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The study explored children's self-assessment of the pain experience and to understood the relative factors that influence the words used to represent children's pain. Using an outline of a human figure and a section of the open questionnaire to study, 106 nine- to sixteen-year-old children marked their pain location using colors to represent pain. They rated the intensity and duration of their pain, and described their experience of pain (sensation, causes, and ways to manage pain). The results showed that children clearly described pain, that there were appreciable differences between feelings of headache, leg pain, backache, and shoulder pain with pain intensity and duration of pain; that explained the difference of occurrence of abdominal pain in cross effect between age and sex; that explained the difference of the occurrence of toothache in cross effect among triangle of hospitalized experience, age, and sex; that there was significant relationship between abdominal pain and family structure. For severe abdominal pain or toothache the children could ask doctors for pain relief. For the others, they could take medication or rest for their middle or mild abdominal pain. The ways to manage leg pain were injection and massage. Change of position was applied to relieve backache. From the children's self-reports, we understand that causes of children's pain were derived from bad sleep, food, decayed teeth, exercising, and hitting. Pain avoidance is best achieved by accident prevention, cultivation of good health habits, and integration of daily living skills.
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PMID:Sensation and experience of pain in children. 832 Jul 54

A one-month health diary was used as a research instrument for measuring health care in the northeastern rural area of Thailand during the month of November, 1992. Three hundred forty-five respondents, which represents 22.2% of the total households in 12 villages from 2 districts in the Khon Kaen province of northeast Thailand, completed the health diaries. Self-medication was most practiced for health care (37.5% of ill persons) followed by health service utilization at local health center (19.4%), at community hospital (11.4%), at private clinic (11.4%), and by "wait and see" (9.0%). Analgesics were the most frequently used drugs for relief of fever, headache, common cold and abdominal pain. The use of a combination of drug (eg. a cocktail) was common as self-medication for relief of back and leg pain. Traditional or herbal drugs were a frequently chosen alternative for self-medication, both in adult and children. The authors suggest that the villagers should be educated concerning drug hazards in order to increase their background knowledge on drug use.
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PMID:Health care of villagers in northeast Thailand--a health diary study. 870 59

The aim of this study was to evaluate the results of surgical treatment of coarctation of the aorta. All patient files on patients operated at Haukeland Hospital, Bergen, Norway, in the period 1975-95 (n = 102) were surveyed. We sent a questionnaire to all patients alive in 1996 (n = 84), and 82 (98%) responded. Six patients (6%) died within 30 days of surgery, and 12 (12%) died later. These mortality numbers were smaller among patients operated in the period 1988-95. Among patients with associated heart defects (n = 28) the numbers were 14% and 25%, respectively. Four patients required reoperation and three patients balloon dilatation. Six of these patients were operated in the period 1975-87. Among the 82 patients that responded to the questionnaire, clinical follow-up by a cardiologist had been discontinued in 35 cases. 31 patients (38%) were not satisfied with the follow-up. Many patients reported muscle fatigue in the legs (30%), reduced exercise performance (29%), headache (26%), general fatigue (22%), and leg pain (17%). 38% did not report any symptoms. Our results are in accordance with previously reported studies, and the mortality numbers were reduced in the second period. The number of recurrences was also reduced in this period. The symptoms reported by many patients may be caused by recoarctation or an abnormal blood pressure. This group of patients should, therefore, be monitored systematically for abnormal blood pressure, recoarctation and aortic valve disease.
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PMID:[Patients surgically treated for aortic coarctation]. 1040 8

Progressive diaphyseal dysplasia (PDD), a rare disorder of bones, in recent years has been accepted as a systemic disease within the spectrum of connective tissue disorders associated with immunological abnormalities. Steroids have been used in the treatment of PDD with variable success. In this report PDD is described in a 5-year-old boy who presented with leg pain, fatigue, headache and anorexia with an onset in infancy. Physical examination revealed a waddling gait, thorax deformity and thickening in the upper extremities. The diagnosis was made by radiologic demonstration of cortical thickening and a narrowed medullary cavity of the long bones of extremities. Bone scintigraphy showed areas of increased osteoblastic activity in the diaphyseal part of the long bones of extremities and the skull. Electron microscopic examination revealed myopathic and vascular changes. Serum immunoglobulin A, G and M levels were elevated and CD4 positive T cell numbers were low. Deflazacort, a steroid with a similar anti-inflammatory effect to prednisolone but with fewer adverse effects, was started in a dose of 1.2 mg/kg/day. Deflazacort treatment resulted in clinical and radiological improvement within 12 months with no side effects. In conclusion, steroids may be recommended as an effective method of treatment in PDD and deflazacort may be a safe alternative steroid.
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PMID:Deflazacort treatment in progressive diaphyseal dysplasia (Camurati-Engelmann disease). 1045 3

