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)

Diabetic neuropathy is a common complication of diabetes mellitus with significant morbidity and mortality. Hyperglycemia with its secondary metabolic, vascular, and enzymatic consequences is most likely to be the predominant cause. The clinical manifestations includes a wide range of somatic and autonomic syndromes. Painful diabetic neuropathy may require symptomatic treatment. The precise role of therapies such as continuous subcutaneous insulin therapy and aldose reductase inhibitors remains to be clarified.
 ...
PMID:Peripheral diabetic neuropathy. 305 62

A case of sulindac-induced toxic epidermal necrolysis (TEN) is described; the etiology, symptoms, and treatment of TEN are reviewed; and sulindac's pharmacokinetic characteristics and other adverse effects are discussed. A 62-year-old black woman was given a prescription for sulindac 150 mg twice daily to relieve pain associated with degenerative joint disease. She also had a nine-year history of type II diabetes mellitus that was being managed with tolbutamide 500 mg once daily. After two weeks of sulindac therapy she developed a rash that spread over her entire body. Sulindac therapy was discontinued, and one day later the patient was admitted to the hospital with a temperature of 104.6 degrees F, conjunctivitis, and an erythematous macular rash over 60% of her body. Initially, therapy included prednisone 160 mg orally every day, applications of silver sulfadiazine cream four times daily for two days, and methylcellulose 0.5% ophthalmic solution (two drops four times daily) for the conjunctivitis. She also received intravenous hydration. By the fifth hospital day the patient's skin lesions and conjunctivitis had improved to the point that the prednisone dosage was tapered to 120 mg, then to 80 mg, and then to nothing over the following three days. Her diabetes was managed by short-term treatment with NPH insulin; however, before discharge, tolbutamide therapy was reinstituted, and insulin was discontinued. At follow-up four weeks after discharge, the patient's skin was largely clear. TEN has multiple etiologies, but the basic mechanism of injury is believed to be an immunological reaction directed at the basal cell layer.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Sulindac-induced toxic epidermal necrolysis. 323 97

Small and large fibre function was studied in 40 non-ketotic, newly diagnosed Type 1 diabetic patients and 48 age-matched controls, using 12 quantitative tests for assessment of cutaneous sensation. Patients were aged 10-39 years and had been treated with insulin for 4-31 days. Thermal discrimination (foot), warm and cold thermal perception (thenar eminence and foot), and heat and cold pain perception thresholds (thenar eminence) were significantly elevated in the patients as compared with the controls (p less than 0.05 to p less than 0.001). No significant differences in thermal discrimination (thenar), heat and cold pain perception (foot), and metacarpal as well as malleolar vibration perception thresholds were noted between the groups. The rates of abnormalities among the individual tests ranged from 0% to 27.5%, being lowest for vibration perception and highest for thermal perception thresholds after cold stimuli. The results in nine of 12 tests correlated significantly with age, but only two were related to HbA1c. Thus, sensory neural functions transmitted by small fibres, but not those transmitted by large fibres, were impaired in newly diagnosed Type 1 diabetics after the correction of initial ketosis and hyperglycaemia. Cooling perception tests were most sensitive in detecting abnormality. An age-related involvement of different small fibre functions was present in these patients.
 ...
PMID:Evaluation of thermal, pain, and vibration sensation thresholds in newly diagnosed type 1 diabetic patients. 323 20

