Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) is the most commonly used measure of disease activity for children with systemic lupus erythematosus (SLE). For headaches to be scored in the SLEDAI as a symptom of active disease, they have to be nonresponsive to narcotic analgesia. This may affect the overall estimation of disease activity, especially because headaches are common among children with SLE and narcotic analgesia is rarely used for headache therapy in paediatrics. Moreover, the importance of headaches for the development of damage and their relation to other clinical parameters and outcomes has not been well described for children with SLE. We reviewed the medical charts of an inception cohort of children (n = 63) who were newly diagnosed with SLE. Information on headaches and other disease parameters was obtained. Disease activity and damage were measured using the SLEDAI and the Systemic Lupus International Collaboration Clinics/American College of Rheumatology Damage Index (SDI), respectively. It has been shown that the accumulated burden of active disease as measured by serial SLEDAI scores over time is one of the best predictors of eventual damage to children with SLE. New-onset or significant increase of severe and/or persistent headaches (LHA) were reported in 43% of the patients during a mean follow-up of 3.6 years. LHA occurred preferentially among patients with elevated levels of antiphospholipid antibodies (aPL) (P < 0.02) and only 6% of all LHA episodes were treated with narcotics and thus considered for the measurement of disease activity in the SLEDAI. LHA were unrelated to proxy-measures of disease activity, such as the need to intensify therapies. When used in children, the insensitivity of the SLEDAI to capture LHA did not seem to decrease the responsiveness of the SLEDAI to detect clinically important worsening of disease, or negatively impact on its ability to predict damage.
Lupus 2003
PMID:Lupus headaches in childhood-onset systemic lupus erythematosus: relationship to disease activity as measured by the systemic lupus erythematosus disease activity index (SLEDAI) and disease damage. 1294 18

The anaesthesiologist facing a pregnant woman with rheumatic disease is caught between a rock (the problems of general anaesthesia, i.e., the difficult airway and/or the cardiopulmonary dysfunctions that can worsen the response to general anaesthetics or to mechanical ventilation) and a hard place (the problems of loco-regional anaesthesia, i.e., intrinsic or iatrogenic haemostatic dysfunctions, potentially causing spinal haematoma, the most threatening complication). However, the term lupus anticoagulant is a misnomer and in the absence of an underlying coagulation deficit or anticoagulant therapy, the anaesthesiologist can usually guarantee epidural analgesia for vaginal delivery to parturients affected by rheumatic diseases (so contributing to the decrease of the caesarean section rate) and, in case of a caesarean section for medical or obstetrical indications, often he can perform a loco-regional anaesthesia, which determines a substantially lower maternal mortality rate. It is very important to adopt a multidisciplinary approach comprising an antepartum team evaluation (to be performed at 36th gestational week) of the basal condition of the parturient: together, the obstetrician, the rheumatologist and the anaesthesiologist should define the type of delivery. We will also try to define the haemostatic safety criteria to be fulfilled for administration of an epidural analgesia to a parturient affected by rheumatic disease.
Lupus 2004
PMID:Anaesthesiological aspects of pregnancy in patients with rheumatic diseases. 1548 7

This article presents a case of a patient with popliteal artery occlusion following anterior and posterior instrumented fusion of the lumbar spine. No previous study has reported acute anterior tibial compartment syndrome due to popliteal artery occlusion and restricted venous return following spine surgery. A 53-year old female, with a twice failed fusion of L5-S1, underwent L3-S1 anterior interbody and posterior L3-S1 instrumented fusion. Due to postoperative continuous analgesia, the patient was sleepy and confused on postoperative day 1. On the postoperative day 2, the right calf and anterolateral tibia manifested clinical signs of compartment syndrome and both thighs exhibited pressure ecchymoses from the antiembolism stockings. Fasciotomies of the right tibial compartments were undertaken and necrosis of the anterior compartment muscles was found. Intraoperative arteriogram revealed occlusion of the right popliteal artery and thrombectomy was performed. Lupus anticoagulant was found to be responsible for patient's coagulopathy. During postoperative year 1, the patient still had weakness and recurrent edema of the right foot. Unrecognized limb ischemia and possibly restricted venous return were the causes of the compartment syndrome. Surgeons should be aware of this devastating complication of spine surgery.
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PMID:Acute tibial compartment syndrome following spine surgery. 2080 63