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)

The medical treatment has an important role in patients with chronic pancreatitis. Pain is the most frequent symptom, at least in the initial phases of the disease. In about 60% of patients it can be successfully treated by medical therapy; in the remaining 40% it requires surgery. Malabsorption of fat and protein and diabetes usually appear in the advanced stages of the disease. The treatment of these complications is based on the administration of pancreatic extracts and insulin. There are several types of pancreatic extracts; the most useful are those with high lipase content and high lipase-protease ratio. Moreover, they should be protected against gastric acid and should have a gastric emptying simultaneously with chyme, with a rapid liberation of enzymes into the duodenum. The treatment of diabetes usually requires low-moderate doses of insulin. Diabetic ketoacidosis is rare, while microvascular changes have the same frequency as in type 1 diabetes.
 ...
PMID:Medical treatment of chronic pancreatitis. 1082 21

Severe acute necrotizing pancreatitis is a disease that is caused by premature activation of pancreatic enzymes. Cytokine release contributes to systemic manifestations such as systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS), adult respiratory distress syndrome (ARDS), and sepsis. Diagnosis is based on a history of abdominal pain, laboratory values such as serum amylase and lipase levels, and CT scan. Medical management focuses on fluid and electrolyte balance, antibiotic therapy, pain control, and decreasing systemic complications. Surgery is indicated when infectious pancreatic necrosis has been identified. This article addresses incidence and etiology; pathophysiology; clinical manifestations; diagnostics; and medical and surgical patient care management.
 ...
PMID:Necrotizing pancreatitis: pathophysiology, diagnosis, and acute care management. 1086 31

Biliary pain resulting from motility disorders is common and may be overlooked due to the difficulty of diagnosing the presence of these disorders. A sound, logical approach to the evaluation and treatment of these specific groups of disorders is essential. In patients who have a gallbladder, we initially exclude the presence of gallstones by use of transcutaneous ultrasonography. If a patient's symptoms are atypical, we initiate therapy (eg, antispasmodics) for irritable bowel syndrome. Subsequently, we perform a quantitative cholescintigraphy with a low-dose infusion of cholecystokinin in patients with typical symptoms and in those with persistent atypical symptoms. Those patients who have abnormally low gallbladder ejection fractions are subsequently referred for laparoscopic cholecystectomy. In postcholecystectomy patients, a standard approach should include obtaining serum liver associated laboratory chemistries, amylase and lipase levels, and a transcutaneous ultrasound to measure bile duct size. Endoscopic retrograde cholangiopancreatography (ERCP) is done to measure bile duct size, assess biliary duct emptying, and exclude other etiologies for pain. In patients with more than two abnormal findings on these tests (type I sphincter of Oddi dyskinesia), we recommend performing an empiric endoscopic biliary sphincterotomy. In patients with no objective abnormalities (type III sphincter of Oddi dyskinesia), it is appropriate to begin medical therapy with antispasmodics and calcium-channel antagonists. In individuals who have one or two abnormalities (type II sphincter of Oddi dyskinesia) we prefer endoscopic biliary sphincterotomy; however, these individuals are offered the opportunity to have endoscopic biliary manometry performed in order to establish a clear diagnosis. If patients refuse this procedure, after careful explanation of risks, alternatives, and possible benefits of the procedure, empiric endoscopic biliary sphincterotomy is performed.
 ...
PMID:Biliary Tract Dysmotility. 1109 61

