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

Persistent pruritus is one of the most common symptoms in hemodialysis patients. The cause of pruritus is not known, and conventional treatment for pruritus is rarely helpful. Some authors thought that release of histamine from increased mast cells in uremic patients was the cause of pruritus. On the other hand, there have been a number of reports suggesting that uremic patients are zinc deficient. In vitro as well as in vivo studies have demonstrated that zinc has an inhibitory effect on various functions of some cells, such as histamine release from mast cells. In this study, we examined the serum zinc and histamine levels in 19 hemodialysis patients with persistent pruritus and the effect of zinc supplementation on the pruritus. In patients with pruritus, the serum zinc level decreased and serum histamine level increased, showing a negative correlation between them. Oral zinc sulfate, 445 mg daily for two months, relieved pruritus subjectively in 53% of the patients. After treatment, serum histamine levels decreased significantly, as well as serum zinc levels increased significantly. These findings suggest that zinc deficiency participates in increased histamine levels in dialysis patients, and subsequently in the development of uremic pruritus.
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PMID:[Beneficial effect of zinc supplementation on pruritus in hemodialysis patients with special reference to changes in serum histamine levels]. 344 19

Inorganic sulfate concentrations are markedly elevated in patients with chronic renal failure (CRF). During hemodialysis, sulfate is removed and circulating levels drop significantly, while chloride concentrations remain relatively constant. We measured sulfate and chloride in sweat from CRF patients collected by pilocarpine iontophoresis. Sweat sulfate concentrations in uremic patients were significantly increased (404 +/- 43 vs. 105 +/- 6 microM in 22 controls). The correlation between plasma and sweat SO4 concentrations in CRF patients was significant (r = 0.77, P less than 0.01). However, the fractional excretion of sulfate in sweat (the sweat/serum ratio) was close to that of chloride (0.26 +/- 0.01 vs. 0.19 +/- 0.02) and was essentially the same before and after dialysis (0.20 +/- 0.01 vs 0.23 +/- 0.01) despite the significant absolute change in the extracellular SO4 concentration (from 2,018 +/- 153 to 709 +/- 21 microM) and no change in chloride concentrations. In patients with CRF, we conclude that the handling of inorganic sulfate by the sweat gland is not significantly different from that for chloride. Hemodialysis reduces absolute sulfate excretion markedly and thus may reduce the likelihood of forming calcium sulfate complexes in the sweat secretions. This could be a significant factor in the dialysis-related pruritus that has been ascribed to excess calcium deposition in the skin.
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PMID:Increased sweat sulfate concentrations in chronic renal failure. 377 82

We performed a prospective, randomized, double-blind study of continuous epidural analgesia for 72 hours after major abdominal procedures. Patients were randomly assigned to one of five treatment groups: epidural morphine, epidural bupivacaine, a combination of morphine and bupivacaine, epidural saline solution, and no epidural catheter. All patients received supplemental morphine sulfate or meperidine hydrochloride, intramuscularly or intravenously, as needed. Epidural infusion was begun at 2 to 4 ml/hr, depending on age and height, with two increments of 1 ml/hr allowed if pain relief was insufficient. All pain management decisions were made by nurses, who also monitored epidural function. Performance was measured four ways: pain as measured at regular intervals in the 72-hour period with a visual analog, pain as measured after 72 hours with the McGill Pain Questionnaire, amount of supplemental narcotics needed, and recovery of respiratory function and ambulation as percent of preoperative levels. The group that received the combination of morphine and bupivacaine did best on all measures; in most instances the difference between the results seen with the combination regimen and those seen with saline solution or no catheter were significant at the 0.05 level. With the exception of pruritus, complications were evenly distributed among all treatment groups, including noncatheterized controls. We conclude that epidural analgesia with the combination of morphine and bupivacaine is safe, is easily managed, and gives pain relief superior to that provided by traditional, systemic administration of narcotics.
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PMID:Continuous epidural infusion for analgesia after major abdominal operations: a randomized, prospective, double-blind study. 390 75

