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

To further define the clinicopathologic features and determinants of survival, we reviewed the cases of 110 patients with primary hepatic malignancy managed surgically between 1975 and 1986. Presenting signs of symptoms were pain (57%), fatigue (48%), abdominal mass (40%), and weight loss (33%). Twenty-six percent of patients had a history of hepatitis or cirrhosis. Histopathologically, tumors were hepatocarcinoma (72%), fibrolamellar variant (7%), cholangiocarcinoma (9%), mixed (7%), and other (5%). Resectability rate with curative intention was 67%. Exploration and biopsy alone was performed in 27% and palliative resection in 6%. Hospital mortality was 9%, and serious morbidity was 22%. Perioperative morbidity and mortality were significantly associated with operative blood loss. Median survival was 12.6 months, with a 5-year survival of 18%. Median survival after curative resection was 22.8 months, and 5-year survival was 27%. Univariate analysis showed that female sex, normal performance status, well-differentiated tumor, and curative resection were associated with increased survival; cholangiocarcinoma, nodal metastases, cirrhosis, hypocalcemia, prolonged prothrombin time, and increased serum transaminase and alkaline phosphatase were associated with decreased survival. Cox multivariate analysis showed that curative resection, normal performance status, and well-differentiated tumors were associated with increased survival, and prolonged prothrombin time and hypocalcemia were associated with decreased survival.
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PMID:Primary hepatic malignancy: surgical management and determinants of survival. 279 50

A 35-year-old woman with severe (less than 1 percent) factor VII deficiency had recurrent hemarthroses involving the left knee, leading to deformity, pain, and virtually complete loss of function. It was elected to perform a total knee replacement. In preparation for surgery, the patient received heat-treated prothrombin complex concentrate containing 870 units of factor VII per vial. A dose of 50 U/kg raised the factor VII level to 115 percent. At surgery, dense adhesions were found within the joint, the articular cartilage was overgrown with pannus extending out to the lateral patella, and there was extensive deformity of the femoral condyle and tibial plateau. The joint was excised and replaced by a cemented Microloc prosthesis. Postoperatively, factor VII levels were maintained above 10 percent by six-hourly infusions of concentrate. Beginning on Day 4, single daily infusions of 25 U/kg were given prior to physical therapy. No bleeding occurred, and the patient was ambulating at the time of discharge 20 days postoperatively. This experience indicates that despite its short half-life (less than four hours), factor VII levels sufficient to prevent bleeding can be maintained in factor VII-deficient patients undergoing major operative procedures.
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PMID:Arthropathy and surgery in congenital factor VII deficiency. 340 Jun 67

Coagulation assays in 10 women in whom 2nd-trimester abortion was induced through intra-amniotic infusion of ethacridine (Rivanol) suggested a lack of negative side effects. The mean gestational age of the study subjects was 22 weeks. Platelet count, thrombin time, partial thromboplastin time, and prothrombin time were measured in serum samples collected before and 12, 36, and 60 hours after ethacridine instillation. Also measured were soluble fibrin monomer complexes and Factors V, VII, X, and XII. In 9 of the 10 women, labor was induced by 1 dose of ethacridine and a dead fetus was expelled; the 10th woman required a 2nd instillation. The average duration of labor was 2.5 hours (range 0.5-5.0 hours) and induction-to-abortion time averaged 38 hours (range 31-47 hours). All coagulation measures were within normal limits before abortion induction and were not significantly influenced by ethacridine administration at any of the time intervals studied. Of particular interest was the lack of evidence of disseminated intravascular coagulation--a side effect of intra-amniotic instillation of hypertonic saline. The injection of ethacridine also seems to cause less pain than hypertonic saline, hypertonic glucose, or prostaglandin in F2 alpha.
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PMID:Lack of coagulation defects after the intraamniotic instillation of ethacridine (Rivanol) for second trimester abortion. 340 72

