1/260. Use of transdermal amitriptyline gel in a patient with chronic pain and depression.A man with severe inflammatory bowel disease suffered from chronic abdominal pain and depression. A transdermal amitriptyline gel preparation was compounded since he was unable to take drugs orally serum concentrations of amitriptyline and its active metabolite nortriptyline were measured over 24 hours. Symptoms of depression were monitored before starting transdermal therapy and at the end of 6 weeks. Pain symptoms and amitriptyline adverse drug events were monitored daily Steady-state serum concentrations of drug and metabolite were within the therapeutic range over 24 hours. The patient reported that his mood was improved but his abdominal pain remained unchanged. Transdermal amitriptyline gel was well tolerated and is an alternative delivery system in patients unable to take drugs orally.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/260. spinal cord compression from precipitation of drug solute around an epidural catheter.We report a previously undescribed complication of long-term epidural catheter placement for the administration of analgesia in terminal malignancy. spinal cord compression resulted from a drug-related precipitate forming around the epidural catheter tip, which was successfully treated by surgical decompression.- - - - - - - - - - ranking = 1.25keywords = drug (Clic here for more details about this article) |
3/260. Low power laser therapy and analgesic action.OBJECTIVE: The semiconductor or laser diode (GaAs, 904 nm) is the most appropriate choice in pain reduction therapy. SUMMARY BACKGROUND DATA: Low-power density laser acts on the prostaglandin (PG) synthesis, increasing the change of PGG2 and PGH2 into PG12 (also called prostacyclin, or epoprostenol). The last is the main product of the arachidonic acid into the endothelial cells and into the smooth muscular cells of vessel walls, that have a vasodilating and anti-inflammatory action. methods: Treatment was performed on 372 patients (206 women and 166 men) during the period between May 1987 and January 1997. The patients, whose ages ranged from 25 to 70 years, with a mean age of 45 years, suffered from rheumatic, degenerative, and traumatic pathologies as well as cutaneous ulcers. The majority of patients had been seen by orthopedists and rheumatologists and had undergone x-ray examination. All patients had received drug-based treatment and/or physiotherapy with poor results; 5 patients had also been irradiated with He:Ne and CO2 lasers. Two-thirds were experiencing acute symptomatic pain, while the others suffered long-term pathology with recurrent crises. We used a pulsed diode laser, GaAs 904 nm wavelength once per day for 5 consecutive days, followed by a 2-day interval. The average number of applications was 12. We irradiated the trigger points, access points to the joint, and striated muscles adjacent to relevant nerve roots. RESULTS: We achieved very good results, especially in cases of symptomatic osteoarthritis of the cervical vertebrae, sport-related injuries, epicondylitis, and cutaneous ulcers, and with cases of osteoarthritis of the coxa. CONCLUSIONS: Treatment with 904-nm diode laser has substantially reduced the symptoms as well as improved the quality of life of these patient, ultimately postponing the need for surgery.- - - - - - - - - - ranking = 0.25keywords = drug (Clic here for more details about this article) |
4/260. Nivaquine and urethral pain.Two patients, one Jewish and the other Nigerian, were investigated for pain in the urethra. They were both fully treated along the usual lines without any change in the pain. The Jewish patient was later found to be sensitive to chloroquine. When ingestion of this drug was discontinued, his urethral pain disappeared after about four months. The Nigerian patient was advised along the same lines when it was found that he too took chloroquine for malarial attacks regularly. He had total symptomatic relief. The probable relationship between chloroquine and urethral pain is discussed.- - - - - - - - - - ranking = 0.25keywords = drug (Clic here for more details about this article) |
5/260. Nosocomial transmission of hepatitis b virus infection through multiple-dose vials.The source of acute hepatitis b virus (HBV) infection in two women (55 and 72 years old) was investigated. They displayed no risk factors for acquiring HBV infection, other than treatment with local anaesthetic injections some months previously. The HBV strains were sequenced and showed distinct homology to strains seen in Swedish intravenous drug users (IVDU). Prior to these patients' acute infection, an outbreak of HBV had occurred among IVDU in the same county. Analysis of the HBV strains from six of these IVDUs showed their core promoter, precore and pre-S sequences (679 nucleotides) to be identical to those from the two patients. Cross-contamination between samples was excluded and the most likely source of infection was thought to be multiple-dose vials of local anaesthetic that had been contaminated with the HBV strain circulating among the IVDU population in the community. We believe that multiple-dose vials have no place in modern healthcare and recommend sequence homology analysis as an alternative or additional way to trace a source of HBV infection.- - - - - - - - - - ranking = 0.25keywords = drug (Clic here for more details about this article) |
6/260. Non-steroidal anti-inflammatory drugs with adverse psychiatric reactions: five case reports.Adverse drug reactions of non-steroidal anti-inflammatory drugs (NSAIDs) are quite prevalent, but there are few reports about possible adverse psychiatric reactions, which may be ignored or underestimated. We describe here five psychiatric outpatients, two with major depressive disorders, one bipolar disorder, one schizophrenic disorder and one anxiety disorder, who were treated with NSAIDs for pain due to rheumatoid arthritis, osteoarthritis or other painful neuromuscular conditions. All five patients developed a moderate to severe depressive state, three patients became obviously paranoid, and four had either thoughts of suicide or an attempt while undergoing co-administration of NSAIDs. The psychiatric symptoms remitted when the NSAIDs were stopped. The depressive and paranoid symptoms returned on seven occasions of re-use or re-challenge with the same or a different type of NSAID in all five patients. When the NSAIDs were stopped again, the patients had another remission of the adverse psychiatric reactions, and eventually recovered to their baseline mental states in clear temporal relationships. The cases presented suggest that NSAIDs can induce or exacerbate idiosyncratic reproducible adverse psychiatric symptoms in certain vulnerable patients, including those with a variety of psychotic or neurotic disorders, and also in elderly persons, but these undesirable side-effects were generally transient and disappeared on withdrawal of the NSAIDs.- - - - - - - - - - ranking = 1.5keywords = drug (Clic here for more details about this article) |
