Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Using an electrophysiological approach, a functional diagnosis was attempted to evaluate lumbosacral compression radiculopathy. The cauda equina action potential (root-CEAP) and the somatosensory evoked potential (root-SEP) were measured by stimulating a single nerve root. The mixed nerve root action potential (MRAP) and the CEAP (P-CEAP) were recorded by stimulating a peripheral nerve. When a root was stimulated, reproduction of pain was also investigated. Seventy-four patients with lumbago and sciatica were examined. Nerve roots involved with neurological signs showed some abnormal conductivity in the order of P-CEAP, MRAP, root-SEP and root-CEAP. Subclinical involvement was also observed. It seems to be that the relationship between neurological signs and classification of root-SEP and root-CEAP are rather close. Pain was reproduced by stimulating the root in all cases of disc herniations irrespective of the neurological deficit. The above mentioned electrophysiological tests make it possible to identify and judge the extent of root involvement.
 ...
PMID:[Electrophysiological study on lumbosacral compression radiculopathy]. 377 11

The RELIEF study (Reflux assEssment and quality of life improvement with micronized Flavonoids in chronic venous insufficiency [CVI]) is a prospective, controlled, multicenter, international study performed in patients with or without venous reflux. This study was conducted between March 1997 and December 1998 in 23 countries worldwide with the participation of more than 10,000 patients suffering from CVI. The European countries, the subject of this report, were represented by the Czech and Slovak Republics, Hungary, Poland, Russia, and Spain. The principal aims of the study were: 1. To validate the first quality-of-life scale specific to chronic venous insufficiency (CMVIQ) in different languages and to assess the evolution of quality of life in patients suffering from CVI, with or without venous reflux, treated with micronized purified flavonoid fraction (MPFF*) (1,000 mg/day). 2. To collect international epidemiologic data on venous reflux assessed with pocket Doppler and photoplethysmography. 3. To assess the evolution of symptoms and signs with a specific emphasis on edema through validated Leg-O-Meter measurement (heaviness, pain, cramps, sensation of swelling, edema) in patients suffering from CVI and treated with MPFF, 1,000 mg/day, during 6 months. The first country-by-country statistical analysis and the European consolidated analysis are now available. The CIVIQ questionnaires adapted to each participating country have been validated with highly significant validity and reproducibility (p<0.0001). All dimensions have demonstrated a highly significant and evolving improvement during the study. The results show several interesting findings concerning the epidemiologic data and, of these, two were particularly interesting: - More than 50% of patients suffering from CVI (class 0 to 4 of the CEAP classification) were reflux-free, which means that they were suffering from functional CVI. Patient distribution between the different classes of the CEAP classification changed in a statistically significant manner after 6 months' treatment with MPFF; the number of patients in the more severe classes decreased to the benefit of the less severe classes. Symptoms such as pain, leg heaviness, sensation of swelling, and cramps were significantly improved (p=0.0001). This was associated with a significant decrease in edema, when present, measured by leg circumferences with the Leg-O-Meter (p=0.0001). In conclusion, the European results of the RELIEF study showed the perfect validity and reproducibility of CIVIQ questionnaire adaptations, and the positive progression of quality-of-life scores on MPFF treatment. This progression was paralleled by clinical improvement of patients reflected not only by assessment of CVI symptoms and signs but also by evolution of the CEAP classification.
 ...
PMID:RELIEF study: first consolidated European data. Reflux assEssment and quaLity of lIfe improvement with micronized Flavonoids. 1066 41

