Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

As patients with HIV/AIDS are living longer with the illness, pain and symptom management are increasingly important health issues. This article will discuss the assessment and management of such common problems as pain, fatigue and weakness, dyspnea and cough, anorexia and weight-loss, nausea and vomiting, sleep disorders, dry mouth, diarrhea, itching, and fever and night sweats.
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PMID:Palliative care: pain and symptom management in persons with HIV/AIDS. 992 83

The incidence of side-effects occurring with epidural diamorphine (0.05 mg.ml-1), fentanyl (2.0 micrograms.ml-1), methadone (0.1 mg.ml-1), morphine (0.05 mg.ml-1) and pethidine (1.0 mg.ml-1) used by infusion in combination with bupivacaine has been compared. One hundred and sixty patients were studied, 32 receiving each opioid. The incidence of nausea and vomiting was significantly greater with morphine than fentanyl (p = 0.0097) and pethidine (p = 0.0021). The incidence of pruritus was significantly greater with morphine and diamorphine than with methadone (p = 0.012) and pethidine (p = 0.027). Morphine was also associated with a significantly greater incidence of urinary retention than pethidine (p = 0.012) and methadone (p = 0.025).
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PMID:Side-effects of epidural infusions of opioid bupivacaine mixtures. 1019 15

We report the analgesic and adverse effects of intrathecally administered hyperbaric neostigmine, alone or combined with morphine, in two patients suffering from severe lower limb ischaemic pain (group 1), five patients undergoing Caesarean section (group 2) and 19 patients scheduled for orthopaedic surgery (group 3) under spinal anaesthesia. These patients were enrolled in three pilot studies undertaken before the initiation of the planned controlled studies. Hyperbaric neostigmine (50 micrograms in glucose 8%) produced analgesia lasting more than 6 h in patients of group 1, but the effect was accompanied by episodes of vomiting. A lower dose of hyperbaric neostigmine (25 micrograms), alone (two patients) or combined with morphine (50 micrograms) (one patient) produced no discernible analgesic effect but was followed by severe nausea and vomiting within 15 min of intrathecal injection in patients of group 2. Two patients who received hyperbaric morphine (100 micrograms) had analgesia for more than 24 h and exhibited mild pruritus. In patients of group 3, hyperbaric neostigmine alone (25 micrograms) produced analgesia of shorter duration than neostigmine (25 micrograms) plus morphine (50 micrograms) or morphine (100 micrograms). Neostigmine alone or combined with morphine was associated with adverse events, mainly nausea and vomiting that lasted up to 9-12 in some patients. Other adverse events observed included anxiety, somnolence and involuntary defaecation. Most patients who received the combination of neostigmine and morphine exhibited more severe nausea, vomiting and somnolence. The low clinical efficacy of intrathecally administered neostigmine alone or in combination with morphine impairs the design of a double-blind protocol and might restrict the clinical usefulness of the drug combination.
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PMID:Analgesic and adverse effects of a low dose of intrathecally administered hyperbaric neostigmine alone or combined with morphine in patients submitted to spinal anaesthesia: pilot studies. 1020 66

Our previous study suggested that when compared between patients, morphine, pethidine and fentanyl were equally satisfactory for use in patient-controlled analgesia (PCA), although quantitative differences in their side-effect profiles were detectable. The present study evaluated whether individual patients could detect differences or express preferences for individual opioids when treated by PCA with all three in random sequence finishing with the first administered opioid. The main side effects were pruritus, nausea and vomiting. There were few differences in patients' responses to morphine, pethidine and fentanyl, or of satisfaction with these drugs, across patients, but individual patients' responses to the opioids could be highly variable. Some patients were able to tolerate all three opioids investigated, some were intolerant to all and some patients appeared to be sensitive to one or two of the opioids but show a preference for the remainder. These findings support the clinical practice of changing from one opioid to another (with good effect) in post-operative patients experiencing intolerable side-effects. The reasons for a patient responding differently to different opioids and even to the same opioid on separate occasions are not clear and appear inexplicable on the grounds of currently postulated receptor affinities or of physicochemical properties of the opioids studied. A plethora of factors will influence how an individual patient will respond to surgery and how he/she will recover. The physiological response to opioids is one variable which appears to be influenced by this complex set of factors and in turn will affect them. The findings of this study, like that of its predecessor, suggest that morphine, pethidine and fentanyl can be used successfully in PCA and that for some patients who are responding poorly, changing the opioid may be beneficial.
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PMID:Intra-subject variability in post-operative patient-controlled analgesia (PCA): is the patient equally satisfied with morphine, pethidine and fentanyl? 1034 16

