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

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

To assess the anti-anginal and anti-ischaemic efficacy of the ACE-inhibitor enalapril in normotensive coronary patients, a double-blind, cross-over, placebo-controlled study was performed. Eight male patients, aged 45-68 years, with stable effort angina were given enalapril (10 mg) once a day or placebo for 7 days. Maximal exercise stress tests 10w/min in the upright position were performed at the end of each period. In comparison to placebo, enalapril increased significantly 1 mm of ST depression time and decreased significantly ST depression at maximal common work. Moreover, enalapril increased significantly the angina threshold and exercise duration. Three of the eight patients ended the exercise without pain. The rate-pressure product was not significantly modified at any time. Thus, the anti-ischaemic and anti-anginal activity may be due to an increase of coronary blood flow, rather than a reduction of MVO2 consumption.
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PMID:Effects of enalapril in normotensive patients with stable effort angina: a double blind, placebo controlled study. 208 65

The follow-up of living kidney donors demands medical as well as psychological competence. In the postoperative period, attention focuses on pain management, early detection of wound complications and the prophylaxis of thromboembolism. Regular visits of the donor who may easily feel neglected should be as much part of the transplant team's post-operative routine as visits of the recipient. The later phase of recovery emphasizes strengthening abdominal wall and lumbar muscles as well as the gradual increase of physical activity. Long-term follow-up focuses on the early detection of arterial hypertension and proteinuria. Antihypertensive therapy in nephrectomized donors should include an ACE inhibitor or an angiotensin-II antagonist. In Switzerland, the long-term course after living donation is prospectively monitored by the Swiss Registry for Living Donors founded in 1993. The registry is responsible for the regular timing of follow-up examinations and assures transparency of the origin of the kidneys used for living donation in Switzerland. The registry heavily relies on the collaboration of the donor's family physicians.
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PMID:[Follow-up care of living kidney donors]. 750 64

Raynaud's syndrome affects 20% to 25% of the population in cool, damp climates. Although its etiology and pathophysiology are poorly understood, treatment options do exist. For mild cases, the wearing of gloves, cold avoidance, tobacco cessation, and assurance that this is a nuisance condition that will not lead to finger amputation are often all that is required. Patients who fail this protocol are treated with extended-release nifedipine, 30 mg, at bedtime. In our experience, 70% to 80% respond with a decrease in severity and frequency of attacks, but 20% to 50% develop intolerable side effects. If nifedipine fails, we consider another calcium-channel blocker, an ACE inhibitor, or Dibenzyline. Biofeedback is offered to patients, but in our experience few are interested. Patients with digital ulceration are treated with nifedipine, pentoxifylline, and antibiotics as needed. We recommend soap-and-water washes and either a damp dressing or Silvadene cream. If there is chronic non-healing or intractable pain, we have on occasion performed a fingertip amputation. Although these do not tend to heal promptly, they generally do heal with time and provide excellent pain relief. We have not performed upper extremity sympathectomy for nonhealing finger ulcers in more than 20 years.
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PMID:Current management of Raynaud's syndrome. 896 Mar 43

To define the clinical characteristics, prognosis and treatment of myocardial infarction (MI) in the elderly, we retrospectively compared the files of 101 patients aged > or = 75 years (mean: 82 +/- 4 years) and of 120 others aged < or = 65 years (mean: 55 +/- 4.7 years). The figures corresponding to younger patients are presented in brackets. The elderly group included 60.4% women (5%: p < 0.001), 58.9% hypertensive subjects (38.3%: p = 0.005); 30.4% diabetics (11.7%: p = 0.0013) and 12.6% smokers (66.1%: p < 0.001); 20.8% of the elderly had a history of MI (10%: p = 0.002), 15.8% of arteriopathy of the lower limbs (8.3%: p = 0.001) and 6.9% of cerebrovascular accident (1.7%: p = 0.02). Elderly patients were admitted after an average of 26.6 hours (10.4 hours: p < 0.001). Only 56.4% (79.2%) reported typical MI pain, 22.8% (7.5%) had a painless form, 31.8% (4.2%) an initial left ventricular failure, 21.8% (7.5%) a global cardiac dysfunction and 20.8% (4.2%) a cardiogenic shock (p < 0.001 for all comparisons). 63.4% had an anterior MI (40.8%: p < 0.001), 40.6% a Q-form (29.6%: p = NS) and 22.2% an atrial fibrillation (0.8%: p < 0.001). Serum myoglobin and total CK concentrations were significantly lower in elderly subjects. 20.8% of them received beta-blockers (86.7%), 43.6% aspirin (80%), 14.6% oral anticoagulant (56.7%), but 63.4% were given diuretics (25.2%) and 31.7% digitalis alkaloids and positive inotropic drugs (6.7%) (p < 0.001 for all these comparisons). Heparin, nitrates, calcium channel blockers, ACE inhibitors and antiarrhythmics were prescribed as often regardless of age. Only 10 elderly patients (9.9%) were treated with thrombolytics (77: 65%: p < 0.001); 6 (5.9%) underwent coronary angiography (43: 35.8%: p < 0.001), 2 (2%) angioplasty (11: 9.2%) and one (1%) coronary bypass surgery (12: 10%). 35 elderly patients (34.7%) died while in hospital (5: 4.2%), 22 suddenly, 10 in cardiogenic shock and 3 due to arrhythmias. 38 cases (37.8%) of heart failure (21: 17.5%), 21 (20.8%) recurrences of coronary insufficiency (8: 6.7%) and 11 (10.9%) mechanical complications of MI (4: 3.3%) were also observed (p < 0.001 for all these comparisons). Due to lack of sufficient data, we could not define the status of the surviving patients discharged from hospital. The wider use of thrombolytics, angiography and angioplasty (coronary bypass surgery still having a heavy mortality and morbidity) is probably the best way to improve the prognosis of MI in the elderly.
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PMID:[Myocardial infarction in the elderly. Comparison between 2 groups of patients over 75 and under 65 years of age]. 953 67

