Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0220723 (PCA)
 4,687 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Forty eight ASA I or II patients of either sex between 20-70 years undergoing major upper abdominal surgery were grouped into sixteen each, on complaint of pain. They received an epidural bolus dose, followed by infusion of the assigned drug at 4ml per hour through BARD PCA I pump. Pain assessment, for the first four hours, was hourly, and subsequently at l0th, 16th, 22nd, 28th, 36th and 40th hour by VAS and VRS. The groups matched for demographic distribution. All groups had lower mean pain scores at first hour by VAS and VRS. In Group II and Group III, the difference was significant (<0.05) at the 2nd (VAS) and 4th (VRS) hours. From 16th (VAS) and 22nd (VRS) hours, the mean pain score was less and significant (<0.05) in Group III. In all groups sedation ranged from 0-1. There was hypotension in Group I (2/16).urinary retention in Group II (8/9 not catheterised); unilateral sensory impairment and motor weakness in Group I (3/16) and Group III (1/16). This study showed that continuous infusion of low dose morphine with bupivacaine provides better quality post operative analgesia with fewer side effects than bupivacaine or morphine alone.
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PMID:Post operative analgesia with continuous epidural infusion. 1544 47

Nontraumatic arterial dissection of the anterior cerebral artery (NAD-ACA) is a relatively rare disease entity, although case reports have recently been increased. We treated 6 patients suffering from NAD-ACA from January 1996 to December 2003, and the neuroradiological findings together with the clinical courses were reviewed. There were 3 males and 3 females with a mean age of 57.7-year-old, ranging from 41 to 65. Five patients had a past history of hypertension and one diabetes mellitus. At the onset, all patients presented with clinical manifestations of cerebral ischemia. Among them, all exhibited contralateral hemiparesis with greater weakness of the lower extremity, and two patients exhibited headache. Initial angiography revealed the pearl and string sign in four patients and string sign, tapered occlusion in each one. Follow-up angiographies revealed sequential changes in all patients; four improved and two progressed. Main anatomic site of the lesion was as follows; five in the A2 and one in the A1 portion, in addition, one patient was complicated by saccular aneurysm, one by PCA dissection, and two had with saccular aneurysm contralateral ACA & MCA and VA dissection each other. Four patients were treated conservatively by intravenous administration of argatroban, one by intravenous administration of Dextrane and one by anti-platelet agent in the acute stage. All patients were treated by anti-platelet agents in the chronic stage. Good recovery was achieved in five patients, but one who suffered from severe subarachnoid hemorrhage in the chronic stage died. Our experience suggests that hypertension and/or the succeeding abnormal structural changes in the arterial wall may contribute to the occurrence of this disease. NAD-ACA showing clinical manifestations of cerebral ischemia could result in a relatively good prognosis; however, attention should be paid to patients treated conservatively with a very closed follow-up angiography to prevent a possibility of severe hemorrhage.
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PMID:[Nontraumatic arterial dissection of the anterior cerebral artery: six cases report]. 1602 47

Spontaneous intracranial artery dissection (SIAD), leading to occlusion or stenosis of arterial lumen is a frequent but less studied cause of ischemic stroke especially in young adults. We studied 17 patients (10 men, 7 women, mean age 27.5 +/- 8.5 years) with SIAD. All the patients have undergone magnetic resonance imaging of the head, magnetic resonance angiography (MRA) (in 16 patients--follow-up MRA), 1 patient--conventional cerebral angiography. SIAD was located in the middle cerebral artery (MCA, 14 patients); posterior cerebral artery (PCA, 2 patients) and basilar artery (BA, 1 patient). Fifteen patients (88%) with SIAD developed ischemic stroke, 2 patients (12%)--a transient ischemic attack (TIA). The appearance of the local brain ischemia symptoms was combined with headache in 93% cases. The course of ischemic stroke was favorable in most cases with complete or good functional recovery in 66% of patients. A fatal outcome was observed in 1 patient (7%) with massive brain infarct. The initial cerebral angiography carried out in most cases (76%) within 3 weeks after the disease onset revealed occlusion (71%) or stenosis (29%) of corresponding cerebral arteries (MCA, PCA, BA). The last cerebral angiography conducted in 90% cases 4,5 months or later showed positive dynamics--appearance or improvement of the blood flow in these arteries--in 82% patients. The factors provoking SIAD were alcohol, contraceptive drugs and less frequent recent infection. None of patients had atherosclerosis, vasculitis or arterial hypertension. Clinical manifestations of connective tissue weakness were in 71% of patients, hypotension--65%, mitral valve prolapse--46%. In conclusion, SIAD is one of the causes of ischemic stroke and TIA in young adults and characteristic clinical manifestations and follow-up MRA have a great diagnostic importance. The development of SIAD appears to be related to weakness of connective tissue of arterial wall.
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PMID:[Spontaneous intramural intracranial artery dissection and ischemic stroke]. 1819 22

