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)

Irradiation lesions of the hip are much better known than they used to be, and problems diagnosis no longer arise. Study of these 49 cases of irradiation lesions of the hip shows that they occur in 1 to 36 per cent of patients irradiated for pelvic cancer. The rate of occurrence may be reduced by selection and improvement in the techniques of radiotherapy. The extent of the lesions is determined from the time that irradiation is stopped. The lesions appear after a delay of several months and develop progressively throughout their extent. This confer on them a false appearance of a progressive lesion. There are severe lesions, which seriously threaten ambulation. Trans-cervical fractures should be considered separately; these are usually isolated lesions, simple to treat and of good prognosis. Fractures of the acetabulum and necroses of the acetabular roof or of the femoral head, developing usually as paired lesions or in the context of an irradiation coxopathy, constitute another group, in which treatment by total prosthesis raises numerous technical problems. Total prosthesis has however given to these hips; in almost 2 cases out of 3, a function which is at present satisfactory but whose future is unknown. The abnormality high levels of infection and in particular loosening are related to the extent to which the lesions have progressed. Resection of these prosthesis in cases of failure is similar to resection of the head and neck, and has its place as a salvage operation since its allows mobility and pain relief to be obtained at the price of stability.
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PMID:[Radiation lesions of the hip]. 84 63

Tumor growth in the pelvis with nerve involvement causes severe pain which is notoriously resistant to pharmacological treatment. Chordotomy is a classical method for the relief of pain. This is a retrospective study of 24 chordotomy cases, operated on at the department of Neurosurgery, and independently evaluated at the department of Gynecologic Oncology. Initially 19 patients (79%) were painfree whereas 4 patients (17%) had only moderate or no relief following the operation (one not evaluable). 10 patients remained free of pain until death. There were no serious complications. Possible causes of pain relapse are analysed. We conclude that chordotomy is worth consideration when facing severe pelvic cancer pain.
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PMID:The use of chordotomy to treat pain from gynecologic cancer. 247 67

The spinal administration of opioids may provide analgesia of long duration to patients with bilateral or midline lower abdominal or pelvic cancer pain. However, cross-tolerance to orally and parenterally administered narcotics and the rapid development of tolerance to spinal narcotics have limited their usefulness. Opioids have extensive distribution in the CSF and plasma when administered into the epidural or intrathecal space, and delivery of drug to brain stem sites may account for many of the toxic and therapeutic effects of spinal opioids. Further clinical and pharmacokinetic studies are required to provide the information regarding: the optimal opioids for use as spinal analgesics; equieffective dose ratios of spinal opioids in comparison to parenteral or oral opioids; strategies useful to forestall the development of tolerance of spinally administered opioids; the analgesic efficacy of this therapy in opioid-tolerant patients; and the role of spinally administered nonopioid analgesics in the management of cancer pain in the tolerant patient. These questions will need resolution before this therapy can be recommended for routine use in the management of cancer pain.
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PMID:Role of epidural and intrathecal narcotics and peptides in the management of cancer pain. 288 Oct 34

Eight-MHz radiofrequency hyperthermia (H) using Thermotron-RF8, and its combination with irradiation (RH), anticancer drugs (CH) or anticancer drugs plus irradiation (CRH), were carried out for a total of 93 urological malignancies: 19 cases of renal cancer, 3 of renal pelvic cancer, 4 of ureteral cancer 39 of bladder cancer, 8 of prostatic cancer, 14 of metastatic lesion of urological cancers and 6 of other urological cancers. All had failed in previous treatments, or had not undergone surgery because of their poor general condition. Nine cases, including 1 of renal cancer, 1 of ureteral cancer, 4 of bladder cancer, 2 of prostatic cancer and 1 of metastatic lesion of bladder cancer, were treated with (H). Fifty cases, including 4 renal cancer cases, 20 bladder cancer cases and 6 prostatic cancer cases, were treated with (RH). Eight of the 19 cases of renal cancer were treated with mitomycin C-microcapsule (MMC-mc) embolization prior to radiohyperthermia (CRH). The remaining 6 cases of renal cancer received embolization with MMC-mc followed by RE-heating (CH). Eighteen of the 48 cases of urothelial cancer or its metastasis, including 1 of renal pelvic cancer, 15 of bladder a cancer and 2 of metastatic lesion of bladder, received a combined treatment of intravenous THP-adriamycin, one of the derivatives of adriamycin and RE-heating (CH). In the remaining 2 cases, one received (CH), and the other received (CRH). Hyperthermia was given twice a week for a total of 10 sessions in 5 weeks. Intratumoral temperature was kept above 42.5 degrees C for 30 to 40 minutes during a one-hour heating. Complete tumor regression was obtained in 9 bladder cancer cases. Partial tumor regression, defined as a regression of 50% or more, was obtained in 17 cases. A pain relief was attained in 18 of 23 patients with intractable pain due to local tumor infiltration. As side effects, mild skin burns were observed in 21 cases. Ten obese cases, having subcutaneous tissue 15mm thick or more, developed fat tissue induration after treatment.
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PMID:[Eight-MHZ RF hyperthermia in urological malignancies]. 338 6

