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Query: UMLS:C0432222 (SEM)
 47,337 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A double-blind, placebo-controlled study was designed to compare the efficacy of demand-dose patient-controlled epidural analgesia (PCEA) with continuous epidural infusion (CEI) for treatment of pain during labor and delivery. Forty patients were randomized to receive 0.125% bupivacaine with fentanyl (2 micrograms/mL) through CEI at 12 mL/h or through demand-dose PCEA. Patients using PCEA could demand 3 mL every 10 min without restriction. Analgesia in both groups was comparable. However, there was a significant reduction in total bupivacaine consumption (in milligrams) associated with the use of PCEA (mean +/- SEM: CEI = 76.1 +/- 8.5 mg; PCEA = 42.2 +/- 5.9 mg; 45% reduction). The hourly bupivacaine consumption during the first (CEI = 15.8 +/- 0.6 mg/h; PCEA = 8.8 +/- 1.1 mg/h) and second (CEI = 17.2 +/- 1.2 mg/h; PCEA = 6.8 +/- 1.2 mg/h) stages of labor was also reduced. Overall, this represented a 47% "sparing" of bupivacaine use per hour with PCEA. Similar reductions occurred in the use of fentanyl. The reductions in analgesic requirement, however, were not associated with a reduction in the degree of motor blockade or in the cephalad extent of sensory blockade. A significant dose-sparing effect was associated with the use of demand-dose PCEA as compared with standard CEI for analgesia during labor and delivery.
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PMID:Patient-controlled epidural analgesia: demand dosing. 195 33

Twenty-five patients who had undergone elective cholecystectomy were prospectively randomized to receive via an interpleural catheter either a continuous infusion of 0.25% bupivacaine at 0.125 mL.kg-1.h-1 (n = 13) or repeated bolus injections (n = 12) of 0.5% bupivacaine with epinephrine 1:200,000 at 0.4 mL/kg every sixth hour. Adequacy of pain relief was measured by the amount of patient-controlled analgesia morphine required postoperatively and by patient scores on a visual analog scale obtained every sixth hour. Two venous blood samples for measurements of serum bupivacaine levels were obtained from patients in the continuous group at hours 6 and 24; four blood samples were obtained from patients in the bolus group, both immediately before and 30 min after injections at hours 6 and 24. Among the patients receiving the bolus injections, morphine was required 62 +/- 15 (SEM) times over the 24-h study period with total morphine dosage averaging 30 +/- 15 mg. Corresponding values for patients in the continuous groups were 35 +/- 10 times and 23 +/- 5 mg of morphine. The difference was not, however, statistically significant, but when activity during the 2-h time periods immediately before reinjection were examined, patients in the bolus group required and received significantly more morphine than did those in the continuous group (P less than 0.05). Patients in the continuous group had visual analog scale scores that averaged 2.9 +/- 0.6 over the 24-h study period. Patients within the bolus group had visual analog scale scores before and again 30 min after injection that averaged 5.8 +/- 0.8 and 1.8 +/- 0.5, respectively (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Continuous infusion of interpleural bupivacaine maintains effective analgesia after cholecystectomy. 200 42

Intravenous 3-amino-1-hydroxypropylidene-1, 1-bisphosphonic acid (APD) was used to treat 26 patients with Paget's disease. Three daily dosages were studied; 20-30 mg/day in 20 patients, 45 mg/day in three patients and 60 mg/day in three patients, by daily 4-hour infusions for 2-10 days. The fasting urinary hydroxyproline excretion (HypE) declined exponentially, reaching 50% of pretreatment values at 1.92 +/- 0.16 (mean +/- SEM) days. This initial rapid decline was complete by 4 days following treatment to a mean of 28.0 +/- 3.4% of pretreatment values. Thereafter, there was no significant decline in HypE. The initial rate of decline of HypE was unchanged by increasing the daily dose of APD. Transient non-symptomatic hypocalcaemia with secondary hyperparathyroidism occurred in all patients. No adverse changes in the renal handling of calcium or phosphate, as seen with high-dose 1-hydroxyethylidene-1, 1-bisphosphonate (EHDP), were seen in any patient on any daily dose. Fever occurred in 73% of patients in the first 2 days of treatment. Overall, there was a significant fall in the lymphocyte count (P less than 0.005 febrile group, n = 19; P less than 0.02 non-febrile group, n = 7) and a fever-dependent rise in the neutrophil count (P less than 0.005 febrile group only). The occurrence of fever was associated with a more rapid decline in HypE, compared to the non-febrile group, so that HypE was significantly lower in the febrile group by day 5 (P less than 0.025). Seventy-two per cent of patients with bone and/or joint pain reported a reduction in pain.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Intravenous aminobisphosphonate in Paget's disease: clinical, biochemical, histomorphometric and radiological responses. 203 28

