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)

Pruritus is a significant problem for many patients undergoing long-term hemodialysis. Topical capsaicin depletes and prevents the reaccumulation of substance P in peripheral sensory neurons. Substance P functions in the transmission of pain and probably itch sensations. An open-label, uncontrolled trial and a double-blind, vehicle-controlled trial were conducted to evaluate the efficacy and safety of capsaicin 0.025% cream in the treatment of localized areas of pruritus in patients undergoing long-term hemodialysis. Eight of nine evaluable patients in the open-label trial reported marked relief or complete resolution of itching during the study period, and two of five evaluable patients in the double-blind trial reported complete resolution of itching in the capsaicin-treated arm with no or minimal improvement in the vehicle-treated arm. Twelve patients in the open-label trial and two in the double-blind trial were unevaluable. No serious treatment-related adverse reactions occurred.
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PMID:Topical capsaicin for treatment of hemodialysis-related pruritus. 173 43

The most frequently used postoperative analgesia techniques are intramuscular injection (IM) and patient controlled analgesia (PCA). Recently, the use of epidural catheter injection (EPI) has been done with success. This study was done to prospectively compare these three techniques for postoperative analgesia after extensive operations upon the colon and rectum. Patients were randomized to one of three analgesia groups--IM, intramuscular morphine sulfate; PCA, patient controlled morphine sulfate, and EPI, epidural morphine sulfate. Data collected included age, time to first bowel movement, amount of narcotic, number achieving 75 per cent of preoperative forced vital capacity, postoperative pruritus, headache, nausea and vomiting, respiratory depression, atelectasis or pneumonitis. A visual analog pain scale was used to evaluate postoperative pain severity (0, no; 1, partial; 2, marked, and 3, total relief). Sixty-eight patients were eligible for study (IM, 19; PCA, 22; EPI, 23, and excluded, four). The EPI group required significantly less daily narcotic compared with either the IM or PCA groups (17.0 +/- 6.12 milligrams; 67.8 +/- 26.8 milligrams; 40.5 +/- 20.6 milligrams, respectively, less than 0.05 ANOVA) and total narcotic (81.3 +/- 31.3 milligrams; 355.4 +/- 147.7 milligrams; 215.3 +/- 105.4 milligrams, respectively, p less than 0.05 ANOVA). EPI achieves excellent pain control in more patients with a significantly lower dose of narcotics and significantly fewer pulmonary complications. Therefore, epidural analgesia is the optimal method of postoperative analgesia after extensive abdominal operations.
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PMID:Epidural analgesia. 173 72

The anatomy and physiology of the epidural space and the mechanism of action, sites of action, and pharmacokinetics of analgesics administered by continuous epidural infusion are reviewed, and the efficacy, adverse effects, and postoperative indications for use of analgesics administered by this route are discussed. Narcotics selectively block pain conduction by occupying specific opiate receptors in the spinal cord. Local anesthetics provide analgesia by axonal membrane blockade; they also can produce nonselective sympathetic and somatic (sensory and motor) blockade in addition to analgesia. A narcotic-local anesthetic mixture should provide an additive analgesic effect, without an increase in the incidence of adverse effects. Comparative efficacy studies have shown that continuous epidural infusions of narcotics, local anesthetics, and narcotic-local anesthetic combinations, when used appropriately, may produce better analgesia than conventional bolus methods of pain relief. Continuous epidural infusions also offer a safety advantage over intermittent epidural injections because peak and trough levels of the analgesic agent are avoided. Adverse effects of epidurally administered narcotics include respiratory depression, pruritus, urinary retention, nausea and vomiting, and sedation. Adverse effects of epidurally administered local anesthetics include urinary retention, hypotension, numbness, motor weakness, tachyphylaxis, and, rarely, systemic toxicity. The cost of epidurally administered drugs is substantially higher than that for i.m. or i.v. narcotic analgesia, but this cost may be offset by other benefits such as a shorter hospital stay. Current studies suggest superior analgesia for the majority of surgical procedures with continuous epidural analgesia infusions compared with more traditional methods of providing analgesia.
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PMID:Management of postoperative pain by continuous epidural infusion of analgesics. 174 61

