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

Non-compliance in children receiving growth hormone (GH) treatment is often caused by pain on injection and difficulties in administration of GH. It has been suggested that automatic needle insertion diminishes pain perception. We quantitatively measured pain intensity on injection with two prototype pens for GH administration, providing either manual or automatic sc needle insertion, using a combined visual analogue/facial scale and a five-item scale in 18 children. With the automatic pen there was a significantly lower maximum pain score compared with the manual pen (median 28.5 versus 52.0 mm) as well as a lower mean pain score (mean 13.7 versus 23.5 mm). The five-item scale revealed that automatic needle insertion was significantly less painful than manual insertion and 13 patients chose to continue treatment with the automatic pen. In conclusion, pain during GH injection can be significantly diminished by automatic needle insertion, which may improve compliance in long-term GH treatment.
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PMID:Automatic needle insertion diminishes pain during growth hormone injection. 778 Feb 58

The case of an adolescent male with short stature and partial growth hormone deficiency who developed a slipped capital femoral epiphysis during the treatment with recombinant growth hormone is reported in this paper. Our patient started GH therapy with recombinant growth hormone at the dose of 15 U/m2/week administered subcutaneously three times a week. After 6 months of GH therapy there was a satisfactory response to the therapy and his growth velocity improved significantly. Unfortunately the patient had pain of the left hip which was exacerbated by walking. The diagnosis of slipped capital femoral epiphysis was confirmed radiographically and treated surgically with internal fixation of the epiphysis with the use of Moore's pins. Treatment with GH was discontinued. After one year there was the complete resolution of the disease and the adolescent was able to return at his usual way of life. Slipped capital femoral epiphysis is a disease in which the anatomic relationship between the femoral head and neck changes by disruption of the epiphyseal plate. This condition can occur only before the epiphyseal plate closes. Patients vary in age from newborn infant to teenager, nevertheless slipped capital femoral epiphysis is probably the most common hip disease during adolescence, and is often associated with endocrine imbalance including growth hormone deficiency. The aetiology of slipped capital femoral epiphysis is still unknown although many theories have been proposed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Slipped capital femoral epiphysis and biosynthetic growth hormone therapy. A case report]. 803 56

Patient compliance is of vital importance for the outcome of any medical therapy. Compliance is a problem especially in the treatment of non-life-threatening conditions, such as growth retardation in children, where motivation can be low and the rewards delayed. One way to improve compliance is through an improvement in patient convenience. As a result of these considerations as well as the positive experiences reported with insulin pen treatment, an injection pen for growth hormone administration (Nordiject) has been introduced. Results from several patient acceptance studies have shown that the injection pen and the preparation for use in the pen have been found effective and safe with good local tolerability and reduced perception of injection pain. The injection pen was found to simplify the injection procedure and was strongly preferred to conventional syringes and vials. Special attention has been paid to local discomfort and injection pain. A double-blind, randomized cross-over study has shown that 0.9% benzyl alcohol solvent causes statistically significantly less local discomfort that a 0.25% metacresol solvent when used for reconstitution of growth hormone. In another study the 30G needle was compared with 27G, and the use of the 30G needle seems also to give a reduction in injection pain. A further reduction in injection pain can be gained by improving the needle insertion technique. A randomized cross-over study compared two experimental devices, one with manual and one with automatic needle insertion. The results from this study showed a statistically significantly lower injection pain score for the automatic device compared to the manual. The above studies have shown that it is possible to improve patient convenience. Long-term studies will show whether this improvement results in improved compliance and hence a better treatment outcome.
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PMID:Improvement of patient convenience in treatment with growth hormone. 806 63

Lactation in humans requires the collaboration of neural and endocrine systems. During pregnancy and after parturition prolactin and also sex steroids, corticoids, growth hormone and human placental lactogen are necessary for lactogenesis. In an open, simple and prospective study, 50 women with normal delivery or cesarean section, between 34 and 41 weeks of gestation, were treated with lisuride, 0.2 mg t.i.d. for 14 days in order to inhibit lactation. The arrest of lactation was mandatory for medical reasons and the results were evaluated by changes in breast related with shape, volume, symmetry, coloring, temperature, turgescence, venous appearance, nipple condition, colostrum and lymph nodes increase. Lactation that was already present in 87% of patients in the first exploration 24 hours after delivery was satisfactorily suppressed and also breast pain, engorgement and discomfort caused by milk leakage. None had rebound lactation. 5 patients had light nausea. The dopamine agonist lisuride can be used for primary arrest of lactation with clinical effectiveness and without potential dangerous side effects of hormonal compounds.
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PMID:[Inhibition of lactation with lisuride. CLinical evaluation]. 816 21

The cause of cluster headache remains to be determined. The involvement of peripheral neurovascular structures can explain the pain and autonomic signs of a cluster attack, but not its rhythmicity. The central theory of cluster headache attributes the cyclic recurrence to involvement of the hypothalamus. To evaluate hypothalamic dysfunction a number of hormone studies have been carried out on cluster headache patients. Alterations in plasma melatonin, cortisol, testosterone, gonadotrophins, prolactin, growth hormone and thyrotropin have been documented, some only in the cluster period but others in the remission phase of the illness. We believe that the hormonal abnormalities in cluster headache support disorders of hypothalamic function.
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PMID:A review of hormonal findings in cluster headache. Evidence for hypothalamic involvement. 824 22