Plasma levels of catecholamines, beta-thromboglobulin (BTG) and arginine vasopressin (AVP), and degree of pain were examined in 22 patients with suspected uncomplicated myocardial infarction within 24 h following onset of chest pain. Sixteen patients developed infarction with peak creatine phosphokinase at 1280 Ul-1 (range 293-3770 Ul-1). Fifteen healthy men served as controls (C). Arterial adrenaline levels were significantly higher in patients with pain (1.15 +/- 0.23 nmol l-1, n = 8, mean value +/- SEM) than in those without pain (0.60 +/- 0.10 nmol l-1, n = 14, P less than 0.05). Plasma catecholamines were moderately but significantly elevated in myocardial infarction; the concentration of arterial adrenaline was 0.83 +/- 0.14 nmol l-1 and that of arterial noradrenaline was 2.70 +/- 0.28 nmol l-1 compared with 0.44 +/- 0.04 nmol l-1 (P less than 0.025) and 1.47 +/- 0.05 nmol l-1 (P less than 0.0005), respectively, in C. One week later, plasma catecholamines had returned to baseline levels. Plasma BTG showed borderline elevation (1.0 +/- 0.1 pmol l-1) compared with C (0.6 +/- 0.1 pmol l-1, P = 0.04), and remained unchanged 1 week later. Plasma AVP was at baseline level. Uncomplicated myocardial infarction, regardless of size, was associated with only moderately increased sympathetic tone. Plasma adrenaline was related more to the degree of pain than to the presence of acute myocardial infarction. Arterial adrenaline may be a sensitive marker of sympatho-adrenal activity related to pain.
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PMID:Increased arterial adrenaline is related to pain in uncomplicated myocardial infarction. 214 43

The measurement of dentinal permeability has been useful in confirming the mechanism of the hydrodynamic hypothesis for pain transmission in hypersensitive patients, has advanced our understanding of how neural agents can reach the pulpal nerves, and has provided useful data to compare and evaluate therapeutic agents. Methods to assess permeability have varied from direct dye penetration techniques to measurement of fluid flow through dentin sections to SEM photography of impression replicas in vivo. A number of clinical therapeutic strategies have emerged from this work as well as ways to mitigate the progressive nature of the condition.
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PMID:Dentinal permeability in assessing therapeutic agents. 219 22

The influence of two different doses of oral naltrexone on the adverse effects and the analgesia associated with intrathecal morphine was compared in a double-blind, placebo-controlled study. Thirty-five patients undergoing cesarean section were provided postoperative analgesia by 0.25 mg intrathecal morphine. Sixty minutes later they were given 6 mg naltrexone, 3 mg naltrexone, or placebo as an oral solution. Pain relief was assessed by the Visual Analog Scale. Requirements for additional analgesics and side effects were recorded. Duration of analgesia was shorter in the 3- and 6-mg naltrexone groups than in the placebo group, 10.0 +/- 2.6, 12.4 +/- 2.6, and 19.2 +/- 4.5 h (mean +/- SEM), respectively, but values did not reach statistical significance. The incidence of pruritus and vomiting was significantly less in the 6-mg naltrexone group than in the other two groups (P less than 0.05). Somnolence was significantly less in the 3- and 6-mg naltrexone groups than in the placebo group (P less than 0.05). Naltrexone (6 mg) is an effective oral prophylactic against the pruritus and vomiting associated with intrathecal morphine for analgesia after cesarean section, but it is associated with shorter duration of analgesia.
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PMID:Prophylactic oral naltrexone with intrathecal morphine for cesarean section: effects on adverse reactions and analgesia. 220 28

We have studied 159 patients 80 years of age or older who have had isolated coronary artery bypass grafting (CABG) since 1977. Eighty-seven percent have had surgery since 1984. Two thirds of the patients were male, and the mean age was 82 years. Most patients (97%) were in New York Heart Association (NYHA) functional class III or IV, 89% had unstable/postinfarction angina pectoris, and 67% had rest pain. Almost half (47%) required preoperative admission to the coronary care unit, 6% required preoperative use of an intra-aortic balloon pump, and 20% were operated on emergently. Significant left main coronary artery disease (greater than or equal to 50% stenosis) was present in 41%. Ten patients (6.3%) died within 30 days of surgery, with seven more patients dying during the same hospital admission or soon after transfer to another institution. This resulted in an overall hospital mortality of 10.7%. The median hospital stay was 10 days. On univariate analysis, the significant predictors of hospital mortality were NYHA IV, angina at rest, preoperative admission to the coronary care unit, emergency operation, ejection fraction less than 0.50, and the presence of mitral regurgitation. On multivariate analysis, ejection fraction less than 0.50 was the only significant risk factor (p less than 0.01). Of hospital survivors, 98% have been followed for a mean of 29 months. The estimated 5-year survival (+/- SEM) of all patients was 71 +/- 4.5%, and for hospital survivors, 80 +/- 4.5%. The most important predictor of adverse survival was an ejection fraction less than 0.50. Seventy-nine percent are angina-free, and 89% are in NYHA classes I and II. The majority of patients felt that they were improved by surgery. We conclude that CABG in patients 80 years or older, although associated with increased operative risk, gives excellent relief of symptoms and good 5-year survival. Patients should not be denied CABG because of age alone.
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PMID:Early and late results after isolated coronary artery bypass surgery in 159 patients aged 80 years and older. 222 9

