Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Prolonged and severe diarrhoea after alcohol celiac plexus block is a rare, but life-threatening, complication if not recognized. This type of diarrhoea may be considered an autonomic neuropathy due to sympathetic denervation. A 65-year-old pancreatic cancer patient developed serious diarrhoea after celiac plexus block which was unresponsive to traditional treatment such as loperamide, dyphenoxylate and opioids. Subcutaneous octreotide, 0.1 mg twice a day, achieved a complete resolution of the symptom. This drug was maintained at the same dosage and was well tolerated for 4 months until death. Octreotide, an analogue of somatostatin, reduces diarrhoea by suppression of intestinal motility and secretion and offers a useful option in the treatment of this complication of celiac plexus block.
Pain 1995 May
PMID:Octreotide in the treatment of diarrhoea induced by coeliac plexus block. 765 45

Opinions are still divided regarding the optimal palliative procedures in patients with cancer of the pancreas. This retrospective, multicentric study, involving 2493 patients operated on between January 1982 and December 1988 compares the results of various procedures aimed at palliation for pancreatic cancer. Cholecystoenteric bypasses (n = 237) in comparison to choledochoenteric bypasses (n = 1770) were associated with a higher post-operative mortality (20% vs 14%), a lower long-term morbidity (26% vs 35%), and a lower survival rate (means: 3.2 vs 5.2 months). Choledochoduodenostomy (n = 1159) and choledochojejunostomy (n = 611) had similar rates of post-operative mortality (14% vs 13%), morbidity (26% vs 27%), incidence of recurrent jaundice (8% vs 7%), and median survival (5.4 vs 5.0 months). Surgically placed biliary stents (n = 114) were followed by the highest post-operative mortality (27%), morbidity (46%), rate of recurrent jaundice (14%), and the shortest median survival (2.6 months). Post-operative mortality in patients undergoing a choledochoenteric bypass and a gastrojejunostomy (n = 1134) was similar to that observed in patients who had only a biliary bypass (n = 636) (16% and 12%), but among the patients who had a biliary bypass alone, 16% developed a gastric obstruction. For the relief of pancreatic pain, radiotherapy was more effective than other symptomatic treatments (P = 0.02). In conclusion, these results and other previous reports suggest the need (1) in patients with obstructive jaundice to perform a choledochoduodenostomy rather than other biliary bypasses, (2) a routine prophylactic gastrojejunostomy to prevent gastric outlet obstruction, (3) and for the relief of pancreatic pain to perform radiotherapy or splanchnicectomy.
 ...
PMID:Surgical palliation for unresected cancer of the exocrine pancreas. 768 88

The non-surgical management of chronic pancreatic pain is reviewed. In accordance with the suggested multifactorial origin of pancreatic pain, different treatment principles are practised. Besides conventional analgesic drugs, oral pancreatic enzymes seem efficient in a subgroup of patients with chronic pancreatitis. Endoscopic treatment aiming at reduction of the pancreatic duct-tissue pressure is promising, but it is still in its infancy. Coeliac nerve blockage is recommended in patients with pancreatic cancer and pain, whereas external radiotherapy plays a role in a diminishing number of these patients. Treatment of chronic pancreatic pain is an example of a complex clinical problem in which a multidisciplinary approach is mandatory.
 ...
PMID:Pancreatic pain: is there a medical alternative to surgery? 769 32

One of the treatments for pain in patients with unresectable pancreatic cancer is chemical splanchnicectomy by phenol. We report two cases of severe cardiac arrhythmia followed by circulatory arrest, during intraoperative chemical splanchnicectomy. The cardiac toxicity of phenol is known in plastic surgery (face peeling). The reasons for this toxicity are not well known. We recommend that phenol be replaced by alcohol during chemical splanchnicectomy, because of its safety.
 ...
PMID:[Circulatory arrest after splanchnic neurolysis with phenol in unresectable cancer of the pancreas]. 773

