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)

The response to porcine calcitonin has been assessed in 38 patients with Paget's disease, observed during 44 treatment periods of from three to 42 months. In 36 of the treatment courses significant relief of pain was achieved but the contribution of placebo effect could not be determined. Serum alkaline phosphatase and urinary hydroxyproline levels reached normal in a few patients, but the grouped data indicated a plateau effect above the range of normal. The acute hypocalcaemic response to calcitonin was lost only in those patients whose bone turnover was restored to normal. Quantitative histology on iliac crest bone biopsy samples showed no statisically significant lowering of osteoclast counts. No antibody-based clinical resistance occurred and the incidence of side effects was low. The results indicate that porcine calcitonin is a useful treatment of Paget's disease, and the experience of the study helps in arriving at patient selection and treatment schedules. Treatment is recommended for bone pain and for active disease in the relatively young, using intermittent therapy with course of at least six months duration. Resumption of therapy is based on clinical and biochemical indications.
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PMID:Clinical, biochemical and histological observations on the effect of porcine calcitonin in Paget's disease of bone. 26 91

Nine patients with painful Paget's disease of bone were treated for 200 days with a drug combination designed to elevated plasma calcium, hence stimulating the production of endogenous calcitoning and suppressing that of parathyroid hormone. This combination was oral calcium, a thiazide diuretic, a low phosphorus diet and aluminium hydroxide. Eight of the nine patients experienced sustained pain relief after 20--70 days. The mean plasma alkaline phosphatase (expressed as a percentage of the pre-treatment level) commenced to fall after 30 days of treatment and at 120 days was 58% of the pre-treatment level; this fall was sustained at 200 days. There was a mean rise of 0-08 mmol/l in plasma calcium; there was no significant change in plasma inorganic phosphorus or plasma creatinine. In view of the extremely low cost of this drug combination and its lack of side-effects, it is suggested it be considered as a treatment for Paget's disease of bone.
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PMID:A cheap oral therapy for Paget's disease of bone. 26 86

Calcitonin has been used in the treatment of Paget's Disease of bone because of its ability to inhibit osteoclastic bone resorption. This results in a return of bone turnover towards normal, as reflected by urinary hydroxyproline and serum alkaline phosphatase. A plateau is reached with these parameters, at about 50% of the pre-treatment level. The cause of this plateau is unknown, but does not indicate resistance to treatment, since it occurs with all forms of calcitonin. Most treated patients experience pain relief, and there is radiological and histological evidence of arrested progression of Paget's Disease in patients treated with calcitonin. Both primary and secondary resistance to calcitonin occur with all calcitonins, including homologous hormone. Antibodies develop commonly in patients treated with pig or salmon calcitonin, but antibody-based clinical resistance has been demonstrated only in a few patients. Methods of selection of patients for treatment and of assessment of response are discussed, and treatment schedules summarized.
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PMID:Treatment of Paget's disease with the calcitonins. 28 41

Duodenal ulcer. Forty-five of 49 adult outpatients with active, severe, endoscopically proven duodenal ulcers completed a 4-week double-blind trial comparing two doses of LS 519 (75 and 150 mg/day) with placebo. After 2 weeks, 1 of 15 patients given LS 75 mg and 4 of 15 given LS 150 mg/day had healed (P = 0.09). No patient given placebo had healed. After 4 weeks, 6 of 15 (40%) on placebo, 9 of 15 (60%) on LS 75 mg and 13 of 15 (86.7%) on LS 153 mg had healed (P less than 0.01). Patients given the highest dose of LS had significantly more pain-free days and nights and took fewer antacid tablets than those receiving the lowest dose of LS or placebo. Gastric ulcer. 19 of 20 adult outpatients with endoscopically proven active benign gastric ulcers completed a double-blind 4-week trial with either LS 519 (75 mg/day) or carbenoxolone (300 mg/day). Six of 10 (60%) given LS and 6 of 9 (66.7%) given carbenoxolone had healed after 4 weeks (N.S.). Symptomatic improvement was significantly faster in the LS group than in the carbenoxolone group. Hypokaliemia, increases in alkaline phosphatase and SGOT were observed in the carbenoxolone group.
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PMID:Pirenzepine (LS 519) in severe duodenal ulcer and in gastric ulcer. A double-blind clinical trial. 39 55

Thirteen cases of advanced Paget's Disease of bone were treated with Sodium Etidronate (EHDP) at 20 mg/kg/day for 6 months and followed at 2 to 3-month intervals for 20 months with serum alkaline phosphatase, 24-hour urinary hydroxyproline, radiographic skeletal survey, whole-body scanning with Tc-99m-Sn-EHDP and F-18, external body counting with the same radiopharmaceuticals over preselected areas, skin temperature, densitometry of normal phalanges and bone biopsies. Sodium etidronate had a marked effect on Pagetoid bone in all cases with reduction of bone turnover demonstrated by the chemistries, scanning, external counting, skin temperature and X-ray diffraction studies of the bone biopsies. Normal bone did not appear to be materially affected by the drug. Complications drug dose-related included new pain in 6 cases, two fractures in Pagetoid areas and one case of severe demineralization. There was one case of spinal cord compression unlikely to be drug related. All complications cleared or were successfully treated by the end of the study. Some patients continued to show reduction in bone turnover to the end of the study, as long as 14 months after stopping EHDP. Long-term follow-up is needed for final evaluation of the efficacy of the drug. Sodium etidronate shows promise as an agent in the treatment of Paget's Disease. Smaller doses or shorter courses of therapy or combination of EHDP and calcitonin may be just as efficacious and may avoid complications.
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PMID:Evaluation of sodium etidronate in the treatment of Paget's disease of bone. Osteitis deformans. 40 46