7/260. Fatal fulminant hepatitis associated with bromfenac use.OBJECTIVE: To report a case of fulminant hepatic failure associated with the use of bromfenac, a new analog of the phenyl acetate class of nonsteroidal antiinflammatory drugs. CASE SUMMARY: A 60-year-old white woman with liver failure who had no known history of chronic liver disease was transferred to the liver transplant unit for evaluation. For three months preceding her illness, the patient was treated with bromfenac 25 mg po qid for arthritic pain. Prior to the initiation of bromfenac, her liver function test results were normal. Etiologic evaluation at presentation was unremarkable. The patient's condition continued to deteriorate, with the development of hepatic encephalopathy and worsening liver function test results while awaiting liver transplantation. Progressive hepatic and renal dysfunction along with respiratory decompensation ensued, and the patient died 48 days after initial presentation. CONCLUSIONS: Fulminant hepatic failure associated with the prolonged use of bromfenac appears to be an idiosyncratic response consistent with experience with other agents of its class. This case along with other cases of serious hepatotoxicity associated with the use of this agent ultimately resulted in bromfenac's removal from the market.- - - - - - - - - - ranking = 0.25keywords = drug (Clic here for more details about this article) |
8/260. Gabapentin leads to remission of somatoform pain disorder with major depression.Gabapentin, a novel antiepileptic drug, is effective in the treatment of partial seizures with and without secondary generalization. Evidence suggests that it may have mood-stabilizing and possibly antidepressant properties in bipolar depression. We report on a 48-year-old woman who had recurrent major depressive disorder. Following inguinal herniorrhaphy, she developed severe stabbing pain in the lower abdomen and inguinal area that progressed to constant pain in her whole body. She was depressive, hopeless, and had given up her social activities. A diagnosis of major depressive disorder and somatoform pain disorder was made. Antidepressants and carbamazepine were ineffective, and she had attempted suicide. Gabapentin resulted in remission of both the pain and the depressive mood at a dose of 1.800 mg/day.- - - - - - - - - - ranking = 0.25keywords = drug (Clic here for more details about this article) |
9/260. Nonoperative and operative intervention for hallux rigidus.STUDY DESIGN: Case study of the management of an individual with hallux rigidus deformity. OBJECTIVE: To describe the outcome of nonoperative and operative treatment, including kinematic and kinetic changes following cheilectomy surgery, for an individual with hallux rigidus deformity. BACKGROUND: hallux rigidus is a common disorder of the first metatarsophalangeal joint characterized by progressive limitation of hallux dorsiflexion, prominent dorsal osteophyte formation, and pain. Surgery may be considered when nonoperative management strategies have proven unsuccessful. Kinematic and plantar pressure changes during dynamic activities have not been previously described following cheilectomy surgery for hallux rigidus deformity. methods AND MEASURES: The patient was a 54-year-old man who sustained a traumatic injury to the great toe. Conservative treatment included nonsteroidal anti-inflammatory drugs, custom insole fabrication, and footwear outersole modification. Because of continued pain, loss of motion, and restrictions in daily activities, the patient elected to have surgery, and a cheilectomy procedure was done. Presurgical and postsurgical kinematic data of first metatarsophalangeal joint motion were collected using an electromagnetic tracking device during clinical motion tests and walking. Peak plantar pressures were assessed during gait. The patient was evaluated preoperatively, at 6 months, and again at 18 months following surgery. RESULTS: The outcome of surgery proved favorable, both subjectively and objectively. Peak dorsiflexion increased significantly (a minimum of 20 degrees) for all clinical tests and walking trials at the first metatarsophalangeal joint when compared with preoperative measurements. Peak plantar pressures also increased over the medial forefoot (68%) and hallux (247%) between preoperative testing and follow-up, indicating increased loading to this region of the foot. CONCLUSIONS: Restrictions in motion and daily activities and persistent pain may warrant surgical intervention for individuals with hallux rigidus deformity. A successful outcome, as measured by the patient's self-reported pain, return to recreational activities, and kinematic and plantar pressure changes at the follow-up examination, was demonstrated in this case study.- - - - - - - - - - ranking = 0.25keywords = drug (Clic here for more details about this article) |
10/260. Iliopsoas haemophiliac pseudotumours with bowel fistulation.Two cases of iliopsoas haemophilic pseudotumours are presented. In one patient a fistula developed between a pseudotumour and the large bowel. This resulted in an abscess involving the pseudotumour and adjacent tissues. It resolved after 5 years of therapy involving percutaneous drainage and closure of the fistula. The second patient had a massive pseudotumour that had obstructed both ureters. Later he suffered a fatal mixed Gram negative septicaemia probably related to erosion into the colon.- - - - - - - - - - ranking = 0.0012798560619359keywords = closure (Clic here for more details about this article) |
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