It is noted that advertisements in medical journals recommend treatment of emotional symptoms in menopausal patients with Premarin (Ayerst brand of conjugated estrogens), Ogen (Abbott brand of piperazine estrone sulfate), or other compounds. There are no acceptable studies proving the usefulness of such combinations for symptoms relating to the menopause and no persuasive evidence to justify use of conjugated or any other type of estrogen in the treatment of emotional symptoms in menopausal women. Vasomotor symptoms, flushing, and sweats respond to estrogens. Symptoms do not recur if treatment is stopped after 1 or 2 years. Systematic or topical use of estrogens fails to promote the appearance of youthfulness. Vaginal pruritus and dyspareunia due to atrophic vaginitis may be relieved by estrogens either applied locally or orally. Libido is not heightened by exogenous estrogens but sufficient androgen doses cause virilization. It is doubtful if osteoporosis is favorably influenced by long-term use of estrogens. Estrogen therapy may cause spotting, menarrhagia, nausea, breast tenderness, or fluid retention. Prolonged use may cause increase in size of uterine fibroids. Personal or even family history of breast or genital cancer are considered contraindications.
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PMID:Estrogens and the menopausal patient. 434 58

This study was designed to determine in postcesarean patients whether in addition to superior analgesic effects, epidural morphine administration results in secondary benefits in maternal well-being and maternal-infant interaction. Following elective cesarean section with bupivacaine epidural anesthesia, 40 healthy mothers received 5 mg preservative-free morphine sulfate in 10 ml of saline, either by the epidural (Group 1, n = 20) or the intravenous (Group 2, n = 20) route, in a randomized, double-blind fashion. Each received a simultaneous injection of saline by the alternate route. Analgesia in Group 1 lasted significantly longer (16.1 +/- 8.8 vs. 4.4 +/- 2.4 h, mean +/- SD; P less than 0.001), and morphine requirements in the first 24 h were significantly less (12.5 +/- 20 mg vs. 36 +/- 21 mg, P less than 0.001) than in Group 2. Seventy-four per cent of patients who received epidural morphine reported excellent analgesia, compared with only 32% of those who received intravenous morphine (P less than 0.05). Although Group 1 mothers ambulated 6 h earlier than those in Group 2 (P less than 0.02), there was no difference between the groups in time of first voiding, number of hours mothers slept, or duration of hospital stay. Mothers in both groups interacted with their infants equally well and for the same duration of time. Itching occurred in 58% of Group 1 patients and only 16% of Group 2 patients (P less than 0.01); the incidences of nausea, vomiting, and urinary retention were not statistically different between the groups. No respiratory depression was observed. Benefits of epidural morphine in this patient population appear limited to the provision of improved analgesia and earlier mobility.
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PMID:The role of epidural morphine in the postcesarean patient: efficacy and effects on bonding. 634 99

To determine the efficacy of epidural morphine during labor and delivery, 40 healthy parturients who requested epidural analgesia were randomly given either a single injection of morphine sulfate (2 mg, n = 9; 5 mg, n = 10; or 7.5 mg, n = 11) or 0.5% bupivacaine (n = 10). Bupivacaine provided excellent analgesia in all patients. Morphine (2 or 5 mg) did not produce adequate analgesia and needed to be supplemented by local anesthesia. Morphine (7.5 mg) gave satisfactory analgesia in 7 of 11 patients until the end of the first stage of labor, and, in an additional patient, for almost 13 hr, at which time cephalopelvic disproportion was diagnosed. In all patients given epidural morphine, local anesthesia was needed for the second stage of labor if instrumentation or episiotomy was required. The only side effect was pruritus, which occurred in three patients. Epidural morphine did not produce neonatal depression, as evidenced by Apgar scores and neurologic and adaptive capacity scores. We conclude that 7.5 mg of epidural morphine can give satisfactory pain relief during labor but not delivery, and that 2 or 5 mg of morphine is ineffective. Although 0.5% bupivacaine provided better anesthesia, epidural morphine might prove useful for selected patients.
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PMID:Maternal and neonatal effects of epidural morphine for labor and delivery. 670 48

Different doses of epidural morphine were studied in order to determine their effectiveness in providing postoperative pain relief after surgery of the lower extremities and their relationship to the incidence of untoward reactions. The study was carried out in a double-blind fashion using five dosages of epidural morphine (0.5, 1.0, 2.0, 4.0, and 8.0 mg) and included 60 patients. The higher doses of morphine (2.0, 4.0, and 8.0 mg) were equally effective and more effective than the lower doses (0.5 and 1.0 mg) in providing postoperative analgesia. Nausea and vomiting were encountered more frequently with the highest dose (8.0 mg) and this finding was statistically significant (P less than 0.03). No statistically significant difference was found between the doses studied with regard to itching, urinary retention, and respiratory depression; the latter was evaluated in a subgroup of 20 patients. These data suggest that effective postoperative pain relief after surgery of the lower extremities can be achieved with relatively low doses of morphine sulfate and with minimal side effects. For the type of surgery studied, 2 mg morphine sulfate appeared to be the optimum dose.
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PMID:Epidural morphine for postoperative pain relief: a dose-response curve. 680 63