Chronic venous insufficiency (CVI) results in considerable morbidity and may seriously affect patients' quality of life. The RELIEF (Reflux assEssment and quaLity of life improvEment with micronized Flavonoids) Study was a prospective controlled study designed to assess differences in the severity and in the evolution of symptoms and signs of CVI according to presence or not of venous reflux. Patients were thus separated into 2 comparative groups: those presenting venous reflux and those without venous reflux. The design of the study was multicentric and international, carried out in 23 countries over 2 years, in which 5,052 symptomatic patients assigned to classes C0 to C4 (on the basis of CEAP clinical classification) were enrolled. Patients were treated with micronized purified flavonoid fraction (MPFF), consisting of 450 mg of micronized diosmin and 50 mg of flavonoids expressed in hesperidin over 6 months. In order to document changes in the quality of life of these patients during MPFF treatment, a new validated Quality of Life Questionnaire specific to CVI (CIVIQ) was used. The study also set out to gather epidemiologic data including the prevalence of venous reflux in symptomatic patients. The RELIEF study provided important information about the epidemiology and clinical manifestations of CVI. Of particular interest was the observation that venous reflux was found to be absent in 57% of patients diagnosed as suffering from CVI belonging to CEAP classes C0 to C4. A positive relationship between symptoms of CVI (pain, leg heaviness, sensation of swelling, and cramps) and presence of venous reflux was found in the RELIEF study: symptoms were more frequent and more severe at presentation in patients with venous reflux. Moreover, during MPFF treatment, all symptoms showed a greater decrease in the group without venous reflux compared with the other group. This difference in the evolution of symptoms between the 2 groups was significant for pain, sensation of swelling, and cramps. Regarding leg heaviness and signs such as edema (assessed by leg circumference), patients improved equally independently of the presence or not of venous reflux. The significant and progressive improvement in the signs of CVI was reflected in significant changes in the clinical class of the CEAP classification, ie, from more severe to less severe stages. Continuous clinical improvement was found throughout the study and after treatment with MPFF for 6 months, the clinical scores of all symptoms and signs had significantly decreased (p=0.0001 versus DO) in both groups. This improvement was also associated with a significant and continuous progression in the quality of life scores of all patients. Age of patients, average time since diagnosis, and presence of venous reflux increased with the severity of the disease. The relationship shown in this study between these parameters and clinical CEAP classification reflects the progressive nature of CVI. Despite obvious symptoms of CVI, a very low percentage (21.8%) of the "intention-to-treat" (ITT) population had previously been treated. This was the case whether venous reflux was present or not.
 ...
PMID:Chronic venous insufficiency: worldwide results of the RELIEF study. Reflux assEssment and quaLity of lIfe improvEment with micronized Flavonoids. 1202 11

Venous insufficiency, for practical purposes, can be divided into primary venous insufficiency and chronic venous insufficiency. The latter is characterized by advanced skin changes of hyperpigmentation, edema, ulceration, scarring from healed ulcers or open ulcerations. These are summarized in the CEAP classification as Classes 4, 5 and 6. Pretreatment evaluation is done with a standing ultrasound reflux examination. Thorough mapping of the extremity reflux is desirable. Physiologic tests of venous function, such as plethysmography, are unnecessary. Treatment is directed at closing refluxing axial veins as well as controlling those perforating veins with outward flow. Varicose veins contribute to axial reflux and must be obliterated. Arterial occlusive disease may complicate venous ulceration in as many as 15% of cases. Initial treatment of severe chronic venous insufficiency is usually carried out by controlling the edema with elastic bandaging or nonelastic support, such as the Unna boot or the CircAid dressing. Surgical intervention has been successful but the advent of foam sclerotherapy has proven to be an attractive alternative to surgery and has added a new tool for the treatment of severe chronic venous insufficiency. In this preliminary experience, the results are quite satisfactory and the technique has been shown to be effective, pain-free, inexpensive, with very little morbidity. Guidelines for obtaining sclerosants for use in foam sclerotherapy legally are provided.
 ...
PMID:Severe chronic venous insufficiency: primary treatment with sclerofoam. 1579 54

An open, observational clinical study to investigate the onset of action of the extract of the red vine-leaf AS 195 has been conducted in 39 patients suffering from Chronic Venous Insufficiency [CVI; grade I or II according to the Widmer classification (grade 2 to 4 of the international CEAP classification)]. Symptoms of CVI in the patients included oedema and subjective clinical complaints. The patients received 180 mg of extract twice daily (360 mg in total) during six weeks. The parameters investigated were objective measurements (lower leg volume by water plethysmography and the circumference of the leg at a fixed height), as well as subjective criteria such as heaviness and pain in the leg, measured using visual analogue scales (VAS). A clear and significant effect was already observed after two weeks of treatment. This effect was still present and increased slightly after four and six weeks in all objective and subjective parameters tested in this study. The decrease of the calf volume was statistically significant after 2, 4 and 6 weeks. The calf volume decreased on average by 26.3 ml after 2 weeks (t=-5.37 p<0.001), 29.8 ml after 4 weeks (t=-6.44 p<0.001) and 32.7 ml after 6 weeks (t=-7.67<0.001). The intensity of the sensation of heaviness and pain decreased also statistically significantly after 2, 4 and 6 weeks. The measured intensity on the VAS decreased on the average by 2.2 points after 2 weeks (t=-8.21 p<0.001), 2.6 points after 4 weeks (t=-10.93 p<0.001) and 2.6 points after 6 weeks (t=-10.75 p<0.001). In general, the treatments were well tolerated. Three patients prematurely stopped the trial for reasons not linked to the treatment or to the disease. This study has shown a fast onset of action and an excellent efficacy of the vitis viniferae Folia AS 195 extract in Chronic Venous Insufficiency.
 ...
PMID:[Efficacy of the red vine leaf extract AS 195 in Chronic Venous Insufficiency]. 1651 88

