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

The balance equation or oxygen-conservation equation in which oxygen consumption is equal to cardiac output times the maximal oxygen binding capacity times the oxygen saturation difference between arterial and mixed venous blood shows the three factors by which the oxygen supply to the tissues can be regulated according to the need. The release of oxygen to the tissues is regulated directly through the venous oxygen tension and indirectly through cardiac output, the 2,3-DPG system, and erythropoietin. Of these indirect regulation mechanisms, cardiac output has the most rapid response and erythropoietin the slowest. As the pool of oxygen in the tissues is comparatively small, the transport and the demand of oxygen under normal conditions are approximately equal over a longer period of time. The tissue oxygen tension (Fig. 21) is thus directly a result of the flows (Fig. 21), solid lines) and indirectly a result of the regulation mechanisms (Fig. 21, broken lines). Hypermetabolism, weight loss, and severe protein wasting characterize the metabolic response to thermal injury. The increased adrenergic activity following severe burns signifies a shift of flow of body substrate from storage to utilization and an increase in energy requirements. The greater the stress, the greater the response. All systems operate at maximal or near maximal levels. The critically injured patients have an accelerated glucose turnover and increased nitrogen loss; the main source of catabolized protein seems to be from skeletal muscle. The metabolic wheel has a tremendous speed. It is thus essential to feed the patient. Energy support with heat supply and nutrition must equal energy demand to avoid weight loss. Most important is to avoid loss of "lean body tissue." No hypermetabolism was found in burned patients when the patients themselves controlled the heat supply from infrared heaters. The metabolic rate corrected for rectal temperature was independent of the total body surface burned. The energy expenditure of patients with burns was studied during the daily treatment routine and showed that it is important to avoid hypovolemia, underhydration, pain, fear, and anxiety, all of which increase the metabolic demands. To prevent hypermetabolism, infrared radiation is a practical way of distributing energy from the environment to the patient. Weight loss can be essentially prevented as energy support equals energy demand (Fig. 20). Furthermore, the method has the advantages that many patients can be treated individually, the method is inexpensive, and the ambient air temperature can be kept normal. From the results of the present investigation, it may be concluded that in patients with burns treated with infrared heaters the energy intake can be predicted in an appropriate way from the calculated basal metabolism, the rectal temperature, and the activity of the patient. The effect of storage of blood on oxygen, proton, and carbon dioxide transport is mainly mediated over the concentration of 2,3-DPG...
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PMID:Transport and demand of oxygen in severe burns. 85 Feb 71

Local pain due to subcutaneous erythropoietin (EPO) injection into the thigh was studied using a verbal score ranging from 0 to 4. Equivoluminous doses of epoetin-alpha (Cilag) and epoetin-beta (Boehringer) were compared in 2 controlled single-blind experiments: 10 dialysis patients were treated at random for 4 weeks at consecutive sessions with both brands of EPO, and 40 patients were treated in 1 session only with the 2 brands simultaneously. Pain scores were 1.12 +/- 0.28 versus 0.15 +/- 0.06 (p less than 0.05) and 1.75 +/- 0.19 versus 0.08 +/- 0.04 for epoetin-alpha and epoetin-beta, respectively (p less than 0.001). Treatment acceptance was 48% for epoetin-alpha versus 83% for epoetin-beta (p less than 0.05).
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PMID:Pain at the injection site of subcutaneously administered erythropoietin in maintenance hemodialysis patients: a comparison of two brands of erythropoietin. 141 68

The efficacy and tolerance of intravenous and subcutaneous administrations of recombinant human erythropoietin (r-HuEPO) have been compared in 50 maintenance hemodialysis patients. A 2 month course of intravenous r-HuEPO given at stable dosage was followed by a 6 month course of subcutaneous r-Hu EPO. We reduced r-HuEPO dosage by 50% when starting subcutaneous administration and regularly adapted the dosage to achieve hematocrit levels between 30 and 35%. At the end of the study, mean r-HuEPO dosage was 82 +/- 8 (mean +/- SEM) IU/kg/week, which represented 70 +/- 7% of intravenous r-HuEPO dosage. Mean hematocrit value was 32.9 +/- 0.5% when starting subcutaneous administration and also at the end of this study. Arterial blood pressure remained stable over the whole trial period as did most biological blood tests which were not influenced by the route of administration. In 98% of cases, patients expressed either pain-free (50%) or slight to moderate pain (48%) at the injection site. This trial confirms a substantial dosage economy when using r-HuEPO by subcutaneous route rather than by intravenous route. Moreover, objective and subjective tolerance was excellent on r-HuEPO subcutaneous administration.
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PMID:[Comparison of the efficacy and tolerance of recombinant human erythropoietin between intravenous and subcutaneous administration in chronic hemodialysis. Prospective multicenter study]. 160 2

