Biomedical subjects
Publications and source records attributed to C R Green.
N-hydroxyphenacetin, a phenacetin metabolite, was fed to rats as a 0.05-0.5% dietary supplement. After 9 months, tumours of the liver were found in 36 of 64 animals. One animal also developed a renal tumour. No tumours were found in control animals. The findings implicate phenacetin as a carcinogen and suggest that N-hydroxyphenacetin may be the metabolite responsible.
The nephrotoxicity of a number of aminophenols, quinols and catechols has been assessed from the extent of necrosis of proximal convoluted tubules produced by intravenous injection in rats, and the toxicity correlated with the oxidation-reduction potentials of the compounds.
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Explore the source record for details and available documents.
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Both aspirin and phenacetin derivatives were shown to be nephrotoxic when administered to rats as a single intravenous injection. Phenacetin derivatives tended to produce more severe renal damage and to be nephrotoxic in smaller doses than aspirin derivatives. With the exception of a single derivative, the renal lesions were confined to the proximal convoluted tubule, even after administration of compounds which under other conditions have induced renal papillary necrosis.
Necrosis of the terminal third of the proximal convulated tubule develops in rats after a single intravenous injection of p-aminophenol hydrochloride. As the tubules regenerate a chronic inflammatory reaction occurs in the interstitial tissue, and this reaction extends beyond the original zone of injury. These findings are additional evidence that some aromatic compounds are selectively nephrotoxic and may be particularly relevant to the problem of renal damage associated with heavy and prolonged doses of analgesics.
BACKGROUND AND OBJECTIVE: Calciphylaxis is a painful complication of end-stage renal disease and secondary hyperparathyroidism. Calcification most commonly affects skin and soft tissue of the lower extremities resulting in excruciatingly painful skin ulcers. Treatment involves correction of hypercalcemia and hyperphosphatemia, parathyroidectomy, and supportive measures. METHODS: The literature and the merits of neurolytic lumbar sympathetic blockade (LSB) for the treatment of pain associated with calciphylaxis are reviewed. CONCLUSIONS: The neurolytic LSB provided pain relief and is a treatment modality to be considered in managing the pain associated with calciphylaxis.
BACKGROUND AND OBJECTIVES: Cutaneous vasculitis is a devastating extra-articular manifestation of rheumatoid arthritis. The potential consequences of digital vasculitis are necrosis, ischemia, infarction, and eventually gangrene. METHODS: A 54-year-old woman with a long history of rheumatoid arthritis developed an acute onset of severe diffuse occlusive cutaneous vasculitis beyond the head of the metacarpals (documented by angiogram). Despite treatment with high-dose prednisone and Cytoxan, her symptoms were poorly controlled. Cervical sympatholysis via continuous epidural infusion of bupivacaine was then initiated to manage her pain as well as to treat the vasoconstrictive sequelae of the cutaneous vasculitis. RESULTS: The cervical epidural infusion relieved the pain and produced significant resolution of the symptoms. CONCLUSIONS: This case highlights the rational use of continuous cervical epidural block for the management of pain and improvement in blood flow to vasoconstricted upper extremities and digits resulting from vasculitis due to rheumatoid vasculitis.
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BACKGROUND AND OBJECTIVES: Erythermalgia is a rare disorder characterized by erythema, edema, elevated skin temperature, and burning pain of the hands and/or feet. The etiology of primary erythermalgia is idiopathic while secondary erythermalgia is associated with autoimmune and rheumatologic factors. Symptoms are typically refractory to medical management. We report the use of epidural bupivacaine as a treatment option for secondary erythermalgia. CASE REPORT: A 28-year-old woman presented with secondary erythromelalgia that was characterized by severe pain, swelling, and erythema. Medical management failed and a lumbar epidural dosed with bupivacaine was used. This resulted in complete resolution of the patient's symptoms. CONCLUSION: Intermittent epidural bupivacaine may provide treatment of the refractory symptoms of secondary erythermalgia.
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