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

A case of spontaneous renal allograft rupture is described. Typically, this infrequent transplant complication occurred in the early post-transplant period in an oliguric setting with progressive pain, tenderness and swelling at the transplant site associated with hypotension and a decreasing hematocrit. Prompt surgical exploration and repair of the defect in the convex border of the renal allograft controlled hemorrhage and resulted in graft survival, and a normal blood urea nitrogen and creatinine 10 months after transplantation. There have been no rejection episodes and the renal biopsy demonstrated no evidence of rejection or acute tubular necrosis. Ice preservation for 24 hours and changes secondary thereto may have made the kidney susceptible to rupture when the position of acute flexion was assumed.
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PMID:Spontaneous renal allograft rupture without rejection: a case report. 78 13

The balance equation or oxygen-conservation equation in which oxygen consumption is equal to cardiac output times the maximal oxygen binding capacity times the oxygen saturation difference between arterial and mixed venous blood shows the three factors by which the oxygen supply to the tissues can be regulated according to the need. The release of oxygen to the tissues is regulated directly through the venous oxygen tension and indirectly through cardiac output, the 2,3-DPG system, and erythropoietin. Of these indirect regulation mechanisms, cardiac output has the most rapid response and erythropoietin the slowest. As the pool of oxygen in the tissues is comparatively small, the transport and the demand of oxygen under normal conditions are approximately equal over a longer period of time. The tissue oxygen tension (Fig. 21) is thus directly a result of the flows (Fig. 21), solid lines) and indirectly a result of the regulation mechanisms (Fig. 21, broken lines). Hypermetabolism, weight loss, and severe protein wasting characterize the metabolic response to thermal injury. The increased adrenergic activity following severe burns signifies a shift of flow of body substrate from storage to utilization and an increase in energy requirements. The greater the stress, the greater the response. All systems operate at maximal or near maximal levels. The critically injured patients have an accelerated glucose turnover and increased nitrogen loss; the main source of catabolized protein seems to be from skeletal muscle. The metabolic wheel has a tremendous speed. It is thus essential to feed the patient. Energy support with heat supply and nutrition must equal energy demand to avoid weight loss. Most important is to avoid loss of "lean body tissue." No hypermetabolism was found in burned patients when the patients themselves controlled the heat supply from infrared heaters. The metabolic rate corrected for rectal temperature was independent of the total body surface burned. The energy expenditure of patients with burns was studied during the daily treatment routine and showed that it is important to avoid hypovolemia, underhydration, pain, fear, and anxiety, all of which increase the metabolic demands. To prevent hypermetabolism, infrared radiation is a practical way of distributing energy from the environment to the patient. Weight loss can be essentially prevented as energy support equals energy demand (Fig. 20). Furthermore, the method has the advantages that many patients can be treated individually, the method is inexpensive, and the ambient air temperature can be kept normal. From the results of the present investigation, it may be concluded that in patients with burns treated with infrared heaters the energy intake can be predicted in an appropriate way from the calculated basal metabolism, the rectal temperature, and the activity of the patient. The effect of storage of blood on oxygen, proton, and carbon dioxide transport is mainly mediated over the concentration of 2,3-DPG...
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PMID:Transport and demand of oxygen in severe burns. 85 Feb 71

Severe, often fatal liver damage results from extreme overdosage with acetaminophen. In usual dosage, it is considered harmless. We describe three cases of toxic hepatitis associated with the chronic ingestion of excessive doses of acetaminophen. Each patient took approximately 5 to 8 g of acetaminophen per day during a period of several weeks. The transient elevations of serum hepatocellular enzyme concentrations and the histologic evidence of a toxic hepatitis suggest the liver damage was related to the use of acetaminophen. Alcohol abuse in one patient and negative nitrogen balance in another may have increased the susceptibility to acetaminophen toxicity. With the increasing popularity of acetaminophen for mild pain relief, hepatotoxicity from acute or chronic ingestion may be more common than previously recognized, especially in those patients with predisposing conditions.
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PMID:Chronic excessive acetaminophen use and liver damage. 90 Jun 73

