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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intraoperative analgesia is the purview of anesthesiologists whereas postoperative pain is traditionally managed by surgeons. This series reports 19 months experience of anesthesiologists using epidural opiate analgesia (EOA) or patient-controlled analgesia (PCA) to treat postoperative pain in 302 patients following surgery for pelvic malignancy. For the 244 (81%) patients who received EOA, a lumbar epidural catheter was placed just prior to surgery, injected with local anesthetic for intraoperative analgesia, and injected with preservative-free morphine at appropriate intervals postoperatively to relieve pain. Fifty-eight patients (19%) used PCA which consisted of small self-administered boluses of intravenous narcotics. All patients were seen daily to ensure adequate analgesia and to treat side effects. Utilizing a 0-10 verbal rating scale (0 = no pain; 10 = worst pain imaginable), mean pain with EOA was 0.75 at rest and 2.6 with coughing. Mean pain ratings with PCA were 2.8 at rest and 5.0 during coughing. Side effects with EOA included nausea or vomiting (28%) and pruritus (20%). The only side effect of significance with PCA was nausea or vomiting (21%). All patients improved with treatment of side effects. Acceptance of these techniques is indicated by a steady increase in the number of gynecologic oncology surgical patients utilizing these modalities (50% at the outset to 87% currently).
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PMID:Postoperative pain management in gynecology oncology patients utilizing epidural opiate analgesia and patient-controlled analgesia. 259 69

One hundred eighty-five dogs with histologically confirmed, measurable malignant tumors were used in a study to determine the toxicity of the anthracycline antitumor antibiotic, doxorubicin, which was administered once or twice (at a 21-day interval) at the rate of 30 mg/m2 of body surface area, iv. During this study, 7 dogs died as a direct result of doxorubicin-induced toxicosis and 16 died as a direct result of the malignant neoplastic disease. Each dog was evaluated for signs of toxicosis for 3 weeks after the last dose was administered (15 dogs received 1 dose, 170 dogs received 2 doses) or until the dog died, whichever came first. The most common signs of toxicosis were vomiting, diarrhea, colitis, anorexia, and pruritus. The probability of doxorubicin-induced toxicosis decreased significantly (P less than 0.0001) in inverse relationship to body weight. Dogs with signs of toxicosis during the 21-day interval from administration of the first dose of doxorubicin were 17.2 times (P less than 0.01; 95% confidence interval; 5.5, 54.2) more likely to develop signs of toxicosis during the 21-day interval from the second dose of doxorubicin. The performance status of each dog was evaluated using a modified Karnofsky performance scheme; the only time the performance status was adversely affected to a significant extent by doxorubicin-induced toxicosis was during the 21-day period, starting with the second dose (P less than 0.0001).
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PMID:Acute and short-term toxicoses associated with the administration of doxorubicin to dogs with malignant tumors. 259 42

Patients undergoing thoracotomy experience severe post-operative pain and marked respiratory impairment, which causes pulmonary atelectasis and pneumonia. The effects of epidural injection on postoperative pain and respiratory function were examined in this study. The group undergoing epidural injection of 3 mg morphine (at the end of operation, 09oo and 21oo for the next 3 days) included 37 patients, while the control group involved 16. The number of required analgesics on the operating day and next three days were compared between the two groups. And postoperative vital capacity (VC), forced expiratory volume in the first second (FEV1), maximum mean flow (MMF) were compared with preoperative value. Patients receiving epidural morphine required significantly less analgesics throughout the postoperative periods (p less than 0.01). The morphine injected group had significantly better value in VC and FEV1 in the first two postoperative day (p less than 0.01), while significance were seen only in the first postoperative day in MMF (p less than 0.01). It seems that epidural morphine is highly effective in alleviating pain and improving respiratory function in post-thoracotomy patients. These effects help the expectoration of sputum especially in senile patients. As the side-effects of epidural morphine, urinary retention, nausea, vomiting and itching were seen in few patients. No serious side effect such as hypotension or ventilatory depression were seen.
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PMID:[The effect of epidural injection with morphine on the post-thoracotomy respiratory function]. 261 15