The effect of a novel CCK-antagonist (lorglumide, CR 1409) was evaluated by "in vitro" tensiometric studies on 16 human (gallstone patients) and 12 guinea pig gallbladder smooth muscle strips. In the animal experiments, increasing doses of lorglumide (0.2-6.5 uM) caused a rightward shift of the dose-response curves of CCK-OP, with an increase of the ED50 from 8.2 nM +/- 1.62 SEM, n = 12; to 100 nM +/- 12, n = 4) without affecting the maximal effect (Emax). Schild plot gave an affinity constant of 7.19. In human gallbladders, the effect of lorglumide was also present (ED50 increased from 47 nM +/- 8 SEM, n = 16; to 300 nM +/- 10 SEM, n = 4) coexisting with a large inter-sample variation for CCK-OP ED50s and maximal contractions, most likely due to the histological changes of the wall in chronic cholecystitis. The affinity constant was similar to that found in animal experiments. We confirm the studies previously reported in animals on the existence of a competitive antagonism of lorglumide on CCK gallbladder receptors. Moreover, our results on gallbladders from gallstone patients show that lorglumide is a highly effective antagonist of CCK-induced contractions despite the presence of chronic cholecystitis. Our study might help for a better comprehension of the role of these new anti-CCK drugs in the treatment of biliary pain.
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PMID:The effect of a novel CCK-antagonist (lorglumide) on human and guinea pig gallbladder strips: a tensiometric study. 225 23

The efficacy of pain relief and the maternal and neonatal effects of continuous epidural infusion of 0.0625% bupivacaine/0.002% butorphanol was compared with the infusion of 0.125% bupivacaine alone in a randomized, double-blind study of 32 women in labor. A test dose of 2 ml 0.5% bupivacaine was given to every patient and followed by two epidural regimens in randomized, double-blind manner. Group B-B (bupivacaine/butorphanol) patients received 7.5 ml 0.125% bupivacaine plus 1 mg butorphanol (0.5 ml) followed by an infusion of 0.0625% bupivacaine/0.002% butorphanol at a rate of 12 ml/hour; Group B (bupivacaine alone) patients received 8 ml 0.25% bupivacaine followed by an infusion of 0.125% bupivacaine at a rate of 12 ml/hour. A bolus of 5 ml 0.125% bupivacaine or 0.0625% bupivacaine was given to Group B or B-B, respectively, if additional pain relief was required. Infusion of B-B combination resulted in similar pain relief and fewer patients with motor block than bupivacaine alone; 12% versus 38% in Groups B-B and B, respectively, had motor weakness. A smaller dose of bupivacaine was used in the B-B group compared to the B group; 71 +/- 14 versus 99 +/- 13 mg (mean +/- SEM; p less than 0.05). Progress of labor and the mode of delivery did not differ significantly between the two groups. All infants were vigorous and had normal acid-base status and neurologic adaptive capacity scores. Butorphanol appears to be useful as an adjunct to epidural bupivacaine for continuous epidural infusion during labor without adversely affecting the mother or the neonate.
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PMID:Continuous infusion epidural anesthesia during labor: a randomized, double-blind comparison of 0.0625% bupivacaine/0.002% butorphanol and 0.125% bupivacaine. 229 85

Studies in the collagen and rabbit models of arthritis have indicated that indium-111 chloride (111InCl3) scintigraphy objectively measures synovial inflammation. Indium-111 chloride scans, with imaging three days after 19 MBq intravenous injection, were performed on 21 patients with definite or classical rheumatoid arthritis (RA), all of whom were functional class II. Standard clinical indices of disease activity were recorded at the time of imaging by the same investigator, who was unaware of the results of joint scans. In addition, eight patients with severe osteoarthritis, four of whom were considered to need hip or knee joint replacement, were similarly scanned. In each patient 16 joints were graded as 0 to 5, based on increasing degrees of 111InCl3 uptake, by a single investigator blinded to the patient's diagnosis and clinical status. In the group with RA significant correlations were observed between individual joint uptake on scan and peripheral joints with swelling, joints reported to be painful, and joints with any abnormality on physical examination. In the group with osteoarthritis joints positive on scan correlated with the presence of pain. A total scan score (sum of individual joint scores) was calculated for each patient. In the patients with RA values ranged from 0 to 42 with a mean (SEM) of 20.7 (2.7) and correlated with the number of swollen joints and decreasing grip strength. In the group with osteoarthritis the mean total scan score (9.2 (1.5), range 3-14) was significantly lower than in the patients with RA. These data show that 111InCl3 scanning can measure joint involvement by RA.
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PMID:Measurement of joint inflammation in rheumatoid arthritis with indium-111 chloride. 231 21


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