This study has shown that repetitive exchanges between the American Apollo space vehicle atmosphere of 100% oxygen at 5 psia (258 torr) and the Russian Soyuz spacecraft atmosphere of 30% oxygen-70% nitrogen at 10 psia (523 torr), as simulated in altitude chambers, will not likely result in any form of decompression sickness. This conclusion is based upon the absence of any form of bends in seven crewmen who participated in 11 tests distributed over three 24-h periods. During each period, three transfers from the 5 to the 10 psia environments were performed by simulating passage through a docking module which served as an airlock where astronauts and cosmonauts first adapted to each other's cabin gases and pressures before transfer. Biochemical tests, subjective fatigue scores, and the complete absence of any form of pain were also indicative that decompression sickness should not be expected if this spacecraft transfer schedule is followed.
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PMID:Prevention of decompression sickness during a simulated space docking mission. 115 3

Crohn's disease involves a great risk of malnutrition. Malabsorption, bacterial contamination, frequent abdominal surgery, meal-related pain, protein loss through the damaged mucosa contribute to creating nutritional problems. Malnutrition can worsen the outcome, both in medical and surgical patients, and deteriorate an often already altered immune response. Weight loss, low levels of blood protein, electrolytes, micronutrients and vitamins are usually related to the extension of the mucosal damage. Nutritional assessment can be difficult due to oedema and bleeding, who interfere with both clinical and laboratory evaluation. The exact amount of nitrogen, lipids, minerals stool loss can be useful. It is widely accepted the use of nutritional support in Crohn's disease, but many Authors do not agree concerning the route (enteral or parenteral) and the kind of nutrient to be used. Still controversial is the role of nutrition: just support or real therapy? Most recent hypothesis concerning the pathogenesis of Crohn's disease indicate food and/or bacterial antigens as involved in determining the pathology. The "bowel rest", considered for many years as a fasting period necessarily supported by parenteral nutrition, can also be obtained by the temporarily reduction or stop in presenting those antigens to the bowel mucosa. This new concept can be achieved not only by parenteral nutrition, but with an enteral elemental diet as well. The elemental diet contains all nutrients in the simplest way and thus succeeds in lowering or eliminating the antigenic power. The reported results seem to indicate an equivalence of enteral and parenteral nutrition; anyway enteral is advisable when feasible, being more physiological and less expensive and involving a lower risk of serious complications.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Possibilities and limitations of nutritional support in Crohn disease]. 129 38

rac-Methadone is used clinically for the chronic maintenance treatment of heroin addiction and for the relief of pain. As the pharmacological activity of methadone is due primarily to the (-)-(R)-enantiomer, stereospecific measurements of methadone serum concentrations in methadone-treated patients are expected to be more relevant for clinical studies than earlier described total drug measurements. This study describes a stereospecific gas chromatographic (GC) method for the determination of methadone in serum. The extracted methadone was derivatizised with (-)-menthyl chloroformate. The diastereometric derivatives were analysed by GC on a capillary column and detected with a nitrogen-phosphorus detector. The resolution factor obtained for the methadone enantiomers was 1.1 with a relatively short time of analysis (30 min). By analysing the pure (-)-(R)-enantiomer, no racemization was seen during the analysis. The lower limit of quantitation was 75 nmol/l for each enantiomer. Measurements of the ratio between (-)-(R)- and (+)-(S)-methadone concentrations in serum from five methadone-treated patients showed interindividual differences (range 0.5-1.1). The patient results correlated well with those from another GC method measuring total methadone.
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PMID:Stereospecific gas chromatographic method for determination of methadone in serum. 138 63

This study examined respiratory function and metabolic and subjective responses in patients undergoing laparoscopic (n = 10) and open (n = 11) cholecystectomy for chronic cholecystitis and biliary colic. Patient groups were matched for age, sex, weight and height. The duration of operation was similar in both groups. Respiratory function tests (vital capacity, forced expiratory volume in 1 s, peak flow and arterial blood gases), urinary cortisol, vanillylmandelic acid, metanephrines and nitrogen loss, serum complement component C3 and C-reactive protein (CRP), full blood count, erythrocyte sedimentation rate (ESR) and subjective responses as assessed on a pain analogue scale and by analgesic usage were determined for up to 48 h after surgery. Deterioration in perioperative respiratory function was significantly less for laparoscopic surgery. Arterial blood gas determinations indicated a greater perioperative decrease in arterial pH, with carbon dioxide retention in patients undergoing open cholecystectomy (P < 0.02), reflecting poorer respiratory performance. Hormonal profile changes demonstrated an increase in urinary vanillylmandelic acid in the laparoscopic cholecystectomy group (P < 0.04); no differences were detected in urinary cortisol, metanephrine or nitrogen excretion. Acute-phase responses were greatest in patients undergoing open cholecystectomy as determined by ESR and CRP level (P < 0.02 and P < 0.003, respectively). Pain and analgesic usage were significantly decreased in the laparoscopic cholecystectomy group (P < 0.0009) and P < 0.0001), which led to a decreased hospital stay after operation in these patients (P < 0.0001). These data indicate improved respiratory and subjective responses and diminished acute-phase responses associated with laparoscopic surgery. Catabolic hormone release may, however, be increased.
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PMID:Physiological and metabolic responses to open and laparoscopic cholecystectomy. 847 69