The process of nociception, the anatomy of the epidural space, and the placement of the epidural catheter are reviewed, and the pharmacology and pharmacokinetics, analgesic efficacy, and potential adverse effects of epidurally administered narcotics and local anesthetics are discussed, as well as patient monitoring standards and solution preparation guidelines for these agents. The epidural space is located between the dura mater (the outer-most membrane surrounding the spinal cord) and the vertebral canal. The site of catheter placement is determined by the dermatomes corresponding to the site of desired analgesia. The primary factors that differentiate epidural narcotics are related to their pharmacokinetic profiles. Morphine, which is hydrophilic, has a slower onset of action and a longer duration of analgesia than lipophilic compounds such as fentanyl; morphine also results in less segmentalization (the degree to which analgesia is limited to discrete dermatomal segments corresponding to the level of the epidural narcotic injection) than is seen with lipophilic compounds. Studies have shown that epidural narcotics provide superior pain relief compared with systemic narcotics. Common adverse effects associated with therapeutic doses of intraspinal narcotics include itching, nausea and vomiting, urinary retention, and sedation; respiratory depression is uncommon after epidural administration of narcotics. The most bothersome adverse effect encountered with analgesic doses of local anesthetics is paresthesia. Solutions for epidural administration must be sterile and preservative free. Epidural administration of narcotics and local anesthetics seems to provide better pain relief than conventional methods but may be associated with more bothersome adverse effects.
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PMID:Epidural analgesia. 174 84

Poorly recognised, despite being common, in particular during pregnancy and above all in multipara, this familial condition falls within the context of venous disease in general. Slight during a first pregnancy, vulval varicosities develop all the earlier and are larger as the number of pregnancies increases. They cause discomfort, heaviness in the pubic region, sometimes pruritus or even pain, which is most often relieved by lying flat. Complications, which are uncommon, may give rise to exacerbation of the clinical symptoms described above in relation with a notable increase in size and, more rarely, traumatic ruptures which respond to compression. They disappear completely post-partum. Often poorly tolerated during successive pregnancies, the symptoms of vulval varicosities of pregnancy are significantly relieved by phlebotonic agents.
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PMID:[Vulvar varicosity and pregnancy]. 176 71

Psychophysical measurements of itch and itchy skin ("alloknesis"--itch produced by innocuous mechanical stimulation) were obtained in human volunteers following intracutaneous or subcutaneous injections of histamine or papain into the volar forearm. Histamine and papain were given in doses of 0.1, 1, or 10 micrograms in 10 microliters of saline. The effects of the depth of injection and of skin temperature on the latency, magnitude, and duration of itch were examined. Also, dose-response functions were obtained for the area of alloknesis produced by intracutaneous injections of histamine. Finally, the neural mechanisms underlying the spread of alloknesis were investigated via local anesthesia of the skin. Intracutaneous and subcutaneous injections of histamine, but not papain, produced a sensation of itch without pain. The latency of itch was shorter after an intracutanous than after a subcutaneous injection of histamine. The mean latencies of itch produced by a 1-microgram dose were 9.5 and 23.0 sec for intracutaneous and subcutaneous injections, respectively. No differences were observed in the magnitude or duration of itch. Similarly, the latency of itch was increased when the skin temperature at injection site was lowered to 15 degrees C, whereas the magnitude and duration of itch were unaffected. Intracutaneous and subcutaneous injections of histamine produced similar areas of alloknesis. However, the magnitude and duration of alloknesis were dependent on dose. The mean maximum areas of alloknesis produced by intracutaneous injections of 0.1, 1, and 10 micrograms of histamine were 28.3, 47.2, and 43.8 cm2, respectively. Alloknesis was present at 2 min after injection, increased to a maximum area without 10 min, and then gradually decreased during the next 25-40 min.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Psychophysical studies of the itch sensation and itchy skin ("alloknesis") produced by intracutaneous injection of histamine. 176 23

Sixty-four patients undergoing oesophageal surgery were randomly allocated to receive either a continuous lumbar epidural infusion of morphine or fentanyl, or, intramuscular morphine for postoperative analgesia. There was no statistical difference in analgesic requirements between the patients who underwent a thoracotomy for their procedure (n = 50) and those who did not (n = 14), as assessed by the total dose of opioid administered, visual analogue scale (VAS) and pain score (PS) comparison. However, by these criteria, epidural morphine infusion provided the most satisfactory analgesia (P less than 0.05). Despite the variable quality of analgesia achieved with the three regimens, the postoperative lung function tests were similar for all groups, and we conclude that routine lung function tests are not an appropriate method of comparing analgesic efficacy. Prophylactic administration of loratadine to 15% of our patients was not shown to be effective in diminishing the incidence of pruritus.
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PMID:Postoperative analgesia for oesophageal surgery: a comparison of three analgesic regimens. 176 98

