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)

Thirteen cases of advanced Paget's Disease of bone were treated with Sodium Etidronate (EHDP) at 20 mg/kg/day for 6 months and followed at 2 to 3-month intervals for 20 months with serum alkaline phosphatase, 24-hour urinary hydroxyproline, radiographic skeletal survey, whole-body scanning with Tc-99m-Sn-EHDP and F-18, external body counting with the same radiopharmaceuticals over preselected areas, skin temperature, densitometry of normal phalanges and bone biopsies. Sodium etidronate had a marked effect on Pagetoid bone in all cases with reduction of bone turnover demonstrated by the chemistries, scanning, external counting, skin temperature and X-ray diffraction studies of the bone biopsies. Normal bone did not appear to be materially affected by the drug. Complications drug dose-related included new pain in 6 cases, two fractures in Pagetoid areas and one case of severe demineralization. There was one case of spinal cord compression unlikely to be drug related. All complications cleared or were successfully treated by the end of the study. Some patients continued to show reduction in bone turnover to the end of the study, as long as 14 months after stopping EHDP. Long-term follow-up is needed for final evaluation of the efficacy of the drug. Sodium etidronate shows promise as an agent in the treatment of Paget's Disease. Smaller doses or shorter courses of therapy or combination of EHDP and calcitonin may be just as efficacious and may avoid complications.
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PMID:Evaluation of sodium etidronate in the treatment of Paget's disease of bone. Osteitis deformans. 40 46

Following a firm diagnostic and therapeutic schedule for patients with prostatic carcinoma. 89Strontium therapy was introduced for multiple metastases. Positive skeletal scintigraphy with 99mTc-EHDP induced check for affinity to Sr using 85Sr scintigraphy. Of 80 patients, multiple metastases were found in 26. Therapy with 1 mCi of 89Sr-chloride was started in 20 cases. In 8 patients, relief from severe pain appeared shortly afterward, and a further 8 it was possible to prevent the development of pain. Moderate success in 3 cases and a failure to provide relief in 1 were observed.
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PMID:89Strontium therapy of bone metastases of carcinoma of the prostatic gland. 49 25

16 patients suffering from Paget's disease were studied before, during and after 3 or 6 month treatment with disodium ethydronate (EHDP) per os. An appreciable improvement in pain symptomatology was noted and at times an evident improvement in audiometry; from the metabolic viewpoint there was a fall in serum alkaline phosphatase and urinary excretion of calcium and hydroxyproline. A study of radiocalcium kinetics demonstrated a reduction in the exchangeable calcium pool and the fractional turnover rate. Histological examination following needle biopsy of the iliac crest showed evident diminution in the active bone cell population (osteoclasts, osteoblasts) and, in certain cases, appearance of osteoid borders.
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PMID:[Treatment of Paget's disease with diphosphonate (disodium ethydronate)]. 81 5

The authors report two cases of melorheostosis discovered in adults because of fairly intense pain and deformation of the affected limb. The radiological appearances were typical. Isotope bone scintigraphy showed strong hyperfixation in the affected bones. A histomorphometric study of a double iliac bone biopsy showed on the one hand, cortical hypertrophy, normal osteonic architecture, and normal lamellar texture in the pathological regions, and, on the other hand, the dynamic character of the healthy bone close the lesions. In one of the patients an original attempt at treatment with diphosphonate (1 200 mg/day of EHDP for 5 months) resulted in a clear improvement in the bone pain. The disease is considered to be a mesodermic dystrophy. It seems to be due to strong hyperactivity of the subperiosteal bone accretion, which, normally, persists only at a weak level in adults.
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PMID:[Melorheostosis in adults. Apropos of 2 cases, 1 of them treated with diphosphonate (EHDP)]. 81 88

Bone imaging was done in patients after total replacement arthroplasty of the hip joint every 3rd month using 99mTc-HEDP and 18F. Uptake ratios were estimated over cup/normal hip and femur prosthesis/normal thigh. Ratios decline rapidly and reach a stable level 6-9 months, postoperatively. Eight cases of late infection were predicted correctly 1-3 months before any radiologic evidence was present. In four cases there had been false-positive results with 99mTc-HEDP while 18F gave always correct information except in cases of soft tissue inflammation. Here both 99mTc-HEDP and 18F ratios were elevated. The early diagnosis of late complications after replacement arthroplasty seems to be possible. The clinical significance, however, is low: only one out of eight patients with manifest infection is still on conservative treatment. Bone imaging should be done to exclude late infection as a cause of pain after total replacement arthroplasty of the hip joint only.
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PMID:Bone imaging after total replacement arthroplasty of the hip joint. A follow-up with different radiopharmaceuticals. 102 28