Epidural analgesia is an important intervention in patients with pain after surgery. This article presents a brief overview of the anatomy of the epidural space and the physiology of pain transmission, including the action of narcotics in pain relief. The importance of written nursing protocols and in-service education for nursing staff members is discussed as being a necessary prerequisite for the safe use of epidural analgesia. A flow diagram with rationale illustrates the epidural injection technique. Nursing care of patients receiving epidural narcotics is detailed. The discussion emphasizes the management of potential side effects from epidural narcotics (respiratory depression, urinary retention, pruritus, pain on injection, dizziness, nausea, and vomiting) and includes information on the use of a narcotic antagonist. Recommendations are made for preoperative and postoperative teaching of the patient and family. A variety of tools for assessing patients' pain levels are described, and a comprehensive nursing care plan with nursing diagnoses and nursing interventions is provided.
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PMID:Nursing management of patients receiving epidural narcotics. 264 76

The safety and efficacy of premedication with oral transmucosal fentanyl citrate (OTFC) was compared with that of an orally administered solution of meperidine, diazepam, and atropine and no premedication in 59 children about to undergo elective operations. The patients were randomly assigned to receive no premedication (n = 19); 0.25 ml/kg of the oral solution (containing meperidine, 1.5 mg/kg, diazepam, 0.2 mg/kg, and atropine, 0.02 mg/kg, n = 20); or OTFC (15-20 micrograms/kg, n = 20). Children had activity (sedation) and anxiety scores, vital signs (including systolic and diastolic arterial blood pressures and heart and respiratory rates) and pulse oximetry determined oxygen saturation measured before and at 10-min intervals after premedication until they were taken to the operating room. Quality of induction and recovery was evaluated using scoring schedules; recovery times were measured and side effects noted. OTFC was readily accepted and provided significant reductions in preoperative activity (sedation) and anxiety starting after 30 min. After OTFC, sedation and anxiolysis were significantly greater than in children having no premedication but similar to children having the oral solution for premedication. Vital signs and oxygen saturations remained unchanged preoperatively in all groups. Induction and recovery evaluations and recovery times were similar in the three groups, although children having OTFC had the lowest requirements for narcotics in the recovery room. OTFC caused an 80% incidence of mild preoperative facial pruritus and a higher overall incidence of postoperative vomiting (37%) than premedication with the oral solution (5%) or no premedication (18%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of oral transmucosal fentanyl citrate and an oral solution of meperidine, diazepam, and atropine for premedication in children. 264 97

We treated 16 patients who had hormone refractory metastatic prostate cancer with 400 mg. ketoconazole orally every 8 hours. None of the patients had an objective response, although 6 (37.5 per cent) had stable disease (2 of whom had a subjective decrease in bone pain). The median duration of stable disease was 6.8 months (range 2 to 12 months) and side effects were seen in 14 patients. Nausea, vomiting or anorexia was noted in 10 patients, rash and pruritus in 2, transient abnormal liver function tests in 1 and transient pulmonary infiltrates in 1. Nine prior studies investigating the use of ketoconazole in hormone refractory metastatic prostate cancer were reviewed. Only 1 complete response was reported. A partial response was noted in 14 per cent of the patients. Most of the patients had stable or progressive disease. High dose ketoconazole as a single agent appears to have limited use in patients who have failed prior systemic therapy.
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PMID:High dose ketoconazole for the treatment of hormone refractory metastatic prostate carcinoma: 16 cases and review of the literature. 265 29

Symptoms were evaluated in 13 haemodialysis patients at dialysate temperatures between 37 and 35 degrees C. After a control period at 37 degrees C (stage 1) dialysate flow rate was increased from 300 ml/min in half the patients but no change in temperature was made (stage 2). In stage 3 dialysate temperature was reduced to 36.5 degrees C and in stage 4 to 35 degrees C. Blood pressure and temperature were measured pre- and post dialysis and patient completed a questionnaire indicating if they experienced any of nine specified symptoms: itch, restless legs, nausea, vomiting, headache, cramp, lethargy, hypotension and change in temperature. Trial stages were compared with chi 2 analysis using Yates correction. Symptoms per dialysis fell from 1.11 to 0.71 between stage 1 and 2 (p less than 0.0005). This was considered to be a trial effect. There was no further significant improvement in symptoms overall as the temperature was reduced to 35 degrees C. However, if complaints of coldness are excluded, there was a progressive reduction in symptoms from stage 1 to stage 4. Dialysate flow rate did not affect symptom reporting. There was no effect on body core temperature or blood pressure due to cool dialysate. Our results suggest there may be some benefit in lowering the dialysate temperature but this is small in relation to the placebo effect. Caution must be used in assessing similar studies using small numbers of dialyses.
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PMID:Assessment of the symptomatic benefit of cool dialysate. 266 42