We describe herein the case of a heterotopic pancreas that caused stenosis in the second portion of the duodenum. A 46-year-old man presented with upper abdominal pain and a 12-month history of intermittent vomiting. There was no history of melena, hematochezia, hematemesis, clay-colored stools, jaundice, or hepatitis and he did not describe any food dyscrasias, although fatty foods and alcohol seemed to make the symptoms worse. No specific medication or change in position relieved the pain. An initial diagnosis of chronic pancreatitis with multiple pseudocysts was made on the basis of elevated serum amylase and lipase levels, and abdominal ultrasonography and computed tomography (CT) findings. Medical treatment with octreotide was given for 8 weeks, but without any marked effect. Double-contrast barium examination and esophagogastroduodenoscopy were not diagnostic. Magnetic resonance (MR) cholangiopancreatography revealed findings indicative of cystic dystrophy of a heterotopic pancreas (CDHP), and an endoscopy supported this diagnosis. A pancreatoduodenectomy was performed and pathological examination confirmed a diagnosis of CDHP. In our opinion, MR cholangiopancreatography is the diagnostic tool of choice when CDHP is suspected.
 ...
PMID:Duodenal pancreatic heterotopy diagnosed by magnetic resonance cholangiopancreatography: report of a case. 1175 93

Proglumide is used in the treatment of neuropathic pain. It acts by inhibiting peptide cholecystokinin (CCK). Neural injury produces an elevation in plasma CCK. Proglumide has been also shown to augment the analgesic effect of sustained release morphine in neuropathic pain. Currently proglumide is administered as a racemic mixture. In the present study, an attempt is made to separate the racemic mixture of the drug using lipase obtained from Candida cylindracea by stereoselective esterification. Enzymatic stereoselective esterification was carried out in organic solvents. The resolution was studied using a chromatographic column with a chiral support and mass spectrometry. The reaction conditions for stereoselective esterification including amount of substrate, amount of enzyme, alcohol, solvent and temperature were optimised during the present investigation. Butanol and hexanol were found to be suitable for formation of S and R esters, respectively. Hexane was the best solvent for esterification and the optimum temperature was found to be 30 degreesC.
 ...
PMID:Resolution of (RS)-proglumide using lipase from Candida cylindraceae. 1188 9

The understanding of the pharmacology surrounding the cannabinergic system has seen many advances since the discovery of the CB1 receptor in the mammalian brain and the CB2 receptor in the periphery. Among these advances is the discovery of the endogenous ligands arachidonoylethanolamide (anandamide) and 2-arachidonoylglycerol amide (2-AG), which are selective agonists for the CB1 and CB2 receptors, respectively. These endogenous neuromodulators involved in the cannabinergic system are thought to be produced on demand and are metabolized by the enzymes fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MAG lipase). Recently, we characterized a reuptake system that facilitates the transport of anandamide across the cell membrane and subsequently developed selective inhibitors of this transport, which have been found to have therapeutic potential as analgesic and peripheral vasodilators. The cannabinergic proteins currently being explored, which include the CB1 and CB2 receptors, FAAH and the anandamide transporter, are excellent targets for the development of therapeutically useful drugs for a range of conditions including pain, loss of appetite, immunosuppression, peripheral vascular disease and motor disorders. As cannabinoid research has progressed, various potent and selective cannabimimetic ligands, targeting these four cannabinoid proteins, have been designed and synthesized. Many of these ligands serve as important molecular probes, providing structural information regarding the binding sites of the cannabinergic proteins, as well as pharmacological tools, which have been playing pivotal roles in research aimed at understanding the biochemical and physiological aspects of the endocannabinoid system. This review will focus on some of the current cannabinergic ligands and probes and their pharmacological and therapeutic potential.
 ...
PMID:Cannabinergic ligands. 1250 86

A 12-year-old girl underwent laparoscopy-assisted splenectomy and cholecystectomy with removal of her spleen through a small Pfannenstiel incision. She had an unremarkable postoperative course but returned 16 days later because of increasing right-sided abdominal pain. The pain was constant, sharp, and stabbing without radiation. Abdominal examination showed diffuse right upper quadrant and epigastric tenderness without peritoneal irritation. Laboratory test results included white blood cell count, 14.4 x 10(9)/mm3; hemoglobin, 8.5 g/dL; platelets, 1,483,000; and normal values for lipase, amylase, aspartate transaminase, and alanine transaminase. Evaluation with ultrasonography and vessel Doppler studies showed an occlusive thrombus throughout the portal and splenic veins. The patient underwent intravenous heparin anticoagulation therapy. Her symptoms resolved completely over the next 2 days. The patient is currently receiving warfarin and anagrelide as an outpatient (international normalized ratio, 2). There were no long-term complications caused by portal vein thrombosis. This is the first reported case of portal vein thrombosis after laparoscopic splenectomy in the pediatric population.
 ...
PMID:Portal vein thrombosis after laparoscopy-assisted splenectomy and cholecystectomy. 1267 88

