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

In a prospective open study, 61 consecutive patients with advanced cancer admitted to a Palliative Care Unit underwent survival estimation by two independent physicians after a complete medical exam performed during the first day of admission. An independent research nurse also assessed each patient during the first day of admission. The assessment included activity, pain, nausea, depression, anxiety, anorexia, dry mouth, dyspnea, dysphagia, weight loss, and cognitive status. After the assessment was completed, patients were followed until discharge or death. In 47 evaluable patients, logistic regression showed a significant correlation between survival and dysphagia, cognitive failure, and weight loss. Accordingly, an "indicator of poor prognosis" was considered to exist in any patient who demonstrated weight loss of 10 kg or more plus cognitive failure (Mini-Mental State Questionnaire less than 24) plus dysphagia to solids or liquids. This indicator had a similar level of sensitivity, specificity, and overall accuracy, and a higher level of significance as compared with the assessment by physician #1 and physician #2, respectively. Our data suggest that three simple determinations, which may be performed by a nurse, can predict survival more or less than 4 wk as well as the assessments of two skilled physicians. These results need to be confirmed in other trials with large numbers of patients. Perhaps confirmation of these results and identification of other prognostic factors will result in staging systems for survival estimation of terminally ill cancer patients.
J Pain Symptom Manage 1992 Feb
PMID:Estimate of survival of patients admitted to a palliative care unit: a prospective study. 157 89

This study refers to the clinical features of 11 cases of hemorrhagic fever with renal syndrome (HFRS) which was prevalent in Nagoya City University Medical School. The clinical course was divided into two parts: the febrile stage and the polyuria stage. Symptoms such as lumbago, muscular pain, general malaise and anorexia disappeared along with a fall of fever. The incubation period of this disease was estimated to be about three weeks. Polyuria, proteinuria, gastric complication and impairment of liver function seemed to be some of clinical features of this disease. There was no HFRS patient with severe renal failure in our cases. The presence of disseminated intravascular coagulation (DIC) was confirmed in 3 of these 11 cases. Therefore, it was suggested that hemorrhagic tendency of this disease might be attributed to DIC. From our experiences, the most important factor for the treatment of the severe case was the earliest detection whether they were complicated by DIC or not. If they were suspected of DIC, it could be necessary to start treatment for DIC as soon as possible. Prophylactic measures for HFRS in our animal facility could contribute to the prevention of this disease.
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PMID:Clinical studies on hemorrhagic fever with renal syndrome found in Nagoya City University Medical School. 168 5

Gallbladder cancer afflicts predominantly women, the elderly, and persons with gallstones. Despite its producing symptoms of abdominal pain, nausea and vomiting, weight loss, jaundice, and anorexia, this disease remains difficult to detect. Even with contemporary imaging techniques, most gallbladder cancers escape diagnosis until the time of laparotomy. The aggressive character of this malignancy permits an overall 5-year survival rate of 3-5%. Although cures occur, the majority of operations performed for gallbladder cancer are for palliation. The objects of palliation include relief of pain, relief of jaundice, relief of intestinal obstruction, and the restoration of normal food intake. Resection of the tumor should be performed whenever possible; however, extensive operations including large liver resections and pancreaticoduodenectomy should be avoided in the presence of distant metastases. In the presence of large unresectable hilar masses, internal biliary bypass may relieve jaundice. Biliary-enteric anastomosis using the segment III duct exposed via the umbilical fissure may offer satisfactory relief of jaundice in selected cases.
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PMID:Palliative operative procedures for carcinoma of the gallbladder. 137 59

A phase II study of YM 881 (zinostatin stimalamer) to determine the response and safety was conducted in patients with hepatocellular carcinoma by injecting a suspension of the drug into the hepatic artery. Repeated doses of 4 to 6 mg of the drug were given every 4 weeks so that the tumor tissues were filled with the suspension. Of the 195 registered patients, 15 were ineligible for the study, 8 dropped out, and data were missing for 5. A total of 167 patients completed the study. Response was assessed in the 167 patients who completed the study. CR was found in one, PR in 59, MR in 25, NC in 67, and PD in 15, with a response rate of 35.9. The safety of the drug was assessed in 177, excluding ineligible patients and 3 who dropped out because of the concurrent use of other drugs. Adverse reactions were found in 93.2% of the patients, and abnormal values in clinical laboratory tests in 60.5%. Major unwanted symptoms included fever, nausea, vomiting, and anorexia. Major abnormal changes in laboratory tests were elevated total bilirubin and LDH and abnormal hepatic function. About half the patients had malaise and pain related to the intra-arterial infusion therapy. The one year survival rate was 56.9%, and the duration of survival of 50% of the patients was 407 days.
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PMID:[Phase II study of YM881 (zinostatin stimalamer) suspension injected into the hepatic artery. Research Group for Intra-arterial Injection Therapy with YM881]. 171 7