A group of 11 female patients (mean age 33.7 +/- 8 years) with a clearly proven primary Raynaud's syndrome of up to five years' duration were subjected to a two-month oral treatment with 3 X 400 mg pentoxifylline per day. The following parameters were studied without and with exposure to cold conditions: hemodynamics (finger photoplethysmography), red cell deformability (filtration test), various clotting variables (prothrombin activity, antithrombin III, plasma fibrinogen, partial thromboplastin time, thrombin time, thrombelastogram), and clinical symptomatology. After treatment 7 of the 11 patients showed a distinct improvement of peripheral blood flow and of symptoms (decrease or removal of asphyxia attacks, pain, color change) under basal conditions, as well as after exposure to cold. Red cell filtration was significantly (p less than 0.05) improved, increasing by 35% under normal conditions and by 30% after exposure to cold. Positive changes were also found in respect to antithrombin III (increase) and plasma fibrinogen (decrease). The thrombelastogram was unchanged. Clinical and instrumental improvements were probably ascribable to better microcirculatory flow due to increased red cell deformability, reduced viscosity, and decreased fibrinogen, all capable of influencing in various degrees the blood flow at the microcirculatory level.
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PMID:Functional vascular disorders: treatment with pentoxifylline. 363 42

Sixty-seven patients with complicated urinary tract infections were randomized in double-blind fashion to ceftazidime or moxalactam (MOX). A total of 54 patients were evaluable, 27 in each group. Patients received 500 mg of antibiotic intravenously every 12 h, except for those with Pseudomonas aeruginosa randomized to MOX who received 2 g intravenously every 12 h. Toxic effects with ceftazidime were experienced by the following number of patients: pain with infusion, one; posttherapy diarrhea, one; liver function test elevations, two; and neutropenia, one. Toxic effects with MOX were experienced by the following number of patients: liver function test elevations, two; and prolonged prothrombin time, one. All resolved. At 1 week posttherapy, bacteriologic results were 74% cured, 11% relapsed, 15% reinfection with ceftazidime and 52% cured, 33% relapsed, and 19% reinfection with MOX. Ceftazidime was effective for infections caused by MOX-resistant P. aeruginosa. P. aeruginosa resistant to MOX and other beta-lactams was isolated from one patient after MOX therapy. Enterococcal reinfection was common in both groups.
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PMID:Randomized, double-blind comparison of ceftazidime and moxalactam in complicated urinary tract infections. 391 59

Twenty-nine patients received intracoronary thrombolytic therapy for acute myocardial infarction 3.5 +/- 1.4 hours (mean +/- standard deviation) after the onset of pain. Ten patients received urokinase (UK) and 19 patients received streptokinase (SK). Laboratory variables of the coagulation system were measured before and immediately after therapy. When comparing patients in whom coronary artery recanalization occurred vs those in whom the artery remained occluded, those in whom recanalization was achieved had greater alterations in fibrinogen, prothrombin time, activated partial thromboplastin time, fibrin/fibrinogen degradation products and plasminogen by thrombolytic therapy than did those in whom recanalization was not achieved (p less than 0.05 for all variables). Euglobulin lysis time showed a similar but nonsignificant trend (p = 0.114). Patients who received SK showed markedly greater alterations in coagulation parameters than did patients treated with UK (p less than 0.05 for 5 of 6 variables measured) and had a much higher incidence of successful thrombolysis (74% for SK, 20% for UK). These data indicate that the development of a systemic fibrinolytic state contributes to success when using intracoronary thrombolytic agents in acute myocardial infarction. Rather than being considered an adverse effect of therapy, a systemic lytic state may serve as a reasonable clinical goal in attempting to produce thrombolysis.
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PMID:Relation of effectiveness of intracoronary thrombolysis in acute myocardial infarction to systemic thrombolytic state. 403 24

A 34-year-old female, six months after surgery for implanting a mitral valve bioprosthesis (Hancock), was admitted to hospital because of acute abdomen. The patient had been on coumarin medication since the operation. On the 15th day of her menstrual cycle the patient presented gingival bleeding, epistaxis, and pain in the left lower abdominal quadrant. The prothrombin time was overdepressed (10% of normal), and coumarin drugs were stopped. Bleeding from the left ovary at time of ovulation was suspected and the patient was treated with vitamin K and then submitted to an exploratory laparotomy. A hemorrhagic cyst of the left ovary was found, and the histologic examination showed the cyst to be follicular in type.
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PMID:Hemorrhagic follicular cyst of the left ovary. An unusual complication of anticoagulant treatment. 616 7

