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)

Delivery of bile into the duodenum involves a series of complex interrelationships between hepatic secretion of bile and pressure differentials generated within the gallbladder, cystic duct and sphincter of Oddi. Theoretically, functional disorders of bile flow may arise from a disturbance of any one of the above factors. A brief review of our present knowledge of the physiology of bile flow and the spectrum of functional biliary tract disorders will be outlined to help explain possible factors which may be involved in biliary tract dysmotility disturbances. The sphincter of Oddi (SO) mechanism is dedicated to maintaining a low pressure system within the hepatic ducts which allows hepatic secretion to proceed irrespective of bile flow rate. Partial obstruction at the SO segment can give rise to intermittent or persistent upper abdominal pain. We classify sphincter of Oddi (SO) motor dysfunction into two broad categories: 1. SO stenosis: defined as a structural narrowing of part or all of the SO segment, and 2) SO dyskinesia: defined as a primary disorder of SO tonic/phasic motor activity. We have attempted to deal with an overlap in etiology of SO motor dysfunction by developing patient group classifications. Biliary I-patients with biliary-type pain, abnormal liver function tests (SGOT; al PO4 greater than 2 x normal) documented on 2 or more occasions, delayed drainage of ERCP contrast greater than 45 min, and dilated CBD greater than 12 mm diameter; Biliary II-patients with biliary-type pain but only 1 or 2 of the above criteria; Biliary III-patients with only biliary-type pain and no other abnormalities. A few of these patients may have primary SO dyskinesia.
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PMID:Biliary dyskinesia. 316 47

Scintigraphy of the biliary system using 99mTc di-isopropyl iminodiacetic acid (DIDA) was performed in 65 subjects who had previously undergone cholecystectomy. Of the 65 subjects, 20 were free of pain and 45 had biliary-type pain both with (group I) and without (group II) features of sphincter of Oddi dysfunction. This dysfunction comprised dilatation of the bile duct, a transient rise in serum levels of liver enzymes after episodes of pain, or both abnormalities. After computer acquisition of images at intervals of 60 seconds for at least 90 minutes, time/activity curves were generated for five regions of interest: liver, common hepatic duct, common bile duct, duodenum, and background. The time at which counts in the common bile duct reached 50% of maximum (CBD T50) and the time of first entry of isotope into the duodenum (TD) were used to compare asymptomatic subjects with those with biliary-type pain. Patients in group I, but not those in group II, showed significant prolongation of CBD T50 (p less than 0.002) and TD (p less than 0.02) when compared to values in asymptomatic subjects. Six patients had a second scan at six to 12 months after endoscopic sphincterotomy and all showed a reduction in values for CBD T50 and TD. In patients with pain, a significant correlation was shown between bile duct diameter and CBD T50 (p less than 0.01) and between bile duct diameter and TD (p less than 0.02) but results from scintigraphy were independent of responses to morphine-neostigmine and motility in the sphincter of Oddi as assessed by endoscopic manometry.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Assessment of bile flow by radioscintigraphy in patients with biliary-type pain after cholecystectomy. 347 Nov 97

Before the laparoscopic era, detection of CBD stones in patients with lithiasis of the gallbladder has been made, preferably, by intraoperative cholangiography. Development of laparoscopy gives the necessity of a preoperative detection of CBD stones, especially when a previous endoscopic treatment is preferred. Tenon's multifactorial score, in the Author's opinion, is able to detect patients "at risk" for CBD stones. This score includes the following parameters: age, CBD diameter, size of gallstones, colic pain and cholecystitis. The chance of CBD stones was 2% for a score lower than 3.5 and 81% for a score greater than 5.9. In this way, patients with high probability of CBD stones can be submitted to a preoperative ERCP or to a intraoperative cholangiography, according to the choices of the surgeon.
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PMID:[The predictive criteria of lithiasis of the main biliary tract associated with gallbladder lithiasis]. 1021 46