A two-stage technique for implantation of an inflatable penile prosthesis has been developed for patients undergoing radical pelvic cancer surgery. Over the past five years, this method has been utilized in 147 men undergoing radical cystectomies or prostatectomies. The technique involves implanting the reservoir and pump of the prosthesis at the time of the radical cancer operation when the lateral neurovascular bundles of erection are being sacrificed. The reservoir and pump are permanently connected, and the cylinder tubings from the pump are temporarily connected and placed in the subcutaneous tissue overlying the pubis. During a second procedure, usually six to twelve weeks later, the cylinders are implanted infrapubically and connected to the easily located pump tubing. The advantages are several. (1) The pump and reservoir are easily implanted during the pelvic surgery while importantly not adding significantly to the operative time or morbidity of the primary procedure. (2) The reservoir is easily positioned in the pelvis. (3) The scrotum with its contained pump already will be healed when the entire prosthesis is connected, bypassing the initial scrotal pain and edema. (4) Psychologically the patients feel relieved that their erectile dysfunction is being treated immediately. This two-stage technique appears to maximize the gain of early and easy implantation while minimizing the potential problems of concomitant surgery.
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PMID:Two-stage technique for implantation of inflatable penile prosthesis in pelvic cancer surgery. 338 54

Hyperthermic isolation-perfusion (I-P) was used to treat 27 patients with refractory pelvic cancer. All patients except one achieved pelvic isolation as manifested by selective pelvic heating and by pharmacologic monitoring. Patient response was good, with rapid pain relief in 75% and tumor control as detected by physical examination, computed tomographic scan, and decline in carcinoembryonic antigen levels. Pelvic drug exposure averaged 7.8 times that of systemic drug exposure. Of the 20 patients with recurrent rectal adenocarcinoma, one complete response (duration, eight months), seven partial responses (average duration, greater than or equal to 10 months), four patients with stable disease (average duration, greater than or equal to 12 months), and five with disease progression were observed. Three patients could not be evaluated due to late deaths as a consequence of their disease. There were two postoperative deaths in the remaining seven patients, one due to drug toxicity and one due to probable cardiac arrhythmia. Pelvic I-P has evolved with the avoidance of laparotomy and increased drug dose. We conclude that hyperthermic I-P for pelvic cancer is a safe, effective procedure and an excellent therapeutic option for patients with persistent pelvic cancer.
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PMID:Hyperthermic pelvic isolation-perfusion in the treatment of refractory pelvic cancer. 367 95

Chronic cancer pain remains intractable by standard treatment in many patients and interferes with their mobility and independence. Epidural morphine infusion therapy is adopted for providing adequate analgesia in patients who are generally morphine independent and have intractable pain. A totally implantable pump system, Infusaid, has allowed continuous epidural morphine infusion without wound care or frequent percutaneous injections and with a potentially lowered risk of adverse reactions including respiratory suppression. Since December 1984, the authors have used this totally implantable drug delivery system for continuous epidural morphine infusion in two patients who had been suffering from chronic pain caused by pelvic cancer associated with metastatic and/or invasive lesions: Case 1: a 61-year-old man with rectum cancer; and Case 2: a 44-year-old man with colon cancer. Before system implantation, a therapeutic response to epidural morphine was confirmed by a one-shot test injection. Pain relief was evaluated by use of Visual Pain Analogue Scale Scores (VPASS). In spite of the presence of an artificial anus on the left abdomen in both patients and of pus discharge from a sacral infectious fistula on admission in Case 2, no infectious complication occurred in either case. Urinary retention developed after the implantation in Case 2, but this improved following the reduction of morphine concentration. No other adverse reaction was observed. In Case 1, the system was effective for 6 months until his death from advancing malignancy, and the patient was able to return to work three months after discharge.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Implantable continuous epidural morphine infusion system for relief of chronic cancer pain]. 374 84

