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Query: UMLS:C0009676 (confusion)
 21,692 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 50-year-old man developed cauda equina syndrome of unknown etiology that was stable for 20 months. Two months prior to sudden death, he experienced new back pain, confusion, seizures, and multiple cranial nerve palsies. Neuropathologic examination revealed angiotropic lymphoma without parenchymal involvement or infarcts in the brain, spinal cord, and muscle. In addition, nerve roots in the cauda equina contained angiotropic lymphoma and infarcts of various ages. Angiotropic lymphoma should be considered as a cause of cauda equina syndrome and of disorders that affect the central and peripheral nervous systems concurrently.
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PMID:Angiotropic lymphoma (intravascular large cell lymphoma) presenting with cauda equina syndrome. 133 59

Before being introduced to wide use, health status instruments should be evaluated for reliability and validity. Increasingly, they are also tested for responsiveness to important clinical changes. Although standards exist for assessing these properties, confusion and inconsistency arise because multiple statistics are used for the same property; controversy exists over how to measure responsiveness; many statistics are unavailable on common software programs; strategies for measuring these properties vary; and it is often unclear how to define a clinically important change in patient status. Using data from a clinical trial of therapy for back pain, we demonstrate the calculation of several statistics for measuring reproducibility and responsiveness, and demonstrate relationships among them. Simple computational guides for several statistics are provided. We conclude that reproducibility should generally be quantified with the intraclass correlation coefficient rather than the more common Pearson r. Assessing reproducibility by retest at one-to-two week intervals (rather than a shorter interval) may result in more realistic estimates of the variability to be observed among control subjects in a longitudinal study. Instrument responsiveness should be quantified using indicators of effect size, a modified effect size statistic proposed by Guyatt, or the use of receiver operating characteristic (ROC) curves to describe how well various score changes can distinguish improved from unimproved patients.
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PMID:Reproducibility and responsiveness of health status measures. Statistics and strategies for evaluation. 166 51

Despite the well characterized physiologic effects of aortocaval or iliac arteriovenous fistulas, patients with such uncommon lesions may manifest a diverse array of symptoms, and diagnosis is often delayed or overlooked. To examine clinical features that facilitate recognition and allow successful repair, a 30-year experience with 20 such fistulas was reviewed. Fourteen fistulas were caused by aneurysm erosion, four followed iatrogenic injury during lumbar disk surgery, and two developed from abdominal gunshot wounds. The interval from presumed occurrence to diagnosis ranged from 3 hours to 8 years. The diagnosis was not recognized before surgery in five (25%) patients. Back pain (70%) was the most common symptom. The presence of a typical abdominal bruit (80%) was the most reliable physical finding, but its significance was occasionally overlooked or misinterpreted. Congestive heart failure was prominent in only seven (35%) patients. Severe lower extremity edema and mottling was the primary manifestation in eight cases, often causing initial confusion with venous thrombosis. Hematuria (5 patients) and oliguric renal failure (4 patients), both fully reversible after fistula repair, also caused diagnostic uncertainty. The mean preoperative cardiac output was 12.2 L/min, falling to 5.4 L/min with fistula repair. Mean blood loss was 5960 ml, supporting use of intraoperative autotransfusion. Two operative deaths (10%) occurred, both in patients not correctly diagnosed before surgery. Despite varied modes of presentation, prompt recognition and use of appropriate operative techniques should achieve successful repair.
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PMID:Aortocaval and iliac arteriovenous fistulas: recognition and treatment. 199 Jan 67

Confusion over dorsolumbar kyphosis and Sheuermann's disease has existed in the literature since the first recorded episodes in 1921. The present article delineates an etiology of back pain that is frequently seen in the adolescent population and is not to be confused with the painless fixed kyphotic deformity so frequently mentioned in the scoliosis literature. These patients with a painful dorsolumbar Sheuermann's disease may well have a traumatic herniation of the disk into the bony vertebral body. This type of x-ray and clinical finding should become familiar to all clinicians dealing with an adolescent population.
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PMID:Dorsolumbar kyphosis or Scheuermann's disease. 293 56