After successful gallstone lithotripsy, biliary pain recurs in about one third of patients. However, gallstone recurrence can be shown in only 40-60% of these patients. Therefore, other causes, such as sphincter of Oddi dysfunction (SOD), may be suspected. Twenty-two consecutive patients with recurrent biliary pain after successful gallstone lithotripsy without evidence of gallstone recurrence at ultrasonography were enrolled. Liver tests were elevated in 13 patients and ERC showed a dilated bile duct in nine. All 22 patients underwent sphincter of Oddi (SO) manometry, bile sample analysis for microlithiasis, endoscopic sphincterotomy (ES), and bile duct exploration with a Dormia basket. Thereafter, the patients were clinically followed at bimonthly intervals. SO manometry revealed SOD in 15/22 patients. This was more often the case in patients with initially larger (>2 cm) or multiple stones than after lithotripsy for solitary small stones (P < 0.01). Microlithiasis was detected in one patient, another patient had small biliary calculi at bile duct exploration (both without SOD). After ES, 14/15 patients with biliary SOD but none of the five without SOD improved (median follow-up: two years; P < 0.01). The one patient with CBD stones became symptom-free after ES, while the patient with microlithiasis improved after additional cholecystectomy only. Overall, ES proved to be the adequate therapy in 15/22 patients (68%, median follow-up: 22 months). After gallstone lithotripsy, SOD is found in about two thirds of patients with recurrent symptoms but without gallstone recurrence. In this group CBD stones or microlithiasis are rare. Therefore, SOD has to be suspected in this situation and ES gives favorable results, even when performed on a clinical basis only (without SO manometry).
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PMID:Sphincter of Oddi dysfunction after successful gallstone lithotripsy (postlithotripsy syndrome): manometric data and results of endoscopic sphincterotomy. 1057 69

Although a referral bias may have resulted in a higher proportion of atypical cases and consequently an overestimation of dystonia, asymmetric limb dystonia particularly affecting one arm initially was observed in 92% of all our CBD cases. Predominant leg dystonia is uncommon, and head, neck, or axial dystonia is rare. Dystonia is often associated with myoclonus, rigidity, apraxia, alien hand phenomenon, and sensory cortical signs in the affected limb, and there are no significant differences between the occurrence of these or other features, between patients with or without dystonia. There is no effective treatment for this relentless disorder except for temporary relief of dystonia and pain with local botulinum toxin injections. Further clinicopathologic studies are needed to elucidate the anatomical and physiologic substrates of dystonia in this disorder.
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PMID:Dystonia in corticobasal degeneration. 1062 71

We characterized anticancer effects of opioid analgesics that are clinically used for cancer patients for pain relief. Treatment with 100 microM buprenorphine, a representative analgesic, induced cell death of human carcinomas, such as A549 (squamous epithelial cell of lung cancer), MCF-7 (breast cancer) and N417 (small cell of lung cancer), but not in KATO III (gastric cancer) cells as evaluated by alamar blue assay. Among 18 clinically utilized and related analgesics, buprenorphine and loperamide showed potent inhibition of cell viability. However, these anti-cancer effects were not affected by opioid receptor antagonists nor by pertussis toxin. Buprenorphine-induced cell death occurred as early as 1 h after the addition, and its T1/2 of cell viability inhibition was 3 h. The cell death manifested the characteristics of apoptosis, such as DNA-laddering and nuclear fragmentation, which were sensitive to a caspase inhibitor, Z-Asp-CH2-DCB. The nuclear fragmentation was independent of cell cycle phase specificity. The activity of caspase-3-like protease which is known to be closely related to apoptotic DNA laddering was markedly enhanced by buprenorphine. However, the inhibition of cell viability by buprenorphine was not affected by the caspase inhibitor. These findings suggest that some opioid analgesics induce typical apoptotic features sensitive to the caspase inhibitor, while also inhibition of cell viability insensitive to the inhibitor.
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PMID:Opioid analgesic-induced apoptosis and caspase-independent cell death in human lung carcinoma A549 cells. 1093 99

It seems that EUS will most likely become the gold standard technique to diagnose chronic pancreatitis not diagnosed on plain radiography, standard transcutaneous sonography, or CT scanning. Because of its low risk and increased sensitivity, it will replace ERCP as a diagnostic test for this condition. Confirmation with cytology may be beneficial for indeterminate cases. EUS will also have an important role in determining the management of cystic lesions in the pancreas. EUS seems to be very effective in determining which cystic lesions have malignant potential. If a cyst appears malignant or produces symptoms, it requires resection and therefore does not require FNA. Prediction of the clinical course for cysts of indeterminate nature requires EUS-guided FNA and analysis of fluid. EUS, although quite accurate in diagnosing CBD stones, has a more limited role in diagnosis and management of stone disease because of current limitations of therapeutic maneuvers, which can be performed at the same time. In general, patients with probable CBD stones or sludge require therapeutic ERCP. Therefore, ERCP is the preferred initial test to diagnose and simultaneously treat these disorders. Patients with a low suspicion for CBD stones, or patients with relative contraindications to ERCP (i.e., pregnancy or bleeding disorders), can be evaluated first with EUS to determine whether further invasive treatment is required. EUS seems to be complementary to therapeutic ERCP for the aspiration and drainage of cysts and pseudocysts. Although celiac plexus nerve blocks using EUS-guided injection of neurolytic agents seems to be more effective than other nerve block techniques, surgical bypass or resection is likely to continue as the primary method of treatment of patients with pain from chronic pancreatitis or those who do not respond to endoscopic stenting when there is a dominant stricture that can be bypassed.
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PMID:Endoscopic ultrasonography in benign pancreatic disease. 1139 20

