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 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Physicians examined the charts of 2295 21-40 year old oral contraceptive (OC) users who presented at 2 hospitals in France with venous disorders to determine the effect of various OCs on the functional symptomatology of venous disorders. The hospitals are the Hospital Notre Dame du Bon Secours in Paris and the Hospital Beaujon in Clichy. The various symptoms have existed between more than 1 year and greater than 3 years. The women used OCs with either a monophsic, biphasic, or triphasic minimal dose (304-40 mcg estrogen and 0.15-1 mg progestogen) or a monophasic normal dose (50 mcg estrogen and 500 mg progestogen). Over the course of OC use, the normal dose OC caused more significant intensity of heaviness, pain, and abnormal sensation (e.g., burning, prickling, or formication) than the minimal dose OCs. Other symptoms examined but not significantly affected by estrogen and progestogen dose are cramps and edema. These results and the fact that functional symptomatology appears several years before dilatation with or without reflux of the saphenous veins and other varices indicate that estrogens, progestogens, or their associative action facilitate varicose vein development in individuals with factors which predispose them to vascular disorders (familial history, prolonged standing, obesity, and sedentary). They also aggravate the superficial venous state in these patients.
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PMID:Influence of estrogens and progesterone on the venous system of the lower limbs in women. 143 May 44

A survey of knowledge and nursing practice in relation to sub-mammary skin problems was conducted among ward sisters and primary nurses in one district health authority. Respondents identified a number of characteristics as predisposing factors, with obesity and poor hygiene being mentioned most frequently. A very wide selection of nursing interventions was recommended, with nurses who mentioned pharmacologically active topical preparations reporting a significantly greater number of recurrences among patients than those who relied on less sophisticated regimes. Nurses expressed a variety of opinions about the effect that this condition has on patients, ranging from no effect at all to pain and discomfort. These findings highlight the lack of a coherent strategy for treating this problem and support the continuation of a research programme examining sub-mammary skin problems and the nursing response to them.
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PMID:Skin problems beneath the breasts of in-patients: the knowledge, opinions and practice of nurses. 143 Jun 28

The most certain symptomatic manifestation of gallstones is episodic upper abdominal pain. Characteristically, this pain is severe and located in the epigastrium and/or the right upper quadrant. The onset is relatively abrupt and often awakens the patient from sleep. The pain is steady in intensity, may radiate to the upper back, be associated with nausea and lasts for hours to up to a day. Dyspeptic symptoms of indigestion, belching, bloating, abdominal discomfort, heartburn and specific food intolerance are common in persons with gallstones, but are probably unrelated to the stones themselves and frequently persist after surgery. Many, if not most, persons with gallstones have no history of pain attacks. Persons discovered to have gallstones in the absence of typical symptoms appear to have an annual incidence of biliary pain of 2-5% during the initial years of follow-up, with perhaps a declining rate thereafter. Gallstone-related complications occur at a rate of less than 1% annually. Those whose stones are symptomatic at discovery have a more severe course, with approximately 6-10% suffering recurrent symptoms each year and 2% biliary complications. The far higher rates of symptom development reported in a few studies raise the possibility that these incidence estimates may be too low. The best predictors of future biliary pain are a history of pain at the time of diagnosis, female gender and possibly obesity. The risk of acute cholecystitis appears to be greater in those with large solitary stones, that of biliary pancreatitis in those with multiple small stones, and that of gallbladder cancer in those with large stones of any number. Drugs that inhibit the synthesis of prostaglandins may now be the treatment of choice in patients with gallstones who are suffering acute pain attacks. Persistent dyspeptic symptoms occur frequently following cholecystectomy. A prolonged history of such symptoms prior to surgery and evidence of significant psychological distress appear to be the best predictors of unsatisfactory outcome.
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PMID:Symptoms of gallstone disease. 148 6

Records of 11 patients undergoing biliary reconstruction after laparoscopic cholecystectomy are reviewed. Ductal injuries resulted from failure to define the anatomy of Calot's triangle. Risk factors include scarring, acute cholecystitis, and obesity. Presenting findings included anorexia, ileus, failure to thrive, pain, ascites, and jaundice. All patients required hepaticojejunostomies, which were multiple and above the hepatic bifurcation in four patients. Given the extensive nature of these injuries and the frequent need for intrahepatic anastomosis and early stenosis of repairs by referring physicians, we recommend reconstruction be undertaken by an experienced hepatobiliary surgeon. To avoid injuries, a greater appreciation of risk factors and anatomic distortion and variance and strict adherence to principles of dissection and identification of anatomic structures are suggested. The use of cholangiography and a low threshold for conversion to the open procedure are advised.
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PMID:Laparoscopic bile duct injuries. Risk factors, recognition, and repair. 153 9

