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At least 631 records · Page 35Linked to original sources
PubMed2003

The burden of acute postoperative pain and the potential role of the COX-2-specific inhibitors.

Pain has been recognized as a problem of global proportions, and postoperative pain is one of the most common types of pain. Postoperative pain is acute and, although it is preventable and/or treatable, it is often undertreated. Lack of appropriate analgesic management has significant impact on clinical and economic outcomes. Negative clinical outcomes of inadequately managed acute postoperative pain include extended hospitalization, compromised prognosis, higher morbidity and mortality, and the development of a chronic pain state as a result of neuronal plasticity. Although estimating the economic burden of postoperative pain is difficult, this burden is considerable and results from direct costs due to excess health-care resource use, as well as indirect costs due to reduced patient functionality and productivity. These latter factors also have a significant adverse impact on patients' quality of life and may be associated with the development of depression and anxiety. Thus, improved clinical outcomes are dependent not only on the availability of effective drugs but also on their appropriate utilization. A multimodal approach incorporating different drugs and techniques is effective in reducing postoperative pain but is limited by the currently available therapies. The efficacy of opioids is well established, but there are concerns about dependency, respiratory depression and side-effects, which patients often find intolerable. Non-steroidal anti-inflammatory drugs (NSAIDs) are effective as adjunctive medication in a multimodal regimen but are associated with side-effects, such as platelet dysfunction and renal and gastrointestinal toxicity, that have special clinical significance in patients undergoing surgical procedures. Cyclooxygenase-2-specific inhibitors such as celecoxib, rofecoxib and valdecoxib, were developed to provide the efficacy of non-specific NSAIDs while limiting associated toxicity. These agents have demonstrated analgesic efficacy and an opioid-sparing effect in a variety of surgical procedures, suggesting their value as an alternative to non-specific NSAIDs. Further studies are needed to determine the impact of these drugs on clinical and economic outcomes when used in a programme of postsurgical pain management.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2004

Irritable bowel syndrome, chronic pelvic inflammatory disease and endometriosis: a comparison of symptomatology.

BACKGROUND AND OBJECTIVES: Both irritable bowel syndrome and some gynaecological diseases can give rise to lower abdominal pain, which may result in diagnostic confusion. Disorders such as endometriosis and chronic pelvic inflammatory disease can be diagnosed definitively only by laparoscopy, which is seldom undertaken in the gastroenterological setting. It was the aim of this study to compare the symptomatology of irritable bowel syndrome with that of laparoscopically confirmed chronic pelvic inflammatory disease and endometriosis. PATIENTS AND METHODS: A symptom questionnaire was administered to 50 women with irritable bowel syndrome and 51 gynaecological patients (30 patients with endometriosis, 21 patients with chronic pelvic inflammatory disease). As the symptoms of the two gynaecological conditions were so similar, the groups were combined for the purposes of comparison with irritable bowel syndrome. RESULTS: Patients with irritable bowel syndrome suffered significantly more upper abdominal pain, colicky pain and exacerbation of pain by food or stress. They also experienced more disturbance of bowel habit, distension and nausea. In contrast, the only gynaecological features that were more common in the gynaecological patients were intermenstrual bleeding, premenstrual exacerbation of pain and forniceal tenderness. CONCLUSION: The presence of gastrointestinal symptomatology, especially bowel dysfunction, in a woman with lower abdominal pain is suggestive of irritable bowel syndrome. However, the history may not be so helpful in detecting gynaecological disease.

Abdominal Pain↗
PubMed2004

Ascites and intraabdominal infection.

PURPOSE OF REVIEW: This review will give an overview of current trends in diagnosis, treatment, and pathogenesis of ascites and intraabdominal infection in cirrhotic and noncirrhotic critically ill patients. RECENT FINDINGS: Single clone-bacterial DNA has been found in sterile ascites and serum, proving the concept of direct translocation. Activation of mesenteric macrophages can be induced by splanchnic vasodilatation but also by hypoxia. Carbon monoxide, an end product of heme catabolism, promotes splanchnic vasodilatation, representing a possible link between gastrointestinal hemorrhage and circulatory dysfunction. Colorimetric test strips and automated counters accurately diagnose spontaneous bacterial peritonitis. Vasopressin V2-antagonists have been introduced as novel therapy for impaired water excretion in hyponatremia. SUMMARY: Emerging pathophysiological concepts have modified the conventional view of hydrostatic and Starling forces in the evolution of ascites. Current data indicate that the dynamic sequence of bacterial translocation, mesenteric inflammation, splanchnic vasodilatation and intrahepatic vasoconstriction determines occurrence, severity, and outcome of ascites and intraabdominal infection.

Ascites↗
PubMed1965

DIABETIC ANGIOPATHY.

Explore the source record for details and available documents.

Capillary Permeability↗
PubMed1988

Familial atrial standstill caused by amyloidosis.