Twenty three patients with chronic calcific pancreatitis of the tropics in Northern India were prospectively studied. All had pancreatic calcification and ERCP changes typical of chronic pancreatitis, the most predominant being ductal dilatation which was detected in all patients by both ERCP and by ultrasonography. Pain was present in 19 (83%) patients and diabetes in 11 (48%) patients. Exocrine pancreatic dysfunction was uncommon, steatorrhoea being present in only 9% of patients. Ten of the 11 patients with diabetes required insulin for control and one case was able to be controlled by an oral antidiabetic agent. Two patients developed ketoacidosis during acute episodes of pancreatitis, 3 patients had peripheral neuropathy and one patient had visual changes. Recurrent severe pain was the reason for operation in 7 patients. All had a lateral pancreaticojejunostomy. In order to obtain an objective assessment of pain, a scoring system was developed to grade its severity according to its intensity, frequency and consequences. Six patients who preoperatively had a pain score of 15 or more (out of a maximum score of 24) attained significant relief after the surgery. We feel this scoring system may provide an easy objective assessment of pain in the subsequent follow-up of these patients.
 ...
PMID:Chronic calcific pancreatitis: clinical profile in northern India. 329 40

The influence of epidural neural blockade on postoperative insulin resistance was studied using the euglycaemic insulin clamp technique. Eighteen patients undergoing elective upper abdominal surgery of moderate severity were allocated to two groups: group G patients underwent operation under general anaesthesia, and postoperative pain was relieved by systemic administration of analgesia; and group E patients received epidural analgesia during surgery and epidural morphine postoperatively. In each patient the euglycaemic insulin clamp test was performed twice: several days before surgery and on postoperative day 1. Peroperative catecholamine and cortisol responses were also measured to investigate possible endocrine mechanisms of the insulin resistance. Glucose disposal (M) decreased in both groups on postoperative day 1 at plasma insulin concentrations ranging from 1.2 to 10.0 milliunits ml-1, resulting in the downward shift of dose-response curves. However, this downward shift was significantly smaller in group E than in group G patients. Urinary adrenaline excretion increased markedly on the day of operation in group G, but was significantly inhibited in group E. Urinary noradrenaline excretion increased mainly on postoperative day 1 in group G, but was significantly inhibited in group E. Plasma cortisol response was lower in group E than in group G during and shortly after operation, and was significantly inhibited in group E on postoperative day 1. These results indicate that insulin resistance after elective abdominal surgery is due to a postreceptor deficit in glucose utilization, as indicated by the downward shift of the dose-response curves. This disturbance in glucose metabolism was reduced by epidural analgesia, the results being associated with inhibited catecholamine and cortisol responses.
 ...
PMID:Effect of epidural analgesia on postoperative insulin resistance as evaluated by insulin clamp technique. 329 93

Previous studies have claimed that changes in insulin and glucose metabolism in patients with peripheral arterial insufficiency indicate an increased sensitivity to insulin for glucose uptake. We have re-evaluated this concept in 11 patients with intermittent claudication and 11 matched controls with a multilevel euglycaemic glucose clamp technique. The groups were matched for age, sex and body composition but not completely for smoking habits and physical fitness. Although the control group had a normal physical fitness the patients had 40% lower maximal exercising capacity. The patients' maximal walking capacity was 186 +/- 27 m evaluated on a treadmill. No patient with ischaemic ulcers or rest pain were included. The euglycaemic glucose clamp was performed at five insulin plateau levels (70, 110, 190, 590 and 1440 mU/l) of one h duration each and whole body glucose uptake during the last 20 min was calculated. No differences in maximal glucose uptake (Vmax) or insulin level for half maximal glucose uptake (Km) between the groups were observed. The concentration or the magnitude of the decrease in arterial FFA levels did not differ significantly between the groups at any physiological insulin level. This study can not confirm previously described changes in insulin sensitivity in patients with arterial insufficiency. Although the discrepancy between present and previous results remains unclear it may reflect the combined effects of different methods used, including the selection of reference patients, rather than an increased insulin sensitivity in patients with arterial insufficiency. This study suggests that previous conclusions based on glucose tolerance tests should be interpreted with caution.
 ...
PMID:Insulin sensitivity in patients with arterial insufficiency. Re-evaluation with the multilevel glucose clamp technique. 330 Nov 68