The presentation of a patient with acute abdominal pain often is both a diagnostic and therapeutic challenge for the veterinary practitioner. Rapid physical examination and assessment of the patient's cardiovascular status are critical to initiating appropriate and often aggressive medical management as diagnostic tests are being performed. A number of diagnostic tests can be performed, including complete blood count, serum biochemistry profile, serum amylase and lipase, abdominal radiographs, abdominal ultrasound, abdominal paracentesis or diagnostic peritoneal lavage, cytology, and fluid analysis. In some cases, surgical exploration may be indicated, depending on each patient's clinical signs and response to therapy. Of the most important aspects of medical management of the patient with acute abdominal pain is to maintain oxygen delivery to tissues and to treat aggressively for pain or discomfort. The initial triage and approach to the patient with acute abdomen are discussed.
 ...
PMID:Triage and approach to the acute abdomen. 1277 64

Systemic lupus erythematosus (SLE) is an uncommon etiology of pancreatic disease. Up to now, only 3 cases of chronic pancreatitis associated with SLE have been reported in adults. We report the case of a 14-year-old girl with SLE and calcifying chronic pancreatitis. At the age of 4 she was diagnosed with SLE. She presented with several acute exacerbations of SLE that were managed with prednisone and azathioprine. At the age of 9, she was admitted with abdominal pain and elevation of serum amylase and lipase levels; no gallstones were found on ultrasound, and treatment with azathioprine was withdrawn. Thereafter, she developed numerous episodes of acute pancreatitis. Later, an ERCP showed pancreatic calcifications and distortion of the main pancreatic duct, both findings consistent with established chronic pancreatitis. At the age of 14, her condition worsened progressively, and a surgical procedure (corporo-caudal spleno-pancreatectomy) was performed. The pathology specimen showed acinar atrophy and intense fibrosis. After surgery, the patient has remained pain-free and is enjoying a normal life.
 ...
PMID:Chronic pancreatitis associated with systemic lupus erythematosus in a young girl. 1450 37

Cystic neoplasms account for about 10% of all cystic lesions of the pancreas and less than 1% of all exocrine pancreatic neoplasms. The authors report 4 cases of pancreatic cystadenoma (3 women and 1 man; mean age 59 years; range: 41-72), 2 serous and 2 mucinous, treated over the period from 1999 to 2002. The main symptoms were hypochondrial pain in two patients and diffuse abdominal pain in one while the fourth patient was asymptomatic. The patients were studied clinically by CT, echotomography and angiography. In three cases the tumours were located in the pancreatic body-tail, and in one case in the head. Serum amylase, lipase and tumour markers were all in the normal range. Only in one case was there an accurate preoperative diagnosis of tumour; in the other cases, a histological diagnosis was possible after surgical resection. Surgical treatment depended on tumour localisation: duodeno-cephalopancreatectomy for tumours in the head and distal pancreatectomy with splenectomy for tumours located in the body-tail, Lymphadenectomy at levels I and II was performed in all cases. There was no postoperative mortality and only one female patient developed postoperative acute pancreatitis. During the follow-up CT scans showed no recurrence of the pancreatic tumours. In agreement with the international literature, we hold that all cystic tumours of the pancreas should be treated by surgical therapy, above all because of the major differential diagnosis problems they continue to present. Conservative treatment is justified only for well documented asymptomatic serous cystadenomas.
 ...
PMID:[Cystadenoma of the pancreas: 4 cases in our clinical experience]. 1472 34


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