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)

An initial clinical phase I trial of inosine dialdehyde has been carried out in 40 patients at dose levels of 30-4000 mg/m2 for 5 days given intravenously (iv) monthly. At 1.5 g/m2, noncumulative dose-related toxicity occurred in all patients which consisted of nausea and vomiting, local pain, alterations in coagulation mechanism, elevated partial thromboplastin time, and positive Coombs' test. No dose-limiting leukopenia, thrombocytopenia, anemia, or bleeding occurred; however, depression of the leukocyte and platelet counts, and decreased hemoglobin value were observed. The dose-limiting toxic effect was renal tubular damage with reversible acute renal failure in one of four patients who received 3000 mg/m2 iv for 5 days. Refractory hypercalcemia was controlled in three of three patients without tumor effect. Responses occurred in patients with seminoma, oat cell carcinoma, and melanoma. A starting dose of 2 g/m2 for 3 days monthly is recommended for phase II trials and a trial in lung carcinoma is now being conducted.
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PMID:Clinical phase I trial of inosine dialdehyde (NSC-118994). 110 41

Hypercoagulable states are disorders of blood coagulation, which include deficiencies of natural anticoagulants, disorders of the fibrinolytic system, presence of antiphospholipid antibody and abnormalities of platelet function. These disorders are well known causes of venous thromboembolic disease and are being recognized in association with arterial thromboembolic occurrences with increasing frequency. The performance of standard prosthetic vascular reconstructions may result in disastrous outcomes in patients with unrecognized and untreated hypercoagulable states. From 1986 to 1990, we identified 12 patients with hypercoagulable states, six of whom presented with evidence of arterial thromboembolism. All of the patients were men who smoked and were somewhat younger than the usual patient with atherosclerosis. Their ages ranged from 41 to 62 years. Four patients presented with ischemic rest pain, one patient with blue toe syndrome and one with rapidly progressive claudication. Four patients had undergone prior vascular reconstruction and two had previous pulmonary emboli. Evaluation of these patients to identify hypercoagulability included determinations of prothrombin time (PT) and partial thromboplastin time (PTT), platelet count, antithrombin III, protein C, free protein S and total protein S levels, along with platelet aggregometry. Two patients had protein S deficiency, one had protein C deficiency, one patient had protein C and S deficiency and two patients had hyperaggregable platelets. Four patients had prosthetic reconstructions and two had autogenous reconstructions. Three of the four patients undergoing prosthetic reconstructions had subsequent loss of limb and one patient died. Only one patient with prosthetic reconstruction had a patent graft on long term anticoagulation. Both patients undergoing autogenous procedures had successful revascularization with limb salvage.
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PMID:Hypercoagulable states in arterial thromboembolism. 154 37

Haemostasis was studied in patients receiving diclofenac for postoperative pain relief. Intravenous diclofenac 75 mg over 60 min, followed first by an infusion of 5 mg/h for 15 h and then by 50 mg every 8 h orally was administered to 20 patients undergoing total hip replacement. Eighteen patients receiving a placebo infusion and dextropropoxyfen per os served as controls. The results showed no statistically significant differences between the groups in blood loss, bleeding time (IVY), partial activated thromboplastin time and prothrombin complex assay or in platelet count. The measurements were performed preoperatively, 3 h postoperatively and on the fourth and tenth postoperative days. Plasma concentrations were also determined in ten patients undergoing knee arthroscopy. An i.v. diclofenac infusion of 75 mg over a period of 15 min was administered either once (to half of the patients) or twice. The mean diclofenac concentrations were 28 +/- 5 nmol/ml (+/- s.d.) after 15 min and 36 +/- 12 nmol/ml after the second infusion. The bleeding time in the arthroscopy patients receiving one or two bolus infusions of 75 mg diclofenac remained at the control level. It is concluded that diclofenac given as an intravenous infusion of 75 mg in 60 min, then 5 mg/h for 15 h, followed by 50 mg every 8 h orally, is a safe as dextropropoxyfen for pain relief in patients undergoing major orthopaedic surgery as far as coagulation data are concerned.
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PMID:Effect of a non-steroidal anti-inflammatory drug, diclofenac, on haemostasis in patients undergoing total hip replacement. 163 74

Postoperative pain relief immediately after major surgery cannot be achieved with opioids alone in all patients without respiratory depression or other significant side effects. This investigation was conducted to determine whether the need for opioids and the incidence of side effects can be reduced while maintaining the quality of pain relief using a nonsteroidal antiinflammatory drug as an adjuvant to an opioid. The analgesic efficacy and safety of patient-controlled analgesia using fentanyl with and without intravenous diclofenac were compared after total hip replacement. Forty patients were randomly assigned to receive either diclofenac 75 mg as an initial intravenous loading dose followed by an infusion of 5 mg per hour or saline in a double-blind fashion. The amount of fentanyl administered was recorded. The patients assessed their pain intensity verbally and on a visual analogue scale at intervals of 4 h. The diclofenac group showed a significant reduction in the amount of fentanyl administered during the first 16 h postoperatively as compared to the placebo group (0.65 mg +/- 0.2 vs. 1.08 mg +/- 0.4 respectively, P less than 0.01), and also reported less pain at 16 h (median score on visual analogue scale 0.75 vs. 2.4 respectively, P less than 0.05)). There were no differences in side effects, postoperative blood loss, plasma activated partial thromboplastin time, or Ivy bleeding time between the groups. In conclusion, the addition of diclofenac led to a reduction in fentanyl requirement but did not have any other significant advantages in the treatment of pain following major orthopedic surgery.
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PMID:Intravenous diclofenac coupled with PCA fentanyl for pain relief after total hip replacement. 173 95

