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 correlation of 22 commonly used clinical and laboratory abnormalities with linear extent of the lesion was studied in 70 patients with Crohn's ileitis, 16 of whom had inactive disease and 54 active disease. Extent was measured radiologically using a well-validated double-contrast technique. In the patients with active disease, lesion length was significantly correlated with weight loss, serum albumin, total protein, and serum iron. In the group without active inflammation, pain and abdominal mass were significantly correlated with lesion extent. No correlation was found between linear extent of lesion and the following: an index of inflammatory activity (New Crohn's Disease Activity Index), several acute-phase reactants, and the components of the complete blood count. Only total protein and serum iron had a significant regression coefficient following a procedure of stepwise regression. No mathematical model was found capable of satisfactorily predicting the length of lesion.
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PMID:Relationship between clinical and laboratory parameters and length of lesion in Crohn's disease of small bowel. 649 27

The cyanide antidote 4-dimethylaminophenol . HCl (DMAP) was administered orally, i.v., or i.m. to man and dog. Ferrihemoglobin formation and changes of several parameters in human blood were investigated to obtain information on damage to liver, kidney, muscle, and red blood cells; in addition, the metabolism of DMAP was studied. In dogs, the initial rate of ferrihemoglobin production (DMAP, 3.25 mg/kg i.v. or i.m., 15 mg/kg orally) amounted to 28%, 3.5%, and 2% of the total hemoglobin per min; the corresponding values for man were 9%, 2%, and 2% per min. The dogs behaved normally while CPK increased after i.m. injection. In man, only i.m. injection of DMAP (3.25 mg/kg) was followed by increases in LDH, GOT, and CPK of 110, 260, and 490%, resp.; while total bilirubin, conjugated bilirubin, and iron concentration rose by 270, 120, and 50%, respectively. Bilirubin and iron concentration increased also after DMAP i.v. (3.25 mg/kg) or when it was taken orally (600 or 900 mg). The lactate concentration was not influenced while the pyruvate concentration increased by 50%. DMAP produced hemolysis in vitro. Generally, the values determined in vivo approached the starting level within 1 week. Intramuscular injection of DMAP induced reversible subjective and objective symptoms, e.g., local pain, swollen buttock, fever reaction. The urine showed no pathological changes. About 54% of DMAP taken orally was excreted as metabolites in the urine, 41% as glucuronide, 7% as sulfate, and 6% as thioethers. After i.v. administration the total of metabolites was somewhat higher, and the thioether proportion was 15%. The results indicate that DMAP is readily absorbed after oral administration but undergoes significant first pass effect in the liver. Therefore, the 4-fold i.v. dose must be administered orally to achieve the same ferrihemoglobin formation.
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PMID:Effects and biotransformation of 4-dimethylaminophenol in man and dog. 663 49

This discussion of vaginal bleeding in adolescents reviews the causes of dysfunctional uterine bleeding (complications of pregnancy, pelvic inflammatory disease and/or complications of the use of oral contraceptives or IUDs, blood dyscrasias, trauma and foreign bodies, tumors, and other causes) as well as the diagnosis and treatment of dysfunctional uterine bleeding. Menstrual irregularities are the most common cause of abnormal vaginal bleeding in adolescence and can be managed easily in the office. On occasion an adolescent needs to be hospitalized for acute menorrhagia; very rarely a surgical procedure such as dilatation and curettage is necessary. Dysfunctional uterine bleeding is defined as abnormal uterine bleeding without local anatomic causes. It is a diagnosis of exclusion and requires an adequate examination of the vagina, cervix, and other pelvic organs. Some local bleeding presents as irregular vaginal bleeding in adolescents and is diagnosed as dysfunctional bleeding. The diagnosis of pregnancy and related complications (threatened abortion, incomplete or complete abortion, ectopic pregnancy, and postabortal trophoblastic disease) may present as irregular bleeding in the practitioner's office. A teenager may give a history of pregnancy if she is questioned about it closely and confidentially. A high index of suspicion will help the clinician to make this diagnosis. Salpingitis should be suspected in any teenager who presents with low abdominal tenderness, pain, abnormal bleeding, low grade fever, and tenderness on cervical movement. Approximately 10% of teenagers with blood dyscrasias present with cyclic hypermenorrhea. Vaginal ulcerations and objects introduced into the vagina occasionally cause irregular bleeding. Such tumors as clear cell adenocarcinoma of the vaginal and sarcoma botyroides may present as metrorrhagia. These etiologic factors comprise as most only about 5% of adolescents who complain of irregular vaginal bleeding. The most common cause of such bleeding is anovulation or oligoovulation due to the noncyclic release of follicle stimulating hormone (FSH) and luteinizing hormone (LH) during adolescence. Although the most common cause of this cyclic disturbance is the hypothalamic pituitary ovarian axis, some well known endocrine disorders can also produce this picture. 95-97% of adolescents will have no organic reason for their irregular bleeding. The diagnosis of dysfunctional uterine bleeding is then made. Detailed suggestions are provided on how to proceed which will prevent grave errors in the diagnosis and treatment of dysfunctional uterine bleeding in adolescents. The patient who has been bleeding very heavily and has a hematocrit less than 30 may have to be hospitalized. A medical D and C can be done with a progestational agent. Such patients may need a transfusion of packed cells and should be kept on oral iron. They also need cycling with Ovral for 2-3 months and must be followed carefully.
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PMID:Vaginal bleeding in adolescents. 674 72

