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)

In 1963, Calverley and Mohnac reported four cases with sensory disturbance of the mental nerve region. They emphasized the symptomatological significance of that finding because of the underlying ominous diseases. The purpose of this paper is to emphasize the clinical importance of this symptom especially as the initial manifestation of the underlying malignant diseases. A 56-year-old Japanese female was seen in consultation because of complaints of the paresthesia over the distribution of the right mental nerve, diplopia and ptosis of the right side. The patient had been well until a hundred days prior to admission, when she noted numbness with pain of the right mental nerve region. This symptom was followed by ptosis of the right side and diplopia after five weeks. MRI-CT scan revealed an abnormally low intensity echo (in T1 weighted image) of the bone around sphenoid sinus and tumor of the cavernous sinus (in T2 weighted image) compressing the right internal carotid artery. The patient was transferred to this hospital 100 days after the occurrence of the initial symptom. Physical examination revealed neither superficial lymph node swelling nor buccal tumor. Abnormal findings were restricted to the cranial nerve regions such as diplopia, adduction disturbance, sluggish light reflex of the right side and hypesthesia on the right chin, lower lip and buccal mucous membrane. Other neurological findings were not significant. Laboratory findings showed elevated LDH (1,503 IU/L). Leucocyte cell count was 7,500/mm3 with almost normal composition. CSF was normal. A diagnosis of Burkitt's lymphoma stage IV was done by nasopharynx and bone marrow biopsies.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of Burkitt's lymphoma with numb chin syndrome as the initial manifestation]. 258 91

This study was undertaken to examine the thermal pain thresholds over a wide area of the lower body surface following the intrathecal administration of capsaicin in rats. Thermal nociceptive thresholds measured under light halothane anesthesia were determined as skin twitch or escape response latencies to the heat stimulation (52.0 degrees C) by a thermal probe. Capsaicin (50 micrograms in 10 microliters) was injected through a chronically implanted catheter whose tip was near the lumbar enlargement of the spinal cord. The hot-plate test (52.0 degrees C) was also performed in all rats tested. Increase in thermal pain thresholds were consistently observed in the low back and abdominal region, while the hind paws did not always respond with prolonged skin twitch or escape latencies. Intensities of thermal analgesia at the sole of hind paws measured by hot-plate test correlated well with those by thermal probe test. In conclusion, intrathecal capsaicin definitely produced thermal analgesia, but its intensity was considerably variable in the hind paws. These results are in keeping with our previous finding that there was much variability in the effect of capsaicin assessed by the hot-plate test, indicating a possibility that capsaicin does not spread uniformly in the CSF because of its water insolubility or difficulty in penetrating to the large nerve roots innervating the hind paws.
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PMID:[Thermal analgesia following intrathecal capsaicin administration in rats--detailed measurements of thermal analgesia over the lower body by a thermal probe]. 258 99

Forty-three ASA physical status I-II adult patients, receiving spinal anesthesia for lower abdominal or lower limb surgery, were allocated randomly to two groups. Group 1 patients (n = 21) were given heavy bupivacaine 12 mg and group 2 patients (n = 22) were given tetracaine 12 mg in 2.5 mL of 10% dextrose. Spinal anesthesia was performed in the lateral decubitus position the at L 3-4 interspace with a 25-G spinal needle. Radial artery blood samples were collected before and after spinal anesthesia fpr pH measurement using a NOVA Biomedical machine; CSF samples were collected before and after injection of local anesthetic, and local anesthetic was also collected at the same time, for pH measurement using a Radio pH meter. The time from injection to maximal cephalad spread of analgesia and level of spinal analgesia were measured by the pin-prick method. The result was regarded as a failure if pain sensation still existed at the level of the operation site after spinal anesthesia. There were 1 failure case in the bupivacaine group and 2 failures in tetracaine group. The pH of CSF and local anesthetic in these failures were compared with those in effective cases, and the results showed that there was no significant relationship between the pH value of CSF and the local anesthetic drug.
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PMID:Effects of pH of cerebrospinal fluid and local anesthetic on the success rate of spinal anesthesia. 263 18

Twelve cases of Lyme's disease with neurological complications are reported. Seven patients had meningoradiculitis of the Garin-Bujadoux-Bannwarth type, with facial palsy in 2 cases. In 1 case the radiculitis involved only the cauda equina. Two more patients had meningomyelitis. Of the remaining 3, 1 had subacute inflammatory polyneuritis with albumino-cytologic dissociation, 1 had probable dorsal epiduritis, and the last one developed parkinsonism and communicating hydrocephalus after an otherwise classical meningoradiculitis. Three patients recalled a tick bite but only one a cutaneous eruption. No arthritis or cardiac involvement were observed. In 2 cases the CSF contained pseudo-neoplastic cells. Severe pain was a prominent feature in most cases. Pain consistently and rapidly improved on high-dose intravenous penicillin, while other signs or symptoms (e.g. paresthesias or fatigue) often lasted several months. Parkinsonism and hydrocephalus were not influenced by penicillin, and both required specific therapy. Isolated neurological (both central and peripheral) involvement is not unusual in Lyme's disease and may give rise to a wide range of signs and symptoms. This diagnosis is to be considered even when other features of Borrelia burgdorferi infection are lacking.
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PMID:[Neurologic forms of Lyme disease. 12 cases]. 266 39