A workshop on the high risk group and the preventive oncology of renal cell carcinoma was held in Kyoto on September 7, 1990. The following subjects were presented: 1. Cohort study of renal cell carcinoma (Dr. Hirayama). 2. Pathoepidemiological study on the background of occurrence of renal cell carcinoma (Dr. Aoki). 3. Case-control study on renal cell carcinoma (Dr. Watanabe). 4. Geographic distribution of renal cell carcinoma in Japan (Dr. Minowa). 5. Pathological findings of small renal cell carcinoma (Prof. Yatani). 6. Pathoepidemiological study on occurrence of renal cell carcinoma (Dr. Tsuchihashi). 7. Clinical evaluation of small renal cell carcinoma (Dr. Masuda). 8. Clinical (biological) characteristics of renal cell carcinoma (Dr. Satomi). 9. Mass screening program for renal cell carcinoma on private urological clinic (Dr. Mishina). 10. Early stage detection of renal cell carcinoma (Dr. Ohe). 11. A review on the literature of epidemiology for renal cell carcinoma (Dr. Nakagawa). Possible risk factors reported for renal cell carcinoma were as follows: 1) Work in petroleum-related and dry-cleaning industries were positive risk. A predominant lifetime occupation as a professional was negative risk. 2) Milk or coffee consumption and use of artificial sweeteners were positive. Drinking of alcohol was negative. 3) Obesity was positive. 4) Personal history of cancer was positive. 5) Cigarette smoking was positive. 6) Exposure to radiation or hydrocarbon was positive. 7) Use of estrogen, diuretic and pain relievers was positive. 8) History of myocardial infarction, hypertension and diabetes mellitus was positive.
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PMID:[A workshop on the high risk group and the preventive oncology of renal cell carcinoma]. 156 64

Radiologic assessment appears to be an objective standard for longterm evaluation of osteoarthritis (OA) and it is inexpensive, quick, simple and noninvasive. We conducted a one year followup study of patients with OA of the knee to evaluate the reproducibility and validity of this evaluation. The intra and interobserver reproducibility of the radiologic variables were evaluated on 275 and 539 patients, respectively, and found to be satisfactory (intraclass coefficient of correlation above 0.70 for the evaluation of the space narrowing of the joint). During the one year followup study, there was a slight but statistically significant deterioration of the joint space narrowing, evaluated on a 6 grade scale on 360 patients (p less than 0.001). The changes in the joint space narrowing were more closely correlated with treatments received by the patients for OA (nonsteroidal antiinflammatory drug (NSAID) intake, synovial fluid aspiration) than with changes in the recorded clinical variables (pain on a visual analog scale, Lequesne algofunctional index). Moreover, some factors such as obesity, generalized OA and flares of OA appeared to be correlated with the deterioration of joint space narrowing. Further studies are necessary to confirm and/or explain the relationship between the deterioration of the joint space narrowing and such factors (i.e., NSAID intake, obesity, flares of OA, generalized OA), which were detected in this study.
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PMID:Longitudinal radiologic evaluation of osteoarthritis of the knee. 157 51

