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

The physiological and biochemical responses of the body following major injury or severe infection are characterized by hypermetabolism, accelerated gluconeogenesis, and the mobilization of substrates from the carcass to be utilized by visceral organs. These responses in the febrile patient are supported by an elevated cardiac output which insures perfusion of vital organs and provides additional bloodflow to the area of inflammation and/or injury. Because of the accelerated substrate flux and increased catabolism, weight loss and negative nitrogen balance are profound. Cumulative losses rapidly approach near-lethal limits if adequate nutritional support is not instituted. Nutritional maintenance will support the febrile response, maintain body nitrogen and acute phase protein synthesis, and assure an ongoing energy supply. Reparative tissue appears to preferentially utilize substrate, but if malnutrition occurs, wound healing and tissue repair may be limited. The effects of nutritional support on immunological function in these critically ill patients are only now being dissected. Clearly, immunosuppression is related to the initial insult and abnormalities in host defense mechanisms occur almost immediately in patients well nourished before illness. In addition, nutrient depletion and erosion of body mass are also associated with immunological dysfunction so that these two factors combine to impair the patient's resistance to subsequent infection. Present therapy should maintain balance of essential nutrients while complications associated with specialized techniques of nutrient support are minimized. Control of the patient's environment, minimizing pain and discomfort, preventing "bad rest" effect through exercise are all techniques of supportive care, but responses are ablated with resolution of the infection or wound closure, and every effort should be directed toward this goal.
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PMID:Alterations in protein, carbohydrate, and fat metabolism in injured and septic patients. 688 43

In order to assess the analgesic properties of epidural low-dose morphine and its possible influence on the adrenocortical, hyperglycemic, renal, electrolyte and leukocyte responses to surgery and nitrogen excretion, a double-blind randomized study was undertaken in 14 otherwise healthy patients admitted for hysterectomy under halothane, N2O/o2 anesthesia. Before induction of anesthesia, an epidural catheter was introduced into the lumbar epidural space. After induction of anesthesia, either morphine 4 mg in 10 ml saline or 10 ml saline was injected into the epidural space, according to the allocation. Postoperatively, the degree of pain was evaluated by mean of a visual analogue scale (0-10). When pain score exceeded 5 points during the 24 -h trial, either 4 mg morphine in saline or saline was given epidurally. If the pain score did not decrease more than 2 points after an epidural injection, morphine was given parenterally (5 mg i.v. +5 mg i.m.). The results showed that pain scores, duration of pain relief and doses of morphine differed significantly between groups (P less than 0.05). Plasma concentration of cortisol and glucose, plasma-and urine electrolytes, 24-h creatinine and free-water clearances, diuresis, fluid balance, leukocyte count and nitrogen excretion differed insignificantly between groups. In conclusion, epidural low-dose morphine is a superior alternative to conventional postoperative pain treatment because of greater and longer lasting pain relief, without apparent side-effects. The measured endocrine-metabolic and renal response did not differ between groups, indicating that low-dose epidural morphine does not inhibit afferent neurogenic stimuli from the site of surgical trauma.
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PMID:Influence of epidural morphine on postoperative pain, endocrine-metabolic, and renal responses to surgery. A controlled study. 707 76

The author investigated the efficacity of the treatment of perianal condylomata by means of kriosurgery. As a kriogen he used Nitrogen oxydul by which is achieved a temperature of minus 75 degrees C. 20 patients was treated of minus 75 degrees C. During the postoperative period 2 of them experienced severe pains, 15 had mild pains, whereas 3 patients only were without pains. The pain lasted up to the fifth day following the surgery. In all patients a leakage of the perianal region was present. Three patients showed recidivation of the illness. The author conclude that by kriosurgical treatment condylomata can be treated effectively, especially if they are of the smaller size.
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PMID:[Treatment of perianal condylomata acuminata with cryosurgery]. 709 Jun 96