1. Tryptophan increases 5HT synthesis, but the extent to which it increases 5HT release and therefore 5HT function is unclear. 2. The possibility that increased 5HT levels will lead to increased 5HT release is enhanced when 5HT neurons are firing at a higher rate. The rate of firing of 5HT neurons is increased as the level of behavioral arousal increases. Thus, altered tryptophan levels will be more likely to influence brain function at higher levels of arousal. 3. In the rat, tryptophan administration increased CSF 5HT appreciably when the animals were aroused by being put in the dark, but not when they were left in a lighted room. 4. In monkeys, the level of behavioral arousal does seem to influence the effect of altered tryptophan levels on aggression. This is consistent with the fact that altered tryptophan levels had no effect on aggression in normal subjects, but that tryptophan had a therapeutic effect in pathologically aggressive patients. 5. The confusing literature on the antidepressant effect of tryptophan can, to some extent, be explained by considering the circumstances in which tryptophan administration will lead to increases in 5HT release as well as increases in 5HT synthesis. 6. Although in some circumstances tryptophan can decrease pain perception by activation of spinal 5HT pathways, when it was given to postoperative patients it attenuated morphine analgesia by activation of a 5HT pathway in the brain. 7. The effect of altered tryptophan levels depend critically on the circumstances in which it is given.
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PMID:Tryptophan availability, 5HT synthesis and 5HT function. 266 90

Bacterially synthesized recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) is an agent with therapeutic potential for neutropenic states, but even at doses below the maximal tolerated dose adverse effects occur during short courses of administration. We have recognized a syndrome of hypoxia and hypotension that follows the first but not subsequent doses of rhGM-CSF. Thirteen of 42 patients receiving rhGM-CSF in phase I studies and 4 of 6 patients in a phase II study developed a reaction that occurred after the first dose of 24 of 78 cycles of rhGM-CSF therapy. The reaction was characterized by flushing (16 of 24), tachycardia (16 of 24), hypotension (14 of 24), musculoskeletal pain (13 of 24), dyspnea (12 of 24), nausea and vomiting (11 of 24), rigors (5 of 24), involuntary leg spasms (3 of 24), and syncope (3 of 24). The reaction did not occur after any of more than 600 second and subsequent consecutive rhGM-CSF doses. Oxygen saturation decreased during first-dose reactions by 8% +/- 4% as compared with 3% +/- 1% on first days without reactions (P less than .001) and 2% +/- 1% on subsequent days (P less than .001). Pulmonary dysfunction was characterized by hypoxemia (59 +/- 9 mm Hg, mean +/- SD) that was fully correctable with supplementary oxygen, decreased single-breath carbon monoxide diffusion capacity, and increased alveolar-arterial oxygen gradients (25 +/- 6 to 60 +/- 4 mm Hg, mean +/- SD), but no significant abnormalities on chest roentgenogram or lung perfusion scan. Factors predisposing to reactions were rhGM-CSF dose greater than or equal to 3 micrograms/kg (P less than .01), intravenous (IV) rather than subcutaneous (SC) administration (P less than .05), occurrence of a reaction after the first dose of a previous cycle of rhGM-CSF therapy (P less than .01), and for patients receiving 15 micrograms/kg/d by SC bolus, the presence of lung cancer (P less than .05). Administration of 15 micrograms/kg/d rhGM-CSF by 24-hour SC infusion rather than SC bolus resulted in a delayed onset of reaction from 30 +/- 8 minutes to 240 +/- 190 minutes (mean +/- SD, P less than .001), and a slower rate of initial transient decrease in neutrophil levels and a more prolonged duration of transient leukopenia. The time of onset of reactions correlated with the rate of rise of rhGM-CSF levels.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Characterization of the clinical effects after the first dose of bacterially synthesized recombinant human granulocyte-macrophage colony-stimulating factor. 268 97