From cumulative reported data the sensitivity of [131I]metaiodobenzylguanidine (131I-MIBG) scintigraphy of carcinoids appears to be greater than 60%; at our Institute 131I-MIBG scintigrams were positive in 51 of 70 patients with metastatic carcinoid. Twenty patients with symptomatic, metastatic disease have received 7.4 GBq doses of 131I-MIBG for palliation. Most of these patients had multiple large metastases showing no response to other therapies. No objective response (greater than 50% tumor volume reduction) was ever observed; however, 13 patients were relieved of symptoms, such as flushes, diarrhea, anorexia and pain. Palliation in some of these patients was meaningful and long lasting. Possible explanations for a palliative effect in the absence of objective remission are discussed. Treatment with escalating doses of stable MIBG (up to 80 mg) in 9 patients does not support the hypothesis that the palliation is due to a purely pharmacological effect. Palliation might be explained by the observation that carcinoid liver metastases may present both as hot and cold lesions; 131I-MIBG therapy will thus target exclusively at metabolically active metastases, which are responsible for the patient's symptoms.
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PMID:Role of [131I]metaiodobenzylguanidine therapy in carcinoids. 172 78

A care system for cancer bearing patients at a highly advanced stage should be informed by a better quality of life based on a life style of the patients and their families. These patients are suffering from various types of trouble including pain, loss of appetite and nausea, which preclude oral intake. Radiotherapy or chemotherapy can be another factor aggravating their nutritional state. In terms of nutritional management, intravenous or enteral alimentation is indispensable, but these conventional alimentary supports generally lead to prolonged hospitalization and re-admission. If parenteral nutritional care can be given to patients at home and not in the hospital, it is leading to the improved quality of life would result. We focus on the issue of home alimentary care, especially intravenous alimentation, for cancer patients at the terminal stage from the nursing standpoint.
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PMID:[Nutritional support for cancer bearing patients]. 174 69

Health professionals should not be forcing the terminal patient into preestablished stages, but rather should take into account the actual experiences of the individual. The purpose of this study was to identify the defining characteristics of the dying process within the terminal phase. A retrospective audit of 11 deceased clients' charts from a hospice program was conducted. Each client had been diagnosed with terminal cancer. Defining characteristics of the process of dying were delineated and organized into groups of subjective and objective phenomena. These included anorexia, absence of pain, nausea, vomiting, tachycardia, respiratory status, withdrawal of self, secretions, mental status, urinary output, restlessness, bowel sounds, blood pressure, internal temperature, skin temperature, skin color, edema, and diaphoresis. Although the sample size was small, these findings confirmed that the dying process for terminal cancer patients was an individualized experience. Additional research is needed to build on this framework.
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PMID:Process of dying. Defining characteristics. 176 Aug 4

The reliability of the signs and symptoms of acute appendicitis are reviewed. The wide variation in clinical findings when the different studies are compared can probably be explained by the huge quantity of retrospective studies. Migration of pain to the right iliac fossa and/or guarding/rigidity support the diagnosis of appendicitis. The diagnosis of appendicitis should be doubted when anorexia, nausea and vomiting are absent, when symptoms have persisted for more than 72 h without apparent perforation, or when tenderness in the right iliac fossa is absent. Presentation in proximity to menstruation, cervical dislocation tenderness and bilateral adnexal tenderness indicates pelvic inflammatory disease. Small children have high perforation rates because of their uniform response to many illnesses and relative inability to express themselves and cooperate. The clinical findings in young and old patients are similar, except for a higher rate of abdominal distension in old patients. With a more thorough knowledge of the signs and symptoms of acute appendicitis and a constant awareness of its possible presence, it should be possible to increase the diagnostic accuracy.
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PMID:Assessment of the reliability of the symptoms and signs of acute appendicitis. 140 57

To validate findings of a reduced pain sensitivity in anorexia and bulimia nervosa, the effects of dieting on somatosensation (especially pain sensitivity) were investigated in healthy young women. One group of subjects (n = 11) received a calorically reduced balanced diet for 21 days, while the other group (n = 14) continued to eat normally. The fasting state induced in the dieting subjects was comparable to that of eating disorder patients, since the dieters showed a reduction of the body mass index, a decrease in triiodothyronine and an increase in beta-hydroxybutyric acid plasma levels. However, neither the thresholds of pain, warmth, cold and vibration sensitivity nor the peripheral skin temperature changed systematically under the diet. Therefore, the reduced pain sensitivity in eating disorder patients is apparently not a mere effect of fasting, but a true pathological feature.
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PMID:Dieting and pain sensitivity: a validation of clinical findings. 180 Oct 20

Acalculous cholangitis and cholecystitis may occur in the course of AIDS. The symptoms are always the same: pain in the right upper quadrant, fever, nausea, vomiting, anorexia and diarrhoea, associated with biochemical signs of cholestasis, often without jaundice. Morphological explorations show thickening of the gallbladder wall and dilatation of the extrahepatic bile ducts, sometimes associated with stenosis of the major duodenal papilla and dilatation of the intrahepatic bile ducts.
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PMID:[Acalculous cholangitis and cholecystitis in two AIDS patients]. 182 15


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