Acute paraplegia caused by an epidural hematoma developed in a patient following the removal of an epidural catheter. This catheter had been used for 3 days for postoperative pain relief with no apparent complications. Heparin (10,000 units/day) had been infused for thrombosis prophylaxis and was associated with a normal activated partial thromboplastin time (aPTT) for the first two postoperative days. However, test results from blood drawn prior to catheter removal revealed, in retrospect, an unexpected prolongation of the aPTT (75 s) and PT (56%, Quick's method). An epidural hematoma extending from T12 to L4 was evacuated during emergency laminectomy and neurologic deficits resolved completely over the next days. Thus, the removal of an epidural catheter has the potential for inducing formation of an epidural hematoma. Accordingly, it may be safest to leave epidural catheters in place if test results demonstrate a bleeding diathesis or if a potential for bleeding is suspected on clinical grounds.
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PMID:[Paraplegia following removal of an epidural catheter]. 182

Treating chronic arterial occlusive disease with heparin is controversial because of the risks associated with long-term anticoagulant therapy. Low molecular weight (LMW) heparin (mw about 5000 Dalton), which selectively inhibits the Xa factor with minimal risk of hemorrhage, seems to offer new possibilities in the prevention and treatment of both venous and acute arterial thromboembolism. Therefore, 44 patients with intermittent claudication were recruited to a randomized, double-blind, controlled study. Twenty-two were treated for six months with a single daily subcutaneous dose (15,000 UaXa) of LMW heparin and 22 with placebo administered in the same way over the same period of time. After six months, LMW heparin treatment not only improved walking capacity (by lengthening the pain-free walking time by 25%) but also significantly modified the hemorrheologic pattern (by reducing fibrinogen concentrations and whole blood viscosity at low shear rates). LMW heparin also exerted an antithrombotic and profibrinolytic effect by significantly increasing both the anti-Xa factor and plasminogen activity without markedly modifying activated partial thromboplastin time (+20%). No LMW heparin-treated patient hemorrhaged or reported other noteworthy side effects. These results suggest LMW heparin might be a useful drug in the long-term treatment of chronic arterial occlusive disease of the limbs.
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PMID:Efficacy of low-molecular-weight heparin in the management of intermittent claudication. 184 26

Carbetimer (carboxyimamidate) was administered at a dose of 6,500 mg/m2/day intravenously for 5 consecutive days to 14 patients with measurable metastatic or recurrent colorectal cancer in a single institution phase II study of the Northern California Oncology Group. A total of 38 cycles of therapy were administered; nine patients completed at least three cycles of treatment. No partial or complete responses were observed. One patient did have a greater than 50% response in the liver while developing new retroperitoneal lymphadenopathy and is considered a nonresponder. Carbetimer was well tolerated with elevations of calcium from 10.2 to 12.5 mg/dl in nine patients, prolongation of prothrombin time and partial thromboplastin time in 14 patients, proteinuria in 10 patients, dizziness in six patients, nausea in two patients, and venous pain during infusion in three patients. Myelosuppression was not observed. Carbetimer at this dose and schedule is inactive in the treatment of colorectal cancer.
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PMID:A phase II trial of carbetimer for the treatment of colorectal cancer. A trial of the Northern California Oncology Group. 219 95

A 61-years old woman who had been healthy without history of abnormal bleeding, developed widely spread ecchymosis and intramuscular bleeding in March, 1987. She was hospitalized for this hemorrhagic diathesis in May, 1987 and the following laboratory data were revealed: activated partial thromboplastin time (APTT), 76.7 seconds; factor VIII procoagulant activity, 2%; factor VIII inhibitor, 27 Bethesda units/ml. The inhibitor was an immunoglobulin of IgG type. Her clinical data of the blood were normal, and tests for antibodies, such as RA test, LE test and thyroid test were negative. Physical examination revealed ecchymosis over her right arm and swelling and pain in the right arm. She was first treated with a large dose of factor VIII concentrates, but the effect was insufficient. Then prednisolone was given, which resulted in decreasing of the inhibitor and improvement of the coagulation profiles. This treatment appeared to offer effective control on severe hemorrhage in patients with factor VIII inhibitors.
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PMID:[Remission of a non-haemophilic patient with acquired factor VIII inhibitor treated with infusion of factor VIII and corticosteroid]. 250 78

Ninety-two patients undergoing vascular surgery took part in a controlled clinical trial to study the effectiveness of a new low molecular weight (LMW) heparin for prevention of post-operative deep vein thrombosis. Forty-six patients were treated daily, for 7 days after operation, with a single subcutaneous injection of 15,000 Anti X-activated Factor Units of the new LMW heparin; the remaining 46 patients were treated, for the same period, with 2 daily subcutaneous injections of 5,000 International Units of calcium heparin. Deep vein thrombosis detection was by the radioactive fibrinogen uptake test, performed each day during therapy in all patients. A very low incidence of sub-clinical deep vein thrombosis was observed; in 3 (6.5%) patients in the LMW heparin group and in 4 (8.6%) patients of the calcium heparin group. The results of laboratory investigation showed that the antithrombotic activity (inhibition of Factor Xa) of the LMW preparation was significantly greater than that of calcium heparin, while activated partial thromboplastin time was greater in the calcium heparin group. The new preparation also showed better local tolerance, with less pain on subcutaneous injections.
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PMID:Low molecular weight heparin prevention of post-operative deep vein thrombosis in vascular surgery. 317 26

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


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