Two cases of sudden death due to perforation of a benign oesophageal ulcer into a major blood vessel are reported. In one man, anaemia and aspiration pneumonitis dominated the clinical picture. He had an oesophageal stricture and a chronic peptic ulcer associated with an incarcerated hiatus hernia. Death was due to haemorrhage caused by perforation of the ulcer into the thoracic aorta. The second patient presented with confusion and falls, backache and indigestion. She had a hiatus hernia and a large benign chronic oesophageal ulcer. Death was due to perforation of the ulcer into the left pulmonary vein. The cases are presented for their rarity, to illustrate the complex and late presentation of problems in geriatric medicine, and as a reminder that reflux oesophagitis can be dangerous.
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PMID:Sudden death from perforation of a benign oesophageal ulcer into a major blood vessel. 325 Dec 22

An accident model was used to analyze data in terms of the first event in all reported accidents occurring in a gearbox factory during 1974. The data were used to study the causes of lumbosacral injuries. A labor force of 2000 men sustained 99 lumbosacral injuries, 54 of which led to absence of one or more days. Twenty of the 54 were initiated by slipping, and 17 presented as a sudden onset of low-back pain without any preceding accidental event. A review of all patients who were absent following a slipping accident disclosed that the lumbosacral region was by far the commonest part of the body injured. Tripping was an infrequent cause of these injuries. Slipping rarely features in the literature as a cause of low-back pain. It is suggested that this is due to confusion between various contributory factors and events forming an accident.
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PMID:Slipping accidents causing low-back pain in a gearbox factory. 645 39

Patients with paralysis may develop radiographic changes in the axial skeleton and sacroiliac joints that resemble those seen in ankylosing spondylitis. These similarities can result in confusion when evaluating paralysed patients with back pain. We report on a patient with paralysis secondary to amyotrophic lateral sclerosis who developed back pain, apparent sacroiliac joint fusion, and a 'bamboo spine', leading to the misdiagnosis of ankylosing spondylitis. Serial radiographs of the bony changes in our patient are presented, along with a brief review of the literature on axial skeletal abnormalities in paralysis and a discussion of the subtle changes that distinguish immobilization spondyloarthropathy from ankylosing spondylitis.
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PMID:Axial skeletal changes in paralysed patients may mimic ankylosing spondylitis. 770 67

Residual Postsurgical Back Pain (RPP) is a complex problem, involving considerable etiologic and diagnostic confusion. About two-thirds of all patients enrolled in chronic pain centers in the United States suffer from RPP. More than 50 billion dollars are spent on the diagnosis and treatment of back pain in this country. In most cases, the etiology of the patient's complaints is multifactorial. Treatment is difficult and frequently involves surgical as well as non-surgical modalities. Surgical treatment is of value in a carefully selected group of patients, either those in whom the original procedure failed to correct the underlying abnormality or those who show evidence of compression of neural elements, or instability of vertebral column. Because extensive co-morbidity is often present, discrete operative intervention may not fully arrest the compete etiology of the patient's distress, and, indeed; may sometimes worsen the patient's complaints. Possible coexisting problems like degenerative disease or depression should be addressed in all patients prior to surgical intervention, so that the corrected variable is the preponderant cause of the patient's difficulty.
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PMID:Residual postsurgical back pain. 862 35

A review was made of five patients with post-laparoscopic cholecystectomy peritoneal soiling with clips and/or stone. Three patients were symptomatic with recurrent abdominal pain or back pain. One of these had clips alone, one had clips and stone and the third had stones alone. The location of the stones in the pelvis and right iliac fossa created confusion in the diagnosis, simulating ureteric calculi and appendicitis, respectively. Surgical operation revealed granulomas around the stones. The consequences of peritoneal clips is not yet known. However, peritoneal lithiasis and potential complications should be considered as a differential of abdominal and pelvic calculi.
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PMID:Peritoneal lithiasis and cliptomas following laparoscopic cholecystectomy. 888 23

One of every two pregnant women experiences some type of back pain. This lowers the quality of life and causes absence from work for many women. Treatment is often unsuccessful because the problem is not well defined. There also is confusion concerning where these women should be treated. The authors define this problem and suggest a method for classification of back pain in pregnancy into two different pain types and provide a model for treating pregnant women with these pain types during and after pregnancy. Following these guidelines, back pain in pregnancy can be reduced in frequency and intensity, absence from work can be diminished, and persistent pain after delivery can be virtually extinguished. The program includes education of pregnant women in how to manage their specific pain type and contains no passive treatment. The cost-benefit relationship is very good. Team work among the obstetrician, midwife, and physiotherapist is important.
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PMID:Assessment and treatment of low back pain in working pregnant women. 889 15


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