Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Substance P-like immunoreactivity (SP-LI) of the cerebrospinal fluid was measured by radioimmunoassay in 40 patients with lumbar disc herniation (hernia group), and in 10 patients with no low back pain and no leg symptoms (control group). The SP-LI was significantly higher in the hernia group (5.49 +/- 3.01 pg/ml) than in the control group (2.05 +/- 0.52 pg/ml) (p < 0.01). In the hernia group, the SP-LI was significantly higher in patients with severe pain in the lower extremities than in those with only mild pain. As the SP-LI was found to be correlated with the severity of pain, it was considered to be a useful index of pain. As for the correlation of SP-LI with the hernia type, the SP-LI was significantly higher in patients with transligamentous extrusion type hernia than in those with protrusion type hernia. This result suggested that the release of substance P was increased with marked compression on the dorsal root.
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PMID:[Substance P-like immunoreactivity in cerebrospinal fluid in lumbar disc herniation]. 754 Jan 93

The problem of low back pain has reached epidemic proportions in the industrialized nations. The predicament of back pain is common, 30-40% of our populations from 10-65 years old report such trouble to occur on a monthly basis. In 1-8% this results in work-disabling back pain. Only in very few of these patients can physicians diagnose a definite pathoanatomical cause for the pain. It can be deduced that psychosocial factors, including insurance benefits are of importance for this variation. Sweden, with 100% sickness benefits, has the highest disability rate. Few non-surgical methods have proven effective in rendering the patient better for him to return to work. Even fewer studies demonstrate any benefit from surgery, simple open removal of a proven disc hernia being the only exception. For patients with unproven diagnostic labels such as facet arthritis, degenerative disc disease, internal disc resorption and instability, no evidence exists that any type of surgery is cost-effective. More attention must be paid to illness behaviour by anyone treating chronic low back pain syndromes (> 3 months). Such psychological reactions to an originally nociceptive pain stimulus somewhere in the motion segment, must be elucidated and addressed, before embarking on risky and expensive treatment modalities including surgery. It is time for all of us, politicians as well as physicians, to distinguish what types of support will contribute to our nations' future and which ones will undermine it. Our welfare systems are at stake.
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PMID:Chronic pain--the end of the welfare state? 786 65

The combination of percutaneous manual and endoscopic Ho:YAG laser discectomy (PELD) is a new minimal intervention technique in treating patients with herniated lumbar discs that do not penetrate the posterior longitudinal ligament. The results in 100 patients treated with PELD were compared randomly with those in 100 patients treated by chemonucleolysis with chymopapain (CN) and 100 patients treated by automated percutaneous lumbar discectomy (APLD) at the same hospital. We followed the 300 patients postoperatively for 1 year, with physical examination, postoperative plain lumbosacral radiography, CT, MRI and a self-assessment questionnaire. Some 68% of the patients in the PELD group considered the outcome as excellent or good and 23% as fair; the corresponding figures were 55% and 27% in the CN group, and 48% and 32% in the APLD group. Nine percent of the patients in the PELD group underwent open microdiscectomy or were suffering from back pain with sciatica, compared with 18% in the CN group and 20% in the APLD group. PELD showed better extraction of the hernia mass than APLD and a lower rate of low back pain and less decrease in disc height than CN.
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PMID:[Comparison of percutaneous manual and endoscopic laser diskectomy with chemonucleolysis and automated nucleotomy]. 862 46

A randomized, controlled, clinical trial (N = 104) was conducted to test the hypothesis that a protocol of collaboration and communication between neurologist and general practitioner, sustained with psychiatric consultation, would reduce medical consumption (especially of diagnostic procedures and medication) in medical outpatients with low back pain. The intervention was designed at the health care provider level; the psychiatrist did not see or examine the patient. A reduction in medical consumption could not be demonstrated. As there was a great variation in adherence to the protocol in the experimental group, this might explain the lack of hypothesized effects. Full implementation of the protocol seemed to imply a lower number of major surgery operations, but this effect disappeared after excluding cases with a diagnosed hernia. The possibilities for consumption reduction for three post hoc-defined patient categories (cases with hernia and chronic and nonchronic cases) and the consequences for patient selection and treatment intensity are discussed. It is concluded that the target groups should be more narrowly defined, and that a more intensive intervention might prove to be more effective.
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PMID:Effects of psychiatric consultation on medical consumption in medical outpatients with low back pain. 873 8

The diagnostic sensitivity of dermatomal somatosensory evoked potentials (DSEPs) was evaluated in a homogeneous group of fifteen patients with low back pain due to isolated lumbosacral radiculopathy. The normative values from L3 to S1 were defined, as were the parameters of abnormality. In seven patients with pseudoradicular or referred leg pain, a negative neurological examination and images indicative of protrusion or paramedian disc hernia, the DSEPs were normal in six cases and slightly altered in one. In eight patients with deafferentation leg pain, clinical signs of root damage and images indicative of an intraforaminal hernia, the DSEPs showed varying degrees of alteration which could generally be correlated to the severity of the clinical picture. This method can therefore be useful in differentiating pain due to stimulation of the receptors of the osteoarticular structures or the root sheath, in which the DSEPs are normal, from pain due to direct root damage, in which the DSEPs are altered. This functional evaluation of anatomical damage provides further information which may help to achieve a better therapeutic approach.
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PMID:Dermatomal somatosensory evoked potentials in the diagnosis of lumbosacral radiculopathies. 885 9