Slipped capital femoral epiphysis is a rare complication of growth hormone therapy. We report on a young man with pituitary insufficiency, diagnosed and treated with growth hormone at the age of 14 9/12. The patient withdrew from treatment after 6 months of growth hormone therapy without significant catch-up growth or complications. At the age of 21 8/12 years slipping of the left femoral capital epiphysis became apparent 2 1/2 months after treatment with growth hormone had been resumed in combination with low dose testosterone. Young adult patients with unfused epiphyses undergoing growth hormone substitution should be informed that pain in the lower extremities during therapy may be an important sign of a complication of growth hormone therapy. In this age group, patients complaining of pain in the limb should alert the physician to the possibility that a slipped capital femoral epiphysis may be present.
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PMID:[Acceleration of epiphyseolysis capitis femoris lenta as a complication of growth hormone therapy in hypophyseal insufficiency]. 844 57

The aim of this study was to evaluate patients' perception and acceptance of a new multi-dose injection device (Genotropin Pen) for recombinant growth hormone (GH) supplied in a two-chamber cartridge. The pen is combined with a very thin needle (B-D Microfine + (29 G) and meets future demands when dosing of GH will be changed from International Units (IU) to milligrams (mg). A total of 39 children receiving GH treatment (East Hospital, Gothenburg and St Bartholomew's Hospital, London), aged between 7 and 17 years, and 39 GH-treated adults (Sahlgrenska Hospital, Gothenburg and Karolinska Hospital, Stockholm), aged between 20 and 68 years, participated in the study. The daily dose ranged from 0.3 mg to 2.6 mg. The injections were given subcutaneously, once daily, and most of the patients used the thigh as an injection site. After a trial period of 2 weeks, injection technique, pain, fear of injection and convenience of the Genotropin Pen were compared with the experience with the prestudy device (Genotropin KabiPen 16, 16(8) or 36) by questionnaire. A total of 95% of the patients preferred the Genotropin Pen to the prestudy device for the following reasons: a greater certainty of correct dosing with the digital display; the possibility of correcting the set dose; the lock function of the injection button when injection is complete; more comfortable to hold due to the design and the plastic material; and reduced pain when injecting due to the thinner needles. Four patients (5%) preferred the prestudy device KabiPen as they considered this to be 'good enough'. Thus, the Genotropin Pen is a convenient injection device and most patients prefer it to the KabiPen.
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PMID:Patient evaluation of a new injection pen for growth hormone treatment in children and adults. 856 72

Fibromyalgia (FM) falls into the spectrum of what might be termed 'stress-associated syndromes' by virtue of frequent onset after acute or chronic stressors and apparent exacerbation of symptoms during periods of physical or emotional stress. Patients with FM exhibit disturbances of the major stress-response systems, the HPA axis and the sympathetic nervous system. Integrated basal cortisol levels measured by 24-hour urine-free cortisol are low. FM patients display a unique pattern of HPA axis perturbation characterized by exaggerated ACTH response to exogenous CRH or to endogenous activators of CRH such as insulin-induced hypoglycaemia. The cortisol response to increased ACTH in these stress paradigms is blunted, as is the the cortisol response to exercise. Functional analysis suggests that FM patients may also exhibit disturbed autonomic system activity. For example, plasma NPY, a peptide co-localized with norepinephrine in the sympathetic nervous system, is low in patients with FM. Abnormalities of related neuronal systems, particularly decreased serotonergic activity, may contribute to the observed neuroendocrine perturbations in FM. Finally, other neuroendocrine systems, including the growth hormone axis, are also abnormal in FM patients. Many clinical features of FM and related disorders, such as widespread pain and fatigue, could be related to the observed neuroendocrine perturbations. This hypothesis is supported by the observation that many useful treatments for FM affect the function of these central nervous system centres. Further clarification of the role of neuroendocrine abnormalities in patients with FM, and the relationship of these disturbances with particular symptoms, may lead to improved therapeutic strategies.
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PMID:Neurohormonal perturbations in fibromyalgia. 891 54

An autopsy case of transfusion-associated graft-versus-host disease (TA-GVHD) is reported with immunohistochemical investigation and polymerase chain reaction (PCR) analysis. In a 58-year-old male, esophagectomy for carcinoma was performed with a transfusion of 4 units of fresh whole blood. Diarrhea, fever, erythematous rash, pain and leukopenia occurred with an onset 11 days after the operation. He died of sudden dyspnea 29 days after the operation. At autopsy, histological examinations revealed lichenoid lesion in the skin, injury of mucosal epithelia in the digestive tract and damage of interlobular bile ducts in the liver. Immunohistochemical investigation suggested the association between these lesions and CD8-positive T lymphocytes. Severe disturbances of bone marrow and lymphoid organs were accompanied with gram-positive cocci infection in the lungs, esophagus and small intestine. PCR analysis of DNA at microsatellite loci, human growth hormone (HGH) and apolipoprotein B (Apo B), showed DNA chimerism and established the definitive diagnosis of TA-GVHD.
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PMID:Transfusion-associated graft-versus-host disease diagnosed by polymerase chain reaction analysis of DNA microsatellites: an autopsy case with immunohistochemical investigation. 894 30

Galanin, a neuroendocrine peptide with a multitude of functions, binds to and acts on specific G-protein coupled receptors. Only one galanin receptor subtype, GalRI, has been cloned so far, although pharmacological evidence suggests the presence of more than one galanin receptor subtype. These receptors mediate via different Gi/Go-proteins the inhibition of adenylyl cyclase, opening of K+-channels and closure of Ca2+-channels. Galanin inhibits secretion of insulin, acetylcholine, serotonin and noradrenaline, while it stimulates prolactin and growth hormone release. Determination of structural components of galanin receptors required for binding of the peptide ligand as carried out recently will facilitate the screening and design of molecules specifically acting on galaninergic systems with therapeutic potential in Alzheimer's disease, feeding disorders, pain and depression.
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PMID:Galanin receptors: involvement in feeding, pain, depression and Alzheimer's disease. 912 74


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