1. The current status of treatment for osteoporosis at the osteoporosis clinic of the Department of Orthopaedic Surgery, Kobe University School of Medicine is reported. A study was made in these osteoporotic patients to investigate the relationships between pain and x-rays and also between pain and the clinical laboratory findings in this particular disease. 2. When pains in osteoporosis were classified into 4 grades, severity I through severity IV, the more severe pain was found to be associated more frequently with elevated blood levels of alkaline phosphatase. Many of the patients with severe pain tended to show indistinct trabeculation and sclerosis of the upper and lower margins of vertebral bodies on x-rays while some demonstrated looser's zones notably in the ribs. 3. A considerable portion of those patients who were receiving treatment under the diagnosis of osteoporosis were found to have evidence of osteomalacia, a finding pointing to the likelihood of coexistence of osteoporosis and osteomalacia. This possibility should therefore always be kept in mind when dealing with osteoporotic patients.
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PMID:Treatment of osteoporosis--with special reference to the coexistence of osteoporosis and osteomalacia. 46 48

The effects of synthetic salmon CT, administered subcutaneously and intermittently (1 MRC U/kg/day for 15 days/month over 6 months) were investigated in 15 uremic patients on regular dialysis treatment (RDT), all presenting various degrees of osteodystrophy. Clinically, osteoarticular pain disappeared in 8 out of 10 cases; 1 patient with rib fractures had a rapid calcification of the bone fracture repair tissue. No significant changes were found in serum calcium and PTH levels. Phosphotemia showed a significant decrease within the first 20 days. The varying individual hypophosphatemic response proved to be related to the initial level of phosphatemia. The alkaline phosphatase, when increased, showed a decrease to the normal range. A significant decrease in osteoclastic hyperactivity (active resorption surface, osteoclast index) and a slight increase in osteoblastic pool (active osteoid surface) were documented. No change was noted when osteomalacia predominated. Side effects included: anorexia, nausea, vomiting, face flushing. Our data suggest that salmon CT may be usefully employed in chronic uremic patients on RDT, when secondary hyperparathyroidism predominates.
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PMID:Effect of calcitonin on bone lesions in chronic dialysis patients. 49 16

The results of liver, bone, and brain scans in 84 patients with recurrent or metastatic malignant melanoma were reviewed. The liver scan was initially positive in 18% (14/78) and ultimately in 32% (25/78). Serum alkaline phosphatase and lactic dehydrogenase were elevated in 92%. These patients ultimately developed positive liver scans, while convincing hepatomegaly was noted in only 44%. Bone scans were eventually positive in 33% (16/49), all of whom had pain. Brain scans were positive in 15% (10/65), all of whom had CNS symptoms. In asymptomatic patients, bone and brain scans only rarely disclosed occult lesions.
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PMID:Radionuclide scanning in patients with advanced malignant melanoma. 52 90

Thirty-two patients with osteitis deformans were treated with porcine calcitonin for 240 patient-months. Relief of pain occurred in 10 patients, while a fall in the serum alkaline phosphatase level was observed in 22 out of 24 patients whose treatment lasted for more than two weeks. Pain relief occurred predominantly in patients with pain in the lower limbs, although not all patients with lower limb pain showed improvement. Side effects, usually mild in nature, were reported by half the patients. Antiporcine calcitonin antibodies were detected in sera of six out of 14 patients. The presence of circulating antibodies seemed unrelated to the effect of therapy or to the occurrence of side effects.
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PMID:Porcine calcitonin in the treatment of Paget's disease of bone: experience with 32 patients. 55 8

Twenty-eight patients with symptomatic Paget's disease of bone were treated with synthetic salmon calcitonin for periods of 9 to 42 months (average, 23 months). Serum alkaline phosphatase concentration and urinary hydroxyproline excretion, which had been elevated before treatment, were decreased by calcitonin treatment in all patients, and some decrease was sustained in 23 in association with variable decreases in pain, heat and stiffness of major joints. Improvement was sustained further in approximately half of these patients; the other half had partial return of symptoms. Calcium absorption was increased in 9 of 10 patients studied; the increase did not correlate with plasma concentrations of parathyroid hormone. The mean endogenous fecal calcium excretion was decreased significantly but there was no significant change in mean urinary calcium excretion. Mean accretion rate of calcium to bone, studied in 10 patients, was decreased by 35% after 6 months of treatment and by a further 23% 1 year later. There was no consistent effect of calcitonin treatment on bone mineral mass. No serious adverse effects of treatment such as allergic reactions were observed. Calcitonin appears to be effective initially in most patients with Paget's disease of bone, but with long-term treatment resistance may be acquired.
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PMID:Long-term treatment of Paget's disease of bone with salmon calcitonin. 56 31


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