To determine if the Nakhodka oil spill and subsequent cleanup efforts had any health effects on the residents along the oil-contaminated coast, we investigated the health status of Anto residents who resided nearest to the coast where the bow ran aground. Two hundred eighty-two men and women involved in the cleanup activities between January 7 and January 20 were interviewed and examined by public health nurses to determine whether they suffered physical symptoms after exposure to the oil spill. Urine examinations for hydrocarbon toxicological markers were performed on 97 residents. The average number of days worked on cleanup activities was 4.7 days for men and 4.3 for women. Seventeen percent of the subjects had worked on cleanup activities for more than 10 days. Protective equipment was used against direct exposure to oil during the cleanup jobs and consisted of gloves used by almost 100% of the subjects and masks used by 87.1% of women and by only 35.4% of men. Glasses were worn by less than 30% of the subjects. Many symptoms emerged after the beginning of cleanup activities. The principal symptoms included low back pain and leg pain, headache, and symptoms of eyes and throat. Among the subjects undergoing urine tests, only three people showed a higher level of hippuric acid, although they returned to normal in the second examination. Accordingly, the exposure to the oil and the subsequent cleanup efforts were suggested to inflict acute health problems on local residents.
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PMID:Acute health problems among the people engaged in the cleanup of the Nakhodka oil spill. 1058 14

A 29-year-old woman presented with severe leg pain that had lasted for several weeks. During that period, she had taken painkillers in order to achieve sleep. In the week before she was admitted to hospital, she had noticed numbness and a cold feeling below her knees. There were no arterial pulsations below her groin, the skin of her legs being cold and pale. She had a history of chronic daily headache and had ingested Cafergot compound corresponding to ergotamine 2 to 3 mg daily for the previous 2 or 3 months. Angiography demonstrated severe narrowing of both superficial femoral arteries for a distance of about 5 to 6 cm and a subtotal stenosis of the right popliteal artery. After discontinuation of ergotamine, the patient's symptoms gradually disappeared within a few days. Angiography was repeated 2 days after the first examination and demonstrated regression of the spasms in the femoral arteries and reestablished flow in the distal vessels. Ergotamine tartrate can induce life-threatening ischemia of an extremity. Discontinuation of ergotamine is usually sufficient to reverse the ischemia, however, intravenous infusion of sodium nitroprusside may occasionally be necessary to avoid limb amputation.
Headache 2000 Apr
PMID:Limb-threatening ischemia due to ergotamine: case report with angiographic evidence. 1075 38

There are comprehensive findings on the immediate recovery of patients from different types of anaesthesia, but more information is needed on how patients manage at home after ambulatory surgery. One hundred and seventy-three elective knee arthroscopy patients were randomised into four different anaesthesia groups to receive either spinal anaesthesia (SA) with 5% lidocaine or general anaesthesia (GA) with propofol infusion, isoflurane inhalation or desflurane inhalation. The patients were interviewed over the phone on the next day and asked to complete a questionnaire after 1 week. One hundred and sixty-eight patients (97%) were reached by phone. The questionnaire was returned by 163 patients (94%). After 24 h, all the patients were satisfied with the type of anaesthesia they had received, but 2% of the SA patients would have chosen GA and 4.3% of the GA patients would have chosen SA for the next operation. Based on the questionnaires returned after 1 week, 8.3% of the SA patients would have wanted to have GA, and 4.7% of the GA patients would have wanted to have SA in the future. The incidence of nausea (4.2%) and vomiting (1.8%) was very low in the whole series, with no differences between the anaesthesia groups. Headache after 24 h was experienced by 15.7% of the SA and 10.3% of the GA patients. After 1 week, SA patients reported headache upon standing in 13.5% of the cases, backache in 36.5% and lower leg pain in 59.6%. The corresponding figures for GA patients were 4.5, 9.9 and 39.6% (P<0.05). In spite of the good immediate recovery profile in the all anaesthesia groups, the fact that SA patients reported a higher incidence of headache, backache and lower leg pain after 1 week may be signs of post spinal headache and transient neurologic symptoms (TNS). For overall patient comfort, GA might be a better anaesthetic choice in ambulatory surgery.
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PMID:One-week recovery profiles after spinal, propofol, isoflurane and desflurane anaesthesia in ambulatory knee arthroscopy. 1085 43