Sixty-seven patients were treated with moxalactam in a noncomparative trial of hospitalized patients; 32 had endometritis or chorioamnionitis, 12 had skin and soft tissue infections, 5 had osteomyelitis, 5 had pneumonia, 5 had urinary tract infections, 4 had arthritis, 2 had sepsis from an unknown source, 1 had endocarditis, and 1 had peritonitis. Bacteremia was present in 12 of these patients. Patients were given 3 to 12 g of moxalactam per day (mean, 6.24 g/day) in divided doses every 6 to 8 h. Seven patients were given intramuscular treatment for 3 to 20 days for part or all of their therapy. The rest were given intravenous treatment exclusively. Treatment was continued for 2 to 42 days (mean, 10 days). The dose and the duration of therapy were determined by the type of infection and the response of each patient. There were four treatment failures and one enterococcal-clostridial superinfection. Moxalactam was well tolerated. Allergic reactions led to the discontinuation of the antibiotic in three patients. Prolonged prothrombin and partial thromboplastin times were observed in 2 of 11 patients tested; in both instances in patients had severe underlying diseases, including malnutrition and alcoholism. Pain on intramuscular injection was noted in two patients receiving 1,500 mg, but not in five receiving a lower dose; in one case the pain forced the use of intravenous therapy after one dose, and in the other case the pain was mild and the patient was treated for 20 days. We concluded that moxalactam was effective in the treatment of the types of infections included in this study and produced few adverse reactions.
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PMID:Moxalactam in the therapy of serious infections. 621 Nov 40

Hepatic tuberculosis was confirmed in 96 patients presenting with the features of liver disease, only 14 of whom had other concomitant hepatic pathology. Although respiratory symptoms occurred in 74 per cent of cases, these were overshadowed by the abdominal manifestations. The latter most frequently included right hypochondrial pain, abdominal distension, firm tender hepatomegaly, splenomegaly and ascites. Icterus was observed in 11 cases (only one of whom had concurrent hepatic pathology) and liver failure was found in 10 patients. A surgical presentation occurred in three patients. Four of 15 patients with pancytopenia were noted to have hypersplenism. Abnormalities in coagulation were noted in 26 patients (24 with low prothrombin index and two with moderately raised fibrinogen degradation products). The characteristic serum profile included hyponatraemia (64 per cent of cases), raised alkaline phosphatase (83 per cent) and gamma glutamyl transferase (77 per cent), hypoalbuminaemia (63 per cent) and hypergammaglobulinaemia (83 per cent). Transaminase levels were moderately elevated in 78 per cent of cases. Hepatic imaging techniques were frequently misleading. Chest radiographs aided the diagnosis but were normal in 25 per cent of cases. Histologically, acid fast bacilli, caseation and granulomas were seen in 9, 83 and 96 per cent of cases respectively. Adverse prognostic features included age (below 20 years), miliary TB, coagulation defects and the presence of predisposing factors; these were of value in selecting appropriate therapy. The overall mortality was 42 per cent. Liver biopsy was the most useful aid to correct diagnosis which was suspected clinically in only 47 per cent of cases.
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PMID:Tuberculosis hepatitis: a clinical review of 96 cases. 651 2

The abdominal hemophilic pseudotumor is a rare but frequently disabling and life-threatening complication in patients with severe hemophilia. Our patients were observed for a considerable period of time to document progressive enlargement of the pseudotumor and increasing disability from severe pain, nerve compression, or leg swelling. The decision to operate was made on the basis of incapacitating symptomatology or fear of impending rupture. Although the complications resulting from operation may be major, with the current availability of large amounts of factor VIII and activated prothrombin complex concentrate, excision of this lesion can be performed without concern for the hazard of uncontrollable hemorrhage. Late recurrence of the pseudotumor may necessitate further operative management.
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PMID:Management of abdominal hemophilic pseudotumor. 679 32


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