Experience in the use of subcutaneous erythropoietin in 18 CAPD patients is presented. The total and mean (SD) durations on CAPD were 419 and 23.3 (20.5) months, respectively. Eleven patients started treatment with normal or elevated iron stores, 7 had an initial iron saturation less than 20%. The initial hematocrit was 22.0 (3.1%). Eleven patients reached a steady state hematocrit (34.1 +/- 3.5%) by the end of the study period, and the mean percentage increase in hematocrit for all 18 patients was 47% over the initial hematocrit. All patients responded to EPO. The initial dose of EPO was 157.6 U/kg/wk, and all patients received oral iron supplements. There was no significant change in the means of any iron parameters. Transfusion requirements decreased from a mean of 0.42 transfusions per month per patient during the 12 months, prior to EPO, to 0.22 during the study. There were no significant changes in blood pressure or other measured parameters. Transient pain at the site of injection was noted infrequently.
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PMID:Experience with subcutaneous erythropoietin in CAPD patients. 168 Apr 49

Subcutaneous erythropoietin (SCEPO) is considered to be more effective than intravenously administered erythropoietin. Patient compliance with SC injections will be important in long-term therapy as there have been reports of pain associated with SCEPO. A double-blind randomized study was performed upon 18 ESRD hemodialysis patients receiving regular subcutaneous erythropoietin replacement therapy for treatment of their anemia. The study involved pain assessment by a visual analogue scale VAS and a verbal descriptive scale VDS following 2 subcutaneous injections of preparation A: rhEPO 2000 IU in 1 ml (Cilag), preparation B: rhEPO 2000 IU in 1 ml (Boehringer Mannheim) and 0.9% saline 1 ml (placebo) over a two-week period. The injections were all administered by the same person and replaced the normal EPO injections for the patient during the study period. Results by VAS and VDS based upon 107 responses showed that preparation A was significantly more painful than preparation B (p less than 0.001) or saline (p less than 0.01). An unexpected finding was that preparation B was less painful than the placebo for VAS (p less than 0.05). It seems unlikely that the erythropoietin itself was responsible for the difference. Further work will be necessary to determine the pain causing factor in preparation A, and the possible local anaesthetic factor in preparation B.
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PMID:Experience of pain after subcutaneous administration of different preparations of recombinant human erythropoietin: a randomized, double-blind crossover study. 176 41

We treated a patient with alcohol-induced cirrhosis, intractable pain from a defective hip prosthesis, and multiple red cell allo-antibodies with recombinant human erythropoietin (EPO) in order to facilitate collection of blood for autologous transfusion during an elective total hip revision. This patient had experienced a delayed transfusion reaction 4 months earlier after receiving least incompatible packed red cells for gastrointestinal bleeding. His blood could not be crossmatched because of the development of multiple antibodies to homologous blood given during previous surgery and several episodes of gastrointestinal hemorrhage. Following initiation of EPO therapy, there was a prompt and persistent increase in the reticulocyte count from a baseline of 1.6% to a maximum of 8.6%. This was accompanied by maintenance of the hematocrit between 32% and 38.5% despite withdrawal of seven units of autologous blood over the 45-day treatment period. Poor venous access and availability of blood bank personnel, not hematocrit level, were the limiting factors that determined how frequently blood could be collected. We conclude that EPO stimulated erythropoiesis in this patient with underlying anemia of chronic disease and facilitated harvest of autologous blood for elective surgery.
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PMID:Use of recombinant human erythropoietin to enhance autologous blood donation in a patient with multiple red cell allo-antibodies and the anemia of chronic disease. 200 23