To assess calculated equivalent doses of intrathecal and epidural opioids for elective Caesarean section in terms of quality and duration of analgesia, and incidence of side effects, we have compared 50 patients, allocated randomly to one of two groups to receive either diamorphine 0.25 mg intrathecally (group 1) or 5 mg epidurally (group 2), in addition to intrathecal bupivacaine 10 mg, using a combined spinal-epidural technique. There was no significant difference in duration of analgesia between groups (group 1 mean 14.6 (SD 5.9) h, group 2 14.2 (6.5) h; mean difference 0.8 h; 95% Cl -2.8-4.5; P = 0.65) or quality of analgesia (VAPS and VRS scores). The degree of pruritus was similar in both groups (80-88%) but the incidence of postoperative nausea and vomiting was significantly higher in the epidural group (24% vs 4%; P < 0.05). Intrathecal diamorphine 0.25 mg produced the same duration and quality of postoperative analgesia as epidural diamorphine 5 mg for elective Caesarean section but with significantly less nausea and vomiting.
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PMID:Comparison of intrathecal and epidural diamorphine for elective caesarean section using a combined spinal-epidural technique. 1036 99

The aim of the study was to evaluate the efficacy and the incidence of clinically significant adverse drug reactions (ADRs) in paediatric patients receiving continuous intravenous morphine infusions for acute postoperative pain. Definitions were established for ADRs and data were collected in an immediately retrospective fashion for a maximum of 72 h in 110 patients >/=5 three months of age (0.3-16.7 years) receiving morphine infusions and admitted to a general ward over a three month convenience sampling period. Inadequate analgesia occurred in 65.5% of patients during the first 24 h of therapy and occurred most frequently in patients with infusion rates of 20 microg.kg-1.h-1 or less. Nausea/vomiting was the most commonly experienced ADR (42.5%). The incidence of respiratory depression was 0% (95% CI=0-3.3%). Other ADRs included: urinary retention (13.5%), pruritus (12.7%), dysphoria (7.3%), hypoxaemia (4.5%), discontinuation of morphine for treatment of an ADR (3.6%), and difficulty in arousal (0.9%). The most common ADRs associated with morphine infusions were inadequate analgesia (in the first 24 h) and nausea/vomiting. There were no cases of respiratory depression. Methods of avoiding initial inadequate analgesia and treating nausea and vomiting associated with morphine infusions are needed.
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PMID:Efficacy and complications of morphine infusions in postoperative paediatric patients. 1041 68

Gallbladder cancer is the fifth most common gastrointestinal malignancy. Although overall 5-year survival is less than five percent, improved survival has been reported in recent years for extended resection of localized lesions. Nonetheless, one-third of operations for gallbladder cancer are palliative procedures. There is no universally suitable palliative surgical procedure and the choice of operation must take into account the general risk to the patient, the likely effect of surgery and the patient's principal symptoms of pain, jaundice and itch, nausea and/or vomiting. Cholecystectomy or drainage of the gallbladder may be necessary where obstruction of the cystic duct results in complication. Gastrointestinal bypass may be required for patients with gastric outlet obstruction. Although biliary bypass can be attempted to the extrahepatic biliary system or can be achieved by surgical intubation, there is increasing evidence that segment III cholangiojejunostomy provides effective long-term decompression of the obstructed biliary tree. A sound multidisciplinary approach is required in the management of these patients, the majority of whom are unlikely to survive beyond six months.
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PMID:Surgical palliation of carcinoma of the gallbladder. 1043 Feb 97