Hypertension is a significant and prevalent risk factor for the development of cardiovascular disease and target organ damage. The urgency of treatment of high blood pressure depends on the level of blood pressure elevation and the presence of coexistent risk factors for cardiovascular disease. Likewise, the level to which blood pressure is reduced is not restricted to the definition of high blood pressure but instead depends on the underlying disease. Diabetes and renal insufficiency, for example, require blood pressure goals below those that are traditionally defined. In the absence of contraindications, beta-blockers and diuretics are still recommended as first-line agents for treatment of uncomplicated hypertension. Calcium channel antagonists also may reduce mortality. In patients with diabetes, ACE inhibitors are effective first-line agents in type 1 and type 2 diabetic patients who are hypertensive or have microalbuminuria. ACE inhibitors may be beneficial in patients with nondiabetic renal insufficiency as well. Calcium channel antagonists may have some effect in retarding progression of diabetic nephropathy although a recent trial found a higher incidence of death as a secondary endpoint in hypertensive diabetic patients who were treated with calcium channel antagonists. Beta-blockers seem to be safe and well tolerated in patients with mild to moderate intermittent claudication, although patients with rest pain or limb ischemia have not been studied. Beta-blockers should not be used in patients with asthma. Dihydropyridine calcium channel antagonists are the preferred treatment of hypertension in patients with Raynaud's but should be avoided in patients with severe gastroesophageal reflux disease. NSAIDs, particularly piroxicam and indomethacin, raise mean blood pressure by approximately 5 mm Hg, enough to consider a change of either NSAID or antihypertensive to one that is not as affected by NSAIDs. Cyclosporine A can induce hypertension by its vasoconstrictive effects, particularly on the kidney. Calcium channel antagonists may antagonize this vasoconstriction while allowing the clinician to reduce the dose of cyclosporine A required to achieve its immunosuppressive effect.
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PMID:Evaluation and treatment of hypertension. 1046 27

Acute pain increases blood pressure by increasing sympathetic activity, but the role of chronic pain on blood pressure is less well understood. Hypertension and co-existing musculoskeletal problems are two of the common conditions for which antihypertensives and analgesics are prescribed together. Among analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs) are most frequently prescribed. NSAIDs decrease the synthesis of prostaglandins (PG) by inhibiting cyclo-oxygenase, an enzyme essential for transformation of arachidonic acid into PGs. The PGs are important in control of blood pressure by virtue of their effects on the kidney and blood vessels. Among the NSAIDs, indomethacin, naproxen and piroxicam have the greatest, and sulindac the least, pressor effect. The NSAIDs antagonize the antihypertensive effect of diuretics, beta-blockers and ACE inhibitors more than that of calcium-channel blockers. The elderly and those with salt-sensitive hypertension experience greater rise in blood pressure with NSAIDs. Physicians should avoid NSAIDs and instead use alternative analgesics such as acetaminophen and physical therapy for control of pain. If necessary, the dose of the antihypertensive medications may have to be increased for better control of blood pressure. It is commonly believed that acute pain increases blood pressure. The effect of chronic pain is less well understood. Certain analgesics may affect blood pressure and may interfere with the effects of antihypertensive therapy. Since both pain and hypertension are common, it is important that their relationship be well understood by the primary care physicians.
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PMID:Effect of pain and nonsteroidal analgesics on blood pressure. 1060 51

