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)

Obstetrician-gynecologists recruited 100 women (mean age = 24.1 years and mean duration of amenorrhea = 51 days) attending the Aberdeen Royal Infirmary in Scotland to undergo elected abortion into an open study of the use of a new regimen of oral mifepristone (600 mg) and vaginally-administered misoprostol (800 mcg). This was the first pregnancy for 77 of the women. No surgical intervention was required in any of the cases. The conceptus was expelled and confirmed within 4 hours after administration of misoprostol in 99 women. The other woman aborted within 2 hours after an ultrasound scan. One women bled heavily and did not completely abort. She was readmitted to the hospital, where she received a blood transfusion. An oxytocic injection resulted in a complete abortion. One woman had a complete abortion with just mifepristone. Vomiting (17%) and diarrhea (12%) were the leading side effects. None of the women with these gastrointestinal effects needed any treatment. Most women (66%) did not ask for any analgesia. Bleeding after the abortion lasted on average 9.5 days. Before and after mean hemoglobin levels were similar (13.1 and 12.9, respectively). No one developed an infection. These findings support those of another study that misoprostol administered vaginally is much more effective at terminating pregnancy than when it is administered orally. They also show that women find vaginally administered misoprostol very acceptable.
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PMID:Early induction of abortion by a combination of oral mifepristone and misoprostol administered by the vaginal route. 814 50

A total of 60 women having termination of pregnancy between 13 and 20 weeks were recruited to the study. Mifepristone 600 mg was given to all 60 patients in the clinic and 36-48 hours later they received the prostaglandin component of the treatment. Group 1 included 30 patients who were given misoprostol 400 mcg 3 hourly to a maximum of 3 doses. If abortion did not occur, 2 further doses of vaginal gemeprost 1 mg were administered 3 h apart. If abortion still did not occur, the treatment regimen was considered a failure and extra-amniotic prostaglandin E2 was administered. Group 2 patients were given gemeprost vaginal pessaries 1 mg, 3 hourly until abortion occurred, up to a maximum of 5 doses. If abortion did not occur, the treatment was considered a failure and extra-amniotic prostaglandin was initiated. Patients were kept for a minimum of 12 hours following the procedure. The patients were reviewed 14 days later. 27 (90%) of patients in group 1 and 28 (93%) in group 2 aborted successfully. Those aborting successfully in group 2 recorded a slightly higher median induction-to-abortion time than those in group 1. The median number of prostaglandin doses in both arms of the study was 3. In group 1, 23 patients (77%) aborted subsequent to receiving misoprostol only. 2 patients in group 1 aborted at 33 hours and 60 hours respectively. 14 (47%) patients in group 1 compared to 17 (57%) in group 2 required narcotic analgesia. Vomiting was 11 (37%) and 13 (43%), respectively, while diarrhea occurred in 6 (20%) patients and 2 (7%) patients, respectively. There were 5 cases of retained placenta, 2 from group 1 and 3 from group 2. 1 patient from each group bled heavily during the abortion. 2 patients from each group required exploratory dilatation and curettage because of heavy vaginal bleeding in the 2 weeks following the treatment. Follow-up was carried out for 36 patients (60%) at 2 weeks. The median duration of bleeding days for the 36 patients was 13 days. No patient experienced bleeding following mifepristone and prior to prostaglandin.
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PMID:The abortifacient effect of misoprostol in the second trimester. A randomized comparison with gemeprost in patients pre-treated with mifepristone (RU486). 830 Aug 40