We have observed the following complications with radial keratotomy which require further evaluation: missing the visual axis while marking the central cornea, regression of myopic flattening, epithelial defects, recurrent erosions, stromal overgrowth, Cogan's map-dot fingerprint corneal dystrophy with Moncreiff iron lines, blood in the incisions, vascular ingrowth, perforation of the anterior chamber, induction of astigmatic errors, epithelial ingrowth, glare complaints and decreased night vision, pain, fluctuating vision from morning to evening, overcorrection and unpredictable results, contact lens refitting difficulties, endothelial cell loss, and corneal scarring. We feel these complications require extensive further study before the relative safety and long-term efficacy of this experimental procedure may be determined.
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PMID:Radial keratotomy: preliminary report of complications. 697 21

A 33-year-old white female of English descent with beta thalassaemia trait developed painful recurring bilateral knee effusion at age 15 years. Trauma was denied. Synovial analyses revealed noninflammatory effusions with normal complement, no inclusions, and no crystals. Knee x-rays normal at ages 18 and 26, showed mild osteoarthritic changes at age 33. Laboratory tests for other known causes of arthritis were repeatedly normal or negative. Bone densitometry was below normal. Light microscopy of the synovial membrane showed no significant abnormalities and no iron deposition. Electron microscopic findings included multilamination of vascular basement membranes and large amounts of thin fibrils surrounding many connective tissue cells. Treatment with salicylates did not prevent recurrence of effusions, and quadriceps strengthening and joint rest were moderately successful in relieving pain. Intra-articular corticosteroids on 2 occasions were not helpful. Whether her knee arthritis is purely secondary to the para-articular bone thinning from the chronic marrow expansion remains to be determined.
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PMID:Arthritis in beta thalassaemia trait: clinical and pathological features. 722 91

We report the hematologic and clinical features of four adult patients (Pts.) with sickle cell anemia and iron-limited erythropoiesis. Two of the Pts. had spontaneous iron deficiency (chronic GI bleeding, low-grade hemoglobinuria). In the other two Pts. iron restriction was induced by periodic RBC aphereses as part of a pilot protocol designed to decrease intracellular HbS polymerization by MCHC reduction. Iron-limited erythropoiesis was defined by reduction in red cell indices (MCV range 60.4-67 fl) in the presence of low serum ferritin (range < 10-20 ng/ml). In these Pts. iron restriction did not cause clinically significant worsening of the anemia (Hb 7.8-9.0 g/dl). In two Pts. the anemia actually improved. Other hematologic effects of iron restriction were: decreased MCHC, reticulocyte count, RDW, and dense cells. A reduced hemolytic rate was suggested by a lowering of serum bilirubin and LDH. In one of the Pts. the 51Cr RBC T1/2 survival increased from 12 to 16 days. The intracellular HbS polymer fractions (fp) were determined at 25% O2 by Csat and with the use of the conservation of mass equation. The baseline fp values ranged from 0.48-0.53. After iron restriction they ranged from 0.33-0.48. The fp decreased even though iron-limited erythropoiesis also lowered the Hb F concentration in three of our Pts. In one of the two Pts. with induced iron depletion, hospitalization days for pain crises decreased from an average of 4.5 days/month (2 year baseline period) to an average of 0.5 days/month in the 3 year follow-up after iron depletion. The second patient with induced iron restriction experienced the rapid healing of a leg ulcer. Controlled iron restriction should be explored as a therapeutic strategy in selected SS patients.
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PMID:Improvement of sickle cell anemia by iron-limited erythropoiesis. 766 35

Activation of cardiac sympathetic afferents leads to excitatory cardiovascular reflexes and pain during myocardial ischemia. We hypothesized that cardiac sympathetic afferents are activated by reactive oxygen species produced during ischemia and reperfusion. Single-unit nerve activity of 55 afferents was recorded from the left paravertebral sympathetic chain (T1-T4) in cats anesthetized with alpha-chloralose. Receptive fields of all afferents were located on the right or left ventricle. Mechanical and chemical sensitivities of each afferent ending were evaluated by von Frey hairs, cardiac distension, and local application of bradykinin (BK, 142 pmol) or H2O2 (7.5-15 mumol) to the receptive field. Thirty-one afferents (56%) were responsive to bradykinin (BK), H2O2, and ischemia (2 or 10 min). Deferoxamine (Def, 10-100 mg/kg), dimethylthiourea (DMTU, 10-100 mg/kg), or iron-loaded Def (10 mg/kg) were employed to evaluate the role of H2O2 and hydroxyl radicals (.OH) in activating these afferents (10A delta and 21C fibers) during ischemia and reperfusion. Treatment with the nonspecific scavenger DMTU (n = 10) significantly diminished the increase in discharge activity evoked by ischemia and reperfusion. Treatment with Def also significantly attenuated the responses during ischemia and reperfusion. Thus reactive oxygen species, particularly .OH, activate a group of cardiac sympathetic A delta- and C-fiber afferents during myocardial ischemia and reperfusion and may play an important role in mediating cardiovascular sympathetic reflex responses and/or pain transmission.
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PMID:Ischemia- and reperfusion-sensitive cardiac sympathetic afferents: influence of H2O2 and hydroxyl radicals. 757 32