Clinical trials for abatement of intractable pelvic cancer pain were conducted in two patients, each electing surgical implantation of one of two indwelling catheter systems for administration of morphine into the spinal epidural space. Both systems, one consisting of a partially indwelling Broviac catheter, and the other, completely indwelling, consisting of a morphine reservoir connected to a shunt pump and on-off Hakim valve assembly, permitted the patients to return home where they could self-administer epidural morphine. Each patient reported that 2 mg of epidural morphine provided 8 to 12 hours of pain relief at a level of superior to their previous narcotic medication. On a regimen of 2 mg of epidural morphine administered twice daily, both patients experienced analgesia for 6 months, unaccompanied by alterations in sensory, motor, or cognitive functioning, and with a little drug tolerance reaction.
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PMID:Cancer pain relieved by long-term epidural morphine with permanent indwelling systems for self-administration. 616 47

Eight patients with refractory pelvic cancer were treated with a technique of hyperthermic pelvic isolation-perfusion (rectosigmoid colon 7, bladder 1). The procedure was successful in achieving regional hyperthermia in all patients. All five patients experiencing severe pelvic pain prior to surgery had resolution of pain, although in one patient this relief was transient. Five patients had additional intraabdominal procedures at the time of laparotomy to control unsuspected foci of recurrent cancer. There were no operative deaths. Five complications occurred in four patients although only one was considered life threatening (fracture of aorta at the time of cross-clamping). Sloughing of necrotic tumor occurred between 1 and 2 weeks postperfusion and at times was dramatic. The efficacy of this technique is impressive and it is suggested that it be utilized earlier in the course of disease in patients with uncontrolled pelvic cancer.
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PMID:Control of pelvic cancer with hyperthermic isolation-perfusion. 619 42

Local recurrence of rectal cancer develops in the posterior bony pelvis as an isolated event in about half of the patients with recurrence. Although radiation can palliate sacral root pain, the disease is usually progressive and is rarely amenable to conventional resection. We have adapted a surgical technique usually used for primary sacral tumors, which permits a complete en bloc excision of recurrent rectal cancer in most instances. This approach consists of a laparotomy with pelvic dissection and mobilization of structures to be resected. The patient is repositioned prone and the posterior pelvis (sacrum and side walls) is then resected with preservation of appropriate nerve roots of the posterior pelvis and the sciatic nerve. Reconstruction is done with muscle and skin flaps. We have done 21 such procedures, of which, 11 were for pelvic recurrence of rectal adenocarcinoma. Seven patients had resections for cure and four had palliative resections of fungating or infected tumors. All but one patient was postabdominal perineal resection and nine patients had been irradiated (3000-9000 rads). Two patients had received up to 9000 rads in separate courses (external beam in one and interstitial radiation in the other). The posterior extent of resection was S1-2 to 5 in six patients; S3 to 5 in three patients, and S4-5 in two patients. Anterior exenteration was performed in three patients and three patients had additional resection of other organs. In the curative resection group, three patients are living free of disease at six, ten, and 52 months, and one patient was NED at 60 months, but has again had tumor recurrance and is living with disease at 65 months. One patient died of disease at 13 months and one patient died of a pulmonary embolus following resection for ureteral obstruction at five months. One postoperative death occurred from a cerebrovascular accident at 52 days. In the palliative resection group, three patients survived with relief of local tumor symptoms four, eight, and 12 months. One patient who had received a total of 9000 rads developed flap necrosis, small bowel fistula and died 60 days after resection. Although this is a small series, it suggests that abdominal sacral resection of locally advanced pelvic cancer is feasible and may provide good palliation in most and possible cure in some patients who develop recurrence after primary resection of adenocarcinoma of the rectum.
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PMID:Abdominal sacral resection of locally recurrent rectal cancer. 728 7


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