It has been established that augmentation of air pressure from 0.1 to 1.1 MPa (with 0.1 MPa intervals) was accompanied in rats with the development of progressive analgesia which was measured according to the threshold of vocalization in the test of electrical stimulation of the tail. The highest analgesic response arose at 0.7-1.1 MPa. All the animals might be divided into two groups: group 1-72% of the animals with a 200% increase of the threshold, group 2--animals with such an increase by 15%. The augmentation of the pressure of heliox (79.1% of helium, 20.9% of oxygen) also caused analgesia, but not so strong. In patients pain thresholds to the mechanical nociceptive stimulation also increased by about 43-67% and 95-100% under the influence of increased air pressure of 0.4 and 0.7 MPa, respectively. In group 1 patients (67%) pain threshold increased by 50-100%, in group 2 by 15-25%. Pretreatment with naloxone (1 mg/kg), atropine (1 mg/kg), yohimbine (1 mg/kg), parachloramphetamine (5 mg/kg) and prasosin (1 mg/kg) decreased hyperbaric analgesia in rats by 41-56, 41-56, 17-19, 17-19%, respectively. The role of increased partial pressure of nitrogen in hyperbaric analgesia and possible neurochemical mechanisms of its realization are discussed.
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PMID:[Changes in pain sensitivity under increased atmospheric pressure]. 146 78

We treated 5 patients diagnosed with rheumatoid arthritis (RA) with nitrogen mustard (HN2) and monitored clinical and immunologic variables. HN2, 0.3 mg/kg ideal body weight was given over 7 days. Disease activity and immune function were monitored during and after treatment. Duration of morning stiffness (p = 0.0044), joint count (p = 0.0140), and assessment of pain (p = 0.0264) and function (p = 0.0057) improved by Day 6. T lymphocytes (p = 0.0060), especially T memory cells (CD4CD29; p = 0.0017) fell dramatically. HN2 is effective for rapidly gaining control of active RA. This effect is T cell specific.
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PMID:Nitrogen mustard as induction therapy for rheumatoid arthritis: clinical and immunologic effects. 149 86

Rapid euthanasia of laboratory rodents without the use of anesthesia is a necessary research technique whenever there is the likelihood of anesthesia or stress interfering with the chemistry of the tissues under investigation. Decapitation has long been the procedure of choice under such circumstances. Recently, however, the American Veterinary Medical Association (AVMA) panel on euthanasia recommended that decapitation be avoided on the grounds that the decapitated head may be conscious and suffering for as much as 15 seconds. The panel further recommended that if decapitation was scientifically necessary, the decapitated head be immediately immersed in liquid nitrogen. These AVMA guidelines now enjoy regulatory status; the recommendation that decapitation be avoided has thus caused considerable difficulty for all research requiring rapid, anesthesia-free collection of tissues. The scientific validity of these recommendations is consequently a matter of great practical as well as theoretical importance. The decision to discourage decapitation appears to have been based on a single literature report claiming that the EEG of the decapitated head revealed conscious suffering for more than 10 seconds (Mikeska and Klemm 1976). This review carefully examines the scientific literature on this subject. It is concluded that the report by Mikeska and Klemm of EEG activation in the decapitated head is correct, but that this phenomenon is also seen when the decapitated head is under deep anesthesia, and in normal brains under ether anesthesia or during REM sleep. Hence these findings do not demonstrate either consciousness or the perception of pain.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Euthanasia by decapitation: evidence that this technique produces prompt, painless unconsciousness in laboratory rodents. 152 30


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