The efficacy of a eutectic mixture of local anesthetics (EMLA) in alleviating the pain associated with subcutaneous needle insertion for infusion of the iron-chelating agent, deferoxamine, was examined in 12 patients with homozygous beta-thalassemia. As reported by the patient using a 100-mm visual analogue scale, the pain of insertion was rated as significantly less after application of EMLA (mean +/- SD, 1.5 +/- 2.2 mm) than the pain associated with needle insertion without EMLA (34.8 +/- 33.5 mm, P = .005). Subsequently, in a double-blind randomized trial of 10 beta-thalassemia patients, EMLA was significantly better (5.7 +/- 8.2 mm) than placebo (27.0 +/- 22.8 mm, P = .01) in reducing the pain of needle insertion for deferoxamine infusion. No adverse effects were reported with the use of EMLA cream. These results suggest that EMLA may be effective in reducing the pain associated with needle insertion for subcutaneous deferoxamine infusion in beta-thalassemia patients, which may lead to improved compliance with this irritating, prolonged therapy. The safety of EMLA use in these patients, and others receiving regular parenteral therapy, should now be examined.
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PMID:Use of a eutectic mixture of local anesthetics for prolonged subcutaneous drug administration. 760 20

Erythropoietic protoporphyria (EPP) is an inherited inborn error of porphyrin metabolism caused by decreased activity of the enzyme ferrochelatase, the terminal enzyme of the haem biosynthetic pathway, which catalyses the insertion of iron into protoporphyrin to form haem. EPP is characterized clinically by photosensitivity to visible light commencing in childhood, and biochemically by elevated red cell protoporphyrin levels. Although the majority of papers and reviews have classified EPP as an autosomal dominant disorder, the inheritance has now been shown to be more complex, and both autosomal dominant and recessive patterns of inheritance have been demonstrated using ferrochelatase activity. Further molecular studies should clarify the exact mode of inheritance. It seems likely that in the majority of families a defective allele from the apparently normal parent will be required for disease expression, but another possibility is autosomal dominant inheritance with low clinical penetrance. Exposure to bright sunlight, for as little as a few minutes in the worst affected patients, causes burning pain in exposed skin, which may be so severe and persistent that it prevents sleep for several nights. Patients usually attempt to relieve the pain by cold water or cold compresses. Apart from sun avoidance, the mainstay of prophylactic treatment has been beta-carotene. Although the published evidence for the effectiveness of beta-carotene is impressive, no controlled trials using adequate doses have been performed to unequivocally confirm its usefulness. The most serious complication of EPP is acute hepatic failure, which is due to accumulation of protoporphyrin in the liver. If jaundice develops, a rapidly fatal outcome often follows, unless liver transplantation is undertaken. Regular monitoring of liver function and red cell porphyrin levels is advisable, but this does not always identify patients before serious liver damage has occurred. Even when patients are identified at an early stage in the development of liver disease the therapeutic options available to prevent further damage are limited, and have not been fully evaluated. The gene for ferrochelatase has been cloned, sequenced and mapped to the long arm of chromosome 18. As mutations continue to be identified, phenotype/genotype correlations should become apparent, and it may eventually be possible to identify those patients at risk of developing hepatic failure. In addition, as the basic enzymatic defect in EPP is at the level of the bone marrow stem cells, which are the target cells of choice in the development of retroviral-mediated gene transfer, definitive treatment of EPP by gene therapy is a distinct hope for the future.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Erythropoietic protoporphyria. 873 51

Twenty-five cases of diffuse pigmented villonodular synovitis of the knee in 23 patients were reviewed to identify characteristic clinical presentations and histologic findings. All cases met strict histologic criteria for diagnosis. Clinical presentation consisted of insidious and progressive symptoms of significant joint swelling with discomfort, but not isolated pain. On physical examination, a suprapatellar pouch that was markedly distended by either effusion, synovial masses, or both, and a slight flexion posture were the most consistent findings. Aspiration to detect a bloody effusion was unreliable as a diagnostic tool. Pigmentation was absent in 16% of the gross specimens. Histologically, iron deposition was present in all cases and to a moderate or marked degree in most. Fibrosis, hyalinization, and chronic inflammatory changes were present in most, but to a lesser degree. No patient had gross, histologic, or treatment follow-up findings consistent with neoplasia. Attempts to predict clinical outcome based on histologic findings were unrewarding.
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PMID:Diagnostic features of diffuse pigmented villonodular synovitis of the knee. 811 78


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