In Scotland, gynecologists used 200 mg mifepristone followed 36 hours later by 1 mg gemeprost pessary every 6 hours for the first 24 hours and, if termination did not occur, every 3 hours for the next 12 hours, to induce second trimester abortion (12-21 weeks gestation) in 100 women 13-42 years old, attending the Simpson Maternity Pavilion of the Edinburgh Royal Infirmary. Most women only required 2 pessaries (range, 1-9). 47 only needed 1 pessary. 96 and 99 women experienced an abortion within 24 hours and 48 hours, respectively. The median interval between gemeprost administration and abortion was 7.5 hours (range, 2.9-52.3 hours). Just 1 woman experienced the abortion after 48 hours, and she required intravenous infusion of oxytocin. The interval for primigravidas was significantly longer than for multigravidas (8.2 hours vs. 6.6 hours; p .01). 31 women vomited after insertion of the gemeprost pessary. 5 experienced diarrhea after gemeprost administration. 84 required intramuscular diamorphine for analgesia. Evacuation of the uterus was required in 33 women after they expelled the fetus. 24 of these women retained the placenta. None of the 100 women required a blood transfusion. These results compared favorably with those of a similar study using 600 mg mifepristone in combination with 1 mg gemeprost every 3 hours. In other words, clinical efficacy was not lost with a reduction in the dose of both mifepristone and gemeprost. These results demonstrated that 200 mg mifepristone followed by 1 mg gemeprost pessary is a cost-effective, simple, and noninvasive method to induce a second trimester abortion on an outpatient basis.
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PMID:Induction of second trimester abortion with mifepristone and gemeprost. 839 16

During a 16-month period, 15 neurologically impaired infants and children for whom medical treatment failed underwent laparoscopic fundoplication. The indications for surgery included feeding difficulties, vomiting, and recurrent chest aspiration. The patients' weight range was 3.9 and 42 kg (6 weighed less than 12 kg). Access was modified according to each patient's size and shape. The average operating time was 2.2 hours (range, 1.4 to 3) for fundoplication and 3.1 hours (range, 2.3 to 4.1) for fundoplication with gastrostomy. Two patients had conversion to open surgery because of hypercarbia or perforated oesophagus. Use of postoperative analgesia was limited to the first 24 hours, and fluid intake and feeding were begun on days 1 and 2, respectively. Gas bloating was common postoperatively, and diarrhoea developed in three children. Twelve patients had clinical improvement, and a recurrent hiatus hernia developed in one. Laparoscopic fundoplication can be successful; however, awareness of the differences in technique for paediatric (disabled children in particular) and adult patients is essential. The technique deserves further investigation.
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PMID:Laparoscopic Nissen fundoplication in disabled infants and children. 880 22

Two regimens of prostaglandin E1 analogue, gemeprost, in combination with mifepristone were compared in a randomized trial for termination of pregnancy at 12-19 weeks. 100 women requesting second trimester abortion were recruited at the Gynecological Department of the Edinburgh Royal Infirmary, Scotland. The women were given a single oral dose of 200 mg mifepristone in the medical abortion unit and allowed home. 36 hours after treatment with 200 mg mifepristone, women were allocated at random to receive either 4 x 1 mg (Group I) or 4 x 0.5 mg (Group II) gemeprost by vaginal pessary every 6 hours (n = 50 m each group). If abortion had not occurred after 24 hours, 5 x 1 mg of gemeprost was administered every 3 hours in both groups of women. Although the median abortion interval was slightly shorter in the 1 mg group (7.8 vs. 8.4 hours, p = 0.5), the cumulative abortion rates at 24 hours were similar (98% vs. 96%). Women in Group I required significantly more gemeprost to induce abortion than those in Group II (p 0.0001). Parous women in both groups required significantly less of the prostaglandin to induce abortion. Primigravidae took longer to abort than multigravidae, although the difference only reached statistical significance in Group II (median 9.5 hours vs. 6.1 hours; p 0.02). The women in Group II required a lower dose of gemeprost to complete the abortion than those in Group I (median 1 mg vs. 2 mg; p 0.0001). There were no significant differences between the groups in the incidence of vomiting, diarrhea or the request for analgesia. Surgical evacuation of the uterus because of retained or incomplete placenta was required in approximately 1/5 of women in each group. One woman in Group II required blood transfusion because of a retained placenta after expulsion of the fetus. The results suggest that in parous women the dose of gemeprost can be reduced to 0.5 mg every 6 hours within the first 24 hours without loss of clinical efficacy.
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PMID:A randomised study of two doses of gemeprost in combination with mifepristone for induction of abortion in the second trimester of pregnancy. 884 86