A case report is presented of toxic shock syndrome associated with the use of a contraceptive diaphragm and recent removal of an IUD. A 23 year old woman was admitted to St. Paul's Hospital in Vancouver, British Columbia because of frequent watery diarrhea and vomiting that had begun suddenly 2 days earlier, as well as generalized abdominal and muscular pain, fever and sweating of 1 day's duration. The patient's last menstrual period had ended 3 weeks earlier. Oral contraceptive (OC) therapy had been stopped 9 months earlier, and 2 weeks before admission an IUD had been removed because of dyspareunia. A diaphragm had been inserted 24 hours before the onset of symptoms and was in place at the time of admission. Removal of the diaphragm revealed about 10 ml of greenish yellow pus. Laboratory tests showed multiorgan involvement. The blood urea nitrogen level was 35 mg/dl and the serum creatinine level 2.9 mg/dl. The serum amylase level was 125 IU/l at the time of admission but rose to 1021 IU/l by day 6. The prothrombin time was 16 seconds. Arterial blood gas studies while the patient was breathing room air showed the following: pH 7.36, carbon dioxide tension 20 mm Hg and oxygen tension 84 mm Hg. Urinalysis showed pus and a small amount of glucose. Treatment consisted of blood volume expansion and electrolyte replacement. The patient showed improvement within 48 hours. 6 days after admission an exfoliative desquamating rash developed on the volar surfaces of the fingers and feet, and a slight scaling rash was noted on the face. These cleared spontaneously, without residual scarring. 6 criteria for the diagnosis of toxic shock syndrome have been defined: an increased body temperature; skin manifestations; shock, frequently with orthostatic hypotension and syncope; involvement of multiple organs; diarrhea; and myalgia. Clinicians need to appreciate that tampons are not the only cause of toxic shock syndrome and that the syndrome can occur at times other than during menstruation. Diaphragms may only rarely be associated, but their relation to toxic shock syndrome must be recognized. Counseling on the use of diaphragms should stress the avoidance of prolonged use.
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PMID:Toxic shock syndrome associated with a contraceptive diaphragm. 712 32

Endorphin levels in human cerebrospinal fluid (CSF) have been determined by using the electrically stimulated mouse vas deferens bioassay. Endorphins were extracted by adsorption to a synthetic resin of Amberlite XAD-2 eluted with methanol, and dried under a nitrogen atmosphere. Three different groups of patients have been studied: a) control subjects without a history of pain (n = 25), b) patients with acute postoperative pain after high abdominal and thoracic surgery (n = 8) and c) patients with chronic pain due to discal hernia (n = 14). The endorphin levels (expressed as equivalents of Met-E) obtained from the control group were 4.36 +/- 0.7 pmol/ml. In the postoperative group an endorphin decrease of 0.42 +/- 0.07 pmol/ml, was found while in the chronic pain group the levels obtained were 1.39 +/- 0.2 pml/ml. Thus a significantly low level of CSF endorphins was observed in both the postoperative and the chronic pain group as compared with the controls (p less than 0.01). These results suggest a correlation between pain levels and endorphin concentration in CSF. However in the acute postoperative pain group other factors such as depletion of endorphins by drugs used for anesthesia or due to surgical stress cannot be excluded.
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PMID:[Measurement of endorphins in human cerebrospinal fluid. Comparative study of various groups of patients]. 715 54

Six months to 5 years after nephrectomy in renal donors, creatinine clearances and PSP tests of 34 cases had recovered to 81.8% and 68.2% respectively of prenephrectomy performance. Blood urea nitrogen, creatinine and uric acid levels had increased to 24.9%, 36.7% and 24.3% respectively of prenephrectomy values. There was compensatory hypertrophy of the remaining kidney. The mean increase in size of the remaining kidney was 12.0% x 17.8%. There were early complications in 11 (32%) of the donors, in the form of pneumothorax in six cases, wound infection in two cases, hepatitis in two cases and urinary tract infection in one case. There was one late complication of neuralgic pain in the scar region.
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PMID:Renal function after nephrectomy in renal donors. 717 20

The purpose of this study was to determine the effects of recombinant human GH (rhGH; 0.025 mg/kg.day) and one of two doses of recombinant human insulin-like growth factor-I (rhIGF-I; 0.015 and 0.060 mg/kg, twice daily) on body composition in elderly women. Sixteen healthy elderly women (mean age +/- SEM, 71.9 +/- 1.3 yr) were randomly assigned to receive either rhGH (GH; n = 5), low dose rhIGF-I (n = 6), or high dose rhIGF-I (n = 5). A 2-week predrug baseline period was followed by 4 weeks of hormone treatment, with a standardized diet fed throughout. All groups experienced a significant increase in serum IGF-I and IGFBP-3 levels over the treatment period, accompanied by significant decreases in IGF-II (P < 0.05). Fat mass decreased in all groups, with significant increases in lean body mass and nitrogen retention occurring in the high dose IGF and GH groups. Total body water did not change, whereas increases observed in intracellular fluid approached significance (P = 0.06). These anabolic changes were accompanied by numerous negative side-effects in the GH and high dose IGF groups, including headaches, lethargy, joint swelling/pain, and bloatedness. The low IGF dose was well tolerated. These results demonstrate that the administration of rhGH and rhIGF-I for 4 weeks results in anabolic changes in body composition in elderly women.
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PMID:The effects of recombinant human insulin-like growth factor-I and growth hormone on body composition in elderly women. 753 17