Contemporary Bartonella quintana infections have emerged in diverse regions of the world, predominantly involving socially disadvantaged persons. Available data suggest that the human body louse Pediculus humanus is the vector for transmission of B. quintana. Descriptions of the clinical manifestations associated with contemporary B. quintana infections have varied considerably and include asymptomatic infection, a relapsing febrile illness, headache, leg pain, "culture-negative" endocarditis, and, in human immunodeficiency virus-infected persons, bacillary angiomatosis. Laboratory diagnosis is most convincing when B. quintana is isolated in blood culture, but growth often takes 20-40 days; problems exist with both sensitivity and specificity of serological assays. On the basis of available information, use of doxycycline, erythromycin, or azithromycin to treat B. quintana infections is recommended. Treatment of uncomplicated B. quintana bacteremia for 4-6 weeks and treatment of B. quintana endocarditis (in a person who does not undergo valve surgery) for 4-6 months are recommended, with the addition of a bactericidal agent (such as a third-generation cephalosporin or an aminoglycoside) during the initial 2-3 weeks of therapy for endocarditis.
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PMID:Bartonella quintana and urban trench fever. 1091 10

The Indian Contraceptive Testing Unit started making field trials with oral contraceptives in 1964. By June 1968, 958 women were taking oral contraceptives. Combination tablets used contained a minimum amount of progestogen (.5-3 mg) and a suitable amount of estrogen. The 21-tablet pack was found mot suitable. It was found that if a woman missed taking the tablets in the latter half of the cycle usually no harm resulted, but if she missed them at the beginning of the cycle pregnancy might follow as ovulation would not be inhibited. Main contraindications are liver damage, toxic hyperthyroidism, thromboembolic disease, and cancer of the genital tract or breast. Caution is advised for persons with chronic nephritis, a history of eclampsia, hypertension, varicose veins, ophthalmological disorders, or psychic depressive states. Side effects have been less with the smaller doses. The most serious side effect is thromboembolism. Those reported have been leg pain, giddiness, headache, breakthrough bleeding, nausea, vomiting, amenorrhea, abdominal pain, weakness, increased blood pressure, and skin rashes. Others have reported ocular disease and cranial nerve palsy. Sequential therapy has been reported to have a lower incidence of side effects but a higher rate of pregnancy. Low-dose progestogen therapy, the "minipill," does not inhibit ovulation but is effective by causing changes in the endometrium and in the mucus. The chlormadinone in the minipill does not affect lactation. However, the incidence of pregnancy is similar to that with an IUD (Lippes loop) which is 2.6/100 cases. Laboratory tests have been normal, except an increase in the thymol turbidity test. Vaginal cytology has revealed no case of malignancy. Results show that oral contraceptives are suitable for use on a mass scale as a method of population control.
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PMID:Experience with oral contraceptives. 1225 72

The treatment of hepato-digestive side effects of combined oral contraceptives using Citro B6 (an association of monopyridoxine citrate, betaine, and citric acid) in 50 women aged 16-62 years is reported. Citro B6 was administered in 1 or 2 courses of 20 days, 3 ampules per day. Therapeutic results were considered good or excellent in 43 patients, with disappearance of nausea and digestive disturbances, and improvement of mastodynia, headache, leg pain, and serum lipid levels. The author recommends the routine use of Citro B6 in association with oral contraceptives.
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PMID:[Prevention and treatment of the secondary effects of oral contraceptives using Citro B-6]. 1225 58


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