Compressive stockings are considered the centerpiece of treatment in chronic venous disease (CVD). It is known that stockings fail in some patients for varied reasons: they are ineffective despite wear in some, but more commonly patients are unable or unwilling to use them as prescribed. Detailed statistics regarding stocking compliance have not been available except in a few selected series focused on leg ulcers. This study focuses on use, compliance, and efficacy of compression stockings among a large cohort of patients referred to a tertiary venous practice. A total of 3,144 new CVD patients were seen from 1998 to 2006. As a referral practice, patients had been under the care of primary-care physicians or specialists for variable times before. A detailed history of past and present compressive regimens was part of our initial evaluation of CVD patients. These data were entered into a time-stamped electronic medical record and later analyzed. Only 21% of patients reported using the stockings on a daily basis, 12% used them most days, and 4% used them less often. The remaining 63% did not use the stockings at all or abandoned them after a trial period in the past. The primary reasons given for nonusage were as follows: unable to specify a reason, 30%; not prescribed by the primary physician, 25%; did not help, 14%; binding/"cutting off" of circulation, 13%; "too hot" to wear, 8%; limb soreness, 2%; poor cosmetic appearance, 2%; unable to apply without help, 2%; contact dermatitis or itching, 2%; and other (cost, work situation, etc), 2%. Multiple factors were cited by 8%. Surprisingly, there was no difference in compliance between men and women (39% vs. 38%) or among different decile age groups. Compliance was relatively better at 50% in patients who gave a prior history of deep vein thrombosis (n = 675) compared to 35% in those without such a prior history (n = 2,437) (p < 0.0001). Compliance was poor in CEAP lower (0-2) as well as higher (3-6) clinical classes (p = nonsignificant). Overall compliance with stockings was low and statistically not different in several subsets with significant symptoms: compliance in pain, 39%; swelling, 37%; stasis dermatitis, 46%; and stasis ulceration, 37%. Compliance was relatively better with longer duration of symptoms: <1 year, 25%; 1-5 years, 34%; 6-10 years, 40%; >10 years, 44% (p < 0.003). Symptoms were still persistent in about a third (37%) of the patients despite apparent compliance with prescribed stockings. Compressive stockings are inapplicable in about a quarter of patients due to the condition of the limb or the general health of the patient. They are ineffective despite wear in about a third of patients seen. In the remainder, noncompliance with prescribed compressive stockings is an apparent major cause of treatment failure. Noncompliance is very high in patients with CVD regardless of age, sex, etiology of CVD, duration of symptoms, or disease severity. The reasons for noncompliance can be grouped into two interdependent major categories: (1) wear-comfort factors and (2) intangible sense of restriction imposed by the stockings.
 ...
PMID:Use of compression stockings in chronic venous disease: patient compliance and efficacy. 1798 Jul 98

Chronic venous disease (CVD) has been reported to substantially affect patients' quality of life (QoL). To evaluate the impact of CVD on patient-reported QoL in a patient series in Serbia, a cross-sectional study of 570 CVD patients, classified according to the CEAP clinical classification into classes (C) 1-6, was performed in a Belgrade outpatient clinic. QoL was assessed by the general short-form (SF)-36 questionnaire, and additionally by a brief CVD-specific questionnaire. The SF-36 scores for all QoL dimensions showed a progressive reduction from C1 to C6. Class 5 and 6 patients scored the lowest across all dimensions, with significant (p < 0.05) reductions in physical functioning, role-physical, general health, vitality and mental health. The score for bodily pain decreased from C1 to C4, but increased in C5 and C6 as compared to C4 patients. Interestingly, despite an increasing rate of aesthetic concerns as the disease progresses, no variations were found in the social functioning and emotional role scores across the groups. There were no age or gender differences in any QoL item across the classes. The data presented show that QoL of CVD patients decreases, particularly after the appearance of skin changes, and suggest that even patients in the early stages consider CVD a disease and not merely a cosmetic problem.
 ...
PMID:Patients' reported quality of life in chronic venous disease in an outpatient service in Belgrade, Serbia. 1973 27