A group of 22 patients with Paget's disease of bone was treated with a diphosphonate (sodium etidronate; EHDP), a stable synthetic analogue of inorganic pyrophosphate. This substance was given during 3 months at the dose of 20 mg/kg body weight per day, and proved effective by reducing the raised urinary excretion of total hydroxyproline and by lowering the concentration of serum alcaline phosphatase. It also improved the disease-related osteo-articular pain in 60% of the patients. A rise in serum phosphate under EHDP therapy is due to the increase in renal tubular reabsorption of phosphate. Bone histology showed regression of disease activity and the appearance of lamellar structure in newly formed bone. Because of a transient increase of the amount of uncalcified osteoid, it is advisable to give the diphosphonate in courses not over 3 months or at a reduced daily dose.
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PMID:[Treatment of Paget's disease with phosphonates]. 121 60

Single intravenous injections of 30 to 35 mCi (1,110 to 1,295 MBq) of Re-186(Sn)HEDP previously have been shown to result in palliation of painful skeletal metastases from prostate cancer. There are no reports of patients receiving repetitive Re-186(Sn)HEDP therapy. We have followed two such patients who received multiple (five to seven) injections of Re-186(Sn)HEDP at 2-month intervals. Each experienced a sustained decrease in both pain and analgesic intake. The only evident clinical or biochemical toxicity was a mild progressive decline in their total platelet counts.
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PMID:Safety and efficacy of repeated sequential administrations of Re-186(Sn)HEDP as palliative therapy for painful skeletal metastases. Initial case reports of two patients. 137 56

Intravenous 3-amino-1-hydroxypropylidene-1, 1-bisphosphonic acid (APD) was used to treat 26 patients with Paget's disease. Three daily dosages were studied; 20-30 mg/day in 20 patients, 45 mg/day in three patients and 60 mg/day in three patients, by daily 4-hour infusions for 2-10 days. The fasting urinary hydroxyproline excretion (HypE) declined exponentially, reaching 50% of pretreatment values at 1.92 +/- 0.16 (mean +/- SEM) days. This initial rapid decline was complete by 4 days following treatment to a mean of 28.0 +/- 3.4% of pretreatment values. Thereafter, there was no significant decline in HypE. The initial rate of decline of HypE was unchanged by increasing the daily dose of APD. Transient non-symptomatic hypocalcaemia with secondary hyperparathyroidism occurred in all patients. No adverse changes in the renal handling of calcium or phosphate, as seen with high-dose 1-hydroxyethylidene-1, 1-bisphosphonate (EHDP), were seen in any patient on any daily dose. Fever occurred in 73% of patients in the first 2 days of treatment. Overall, there was a significant fall in the lymphocyte count (P less than 0.005 febrile group, n = 19; P less than 0.02 non-febrile group, n = 7) and a fever-dependent rise in the neutrophil count (P less than 0.005 febrile group only). The occurrence of fever was associated with a more rapid decline in HypE, compared to the non-febrile group, so that HypE was significantly lower in the febrile group by day 5 (P less than 0.025). Seventy-two per cent of patients with bone and/or joint pain reported a reduction in pain.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Intravenous aminobisphosphonate in Paget's disease: clinical, biochemical, histomorphometric and radiological responses. 203 28

Paget's disease of bone is most commonly seen in the spine; it may either be asymptomatic or may cause pain and neurologic impairment. We describe a patient with back pain due to Paget's disease of the second lumbar vertebra and spinal stenosis. The patient had a dramatic clinical and radiographic response to 2 courses of etidronate disodium, which was evidenced by resolution of the back pain and improvement in bony spinal stenosis. Etidronate may be effective in reversing bony spinal stenosis due to Paget's disease.
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PMID:Clinical and radiographic improvement of bone of the second lumbar vertebra in Paget's disease following therapy with etidronate disodium: a case report. 250 Jan 30

The pathogenesis, clinical features, indications for therapy, and current pharamacologic management of Paget's disease are reviewed. Paget's disease is a bone disorder of unknown etiology primarily affecting the elderly. Overactive bone resorption leads to the accelerated formation of disorganized, weak bone. Pain and fractures are common clinical features. Neurologic, cardiovascular, metabolic, and neoplastic complications are also reported. Because most patients are asymptomatic, the disease is often detected during routine roentgenography or laboratory tests. Primary indications for pharmacologic intervention include bone pain, neural compression, immobilization hypercalcemia or hypercalciuria, cardiac failure, and orthopedic surgery. Recurrent or non-healing fractures and rapidly progressing complications are additional indications. Drugs used in the management of Paget's disease include calcitonin, etidronate disodium, and plicamycin. Although these agents are efficacious, each has disadvantages. Clinical resistance to animal calcitonins may develop, and the cost of therapy may be prohibitive. Etidronate may induce ostemalacia. The use of plicamycin is limited by potentially severe toxicities. Dichloromethylene and aminohydroxypropylidene are promising diphosphonate compounds but are still investigational In those patients who are unresponsive to single-agent regimens, combination therapy may prove effective. Although many patients with Paget's disease do not require pharmacologic therapy, calcitonin and etidronate are the agents of choice when it is indicated.
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PMID:Pharmacologic management of Paget's disease. 266 12


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