The randomized clinical trial, LU19, conducted by the Medical Research Council Lung Cancer Working Party, was designed to compare ACE (doxorubicin, cyclophosphamide and etoposide) chemotherapy plus G-CSF (granulocyte colony-stimulating factor) at 2-week intervals versus ACE chemotherapy alone at standard 3-week intervals in patients with small-cell lung cancer. This trial investigated whether more intensive administration of ACE would improve overall survival and affect the quality of life of patients. The report on overall survival and other outcome measures will be published in the Journal of Clinical Oncology. In this paper we focus on methods of analysing aspects of data reflecting quality of life. Twelve symptoms of lung cancer and its treatment - cough, haemoptysis, pain, nausea, vomiting, hoarse voice, sore mouth, rash, lethargy, lack of appetite, alopecia, and dysphagia - were scheduled to be assessed on seven occasions for the ACE arm and on eight occasions for the ACE+G-CSF arm by clinicians during the first 18 weeks of the treatment period. However, in practice the number of assessment forms completed per patient ranged from 1 to 9, and assessment time-points were very different from those planned. These 'messy' longitudinal data are explored by both a summary measure approach, in which experience of a symptom is summarized by a single value, and an extensive model-based statistical approach, which explicitly takes into account correlation within repeated measures. These analyses provide a clear picture of symptom comparisons between the two treatments. The application of various methods offers not only an approach to assessing the robustness of the results but also a basis for investigating reasons for inconsistency of results across methods. We conclude that except lethargy, which is worse in the ACE+G-CSF arm, all symptoms are similar across the two arms during the treatment period.
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PMID:Analysis of messy longitudinal data from a randomized clinical trial. MRC Lung Cancer Working Party. 1098 40

A total of 72 patients with femoral fractures was treated between July 1997 and November 1999, 41 of them with retrograde intramedullary fixation. A minimally invasive technique was performed in 18 cases using a recently designed retrograde dilatator system (RDS) for the insertion of ACE-nail (DePuy), the reaming of the femoral canal and the locking of the distal screws. The mean age of the 18 patients (7 men and 11 women) was 49 (+/- 21) years. 8 type A, 6 type B and 4 type C fractures of the femoral shaft according to the AO classification were observed. 5 of the patients had sustained a severe polytrauma. The mean ISS of the total collective was 18 (+/- 19). No nail failed, no infection occurred, and no nerve palsies were recorded. The follow-up time was 10 (+/- 7) months. All fractures healed uneventfully. 16 patients were mobilized under full weight-bearing and regained a full range of motion without pain. In 2 cases of very old patients nursing was possible without pain. In 5 cases an implant removal was carried out in the same technique. The performed minimally invasive technique using the RDS minimizes damages to the patella ligament and the articular cartilage. It facilitates the control of rotational deformities and length discrepancies of the femur also under difficult conditions, e.g. polytrauma and obese patients.
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PMID:[A minimally invasive technique of intramedullary femoral nailing using the RDS system. A new technique for insertion of retrograde femoral nail]. 1156 54

The aim of this work was to determine the concentration of total and ionized magnesium in hair and blood of patients with primary hypertension and the influence of oral magnesium supplementation (Slow-Mag B6) on clinical parameters and blood pressure values. 92 patients were recruited from the Family Care Unit, Pomeranian Academy of Medicine in Szczecin. Each patient was treated during at least 6 months preceding the study with a single antihypertensive agent from one of the following groups: ACE inhibitors, beta-receptor inhibitors, Ca channel blockers, diuretics. The control group included patients with hypertension not treated pharmacologically. Changes in ionized magnesium concentration before and after oral magnesium supplementation were studied in relation to total cholesterol, triglycerides, and other parameters of importance in hypertension. Significantly lower total magnesium concentrations were demonstrated in hair of patients receiving ACE inhibitors and diuretics in comparison to controls. Ionized magnesium concentrations in serum of hypertensive patients were significantly reduced as compared with controls. A highly significant increase in these levels was noted after magnesium supplementation. Blood pressure values after magnesium supplementation were reduced in the study group by an average of 15-20 mmHg for systolic and 5-9 mmHg for diastolic blood pressure. Correlations between ionized magnesium and triglyceride concentrations in patients treated with Ca channel blockers before oral Mg supplementation were found. Patients treated with diuretics demonstrated correlations between total magnesium and total cholesterol concentrations. Following oral magnesium supplementation with Slow-Mag B6 at 320 mg/day, the frequency of complaints reported by patients, including irregular heart beat, pricking heart pain, nervousness, sleep disorders, irritability/tearfulness was reduced. There was no effect on other complaints, such as mental and physical fatigue, constipation/diarrhea, and anxiety.
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PMID:[Level of total and ionized magnesium fraction based on biochemical analysis of blood and hair and effect of supplemented magnesium (Slow Mag B6) on selected parameters in hypertension of patients treated with various groups of drugs]. 1460 71


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