A case of hepatitis is reported in a 38-year-old alcoholic woman taking disulfiram to aid in maintaining sobriety. She presented with anorexia, vomiting, fatigue, right upper-quadrant pain, pruritus, darkened urine, and jaundice after about two weeks of disulfiram 500 mg/d. The patient also had been taking enalapril 10 mg/d for one year. Hepatocellular enzymes, total bilirubin, and eosinophils were significantly elevated. Hepatitis B core antibody, hepatitis A antibody, hepatitis B surface antibody, and antinuclear antibody were negative. After discontinuation of disulfiram, the clinical and biochemical manifestations of hepatitis began to resolve and the patient was discharged in a much improved condition. Seventeen previous cases of disulfiram-induced hepatitis are reviewed. It has been suggested that the mechanism of hepatotoxicity is an allergic or hypersensitivity reaction. The findings in this case are consistent with the earlier descriptions of hypersensitivity hepatitis, and lend further support to the possibility that disulfiram may cause hepatitis.
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PMID:Disulfiram-induced hepatitis: case report and review of the literature. 268 28

Histamine poisoning results from the consumption of foods, typically certain types of fish and cheeses, that contain unusually high levels of histamine. Spoiled fish of the families, Scombridae and Scomberesocidae (e.g. tuna, mackerel, bonito), are commonly implicated in incidents of histamine poisoning, which leads to the common usage of the term, "scombroid fish poisoning", to describe this illness. However, certain non-scombroid fish, most notably mahi-mahi, bluefish, and sardines, when spoiled are also commonly implicated in histamine poisoning. Also, on rare occasions, cheeses especially Swiss cheese, can be implicated in histamine poisoning. The symptoms of histamine poisoning generally resemble the symptoms encountered with IgE-mediated food allergies. The symptoms include nausea, vomiting, diarrhea, an oral burning sensation or peppery taste, hives, itching, red rash, and hypotension. The onset of the symptoms usually occurs within a few minutes after ingestion of the implicated food, and the duration of symptoms ranges from a few hours to 24 h. Antihistamines can be used effectively to treat this intoxication. Histamine is formed in foods by certain bacteria that are able to decarboxylate the amino acid, histidine. However, foods containing unusually high levels of histamine may not appear to be outwardly spoiled. Foods with histamine concentrations exceeding 50 mg per 100 g of food are generally considered to be hazardous. Histamine formation in fish can be prevented by proper handling and refrigerated storage while the control of histamine formation in cheese seems dependent on insuring that histamine-producing bacteria are not present in significant numbers in the raw milk.
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PMID:Histamine poisoning (scombroid fish poisoning): an allergy-like intoxication. 268 58

The literature was reviewed for cases of cutaneous pigmentation induced by rifampicin overdosage. 29 examples have been described, in which 2 general groups of individuals were observed. The first consisted of older individuals (average age 27.1 years) who attempted suicide. A prior history of suicide attempts, depression and substance abuse was a predominant factor in these patients. The second group included generally younger patients (average age 2.9 years) in whom misformulation of rifampicin preparations for treatment of Haemophilus influenzae Type B resulted in bright reddish-orange discoloration to the skin. The time to clinical appearance of skin discoloration was approximately 2.2 hours after administration. Periorbital or facial oedema occurred in 72.4% of the patients, pruritus in 62.1% and either nausea, vomiting or diffuse abdominal tenderness in 51.7%. Limited laboratory data are available but these indicate that all patients had elevated levels of total bilirubin. Histological examination in selected individuals revealed rifampicin crystal deposits in the nasopharynx, gastrointestinal tract and lining of the aorta. In adults, it appears that a dose of at least 14 g of rifampicin is necessary before cardiovascular-pulmonary arrest occurs. Other than general supportive measures, very few methods are described in the literature for the treatment of acute intoxications with this drug. A differential diagnosis of other causes of reddish-orange pigmentation is discussed, together with clinical information to differentiate these cases from toxic rifampicin ingestion.
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PMID:A review of the Redman syndrome and rifampicin overdosage. 268 37


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