Three of nine siblings were affected by atrial standstill. Clinical, electrophysiological, and histological findings in two of these cases were studied. Electrophysiological studies showed persistent atrial standstill in one and partial atrial standstill in the other. Biopsy specimens of the right atria showed amyloid deposits, but specimens of the right ventricles and skin did not. Neither patient had peripheral neuropathy, gastrointestinal disorder, or renal dysfunction. Familial atrial standstill is usually associated with peripheral neuropathy. In the two cases studied amyloid deposition mainly affected the atrium, rather than the ventricles or other organs, and caused atrial standstill.

Adult↗
PubMedDate not supplied

Acute febrile mucocutaneous lymph node syndrome (Kawasaki disease) in adults: case report and review of the literature.

A 25-year-old female meeting all six criteria for Kawasaki disease is reported. A total of 22 reported cases of adult Kawasaki disease, including the present case, are reviewed. In adult Kawasaki disease, arthralgia, gastrointestinal complications and hepatic dysfunction are seen more frequently than in childhood cases. Cardiac complications are rarely seen in adult Kawasaki disease. Two cases have been positive for anti-nuclear antibody (ANA). The present patient had increased levels of serum IgE and was positive for ANA, suggesting involvement of an immune mechanism. Adult Kawasaki disease is rare but appears to be on the increase; internists treating adults must be aware of this disease.

Adult↗
PubMed2003

[Intensive care therapy for cancer patients].

OBJECTIVE: To review the most important aspects of the clinical presentation and treatment of children with cancer in intensive care units. SOURCE OF DATA: Medline (1970 to 2003); search terms: children, cancer, oncology, intensive care, complications. General and pediatric oncology textbooks. SUMMARY OF THE FINDINGS: Practically all organs may be affected by cancer or by its treatment. The main complications include infections, hematological problems and electrolyte/ metabolic disturbances. Intensive care therapy is necessary to correct organic dysfunctions (cardiovascular, respiratory, renal, gastrointestinal, and neurologic). Nutritional and emotional support, as well as pain control are fundamental aspects for recovery in children. The intensivist should be alert to interrupt intensive care measures if required. CONCLUSIONS: Many studies show that the use of intensive care therapy in children with cancer is not futile, with a reduction in mortality and improvement in the quality of life of these children in the medium and long terms.

Child↗
PubMed2001

Systemic vector leakage and transgene expression by intratumorally injected recombinant adenovirus vectors.

Interleukin 12 is a heterodimeric cytokine that exhibits potent immunostimulatory effects. It has shown some promise in preclinical and clinical studies but was accompanied by serious systemic toxicity such as flu-like syndromes, a rapid transient leukopenia, elevated liver transaminases, gastrointestinal toxicity, and/or liver dysfunction. Gene therapy with intratumorally injected recombinant adenoviral vectors offers the potential to restrict therapeutic gene expression in the tumor. Here we show that a substantial amount of adenoviral vectors disseminates into the systemic circulation and infects parenchymal organs. We further show that this results in high systemic levels of potentially toxic transgene products. To reduce potential toxicity, we tested an inducible promoter based on the heat shock proteins (hsp70B) and present evidence that high intratumoral levels of a therapeutic transgene can be obtained while systemic expression is reduced to a minimum, increasing the safety of adenovirus-based tumor gene therapy.

Adenoviridae↗
PubMedDate not supplied

Diabetic neuropathy, A review of clinical manifestations.

Diabetic neuropathy in some form or other afflicts a majority of patients with diabetes mellitus. Neuropathic disturbance of sensory, motor or autonomic nerves may occur singly or in combination. Cranial nerve and other mononeuropathies generally resolve spontaneously. Autonomic neuropathy which can result in orthostatic hypotension, gastroparesis diabeticorum, nocturnal diarrhea, atonic bladder and impotence, although chronic, may wax and wane in clinical severity. Neuritis, disesthesias and painful sensory neuritis may resolve with good diabetic control; on occasion, diphenylhydantoin has been of therapeutic benefit.

Adolescent↗
PubMed2002

[Essential microelements and gallstones in children].

The article presents a study of particular features of the essential microelements content in the hair, blood, bile and gallstones in infants with cholelithiasis. It was shown that this disease is accompanied by a lack of microelements, which appears as a lack of selenium, imbalance of zinc and accumulation of iron and copper in biological objects. In conjunction with other factors (vegetative dysfunction, comorbidities of the gastrointestinal tract and maldevelopment of the bile-excreting tract), the lack of microelements can promote the formation of gallstones in infants. It is possible to obtain complete information on particular features of microelements changes with the help of simultaneous studies of tissues of the hair, blood, bile and gallstones.

Adolescent↗
PubMed2005

Fatal adenovirus infection indistinguishable from thrombotic microangiopathy after allogeneic CD34+ peripheral progenitor cell transplantation.

A 10-year-old boy with acute lymphoblastic leukemia in second relapse received CD34+ purified allogeneic peripheral blood stem cell transplantation (PBSCT) from his HLA-haploidentical father. The patient developed grade II acute GVHD and received high-dose methyl-prednisolone starting on day + 13 posttransplant. Renal dysfunction followed by massive gastrointestinal bleeding was observed from day + 14. The laboratory findings including elevated serum LDH, increased RBC fragmentation, higher level of thrombomodulin and undetectable haptoglobin corresponded with the diagnosis of thrombotic microangiopathy (TMA). In spite of various treatments, the patient died of multiple organ failure on day + 93. Post-mortem examination revealed systemic adenovirus infection without histological findings of TMA. Severe adenovirus infection may be confused with TMA, and should be distinguished by rapid virological assay.