From 2008 to 2009, we operated on a total often 40-to-54-year-old patients (eight women and two men). In four cases, avalvulation of the deep veins was congenital (primary) and in the remaining six instances, it was secondary to postthrombotic lesions of the valves with complete recanalization and pronounced vertical reflux along the deep veins. The distribution of the patients according to the CEAP classification was as followed: two patients were found to have grade C4b, seven patients were diagnosed with grade C5 and one patient suffered grade C6. All patients were subjected ultrasonographic duplex scanning. Four patients required additional procedures following aortic repair. Retrograde phlebography performed in all the patients revealed that all had grade 4 pathological reflux according to R. Kistner's classification. Nine patients had a history of previously performed interventions on the superficial and perforating veins. The operation was indicated in severe forms of chronic venous insufficiency and failure of conventional methods of surgical and conservative treatment. The formation of a multi-flap valve of the common femoral vein was carried out according to an original technique suggested by J. C. Opie (2008). Clinical improvement (i.e., pain syndrome relief, decreased oedemas, lowered degree of trophic disorders in crural soft tissue, permanent healing of trophic ulcers) was observed in eight (80%) patients. According to the VCSS scale, we registered a significant decrease in intensity of manifestations of chronic venous insufficiency along all parameters. The integrated index decreased from 7.53 +/- 0.54 to 4.33 +/- 0.42 (chi2 = 4.67; p < 0.01). The malleolar volume decreased from 271.1 +/- 4.7 to 231.5 +/- 5.7 mm (chi2 = 7.17; P < 0.001). Pathological reflux of blood was corrected in all patients within the follow-up terms amounting to 8 months. No thrombotic complications were observed.
 ...
PMID:[First experience in forming a multi-flap valve of the common femoral vein in avalvulation of the deep veins of lower extremities]. 2063 20

Chronic venous disease (CVD) is an important clinical condition with substantial epidemiological implications and socio-economic repercussions. In the Western world the consequences of its high prevalence, the costs of diagnosis and therapy, the significant loss of working hours and the repercussions on patients'quality of life are well known. Pharmacotherapy for CVD has greatly developed over the last 40 years and largely used in the symptomatic treatment of CVD together with compression therapy and to make patients more comfortable. The clinical efficacy on the symptoms (feeling of heaviness, pain, paresthesia, heat and burning sensations, night cramps, etc.) has long been confirmed by Level III, IV and V evidence, but there are now Level I and II trials on specific drugs. For the bioflavonoids double-blind, randomised trials have used micronized purified flavonoid fraction; rutosides; escin; anthocyanosides; and synthetic calcium dobesilate. It was therefore surprising some recent difficulties in the use of this important treatment in health national system in Italy. In this up-date we use the method on evidence-based medicine from the medical literature. We have started a governance and economic analysis of the problem in Italy. Particular consideration was given to the evidence set out in review, meta-analysis, guidelines and Consensus Statements in this field. The evidence for pharmacological agents in the treatment of CVD suggests today a wide use in all CEAP classes.
 ...
PMID:[Medical treatment of chronic venous disease: evolution or involution?]. 2151 76

The objective of this paper is to explore patterns of incompetence and disease distribution in patients with chronic venous disorders and to correlate this with CEAP (Clinical, Etiologic, Anatomic and Pathologic) classification and presenting symptoms to determine which features of chronic venous disorder (CVD) could be used to guide a patient pathway for referral and treatment. Consecutive patients attending a one-stop venous clinic at a university teaching hospital were recruited over a 12-month period. Patients were clinically assessed, assigned CEAP scores, duplex-scanned and categorized. Data were analyzed to identify associations between symptomatology and disease. Four hundred twenty-four limbs were divided into groups A (C2-3) (339) and B (C4-6) (85). The number of men, mean patient age, varicose vein diameter and quality-of-life score (Aberdeen Varicose Vein Questionnaire - AVVS) were significantly higher in group B (P < 0.01). Ache occurred more commonly in group A and in women (P < 0.01). Ache and pain were seen more frequently with saphenofemoral junction reflux (P < 0.05). Group A women were more likely to be offered surgical intervention while men were managed conservatively (P < 0.05). In conclusion, CVD symptoms are independent of disease severity assessed by CEAP score. Advanced disease is associated with larger venous diameters, older age and corresponds to a poorer quality of life. Objective markers such as CEAP, Venous Clinical Severity Score and AVVS should be used in determining a patient pathway for referral and treatment of CVD.
 ...
PMID:Patient-reported symptoms are independent of disease severity in patients with primary varicose veins. 2182 63


1 2 3 Next >>