We compared preoperative pain-drawing patterns of 159 patients with findings at lumbar disc surgery. Disc pathology was classified into 2 groups: intact anulus (negative exploration and protruding disc) and ruptured anulus (subligamentary perforation and sequestrated hernia). Patients with intact anulus drew fewer modalities, but more often marked pain in the trunk, neck and upper extremities, than those with ruptured anulus. Certain pain-drawing patterns--e.g., extra text, arrows and nonanatomical pain distribution--have previously been shown to correlate to unfavorable pathological traits in psychometric tests in populations of patients with chronic low back pain. In our study, most of these so-called nonorganic pain-pattern items occurred equally often in the 2 groups. In fact, one third of the patients with ruptured anulus produced pathological drawings according to the scoring system designed by Ransford et al. (1976). Although pain drawings help the investigator to obtain a rapid overview of the patient's pain pattern, the use of penalty points as a preoperative psychological screening instrument in patients with pain that is not chronic may be questioned.
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PMID:Pain patterns in lumbar disc hernia Drawings compared to surgical findings in 159 patients. 917 60

Lumbar pain is a most common suffering which frequently becomes chronic. In the mechanical low back syndrome caused by an abnormality in the intervertebral joints, lumbar pain may be rather easily differentiated from pain induced by to spinal root compression due to discal hernia or intervertebral foramen stenosis. The absence of benefits from conservative treatment of lumbar pain caused by intervertebral joint abnormalities is an indication for the highly effective and low-traumatic surgical technique transcutaneous radiofrequency destruction of intervertebral facette nerves. The technique yields good results in small displacements of the lumbar vertebra which cannot undergo orthopedic interventions, as well as in severe vertebral deformities which cause a higher load on the intervertebral joints.
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PMID:[Transcutaneous radiofrequency destruction of the articular nerves in treating low back pains]. 923 28

A 61-year-old woman began to suffer bronchial asthma in 1985. She then developed low back pain and numbness along the lower extremities, eventually leading to bilateral drop foot in 1990. At that time, she was diagnosed as having lumbar disc hernia, and extirpation of the discs at the L3-4 and L4-5 was performed. However, her clinical condition showed little improvement. Six months later, she was emaciated and bedridden with distal dominant muscular atrophy in all four limbs, purpura in the left leg and hypereosinophils. Motor conduction velocity (MCV) was not detected in the peroneal nerves. The toes gradually became cyanotic, and a skin biopsy from the cyanotic region revealed necrosis in the vessels surrounded by infiltration of a large number of neutrocytes and lymphocytes. She was diagnosed as having mononeuritis multiplex due to allergic granulomatous angiitis (AGA), which is characterized by bronchial asthma, hypereosinophilia and necrotizing vasculitis. Thirty mg/day prednisolone was then administered. However, the toes and calcaneal areas gradually became necrosed. Finally, amputation of both feet was necessary. We concluded that an early diagnosis of this syndrome is most important, and corticosteroids should be administered early.
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PMID:Peripheral neuropathy in allergic granulomatous angiitis. 933 54

We report four patients with various degrees of chronic, tonic, mildly painful, or non-painful, kyphoscolioses in orthostatism, which developed weeks, or months, after one or several laminectomies for lumbar disk hernia, in the absence of recurring radicular pain or acute lumbar pain. No family history or personal antecedent, of focal or generalized dystonia was found and the dystonia was not seen in any of the four patients pre-operatively, or during the immediate post-operative period. Only ill-defined lumbar 'discomfort', unlike their pre-operative lumbago, was reported by the patients, before and during the occurrence of the pathologic trunk posture on standing. Asymmetric lumbar muscle tonic contraction and hypertrophy was found on physical examination. In all patients, the kyphoscoliosis was maximal when standing, partially disappeared when seated, and completely when lying down. One patient responded well to clonazepam, but the other three showed no improvement with either clonazepam or local injections of botulinum toxin; L-dopa was ineffective in all cases, and trihexiphenidyle in three.
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PMID:Delayed segmental axial dystonia of the trunk on standing after lumbar disk operation. 941 41

The puncture laser discectomy was conducted in 273 patients with discogenic lumbosacral radiculitis while the conservative therapy inefficacy, pain syndrome in a lumbago stage present and lumboischialgia with absent prominent locomotive disorders and if the intervertebral disc hernia has the size up to 0.6 cm.
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PMID:[The puncture laser dissectomy application for the discogenic lumbosacral radiculitis]. 998 37


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