We performed a meta-analysis of the efficacy and safety of neurolytic celiac plexus block (NCPB) for cancer pain. A literature search yielded 59 papers, but data on NCPB in two or more patients was available in only 24 papers. Twenty-one studies were retrospective, one was prospective, and two were randomized and controlled. Cancer type was stated in 1117 of 1145 patients reported (63% pancreatic, 37% nonpancreatic). A bilateral posterior approach with 15-50 mL [corrected] of 50%-100% alcohol was the most common technique. Nonradiologically guided NCPB was performed in 246 patients (32%); guidance was by computed tomography (CT) in 214 (28%), radiograph in 271 (34%), fluoroscopy in 36 (5%), or ultrasound in 7 (< 1%). Good to excellent pain relief was reported in 878/989 patients (89%) during the first 2 wk after NCPB. Long-term followup beyond 3 mo revealed persistent benefit. Partial to complete pain relief continued in approximately 90% of patients alive at 3 mo post-NCPB and in 70%-90% until death even if beyond 3 mo post-NCPB. Patients with pancreatic cancer responded similarly to those with other intraabdominal malignancies. Common adverse effects were transient, including local pain (96%), diarrhea (44%), and hypotension (38%); complications occurred in 2%. This analysis suggests that: 1) NCPB has long-lasting benefit for 70%-90% of patients with pancreatic and other intraabdominal cancers, regardless of the technique used; 2) adverse effects are common but transient and mild; and 3) severe adverse effects are uncommon.
 ...
PMID:Neurolytic celiac plexus block for treatment of cancer pain: a meta-analysis. 781 15

Interferon alpha-2a (IFN-alpha) and folinic acid (FA) have been shown to modulate the cytotoxic effects of 5-fluorouracil (5-FU) in the treatment of cancer. A phase II study was initiated to evaluate the effect of a combination of 5-FU/FA/IFN-alpha in patients with advanced pancreatic cancer. Sixty previously untreated patients with advanced adenocarcinoma of the pancreas were treated with 500 mg m-2 FU via an intravenous bolus 1 h after the initiation of a 2 h infusion of 500 mg m-2 FA. Before starting the FA infusion, 6 million units (MU) of IFN-alpha was administered subcutaneously. The treatment was repeated once a week. Of 57 evaluable patients, eight (14%) had a partial response (PR), eight (14%) a minor response (MR) and 28 (49%) no change of disease (NC). Thirteen patients (23%) had progressive disease (PD). The median survival time was 10 months for all patients, 22 months for patients with partial remission and 5 months for patients with progressive disease. Many patients with tumour-related pain whose tumours were affected in terms of PR, MR, NC were free of pain during treatment with this regimen (22/36 patients). The common toxicities observed were fever (56%), nausea (37%) and diarrhoea (33%). These data suggest that biochemical modulation of 5-FU with FA and IFN-alpha has some positive effects in the treatment of pancreatic cancer of moderate toxicity.
 ...
PMID:Treatment of advanced pancreatic cancer with 5-fluorouracil, folinic acid and interferon alpha-2A: results of a phase II trial. 781 23

In a personal series, 22 patients (11 men, 11 women) of median age 60 (range 25-81) years with primary duodenal adenocarcinoma underwent operation between 1979 and 1993. Tumours arising from bile duct, ampullary or pancreatic tissue were excluded. Principal presenting symptoms were jaundice (12 patients), pain (seven), anaemia (six) and vomiting (six). A pre-existing villous adenoma was seen in 11 patients and adjacent duodenal dysplasia in 13. Sites of origin were mostly the second part of the duodenum (18 patients) but also the third and fourth parts (two each). Seventeen patients underwent 'curative' resection with one hospital death at 25 days; the 5-year survival rate thereafter was 40 per cent. Five patients who received palliative surgery survived for a median of 7 months. Primary duodenal carcinoma is a distinct entity with a better prognosis than pancreatic cancer after radical resection. It favours the descending duodenum and is closely linked with villous adenoma and epithelial dysplasia.
 ...
PMID:Surgical treatment of primary duodenal carcinoma: a personal series. 782 Apr 75