Two separate trials compared controlled-release (CR) oral oxycodone (administered every 12 hours) with immediate-release (IR) oxycodone (4 times a day) to determine whether patients with chronic pain could be titrated to stable pain control as readily with the CR as with the IR formulation. In one study, 48 patients with cancer pain were randomized to open-label titration with either CR or IR oxycodone (maximum dose, 400 mg/day) for a period of up to 21 days. In a study of similar design, 57 patients with low back pain were titrated with either CR or IR oxycodone (maximum dose, 80 mg/day) for a period of up to 10 days. The majority of patients in both studies were converted to oxycodone from other opioid analgesics. Results of both studies showed no difference between CR and IR oxycodone with respect to both the percentage of patients achieving stable pain control, the time to achieve stable pain control, and the degree of pain control achieved. Among cancer patients, 85% achieved stable analgesia, 92% with the CR formulation and 79% with the IR formulation. Among noncancer patients, 91% achieved stable pain control, 87% with the CR formulation and 96% with the IR formulation. The most commonly reported adverse effects in both studies were similar for the two formulations and were those anticipated with opioids: nausea, vomiting, constipation, somnolence, dizziness, and pruritus. Nausea and vomiting were the most frequently cited reasons for treatment discontinuations. These studies suggest that dose titration can be accomplished as readily with oral CR oxycodone as with IR oxycodone in patients with chronic, moderate to severe pain.
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PMID:Can a controlled-release oral dose form of oxycodone be used as readily as an immediate-release form for the purpose of titrating to stable pain control? 1053 67

The Australian elapids inject venom which is characteristic of each species; and which cause characteristic and specific envenomation syndromes in human victims of snakebite. Because many of the medically significant Australian elapids look similar, when glimpsed in the field by snakebite victims, defining human envenomation syndromes with secure species identification has been a slow process. Correlations between securely identified species and the human envenomation syndromes which they produce are still evolving. The genus Pseudechis is the most widespread in Australia of the dangerous Australian elapid genera; and P. porphyriacus, the Red-bellied Black Snake, was the first terrestrial Australian elapid to be described and illustrated and the first to be the subject of experimental study. We present here five previously unreported cases of human envenomation in which the species diagnosis is secure. From these and with the perspective of a selected literature review, we describe the full envenomation syndrome of this species. Until the development of the Commonwealth Serum Laboratories' Venom Detection Kit in 1979 and the occasional case report of victims of securely identified species, envenomation syndromes for most Australian snake species have remained indeterminate, because of the lack of professional expertise in the identification of the species involved. Symptoms of the P. porphyriacus envenomation syndrome include those of bite-site pain, nausea and vomiting, generalised pruritus, chest pain, prostration and abnormalities of taste and smell. Signs include local necrosis and scarring of tissue at the bite-site, gross inflammation of surrounding tissues and, at least in one case, epilepsy. Although envenomation by the Red-bellied Black Snake is not lethal in adults, the correct therapy is Tiger Snake antivenom, administered with judgement, taking into account knowledge of the specific envenomation syndrome of this species and the clinical status of the victim.
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PMID:The envenomation syndrome caused by the Australian Red-bellied Black Snake Pseudechis porphyriacus. 1085 12

Despite the wide use of the World Health Organization (WHO) analgesic ladder for the relief of cancer pain, it is not uncommon to find patients presenting with severe pain to palliative care centres. This is more so in the developing world, where facilities for pain relief are few and the health care system is not well organized. It has been the practice in a pain and palliative care clinic in south India to give repeated boluses of 1.5 mg of morphine intravenously every 10 min to patients presenting with severe pain. An audit of the procedure was undertaken by a retrospective study of 793 case notes. Seventy-nine per cent of patients had total relief of their pain with intravenous morphine. Three per cent of patients experienced side-effects during the procedure. These included nausea and vomiting, itching, giddiness, restlessness, dyspnoea, chest pain, disorientation and a feeling of uneasiness. Thirty-two per cent of patients had drowsiness, which was one of the end-points of the procedure. It is concluded that intravenous morphine in repeated boluses of 1.5 mg every 10 min is a safe and effective method of managing cancer pain emergencies in a clinical setting in a developing country.
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PMID:Intravenous morphine for emergency treatment of cancer pain. 1085 25


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