Adenoviridae Infections↗
PubMedDate not supplied

[The health status of pupils from different-profile schools].

The paper presents the results of prenosological examination of 1246 pupils from different-profile schools by computer-aided electrostructurography. The least children with morphofunctional changes in the viscera and systems were found at sports school. Gastrointestinal functional changes (intestinal dysfunction, biliary dyskinesia) and structural disorders (chronic gastritis, chronic colitis, posttoxic hepatic changes) hold the lead in the structure of total morbidity. In a great deal of the examinees, functional changes are frequently associated with morphological disorders within one or several systems.

Adolescent↗
PubMed1988

Therapeutic applications of drugs acting on alpha-adrenoceptors.

For over a decade it has been known that clonidine and alpha-methyldopa lower blood pressure by activating central and peripheral alpha-2-adrenoceptors and prazosin likewise by antagonizing alpha-1-adrenoceptors. During the 1980s, the number of therapeutic indications for drugs which act via these classes of alpha-adrenoceptors has expanded greatly, particularly the non-cardiovascular applications of drugs acting on alpha-2-adrenoceptors. Novel alpha-2-agonists such as detomidine and medetomidine have been introduced into veterinary medicine as sedative/analgesics. It is possible that these and other compounds with better alpha-2-adrenoceptor selectivity than clonidine may be used in human medicine to ease symptoms of anxiety in drug- and alcohol-related withdrawal syndromes, and as preanaesthetic agents. Several novel alpha-2-adrenoceptor antagonists, such as idazoxan and atipamezole, have been developed with improved selectivity compared to the traditional antagonist at these receptors, yohimbine. At present none of these new compounds are registered for use, but several are undergoing clinical trials for a variety of therapeutic applications such as depression (idazoxan), arousal of animals sedated with alpha-2-agonists (atipamezole), and adult-onset diabetes (DG-5128). The established use of yohimbine in the treatment of male sexual impotence has been reconfirmed and several of the above compounds may be evaluated in the future to treat this disorder.

Adrenergic alpha-Agonists↗
PubMed1986

[Combination therapy with IFN-beta, ACNU and radiation (IAR) in malignant brain tumors].

In order to analyze the efficacy of combination therapy with Hu-IFN-beta, ACNU and radiation (IAR), nine patients with malignant glioma were treated as a control study. They received 100 X 10(4) IU Hu-IFN-beta daily for seven days intravenously or intratumorally, 3 mg/kg ACNU on day 2 and 5,000-6,000 rads of radiation from day 3. Four out of nine patients showed complete response and one partial response with this IAR therapy. Case 1 was a 64-year-old man who had glioblastoma in the left frontal lobe. Postoperative residual tumors disappeared completely with this therapy. Case 3 was a 8-year-old girl who had an enhanced high-density lesion in the medulla oblongata and pons. After IAR therapy, the high-density lesion was completely vanished and her clinical manifestations of multiple cranial nerve palsy and pyramidal sign were improved remarkably. The major side effects of IAR therapy were mild or moderate myelosuppression, and some patients also showed hepatic dysfunction, mild fever and gastrointestinal toxicities. However, all these side effects were mild and transient and soon recovered to normal levels. These results suggest that IAR therapy is effective and will prolong the survival time of patients with malignant glioma.

Adolescent↗
PubMed1983

Neurologic complications in diabetes mellitus.

This article has discussed diabetic neuropathies and current knowledge about these somewhat baffling disorders. As research continues, new therapies for diabetic neuropathies will be found. Meanwhile, the nurse should remember that encouraging tight blood glucose control may be the best preventive therapy we have currently.

Autonomic Nervous System Diseases↗
PubMed1993

Solid phase radionuclide esophageal motility in polymyositis and dermatomyositis.

Polymyositis (PM) and dermatomyositis (DM) may be associated with motor dysfunction of the entire gastrointestinal tract. Abnormal esophageal motor function is a well-recognized complication of these diseases. In this study, we used a solid phase esophageal study to evaluate the motor function in patients with PM or DM. Twenty-three patients and 36 age-matched normal volunteers were studied. Each subject was placed in a supine position above a gamma camera linked to a computer and was given a 4-ml bolus of solid gelatin containing 1 mCi of Tc-99m phytate. Data were acquired in the list mode. A computer method modified from Kelim and Wald and Russell et al. was used to calculate the following: A) total mean transit time (MTT); B) residual fraction after the first swallow (RF); and C) retrograde index (RI). All values are presented as mean +/- standard deviation (SD). The Student's t-test was used to test statistical significance. Our preliminary results suggest: 1) delayed esophageal emptying is common (17/23) in PM/DM, indicating frequent malfunction of the smooth muscle of the upper gastrointestinal tract in PM/DM and 2) measurement of esophageal motility may monitor disease activity in PM/DM.

Adolescent↗