In June 1986, eight haemodialysis patients, seven male, one female, entered a pilot trial of recombinant human erythropoietin (EPO) at the Churchill Hospital Renal Unit. Six patients completed the Nottingham Health Profile (NHP) before starting EPO therapy, in order to assess quality of life, and were retested when haemoglobin level reached 120 g/l. A further test was given at one year. Statistically significant improvements were seen in the areas of Energy and Emotional Wellbeing. In the subsequent UK trial, involving previously transfusion dependent patients from nine centres, the pre and post treatment NHP scores of a further 18 patients have been assessed. Highly significant improvements were found in Energy, Physical Mobility (p less than 0.005) and in Emotional Wellbeing (p less than 0.002). Improvements which did not reach significance were found in the areas of Sleep, Social Isolation and Pain problems. An increase in appetite, and less sensitivity to cold were noted by over one third of patients. Problems with Employment, Looking after the Home, and Relationships were greatly reduced. We conclude that early findings show EPO treatment to improve not only the haemoglobin levels, but also the quality of life of haemodialysis patients with the anaemia of end stage renal failure.
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PMID:The quality of life of dialysis patients treated with recombinant human erythropoietin. 207 72

A markedly anaemic, haemodialysis patient with a mixed deficiency of erythropoietin (EPO) and iron developed a life-threatening worsening of anaemia during an episode of severe rectal bleeding. Despite frequently recurring episodes of considerable ischaemic cardiac pain, the patient's religious conviction did not permit blood transfusion. Consequently, combination therapy with both recombinant human EPO (rhEPO) and oral iron was instituted. In this haemodialysis patient, the vitally significant replacement therapy of rhEPO and iron was followed by a steady and uncomplicated restoration of subnormal hematocrit and complete disappearance of cardiac ischaemia.
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PMID:Vital indication for erythropoietin in a chronic haemodialysis patient. A case report. 261 27

Prostaglandin E2 is known to stimulate erythropoiesis by different mechanisms. A clinical trial of prostaglandin E2 to stimulate erythropoiesis in four patients with anemia of end stage renal disease resulted in an increment in peripheral blood Burst Forming Units-Erythroid (BFU-E). This increase in erythroid progenitors returned to baseline with cessation of therapy. A significant increase in serum erythropoietin (EPO) activity was demonstrated in one patient and was noticeable in another. Side effects mainly consisted of local pain at the site of the infusion and vomiting.
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PMID:A clinical trial of prostaglandin E2 to increase erythropoiesis in anemia of end stage renal disease. A preliminary report. 637 77

A 70-year-old woman on maintenance hemodialysis for 3 years was admitted to our hospital because of deep vein thrombosis (DVT) in the right femoral vein. Seven days before admission, she suddenly noticed severe pain in her right inguinal region while she was walking on the street. A wide range of stenosis from the iliac to the distal femoral region was detected by both CT scanning and venography. Her hematocrit reading was 30% and her serum erythropoietin level was 10.5 MU/ml, which was within the normal range, on the day of admission. The results of routine coagulation tests, including prothrombin time, activated partial thrombin time and plasma fibrinogen values, were normal. Plasma anti-thrombin III and plasminogen were also normal. In contrast, beta-thromboglobulin, platelet factor IV, fibrinogen degradation product, D-dimer, thrombin-antithrombin III complex (TAT) and fibrinopeptide A were abnormally elevated. In the venous occlusion test which was performed in the forearm of the opposite side of the arterio-venous shunt, plasma tissue type plas-minogen activator values showed little response to occlusion indicating that the vessel endothelium may have been partially damaged. These data suggest that the DVT had been induced by imbalance of increased blood coagulation and decreased fibrinolytic activity. Damaged vascular wall may also have contributed to the production of DVT. Furthermore, it is surprising that the patient had elevated values of D-dimer and TAT for many years without recurrence of the DVT. Spontaneous DVT in an apparently healthy individual on maintenance hemodialysis seems to be rare, compared with arterial thrombosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A long-term hemodialysis patient with spontaneous deep vein thrombosis, showing high levels of coagulo-fibrinolytic markers]. 760 31


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