In a recent editorial, Kapur described perioperative nausea and vomiting as "the big 'little problem' following ambulatory surgery."257 Although the actual morbidity associated with nausea is relatively low in health outpatients, it should not be considered an unavoidable part of the perioperative experience. The availability of an emesis basin for every patient in the postanesthesia recovery unit is a reflection of the limited success with the available therapeutic techniques.257 There had been little change in the incidence of postoperative emesis since the introduction of halothane into clinical practice in 1956. However, newer anesthetic drugs (e.g. propofol) appear to have contributed to a recent decline in the incidence of emesis. Factors associated with an increased risk of postoperative emesis include age, gender (menses), obesity, previous history of motion sickness or postoperative vomiting, anxiety, gastroparesis, and type and duration of the surgical procedure (e.g., laparoscopy, strabismus, middle ear procedures). Anesthesiologists have little, if any, control over these surgical factors. However, they do have control over many other factors that influence postoperative emesis (e.g., preanesthetic medication, anesthetic drugs and techniques, and postoperative pain management). Although routine antiemetic prophylaxis is clearly unjustified, patients at high risk for postoperative emesis should receive special considerations with respect to the prophylactic use of antiemetic drugs. Minimally effective doses of antiemetic drugs can be administered to reduce the incidence of sedation and other deleterious side effects. Potent nonopioid analgesics (e.g., ketorolac) can be used to control pain while avoiding some of the opioid-related side effects. Gentle handling in the immediate postoperative period is also essential. If emesis does occur, aggressive intravenous hydration and pain management are important components of the therapeutic regimen, along with antiemetic drugs. If one antiemetic does not appear to be effective, another drug with a different site of action should be considered. With the availability of new antiserotonin drugs, the incidence of recurrent (intractable) emesis could be further decreased. Research into the mechanisms of this common postoperative complication may help in improving the management of emetic sequelae in the future. As suggested in a recent editorial, improvement in antiemetic therapy could have a major impact for surgical patients, particularly after ambulatory surgery. Patients as well as those involved in their postoperative care look forward to a time when the routine offering of an emesis basin after surgery becomes a historical practice.
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PMID:Postoperative nausea and vomiting. Its etiology, treatment, and prevention. 843 45

The value of the vascular examination cannot be over-estimated. Symptoms of vascular disease present in the foot and lower extremity may actually be manifestations of severe life-threatening disease. Symptoms, their location, and the frequency and quality of the patient's pain often provide valuable clues for the clinician's diagnosis. Central nervous system symptoms, ocular disturbances, cardiac symptoms, impotence, or constitutional disturbances may all indicate systemic arterial disease. Risk factors for this disease include smoking, hypertension, hyperlipidemia, genetic predisposition, diabetes, emotional stress, and physical inactivity. Those factors attributable to hypercoagulability and venous disease are birth control pill use, estrogen chemotherapy, obesity, prolonged immobilization, paralysis, previous thrombotic episodes, venous stasis disease, and varicose veins. An accurate bilateral assessment of blood pressure, pulses, and capillary perfusion is of critical importance. Careful inspection of the extremity for trophic changes, skin color, texture, temperature, edema, ulceration, atrophy, or paresis, will provide clues of vasculopathy. A relatively accurate assessment of circulatory status may be obtained without the use of exotic instruments. Simple tests such as the elevation and dependency tests, capillary bed return test, venous filling time test, along with blood pressure, pulse, and possibly oscillometry data are valuable in arterial evaluation. Such venous tests as inspection, percussion, Homan's sign, Trendelenburg, and Perthes' tourniquet are useful in the determination of the presence of venous disease. Fortunately, over the past few years tremendous advances have been made in the technology of the vascular laboratory. If symptoms are discovered during the vascular history and physical examination, the complete noninvasive study will provide impressive data to quantitate and specifically establish the diagnosis.
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PMID:The vascular history and physical examination. 173 54

This study used the Coping Strategies Questionnaire (CSQ) to investigate pain coping strategies in 52 rheumatoid arthritis patients who reported having knee pain 1 year or more following knee replacement surgery. Data analysis revealed that, as a group, these patients were active copers in that they reported frequent use of a variety of pain coping strategies. Pain coping strategies were found to be related to measures of pain and adjustment. Patients who rated their ability to control and decrease pain high and who rarely engaged in catastrophizing (i.e., who scored high on the Pain Control and Rational Thinking factor of the CSQ) had much lower levels of pain and psychological disability than patients who did not. Coping strategies were not found to relate to age, gender, obesity status or disability/compensation status. Taken together, these results suggest that an analysis of pain coping strategies may be helpful in understanding pain in arthritis patients who have pain following joint replacement surgery.
Pain 1991 Aug
PMID:Analyzing pain in rheumatoid arthritis patients. Pain coping strategies in patients who have had knee replacement surgery. 174 38

Adiposis dolorosa or Dercum's disease consists of a painful progressive localized state of obesity with four cardinal symptoms: a) painful circumscribed or diffuse fatty deposits, b) generalized obesity in women usually of menopausal age, c) asthenia, weakness and frequently tendency to fatigue and d) mental phenomena including emotional instability, depression, epilepsy, mental confusion and true dementia. Only a few cases in men have been described. The pain may be treated with intravenous administration of lignocaine or oral mexitil while no causal treatment is known. An illustrative case is reported.
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PMID:[A case of adiposis dolorosa--Dercum's disease]. 150 54


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