously with saline, and 50 cc 1% lidocaine, 100 mg hydrocortisone, and dimethyl sulfoxide were instilled intravesically. The substance in the suppository was a detergent, thus no specific treatment was performed. In case 2, a 22-year-old woman was hospitalized for severe symptoms of urgency, marked dysuria, and severe burning pain following inadvertent insertion of a vaginal suppository into the bladder. A 3-way Foley catheter was inserted, and oxybutynin and ciprofloxacin therapy was initiated. Bladder irrigations were begun with normal saline. She received 100 mg hydrocortisone intravenously every 8 hours. Cystoscopy revealed diffuse severe hemorrhagic cystitis. Retrograde cystography with the patient under anesthesia demonstrated a bladder capacity of only 300 cc. The patient had severe bladder spasms for approximately 1 month after initial insertion of the vaginal suppository. A serious fixed drug eruption developed in the right leg secondary to the nonoxynol-9. In case 3, a 26-year-old woman presented to a urology clinic 36 hours after transurethral insertion of a vaginal suppository into the bladder. Cystoscopy revealed severe hemorrhagic cystitis. The patient was treated with 1 tablet of trimethoprim-sulfamethoxazole twice a day and 5 mg oral oxybutynin every 6 hours. Significant irritation was reported using latex condoms lubricated with nonoxynol-9. The absorption of the drug via the bladder wall occurs rapidly and reaches high concentrations.
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PMID:Severe chemical cystitis from the transurethral intravesical insertion of a vaginal contraceptive suppository: a report of 3 cases and proposed method of management. 838 72

Both acute and chronic bacterial prostatitis are generally caused by gram-negative organisms. However, acute infections are seen in younger men and cause fever, difficulty in voiding, low back and perineal pain, and other systemic symptoms. Chronic infections are more often seen in older men and may or may not be associated with symptoms of prostatitis. Nonbacterial prostatitis is the most common type. Patients have symptoms and signs of prostatitis, but infecting organisms cannot be demonstrated. Studies attempting to identify a causative organism have not been conclusive. Prostatodynia is a complex of symptoms similar to prostatitis that occurs without objective findings that definitely implicate the prostate gland. Bladder disorders such as internal sphincter dyssynergia, tension myalgia of the pelvic floor, or, at times, stress and emotional problems may be associated. Management depends on the precipitating factor.
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PMID:Prostatitis. Sorting out the different causes. 841 32

Many patients with interstitial cystitis (IC) also have irritable bowel syndrome (IBS), both of which occur overwhelmingly in women, are characterized by pain, and worsen under stress. Bladder and colon biopsies of a female patient with both IC and IBS were evaluated immunohistochemically. There were 40 +/- 10 mast cells (MC)/mm2 (normal, less than 10) in the bladder, which were degranulated. The colon contained 148 +/- 11 MC/mm2 (normal, less than 50), mostly close to numerous substance P (SP)-positive nerves. Histamine, methylhistamine, and the unique MC enzyme tryptase were evaluated in 24-hour urine during two flare-ups. These results may help explain the concurrent presentation and the painful nature of these syndromes.
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PMID:Mast cell and substance P-positive nerve involvement in a patient with both irritable bowel syndrome and interstitial cystitis. 863 18

Irritable bladder syndrome (IBS) was induced in four female African green monkeys (Cercopithecus aethiops) by the use of intravesical instillation of acetone. The animals were housed in a modified metabolic cage for continuous micturition monitoring, and two uroflowmeters connected to a remote PC monitored the frequency, voided volumes, and peak flows. Before and after, urea absorption studies and urodynamics were obtained for each animal. Urea absorption increased significantly after acetone instillation and returned to baseline after 4 weeks (26 to 66 to 32%). Intravesical acetone instillation produced marked effects on bladder physiology in the first week. Bladder compliance dropped from a baseline of 10.47 to 0.58 ml/cm H2O. The voiding pattern changed from a normal pattern with a mean voided volume of 17.58 ml into marked increase in frequency and dribbling pattern with few voids (mean = 5.03 ml). Systematic behavioral observations were carried out for 4 hours per day utilizing an observation program on a laptop computer. Activity patterns, attention, sterotypic behaviors, and self-directed activities were recorded for each monkey. The animals demonstrated decreased frequency of activity and increased frequency in self-directed activities (groom, scratch), behaviors consistent with an animal experiencing pain or discomfort. The findings suggested that IBS induction in monkeys is feasible and produces a clinical picture similar to interstitial cystitis in humans. It offers a suitable animal model to enhance the understanding of voiding dysfunction with its neural pathways and to test the different therapeutic modalities to control IBS.
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PMID:Irritable bladder syndrome in an animal model: a continuous monitoring study. 875 Mar 84


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