Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: 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 a prospective study, the effect of anterior retinal cryoablation (ARC) in the management of neovascular glaucoma (NVG) was evaluated over two years, in 72 patients (74 eyes). The outcome of trabeculectomy/seton surgery preceded by 360 degrees ARC was also analysed in 12 eyes of 12 patients (6 eyes in each group). Following ARC, pain relief with dramatic regression of anterior chamber inflammatory reaction was observed in 95% of the patients (59 eyes). At the end of the follow up, as confirmed by iris fluorescein angiography, regression of neovascularization of the iris was documented in 93.5% (58 eyes) of the cases. Intraocular pressure control (< or = 22 mm Hg) was achieved in 82.3% (51 eyes) cases. IOP control of < or = 22 mm Hg was achieved in all the 6 eyes with the seton surgery following ARC. Similarly, control of IOP was successfully achieved in all the 6 eyes of patients with NVG with trabeculectomy with post operative course of 5-fluorouracil following ARC. ARC is strongly recommended in NVG, especially in eyes with media opacities and as a preliminary procedure for filtering surgery or drainage implant surgery.
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PMID:Role of anterior retinal cryoablation in the management of neovascular glaucoma. 750 13

Adrenal medullary chromaffin cells are a potential source of neuroactive substances for transplantation into the CNS to alleviate neurochemical deficits. In particular, work in our laboratory has suggested that adrenal medullary transplants in the spinal subarachnoid space can alleviate pain by providing sustained local delivery of catecholamines and opioid peptides. One of the major limitations for clinical application of neural transplantation is the availability of donor material in sufficient quantities. This limitation may be overcome by the use of xenogeneic donors if long-term graft rejection can be prevented. The purpose of this study was to assess whether xenogeneic chromaffin cells immunologically isolated by semipermeable membranes could survive and continue to reduce pain when transplanted into the CNS. Isolated bovine chromaffin cells were encapsulated by semipermeable polymer membranes and implanted into the rat spinal subarachnoid space. Pain sensitivity was assessed at several intervals up to 3 months following implantation. Results indicated that encapsulated bovine chromaffin cell implants, but not empty control capsules, could repeatedly reduce pain sensitivity with nicotine stimulation for the duration of the study. This response was dose related, indicating that pharmacologic integrity of the transplanted chromaffin cells is retained. The analgesia induced by encapsulated chromaffin cell implants could be attenuated by the opiate antagonist naloxone and the alpha-adrenergic antagonist phentolamine, suggesting the involvement of both opioid peptides and catecholamines in mediating this response. In addition, in vitro neurochemical studies of recultured capsules revealed sustained release of Met-enkephalin and catecholamines from encapsulated cells 3 months following implantation into the spinal subarachnoid space.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Transplants of immunologically isolated xenogeneic chromaffin cells provide a long-term source of pain-reducing neuroactive substances. 768 73

A 12-year-old Standard-bred mare and a 21-year-old Quarter Horse gelding were treated for signs of abdominal pain and sweating. The mare also had muscle fasciculations, azotemia, and ataxia, and was euthanatized after signs of pain became refractory to analgesics. The gelding died when ventricular tachycardia developed during general anesthesia for exploratory celiotomy. Adrenal pheochromocytomas (bilateral in the mare), associated with retroperitoneal and intra-abdominal hemorrhage, were found on postmortem examination. Pheochromocytoma should be considered in older horses with signs of abdominal pain and sweating. Further consideration of pheochromocytoma should be afforded in older horses in which muscle fasciculations, ataxia, azotemia, and intraperitoneal hemorrhage are recognized. Identification, by per rectum palpation, of retroperitoneal swelling in the dorsal aspect of the abdomen also should alert the diagnostician to the possibility of a ruptured pheochromocytoma.
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PMID:Pheochromocytoma in two horses. 775 37

The case records were reviewed of 27 patients with chronic glaucoma after vitreoretinal surgery who underwent 28 cyclocryotherapy procedures between March 1987 and March 1992. The average intraocular pressure after 3 months was between 11.0 and 13.3 mmHg with an average fall of 24-26 mmHg. More than 85% had intraocular pressures of less than 21 mmHg after 3 months; 28% were hypotonic (IOP < 6 mmHg). Six months postoperatively, 68% maintained or had improved vision. The hypotonic eyes were found to have deterioration in vision more frequently than those with an intraocular pressure > 5 mmHg (57% compared with 24%). The odds of a hypotonic eye losing vision were 4.27 times greater than for a non-hypotonic eye. Cyclocryotherapy was successful in relief of pain in all 4 eyes which were painful pre-operatively.
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PMID:Cyclocryotherapy for chronic glaucoma after vitreoretinal surgery. 782 63