Bayer AG has recently announced that it acquired exclusive rights for the marketing of GW Pharmaceuticals' new medicine Sativex in Europe and in other regions. Sativex is a sublingual spray on Cannabis extract basis, and is equipped with an electronic tool to facilitate accurate dosing and to prevent misuses. It is standardized for the THC and CBD. The new analgesic is proposed for the treatment of muscle spasticity and pains accompanying multiple sclerosis and as an efficient analgetic for neurogenic pain not responding well to opioids and to other therapies available. The entirely new mechanism of action through the recently discovered cannabinoid receptor system may offer a real therapeutic potential to the drug. Although the Government of Netherlands has authorized the sale of pharmaceutical grade Cannabis herb by pharmacies in the Netherlands, the availability on the pharmaceutical market of the registered preparation may render requests for the authorization of the smoking of Cannabis herb (marihuana) by individuals suffering of multiple sclerosis, neurogenic pain, AIDS wasting syndrome unnecessary. Nevertheless, the "old chameleon" plant Cannabis appears to gradually regain its previous status in mainstream therapy and pharmacy. As long as the plant Cannabis and its products continue to be classified as narcotic drugs, medical use of the new preparation will need close supervision.
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PMID:[A novel analgesics made from Cannabis]. 1504 67

The majority of patients with multiple sclerosis (MS) develop troublesome lower urinary tract symptoms (LUTS). Anecdotal reports suggest that cannabis may alleviate LUTS, and cannabinoid receptors in the bladder and nervous system are potential pharmacological targets. In an open trial we evaluated the safety, tolerability, dose range, and efficacy of two whole-plant extracts of Cannabis sativa in patients with advanced MS and refractory LUTS. Patients took extracts containing delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD; 2.5 mg of each per spray) for eight weeks followed by THC-only (2.5 mg THC per spray) for a further eight weeks, and then into a long-term extension. Assessments included urinary frequency and volume charts, incontinence pad weights, cystometry and visual analogue scales for secondary troublesome symptoms. Twenty-one patients were recruited and data from 15 were evaluated. Urinary urgency, the number and volume of incontinence episodes, frequency and nocturia all decreased significantly following treatment (P <0.05, Wilcoxon's signed rank test). However, daily total voided, catheterized and urinary incontinence pad weights also decreased significantly on both extracts. Patient self-assessment of pain, spasticity and quality of sleep improved significantly (P <0.05, Wilcoxon's signed rank test) with pain improvement continuing up to median of 35 weeks. There were few troublesome side effects, suggesting that cannabis-based medicinal extracts are a safe and effective treatment for urinary and other problems in patients with advanced MS.
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PMID:An open-label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis. 1575 66

Ascariasis is the most common parasitic infestation in endemic areas and accounts for 50-60% of pediatric admissions in the surgical emergency department. Hepatobiliary and pancreatic ascariasis accounts for about 10% of such admissions. The present study was undertaken to evaluate the clinical features, investigations, and management of hepatobiliary and pancreatic ascariasis. The study was conducted in the endemic areas of Kashmir in northern India over a period of 3 years. During the study period (May 2001 to April 2004), 214 children with hepatobiliary and pancreatic ascariasis were admitted in the department. These children underwent complete clinical evaluation, investigation including ultrasound, and ERCP when required. Surgical intervention was done in patients who failed to settle with medical treatment. Ninety percent of our admissions were from rural areas and 86% of the children presented with pain in the right hypochondrium. Twenty-two percent of patients presented with cholangitis, whereas 39% of the children had mild icterus at presentation. Thirty-eight percent of the children had vomited worms during the episode of illness. Ultrasound was the diagnostic method of choice, which revealed the worms in the CBD in 80% of the patients, and in gall bladder in 16% of the children. Eight patients had worms in the main pancreatic duct while seven (4%) had multiple small liver abscesses. Serum alkaline phosphatase was raised in majority of children (80%). Twenty (9%) children were referred for ERCP. Medical treatment including endoscopic management was successful in 97% of the children. Seven (4%) children had to be operated upon due to complications of the disease. We conclude that the majority of the children with hepatobiliary and pancreatic ascariasis respond to conservative treatment, and surgical treatment is rarely needed.
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PMID:Management of hepatobiliary and pancreatic ascariasis in children of an endemic area. 1632 39


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