To evaluate the efficacy and side effects of intracervicovaginal misoprostol in termination of second-trimester pregnancy in women with live fetuses. A total of 50 pregnant women between 14 and 27 week's gestation undergoing termination of pregnancy for medical, obstetrical and genetic reasons were recruited to receive 200 ug misoprostol gel administered intracervicovaginally every 12 hours. The rates of successful abortions within 24 hours and 48 hours were 54 per cent and 92 per cent respectively. The mean time from induction to abortion was 27.5 hours. The rate of complete abortion, defined as the passage of the fetus and placenta without operative assistance was 80 per cent. Side effects were fever (8%), nausea and vomiting (6%) and diarrhea (2%). Thirty one patients (62%) required meperidine as analgesia. Two patients (4%) had postpartum hemorrhage. Intracervicovaginal misoprostol is an effective, cheap, safe and relatively convenient method for termination of second-trimester pregnancy with a live fetus.
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PMID:Termination of second-trimester pregnancy with intracervicovaginal misoprostol. 917 93

This article presents a summary of drug safety data concerning the use of tramadol hydrochloride and an outline of the specific aspects of this analgesic in particular with regard to respiratory depression and dependence potential. Information from phase II to IV clinical studies, postmarketing surveillance studies (covering safety data from a total of more than 21,000 patients) and the spontaneous reporting system have been taken into consideration. The data from the spontaneous reporting system covers the period between 1977 and 1993, during which more than one billion single dose units were distributed throughout the world. The phase II to IV studies compare acute intravenous, acute intramuscular, acute oral and multiple dose oral administration Postmarketing surveillance studies provide a picture of everyday use of tramadol in general medical practice. Further analyses were performed to provide information about the gender-, age- and dose-related distribution of adverse reactions The prevalence of side effects was calculated by comparing the number of symptoms with the number of patients. The pooled data from the clinical studies and the postmarketing surveillance studies reveal that the most commonly observed side effects were nausea, dizziness, drowsiness, tiredness, sweating, vomiting and dry mouth, with an overall incidence of between 1 and 6%. In the postmarketing surveillance studies on long term and acute administration, the profile of adverse events was qualitatively almost identical to that in the phase II to IV studies. However, there were distinct quantitative differences it favour of the long term studies. In the postmarketing surveillance study on acute parenteral administration, the incidences of nausea and vomiting were only 4.2 and 0.5% respectively, which is significantly lower than the 20.7 and 11.4% in the patient-controlled analgesia studies. Nevertheless, it is important to take into consideration the different conditions in these studies. All the postmarketing surveillance studies were outpatient studies, whereas almost all of the phase II to IV studies were carried out in hospitals. The studies with intravenous and intramuscular administration were mainly postoperative, which explains the relatively high incidence of nausea and vomiting, 17.8 and 7.0%, respectively, with intramuscular administration. The different conditions in the phase II to IV studies and the postmarketing surveillance studies are also reflected in the occurrence of dizziness and postural hypotension: The incidence of dizziness in the postmarketing surveillance studies is slightly higher than that observed in the phase II to IV studies. Particularly in the studies with intravenous and intramuscular administration, the patients were confined to bed and were therefore much less sensitive to dizziness than those in the long term oral and postmarketing surveillance studies, who were all outpatients. On the other hand, postural hypotension played almost no role in the multiple dose studies, in which the oral formulation were used most frequently. It is interesting to note that diarrhoea, pruritus and gastrointestinal disorder (except nausea and vomiting) are mainly reported in the multiple dose studies in the groups receiving oral tramadol, and also in the postmarketing surveillance studies. Once again, the study conditions may well be the explanation. The adverse effects reported in both clinical and postmarketing surveillance studies are similar to those in the spontaneous reports. The most frequently documented adverse effects in clinical and postmarketing surveillance studies, i.e. nausea/vomiting, dizziness, drowsiness, tiredness, sweating and dry mouth, are noted very infrequently in spontaneous reports, since in medical practice these side effects are usually known and are described in the product information. Almost all reports referring to abuse/dependence are connected with pain therapy; they give no reason to suspect any pro
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PMID:[Tolerance and safety of tramadol use. Results of international studies and data from drug surveillance]. 919 Mar 25