Twelve laboratory beagles underwent a routine left thoracotomy to insert permanent instrumentation. Every second dog was given 10 micrograms/kg of medetomidine, an alpha 2-agonist sedative. The rest of the animals were treated with 20 micrograms/kg of buprenorphine, an opioid agonist-antagonist, which is regularly used to treat postoperative pain in laboratory animals. The drugs were given at the end of operation (0) and 4, 8, 20, and 24 h postoperatively. Blood samples for catecholamines (adrenaline and noradrenaline) and blood gases (pCO2 and pO2) and pH were drawn immediately before any drug administration, and 30 min later. At the same time points, the pain level was subjectively evaluated using a pain score, and heart rate and rectal temperature were measured. Adrenaline and noradrenaline concentrations were lower in the medetomidine group than in the buprenorphine group. Accordingly, it was concluded that medetomidine had better analgesic effect than buprenorphine in the treated animals. This result was supported by subjective evaluation of the severity of pain, even though subjective evaluation is not considered very reliable in the present kind of open studies. pO2 was lower in the buprenorphine group than in the medetomidine group after the first injection of the analgesics. pCO2 and pH were similar in both of the groups. Medetomidine decreased heart rate after every injection, this fall and subsequent rise might be avoided by a lower dose regime. Buprenorphine did not effect heart rate. Rectal temperature did not differ in either group. It was concluded that medetomidine, and other alpha 2-agonists, possess some potential in postoperative pain alleviation.
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PMID:Medetomidine, an alpha 2-agonist, alleviates post-thoracotomy pain in dogs. 783 Mar 78

Eight female patients (aged 51 to 65 years) with New York Heart Association class II angina pectoris, normal coronary angiograms, normal hyperventilation, and abnormal exercise stress tests (chest pain and ST depression), and 5 sex- and age-matched controls participated in this study. Epinephrine was given intravenously to both patients and controls at 5-minute intervals in doses of 0.1, 0.2, 0.3, 0.4, and 0.6 nmol/kg/min. After rest (15 minutes), the alpha-adrenoceptor antagonist phentolamine or placebo was administered intravenously to patients in a double-blind, crossover study on 2 separate occasions in doses of 250 micrograms/min for 5 minutes and 500 micrograms/min for the next 10 minutes; the epinephrine infusion was repeated. Blood pressure, heart rate, and electrocardiogram were monitored continuously and pain was estimated on the Borg CR-10 scale. On a third occasion, chest pain was induced in patients using the same epinephrine protocol during echocardiographic monitoring. In the control group, all patients received the maximal epinephrine dose. No chest discomfort or pain developed. In the patient group, the maximal tolerable epinephrine dose (0.39 +/- 0.19 nmol/kg/min) decreased diastolic pressure (-14 +/- 9 mm Hg, p < 0.01) and increased heart rate (+24 +/- 10 beats/min, p < 0.01), not statistically different from the control group. Pulse pressure increased in the patient group (27 +/- 17 mm Hg, p < 0.01) but not in the controls. Left ventricular ejection fraction at baseline was within reference limits (58% to 75%) and did not change during epinephrine infusion.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effect of epinephrine infusion on chest pain in syndrome X in the absence of signs of myocardial ischemia. 757 75

Epidural opioids provide a potent analgesia not devoided of side effects. In addition, epidural administration of lipid soluble opioids has no clear advantage over the IV route. Combination of epidural opioids with other analgesics may strengthen analgesia and may decrease the incidence of side effects because of a reduction in the amount of opioid administered. Improvement in analgesia quality is documented when local anaesthetics are associated to opioids. Low concentrations of local anaesthetics may potentiate the effect of opioids on ions membrane channels at the level of the dorsal horn of the spinal cord. Alpha adrenergic agonists provide an alternative to local anaesthetics, allowing to improve pain control achieved with opioids. Epinephrine decreases plasma absorption of opioids and is especially useful to prolong the effect of short acting lipid soluble opioids. Alpha adrenergic agonists atc on alpha-2-adrenergic receptors of the spinal cord dorsal horn to depress pain nociceptive transmission. This effect potentiates the one of opioids at this level. Clonidine, which is a selective alpha-2-adrenergic agonist has been demonstrated to improve and to prolong analgesia produced by opioids in postoperative patients. Clonidine administration induces side effects, like sedation, bradycardia and hypotension, but allows to highly reduce the opioid dose. None of the combined techniques of analgesia implies that monitoring of the side effects of opioids has to be reduced.
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PMID:[Is there an advantage to using opioid combinations by the peridural route?]. 790 34