Ten healthy males between 18 and 33 years received 10 mg morphine sulfate intravenously, or by lumbar epidural injection at two sessions 2-4 weeks apart, in random sequence. The following observations were made at intervals for 22 h. (1) Segmental hypalgesia to ice and pin scratch. (2) Cold pressor response test in hand and foot as an index of analgesia. (3) Time of onset and duration of side effects. (4) Serum concentrations of morphine. Few non-respiratory changes were seen after intravenous morphine. Cold pressor response was unchanged in hand and foot, no segmental hypalgesia or itching occurred, and only one subject complained of nausea. Marked changes occurred after epidural morphine. Cutaneous hypalgesia to ice and pin scratch appeared in the thoracolumbar region all subjects. In six subjects hypalgesia rose to the midthoracic region during the second or third hour and to the trigeminal distribution between the sixth and ninth hour in five subjects. Cold pressor response fell rapidly in the foot during the first 1.5 h after epidural morphine, and a little later cold pressor response also fell in the hand in all subjects, and remained depressed for the duration of the experimental period. Pruritus occurred at three hours in nine of the 10 subjects, nausea at about four hours in six of the subjects, and vomiting at about six hours in five of the subjects. Hypalgesia and side effects were not related to serum concentrations of morphine. These results suggest that lumbar epidural morphine travels cephalad in the cerebrospinal fluid to reach the brain stem and fourth ventricle by the sixth hour.
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PMID:Rostral spread of epidural morphine. 708 27

Ten healthy young male volunteers received in random sequence 10 mg of morphine sulfate intravenously and by lumbar epidural route during two 26-hour study sessions, in order to observe the appearance and resolution of the following side effects: (a) pruritus, (b) nausea, (c) vomiting, (d) urinary dysfunction. With the exception of one subject, who experienced transient (2 hours) nausea, none of the subjects experienced any adverse side effects after the intravenous morphine. However, all subjects experienced some degree of one or more complications, starting 3 hours after the epidural administration: generalized pruritus started at 3.0 +/- 0.3 hours (nine of 10 subjects, mean +/- SD) and lasted 5.3 +/- 4.0 hours. Nausea occurred in six subjects at 4.0 +/- 0.6 hours, and lasted 3.0 +/- 2.1 hours; vomiting occurred at 6.3 +/- 2.0 hours in five of the nauseated subjects. Urinary retention of varying intensity and duration appeared in nine subjects and required pharmacologic intervention in six subjects. Serum levels of unmodified morphine were measured at various times after administration during both sessions and did not correlate with the incidence or temporal appearance of side effects. Serial evaluation of dermatomal level of hypalgesia to ice and pin scratch demonstrated a progressive spread in the rostral direction after epidural morphine; trigeminal areas were affected by 9 hours in five of the 10 subjects. The stereotyped sequence of side effects after 10 mg of morphine by the epidural route can be interpreted to reflect widespread dispersion of morphine throughout the subarachnoid and ventricular cerebrospinal fluid.
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PMID:Nonrespiratory side effects of epidural morphine. 720 Jul 37

Colombian patients with New World cutaneous leishmaniasis were treated with a combination of a topical formulation (15% paromomycin sulfate/5% methylbenzethonium chloride, twice a day) and parenteral meglumine antimonate (20 mg of antimony [Sb]/kg.d]). Cohort 1 received topical therapy for 10 days and Sb for 7 days; 18 (90%) of the 20 patients were cured (follow-up, 12 months). Other clinical data suggested that neither the topical formulation alone nor the 7-day regimen of Sb alone would have cured many patients. In a subsequent cohort, which received topical therapy for 10 days and Sb for 3 days, the cure rate was 42% (eight of 19 patients). In Colombian cohorts (historical controls) treated with Sb alone for 10-15 days, the cure rate was 31%-36%. Side effects in cohort 1 patients consisted of local reactions to the topical formulation: burning and pruritus in 25% of patients and vesicle formation in 15% of patients. This is the first report that a regimen partially composed of topical antimicrobial agents can be highly effective for treatment of New World cutaneous leishmaniasis.
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PMID:Successful treatment of New World cutaneous leishmaniasis with a combination of topical paromomycin/methylbenzethonium chloride and injectable meglumine antimonate. 772 69


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