In the multicenter clinical study of 111In-Antimyosin Fab (74 MBq, 0.5 mg), human anti-mouse antibody (HAMA) titers have been evaluated in serum from 456 patients using the sensitive enzyme-linked immunosorbent assay. Presence of HAMA was confirmed by the neutralization test or using the size exclusion high performance liquid chromatography (HPLC) analysis in 11 of 393 patients (2.8%). HAMA was still detectable in 2 patients even 40 weeks after injection. None of 7 patients judged as positive for the intradermal test, a patient with vascular pain or 3 patients with fever or flare and itching with fever, developed detectable levels HAMA in their serum. These results suggest that patients may develop HAMA response after infusion of 111In-Antimyosin Fab, but pathogenic role of HAMA in these patients remains to be studied.
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PMID:[Detection of human anti-mouse antibody in patients receiving 111In-antimyosin Fab: multicenter clinical study in Japan]. 177 Jun 44

Forty adult patients (31 females and 9 males), mean age 48.41 years with chronic venous insufficiency of the lower limbs due to a variety of etiopathogenesis, were randomly divided into two groups of twenty subjects and treated with heparan sulphate and sulodexide. The experimental clinical protocol was formulated using a single blind model. The following dosages were used: a tablet of heparan sulphate in the morning and evening (200 mg/die), and one capsule of sulodexide in the morning and evening (500 ULS/die); treatment lasted 60 days. The aim of the study was to compare the two compounds in terms of efficacy and tolerability. The clinical effect of the two drugs was substantially similar: in particular the symptoms of itch, edema, spontaneous pain and nocturnal cramp responded significantly to (p less than 0.01) to both forms of treatment. The response of fibrin degradation products to heparan sulphate treatment was more positive and differed significantly from that obtained using sulodexide (p less than 0.001). Other parameters, namely erythrocytic filtration and blood viscosity, responded significantly to heparan sulphate treatment in comparison to sulodexide (p less than 0.001). Other blood coagulation and hemorheological parameters and Doppler response showed no change using either drug. With regard to side effects, five cases of digestive intolerance were observed using heparan sulphate and two with sulodexide. Two patients failed to complete heparan sulphate treatment, and one sulodexide treatment. In conclusion, heparan sulphate showed a marked pro-fibrinolytic and prohemorheological effect compared to the reference drug.
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PMID:[Evaluation of anti-thrombophilic properties of heparan sulfate in venous vascular pathology. A controlled clinical study versus active reference]. 178 78

Epidural morphine injection was done in nineteen patients who had been admitted from March to August 1990 to the Intensive Care Unit, Severance Hospital, Yonsei Medical Center for respiratory care including ventilator care. Morphine suplphate, 2.67 +/- 0.27 mg was injected one to three times to four patients after chest trauma, and to fifteen patients after thoracotomy. Tidal volume and vital capacity were increased from 4.45 +/- 0.48 and 8.31 +/- 0.50 to 6.91 +/- 0.41 and 12.81 +/- 0.73 mg/kg. However, respiratory rates decreased from 26.07 +/- 1.41 to 20.07 +/- 1.16/min. Inspiratory force increased from -13.40 +/- 1.31 to -26.53 +/- 1.82 cmH2O. Pain score decreased from 9.22 +/- 0.57 to 3.56 +/- 0.83 during this period. PaCO2 did not differ significantly (39.33 +/- 1.13 and 39.48 +/- 1.42 mmHg). Side effects such as pruritus and urinary retention were treated with naloxone 7 approximately 10 ng/kg/min. Mean arterial pressure and pulse rates stayed stable during the study periods. Ventilator hours and ICU stays differed from the control group. However, the duration was not statistically significant. The control group consisted of patients who were admitted during the six months from September 1989 to February 1990 to the ICU for respiratory care, without epidural morphine injection.
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PMID:Epidural morphine on ventilatory function in chest trauma and thoracotomy patients. 178 Nov 84


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