Adrenal medullary transplants in the spinal subarachnoid space may be a means of achieving sustained local delivery of pain-reducing neuroactive substances on a continually renewable basis. However, a potential limitation of this approach is tolerance development to agents released from the transplanted cells. In particular, since adrenal medullary chromaffin cells release opioid peptides, reduced antinociceptive efficacy of opioids is possible. To determine this, alterations in the dose-effectiveness of morphine were assessed in animals with adrenal medullary transplants. Results indicated that, not only was there no apparent tolerance, but that adrenal medullary transplants could potentiate the analgesic efficacy of morphine. An additional goal of these studies was to determine whether chronic or intermittent nicotine could produce increased antinociception, since stimulation of cell surface nicotinic receptors increases release of neuroactive substances from chromaffin cells. This was assessed using subcutaneously implanted nicotine pellets or repeated systemic administration of nicotine. Findings indicated that exposure to nicotine results in an acute tolerance, or tachyphylaxis, to nicotine which is rapidly reversed following cessation of nicotinic stimulation. Together, these results suggest that adrenal medullary transplants may provide a constant source of opioid peptides, augmentable by intermittent nicotinic stimulation, without the development of appreciable tolerance to these pain-reducing neuroactive substances.
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PMID:Absence of appreciable tolerance and morphine cross-tolerance in rats with adrenal medullary transplants in the spinal cord. 793 4

Abnormal constriction of coronary resistive vessels can induce angina and myocardial ischemia. The possibility that a microvascular vasomotor dysfunction could cause ischemia is in contrast with the well-known traditional notion that a metabolically induced vasodilation could compensate for the effect of an epicardial coronary stenosis. Vasoconstrictor stimuli can plausibly act on vessels situated immediately proximal (prearterioles) to those that can be dilated by ischemia metabolites (arterioles). This functional 2-compartment model of resistive vessels is based on the ability of different substances to cause opposite actions on resistive vessels with different sizes. The possible mechanisms of prearteriolar dysfunction, observed in patients with syndrome X, single vessel disease after a successful PTCA and in a subset of chronic stable patients include: an organic reduction of total vascular section; vascular smooth muscle hyperreactivity to heterogeneous constrictor stimuli; an impaired flow-mediated endothelium-dependent vasodilation (possibly due to a reduced NO and/or EDHF synthesis). The first and third hypothesis can only account for anginal episodes at effort while the second model could explain episodes occurring at rest and without an increase in heart rate. Those mechanisms causing an imbalance between myocardial oxygen supply and demand, induce an increased release of adenosine in order to promote a compensating vasodilation. Adenosine can possibly avoid the occurrence of ischemia but, being a powerful algogenic stimulus, causes pain. It is worth noting that the presence of patchy prearteriolar dysfunction induces areas with excessive release of adenosine. Since total vascular section is extremely large a massive adenosine spill-over can occur with a consequential boosting of algogenic and vasodilatory effect.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Mechanisms of coronary microvascular dysfunction]. 802 13

The specific ablative effect of pulsed 308 nm XeCl-excimer laser radiation (4 mJ 80 Hz) on the tissue has proved its worth in clinical use in glaucoma patients. However, the cytotoxic and mutagenic photochemical reactions induced by intraocular ultraviolet irradiation could theoretically be cataractogenic and retinotoxic. Unlike the excimer laser technique, ab externo sclerostomy with the Er:YAG laser (2940 nm/11 mJ, 7 Hz) excludes these risks. Histological and scanning electron microscope analysis of pig eyes showed thin, and smoothly limited zones of necrosis and only minimal irritation of the adjacent tissue and a slightly wavy surface. A newly developed handpiece for the Er:YAG laser enables energy transport via zirconium fluoride fiber and coupling to a quartz fiber tip with a core diameter of 320 microns. Er:YAG laser sclerostomy has so far been performed on 16 eyes in which the average preoperative IOP was 29 mmHg. The procedure took only a few minutes and the patients reported feeling no pain although retrobulbar anesthesia was not induced. The postoperative average IOP was less than 20 mmHg after 6 weeks and for the rest of a maximum observation period of 12 weeks. Reoperation was necessary in 2 cases. Er:YAG laser ab externo sclerostomy could be another alternative for the operative therapy of glaucoma.
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PMID:[Comparative study of ab-externo sclerostomy with the excimer and Er:YAG laser]. 812 20


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