The active morphine metabolite, morphine-6-glucuronide (M-6-G), may contribute to both the analgesia and the adverse effects observed during morphine (MOR) therapy. To evaluate the relationship between M-6-G and adverse effects, we measured steady-state plasma concentrations of MOR and M-6-G and concurrently noted the presence or absence of moderate to severe cognitive impairment or myoclonus in 109 cancer patients who were receiving either oral (n = 71) or parenteral (n = 38) morphine. MOR and M-6-G plasma concentrations were determined by HPLC with electrochemical detection. The presence of cognitive impairment or myoclonus was analyzed in relation to molar M-6-G/MOR ratio, age, morphine dose, the use of other centrally acting drugs, renal function (blood urea nitrogen (BUN) and serum creatinine), hepatic function (serum bilirubin, serum glutamic oxalacetic transaminase (SGOT), and alkaline phosphotase) and serum lactate dehydrogenase (LDH). The patient population consisted of 60 women and 49 men. The mean age was 51.5 years (range: 10-85 years). The mean morphine dose (total dose-prior 48 h) was 486 mg (range: 40-4800 mg) for the oral group and 931 mg (range: (10-9062 mg) for the parenteral group. The mean molar M-6-G/MOR ratios were 6.1 (SD: 18.2; range: 0.01-153.3) for the oral treatment group and 2.7 (SD: 4.16; range: 0.05-23.8) for the parenteral treatment group. Overall, the M-6-G/MOR ratio demonstrated a moderate but significant correlation with BUN (r = 0.4; P < 0.001) and creatinine (r = 0.45; P < 0.001) levels, but not with the other clinical variables examined.(ABSTRACT TRUNCATED AT 250 WORDS)
Pain 1995 Apr
PMID:Morphine-6-glucuronide concentrations and opioid-related side effects: a survey in cancer patients. 764 48

Our aim was to evaluate the response to intraluminal gas in irritable bowel syndrome and to determine whether this response was consequent upon disordered motility or altered perception. We evaluated 10 patients who satisfied the clinical criteria for the diagnosis of irritable bowel syndrome and 10 healthy controls. An eight-lumen perfused catheter assembly was positioned to monitor motor activity in the duodenum and proximal jejunum; a separate side port in the distal duodenum permitted gas infusion. Subjects recorded symptoms of abdominal pain, bloating, and nausea throughout the study, using a visual analog scale. Following an overnight fast and a 60-min basal recording period in the fasted state, subjects ate a standard meal; 60 min later, "sham" gas was administered for 20 min, followed by the actual infusion of nitrogen gas at 40 ml/min. Subjects were randomized to receive atropine (7 micrograms/kg) or placebo intravenously during the period of actual gas infusion. Patients with irritable bowel syndrome described more pain (score, mean +/- SE, control versus irritable bowel: 0.22 +/- 0.16 vs 1.65 +/- 0.5, P < 0.01) and nausea (0.25 +/- 0.21 vs 1.45 +/- 0.64, P < 0.04) during sham gas; motility indices were similar in both groups. During active gas, irritable bowel syndrome patients reported more pain (0.40 +/- 0.39 vs 2.94 +/- 1.16, P < 0.03); motility indices at all sites were similar in both groups. Symptom severity in irritable bowel syndrome subjects randomized to receive atropine was similar to control subjects during active gas infusion; motility indices were similar.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Response to intraluminal gas in irritable bowel syndrome. Motility versus perception. 778 64

A six-month-old, female German shepherd dog was presented because of depression, anorexia, vomiting, polyuria, and polydipsia of approximately 10 days' duration. The puppy was depressed, and pain could be elicited on palpation of both shoulders and hips. The most significant results of serum chemistries and hematology were hypercalcemia; increased blood urea nitrogen, creatinine, and alkaline phosphatase; and leukocytosis with neutrophilia. Thoracic radiographs revealed a large thymic mass, diagnosed on histological examination as a thymic lymphoma. Radiographs of the shoulders revealed destructive bone lesions involving the proximal metaphyses of the humeri, causing slipped epiphyses. Bone lesions were found at necropsy on the proximal and distal aspects of both humeri and femurs. Bone resorption was due to local neoplastic infiltration and presumed humoral factors secreted locally and systemically by neoplastic thymic lymphocytes.
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PMID:Multiple metaphyseal involvement of a thymic lymphoma associated with hypercalcemia in a puppy. 782 Jul 70


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