This prospective study aimed to compare the efficacy of epidural (EDA) versus intravenous (PCA) application of analgesics after lumbar fusion. Fifty-two patients scheduled for elective posterior instrumented lumbar fusion were randomized into two groups. EDA patients received an epidural catheter intraoperatively, and administration of ropivacain and sulfentanil was started after a normal postoperative wake-up test in the recovery room area. PCA patients received intravenous opioids in the post-operative period. Differences between EDA and PCA groups in terms of patient satisfaction with respect to pain relief were not significant. Nevertheless, EDA patients reported less pain on the third day after surgery. There were significantly more side effects in the EDA group, including complete reversible loss of sensory function and motor weakness. There were no major side effects, such as infection or persisting neurological deficits, in either group. The routine use of epidural anesthesia for lumbar spine surgery has too many risks and offers very little advantage over PCA.
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PMID:Efficacy of post-operative analgesia after posterior lumbar instrumented fusion for degenerative disc disease: a prospective randomized comparison of epidural catheter and intravenous administration of analgesics. 2180 4

A 36-year-old female with systemic lupus erythematosus and antiphospholipid syndrome was referred to our department because of mild weakness of left arm and an episode of right amaurosis fugax for twenty days. Brain MRI showed right ACA/MCA/PCA border zone infarction on DWI/T2WI/FLAIR and MR angiography (MRA) showed multiple segmental stenosis in right internal carotid artery, right and left middle cerebral artery, and bilateral posterior cerebral arteries. Treatment with oral aspirin (100 mg/day) and continuous infusion of heparin kept her neurological symptoms and signs stable. MRA on 28 days revealed complete recovery of multiple stenotic lesions, thus, diagnosis of reversible cerebral vasoconstriction (RCVS) was made. RCVS should be considered as a cause of neurological deficit in patients with SLE regardless of thunderclap headache.
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PMID:[Reversible cerebral vasoconstriction syndrome in a stroke patient with systemic lupus erythematosus and antiphospholipid antibody]. 2360 42

Infrared imaging was applied to investigate a reconstituted basement membrane, known as Matrigel, in three-dimensional cell cultures. Matrigel, in the vicinity of the colonies, was examined for four breast cancer cell lines presenting different 3D colony morphologies. MCF-7 and T-47D present mass colonies, SKBR-3 grape-like colonies and MDA-MB-231 stellate colonies associated with a more invasive phenotype. The edge of the cell colonies was found to be significantly depleted in Matrigel. Except in a limited number of cases, Matrigel appeared to be thinner at the edges of the colonies but not completely destroyed or torn off as it would be for a purely mechanical effect. When a PCA was run on the spectra of one or several colonies, the score images on PC#3 and PC#4 presented structures in the Matrigel areas which appeared as fringes, lines, dots or regular patterns. This effect represents a very small fraction of the total variance but is reproducible for all the 4 cell lines. PC#4 presents systematically a maximum near 1624 cm(-1) and a minimum around 1700 cm(-1). When spectra are normalized, the effect is less marked but does not disappear. The nature of the variations that exist in the Matrigel layer is therefore not solely related to thickness but also to the chemical composition. At this stage, the weakness of the effect prevents a thorough investigation.
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PMID:FTIR imaging of the 3D extracellular matrix used to grow colonies of breast cancer cell lines. 2661 20

Paramedian thalamic strokes following occlusion of the posterior medial (paramedian) thalamic perforators have been previously described in great detail. However, the stroke syndrome associated with occlusion of posterior lateral (inferolateral) thalamic perforators is less commonly known. We present an illustrative case of an inferolateral thalamic perforator stroke mimicking a middle cerebral artery (MCA) syndrome and provide a review of the literature. A 62-year-old male presented with dysarthria, contralateral hemisensory loss, and contralateral weakness, concerning for possible MCA stroke. However, close examination revealed the hemiparesis to be ataxic in nature. Imaging revealed a left PCA P2 segment occlusion and lacunar infarction of the ventral lateral (VL) and ventral posterior (VP) thalamus, the main thalamic destination of cerebellar and sensory pathways. The case is unique because the P1 segment and posterior communicating artery (Pcom) remained patent, resulting in selective occlusion of only the posterior lateral (inferolateral) thalamic perforators at the P2 level. Acute loss of the posterior lateral (inferolateral) thalamic perforators at the proximal P2 segment results in a ventral lateral and ventral posterior thalamic stroke characterized by contralateral hemisensory loss, contralateral ataxic hemiparesis, and dysarthria. It is important to recognize the inferolateral thalamic stroke syndrome, as it may be mistaken clinically for an MCA occlusion. The benefit of mechanical thrombectomy for this type of stroke is not well established and should be considered carefully.
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PMID:Inferolateral thalamic ischemia secondary to PCA P2 perforator occlusion mimics MCA stroke syndrome. 3170 67