Reye's syndrome (RS) is a biphasic illness that occurs predominately in children and adolescents. A prodromal viral illness (frequently influenza A or B or chicken pox) is followed by protracted vomiting and neurologic changes that start 3 to 5 days later, just when the child seems to be recovering. Aspirin has been identified as one factor contributing to the metabolic disorder that occurs. Since 1986 the FDA has required labels on all aspirin products warning about the association of aspirin use and RS. Media messages heightened public awareness regarding the alternatives to aspirin for analgesia and antipyretic use. Since 1988, the incidence of RS has decreased dramatically. RS is now more prevalent in older adolescents who may self-medicate. Because early recognition of the disease is associated with decreased morbidity and mortality, it is important for health care providers to recognize the symptoms of RS. Unexpected vomiting and disturbed brain functioning following a viral illness are symptoms of RS in children and adolescents. In infants, the symptoms of RS may be more subtle, including diarrhea, respiratory disturbances, and seizures.
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PMID:Reye's syndrome: an update. 943 71

Recent reports commissioned by the Australian Government have highlighted the need to improve medication use in both community and hospital settings. Nurses are placed ideally to promote safe and effective drug use. The aim of this project was to develop and evaluate a computer-assisted instruction package, to help undergraduate nursing students improve their knowledge of clinical pharmacology, and to enhance their ability to contribute to the quality use of medications. In a collaborative project, staff of the Tasmanian Schools of Pharmacy and Nursing have produced the program PharmaCAL, using HyperCard 2.2 for the Apple Macintosh. A wide range of clinical pharmacology units are covered extensively, concentrating on drugs in common use and based on body systems: cardiovascular pharmacology (including hypertension, cardiac failure and angina); respiratory pharmacology; alimentary tract pharmacology (including peptic ulcer, diarrhea, and constipation); central nervous system pharmacology (analgesia, anxiety and insomnia, depression, psychoses, and epilepsy); antibiotic chemotherapy; and diabetes mellitus. Many color illustrations have been included. Each unit has a set of multiple choice questions to provide feedback to students. The package was evaluated in two ways. First, a questionnaire was used to assess users' opinions of the package. Second, a validated multiple choice test on clinical pharmacology and therapeutics was administered to 24 third-year nursing students before and after a set of sessions using the package and to a control group of 28 nursing students who were not exposed to the PharmaCAL package. The package generally was well received by the nursing students. Clinical pharmacology test scores significantly improved after using the package and were significantly higher than for the control group of students. The program is a useful adjunct to the existing nursing curriculum. It also could be used in postgraduate nursing education and other health sciences.
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PMID:Development and evaluation of a computer-assisted instruction package in clinical pharmacology for nursing students. 945 93

The antiprogesterone mifepristone (RU-486) and a prostaglandin preparation (misoprostol), in combination, have been documented to be effective for inducing abortion in France, Sweden, and Great Britain. They are effective up to 63 days of gestation with a slightly longer period of bleeding, pain requiring analgesia, diarrhea, and nausea. In Sweden, 70% of abortions are carried out by the use of drugs. In Norway, medically induced abortion has been introduced as an alternative to surgical intervention. The patient takes mifepristone in a hospital under the supervision of health personnel, then 48 hours later the prostaglandin is administered transvaginally in the hospital where the abortion also takes place. About 4 weeks later, a check-up follows with clinical examination and a pregnancy test. The political debate about medical abortion has also flared up in Norway as in many other countries, mainly in connection with the issue of abortion decided by the individual. In 1989 there was a motion introduced in the Parliament to ban medically induced abortion, but it failed to be adopted. The argument that abortion could be used for contraception is not supported, because there was almost the same rate of decline of abortions in Sweden, where this had been used for several years during the period of 1991-94, as in Denmark, Finland, and Norway, where it had not been. From an ethical point of view, abortion should be the simplest and least invasive, and it could also be less stigmatizing in a hospital because of the outpatient status. The better use of resources for other women waiting for operations also advocates this method as does its acceptability to women.
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PMID:[Should antiprogesterone be used in pregnancy termination?]. 948 12


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