Shunt complications are reported to occur at a rate of approximately 26%. One of the less frequent but important complications is that of the pseudocyst. Since Harsh's first mention of a periumbilical cyst associated with a shunt in 1954, 44 cases have been reported in the literature. These are reviewed in addition to 12 cases of our own. From the collected series several features about the etiology and management become apparent. The most common presentation is that of abdominal distension and/or pain rather than shunt malfunction. Diagnosis is then readily made with ultrasonography. Etiologically, it is evident that an inflammatory process is a frequent predisposing factor. In our series 16% had acute infection, 41.6% had a past history of CSF infection (6 months to 6.2 years), and 16% had CNS tumor although tumor cells were not isolated from the peritoneal cysts. Our management of the cyst itself was different from that reported in other series; it was found that the cyst reabsorbed spontaneously without excision or aspiration once the CSF was diverted. The peritoneal cavity could then be used for shunting once the cyst had reabsorbed. This sometimes required conversion to an atrial or pleural shunt before reutilization of the peritoneal cavity. There were no problems with cyst recurrence despite the conversion of 58% of the shunts to ventriculoperitoneal shunts with follow-up ranging from 3 months to 4 years. The mode of management of both the cyst and the hydrocephalus is reviewed.
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PMID:Pseudocysts of the abdomen associated with ventriculoperitoneal shunts: a report of twelve cases and a review of the literature. 269 57

A total of 27 patients with leptomeningeal neoplasia were treated with the water-soluble nitrosourea ACNU given intraventricularly or intrathecally in a phase I/II study. Patients were entered in the study if they showed evidence of either a positive CSF cytology or neurodiagnostic evidence of leptomeningeal disease, or both. Patients were evaluated for toxicity and efficacy; additionally, in 13 patients ACNU pharmacokinetic studies were carried out. A variety of tumor types were represented in the study group, including primary and metastatic CNS tumors. Toxicity was mild and included pain at the injection site (four patients), transient radicular symptoms at a short distance from the injection site (three patients), and nausea and vomiting (one patient). No myelotoxicity was seen. Of 21 patients who presented with positive cytology, 8 (38%) had a conversion from positive to negative cytology, with a range of response durations from 1 to 20+ months. Of the remaining six patients with negative cytology but other neurodiagnostic evidence of leptomeningeal disease, one patient showed an improvement seen on the myelogram and one underwent a brief reduction in CSF protein. ACNU elimination from the ventricular system is rapid, with a beta slope of 0.028 min-1 and a computed elimination constant, Ko of 13 min. The mean clearance was 3.8 ml/min (range, 1.0-6.2 ml/min). Peak ACNU levels varied between 108 and 620 micrograms/ml, with the AUC being 1.4-14.7 mg.min/ml. The total dose of ACNU given was between 9 and 104 mg, and the single dose range was 4-16.5 mg. We conclude that ACNU can be given safely with minimal toxicity as intra-CSF therapy, that it demonstrates efficacy in some patients with leptomeningeal disease, and that further studies are warranted to evaluate more fully alternative dosing and drug delivery approaches.
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PMID:Phase I/II study of intraventricular and intrathecal ACNU for leptomeningeal neoplasia. 270 35

Seven patients with supratentorial gliomas developed leptomeningeal gliomatosis (LMG) without symptomatic recurrence at the primary tumor site. In all, severe back and radicular pain, often simulating disc disease, preceded the development of spinal cord or cauda equina dysfunction. In 4 instances, intracranial hypertension due to hydrocephalus developed prior to spinal involvement. Cytological examination of the CSF revealed malignant cells in only 2/7 but a myelogram was diagnostic in all 7. All patients received spinal irradiation (RT) and 5 received chemotherapy. Two patients with low-grade gliomas improved transiently; 5 with malignant gliomas responded poorly, became paraplegic over 4 months and eventually died of LMG. When fatal LMG occurs in young adults suffering from supratentorial glioma, the primary tumor is often quiescent. Hydrocephalus is often the first manifestation of LMG and, when it is detected, a myelogram and CSF cytology study should be performed in the hope that diagnosis and treatment of spinal cord lesion at a very early stage will prove beneficial. Irradiation of the entire spinal canal is probably required as there is a high risk of rapid development of new lesions in non irradiated segments of the spinal canal.
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PMID:Leptomeningeal gliomatosis with spinal cord or cauda equina compression: a complication of supratentorial gliomas in adults. 271 19

We report on 3 patients with meningoradiculoneuritis (MRN) due to Lyme-borreliosis (LB), which presented clinically as vertebral disc herniation. In 2 cases the underlying infection was discovered only after unsuccessful neurosurgical treatment. In the differential diagnosis between MRN and disc herniation the following criteria are suggestive of MRN and should raise suspicion of a non-discogenic aetiology: History of tick bite or erythema chronicum migrans, fever or general malaise, mono- or oligoradiculopathy with absent or insignificant lumbar pain and complaints of a burning character of the radiating pain. In suspicious cases we recommend blood investigations including antibody determination against borrelia burgdorferi and CSF investigations including cell count and cytology, protein and glucose determination, nephelometry and isoelectric focusing to exclude MRN and other conditions that may mimic disc herniation.
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PMID:Meningoradiculoneuritis mimicking vertebral disc herniation. A "neurosurgical" complication of Lyme-borreliosis. 274 34


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