Diagnostic laparoscopy provides useful information in patients with pancreatic disease and is the most reliable technique for the staging of patients with pancreatic cancer. The advent of laparoscopic contact ultrasonography has enhanced the diagnostic and staging potential of laparoscopy. In addition to laparoscopic cholecystectomy for acute gallstone-associated pancreatitis, the following operations have been performed laparoscopically: bilio-enteric bypass and gastrojejunostomy in patients with advanced pancreatic cancer; internal drainage for pseudocysts; resection of insulinomas; distal resection for chronic pancreatitis; and pancreaticoduodenectomy for pancreatic cancer. Aside from cholecystectomy, there is as yet, insufficient information to conclude on the advantages of these laparoscopic approaches although the early results, particularly in the palliation of patients with malignant jaundice, are promising. Bilateral thoracoscopic splanchnicectomy for the relief of intractable pancreatic pain is also under current evaluation.
 ...
PMID:Laparoscopic surgery of the pancreas. 793 41

Staging of pancreatic cancer still represents a challenge for surgeons involved in this field. Diagnostic methods of radiological imaging used routinely (CT, NMR, angiography) may understage this neoplasm. In fact, the presence of peritoneal or subglissonian hepatic micrometastases (< 2 cm) is a frequent surprise at laparotomy and forces the surgeon to use a palliative procedure. Actually this policy has not to be followed because the possibility to perform non-surgical palliation of jaundice or pain respectively by percutaneous radiological stent insertion and celiac alcoholization. In this viewpoint, preoperative staging has acquired an important role for a correct treatment, be it surgical or medical. Laparoscopy allows it to overcome the understaging produced by the more common diagnostic means, with the possibility to view directly the celomatic space and the surface of the abdominal viscera; moreover, during this procedure it is possible to perform a peritoneal washing to obtain other information about the cancer stage. In our experience, 56 patients were judged as resectable by radiologic methods; 31 were excluded from surgery by laparoscopy; 10 of the remaining 25 cases were submitted to radical resection. The operative resectability rate resulted in 40%, against 18% in cases where we submitted to surgery all the patients. Seven patients underwent peritoneal washing, always with a negative result; all were submitted to surgery and radically resected. In our opinion, laparoscopy and peritoneal washing represent useful tools in the staging of patients affected by pancreatic cancer.
 ...
PMID:Implication of laparoscopy and peritoneal cytology in the staging of early pancreatic cancer. 794 32

The staging of pancreatic cancer still represents a challenge for surgeons involved in this field; radiological diagnostic methods used routinely (CT, NMR, angiography) may under-estimate this neoplasm; in fact, the presence of peritoneal or subglissonian hepatic micrometastasis (< 2 cm) is a frequent surprise at laparotomy and force the surgeon to undertake a palliative procedure. This policy need not be followed because it is possible to perform non-surgical palliation of jaundice or pain respectively by percutaneous radiological stent insertion and coeliac alcoholisation. Pre-operative staging thus acquires an important role in the correct treatment, surgical or medical. Laparoscopy allows us to overcome the understaging of the more common diagnostic methods and view directly the coelomatic space and the surface of the abdominal viscera; moreover during this procedure it is possible to perform a peritoneal wash to obtain other information on the cancer stage. We judged 56 patients by radiological diagnosis; 31 were excluded from surgery by laparoscopy; 10 of the other 25 cases were submitted to radical resection. The resectability operative rate was 40%, compared with 18% if we had submitted patients to surgery. Several patients underwent peritoneal wash, always with negative results; all were submitted to surgery and radically resected. In our opinion, laparoscopy and peritoneal wash represent useful tools in the staging of patients affected with pancreatic cancer.
 ...
PMID:[The role of laparoscopy and peritoneal cytology in the preoperative staging of pancreatic carcinoma]. 795 81


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>