In experiments on male Albino-Swiss mice weighing 18-22 g insulin given in doses of 2 i.u./kg caused no change in the time of reaction to pain, while the same dose administered daily for 7 days potentiated the analgesic action of morphine (3 mg/kg s.c.). Glucose caused no change in this effect of insulin. After 14 days of insulin treatment the time of reaction to pain in the animals subjected to the action of morphine returned to its initial value. Twenty-four hours after the last administration of morphine the level of gamma-aminobutyric acid (GABA) was found to be decreased in the animals receiving insulin with glucose. These results suggest that the central action of insulin is dependent not only on hypoglycaemia produced by it, but may be due also to its direct action on the central structures and an indirect action mediated by its effect on other neurotransmitter systems.
 ...
PMID:The effect of repeated administration of insulin on pain threshold and gamma-aminobutyric acid level in mouse brain. 333 Dec 34

The operation of total pancreatectomy is performed rarely. Its role in the management of patients with chronic pancreatitis remains to be elucidated. We have reviewed our series of 29 total pancreatectomies for benign disease [14 women median age 39 years; 15 men median age 34 years]. Twelve underwent standard total pancreatectomy, in 17 duodenum preserving total pancreatectomy (DPTP) was performed. There was one death (mortality 3.4%). In no patient was the total pancreatectomy the first operative procedure. The patients were compared with age and sex matched diabetic control subjects selected on a best fit basis from the diabetic clinic database. The aetiology of the pancreatitis was idiopathic nine, pancreas divisum nine, alcohol eight and other causes three. The indication for surgery was pain 27, acute pancreatitis one and cholangitis with pancreatitis one. The complications of the procedures were mainly caused by infection [wound three, chest six and central line sepsis four] and in two there was a leak from the duodenum; no patient required re-operation. The postoperative stay [standard total, median 21 days (range 13-98) DPTP median 31 days (range 17-49)] has lengthened over the period due to greater attention to analgesic, diabetic and enzyme deficiency control before discharge. In standard total pancreatectomy there were five major hypoglycaemic episodes with only two in 17 DPTP patients. The per cent ideal body weight, the insulin requirement and the HbAl compared less well in standard total pancreatectomy group compared with controls than did DPTP. With both groups large doses of enzyme replacement were required, and this proved of importance in diabetic control. Our experience with total pancreatectomy suggests that pain will be improved in over 80% of patients and that the results of surgery will improve with prolonged follow up provided attention is given to analgesic abuse, enzyme deficiency and diabetes.
 ...
PMID:Total pancreatectomy for chronic pancreatitis. 335 68

The effect of combined use of pentoxifylline and solcoseryl was studied in 35 patients with chronic pancreatitis. General clinical findings were studied in parallel with the time course of pancreatic exocrine (trypsin) and endocrine (insulin, C-peptide) function. The blood level of gastrin and changes in intestinal function using 131I-lipids were also studied. The incorporation of both drugs in multimodality therapy made a positive therapeutic effect, resulting in a decrease in the pain syndrome and dyspeptic symptoms. At the same time some favorable shifts in pancreatic and GI tract function were noted. Possible mechanisms of a positive therapeutic effect were discussed. A conclusion was made that the incorporation of pentoxifylline and solcoseryl in multimodality therapy of chronic pancreatitis was clinically justified and determined pathogenetically.
 ...
PMID:[Trial of the combined use of trental and solcoseryl in treating patients with chronic pancreatitis]. 336 55

In healthy volunteers, possible complications at the needle site were studied during short-term as well as continuous subcutaneous infusion of aqueous fluid with portable mini-pumps. Local complications, such as leakage of fluid, erythema, and bacterial contamination of the hypodermic needle were associated with the duration of the indwelling time, but not with the total volume delivered during every experiment. The hypodermic steel needle caused pain when the subcutaneous fat tissue layer was thin. These findings may have clinical relevance for the performance of continuous subcutaneous hormone infusion therapy (e.g. insulin-pump treatment of type-I diabetes mellitus).
 ...
PMID:Cutaneous complications induced by continuous subcutaneous infusion. Experimental studies with portable mini-pumps. 340 42


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