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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 62-year-old woman, who had been diagnosed as having rheumatoid arthritis (RA) with systemic amyloidosis and diabetes mellitus, was admitted to our hospital because of polyarthralgia on October 1, 1987. She had some subcutaneous nodules and rheumatic pleural effusion. Therefore she was treated with 20 milligrams of prednisolone (PSL) daily. On the ninth day after the beginning of steroid therapy, she complained of severe pain and a new swelling in her right knee joint. The knee joint aspirate on arthrocentesis yielded a pure growth of group B Streptococcus (GBS). Blood culture was also positive for GBS. Her suppurative arthritis gradually improved by treatment with penicillin G. However, after the discontinuance of PSL, her pleural effusion deteriorated and she died on January 10, 1988. To our knowledge, there have been no prior reports of group B streptococcal suppurative arthritis complicating RA in Japan.
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PMID:[Case report: suppurative arthritis due to group B Streptococcus in a patient with rheumatoid arthritis]. 831 3

Dialysis-related amyloidosis is characterized clinically by the carpal tunnel syndrome, pain and swelling of joints. These alterations are due to amyloid deposits in the carpal tunnel, in the synovia, ligaments and bones. It has been shown that beta 2m is the major component of this amyloidosis. Serum and urine concentration of beta 2m are markedly elevated in chronic renal failure due to failure of filtration and lack of metabolism by the renal tubular epithelium. beta 2m-derived amyloid is identified by immunohistochemistry using antibodies derived against beta 2m. Radiology shows cyst-like periarticular bone defects, destructive arthropathy and spondylarthropathy.
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PMID:[Dialysis-associated amyloidosis. Part 1: Biochemistry, clinical aspects, roentgen morphology]. 835 14

Amyloidosis involving the musculoskeletal system is an uncommon occurrence. The primary form is rare and only six cases involving the spine have been reported in the literature. The following case is believed to be the first reported in Taiwan. A 65-year-old male was admitted due to chronic nonspecific pain in the lower back with progressive paralysis of the lower limbs. Amyloidoma involving both thoracic and lumbar spine, never reported in the literature, was proved by histologic and histochemical studies. Serial radiographic examinations were also presented. Anterior decompression of the thoracic spine with iliac crest strut bone graft and Kaneda device fixation achieved good functional results. The symptoms and signs of spinal amyloidoma are nonspecific and difficult to diagnose; hence a correct diagnosis requires the surgeon to be extremely suspicious. A special histochemical stain is essential for this purpose. Because of the rarity, we report this case with review of the literature.
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PMID:[Primary amyloidoma of the spine]. 838 62

Among 17 patients with amyloid polyneuropathy type IV in a Japanese family, we found a 72-year-old woman, who showed extraocular symptoms approximately 10 years after the onset of the disease. she developed weakness of the right facial muscles and dysarthria at age 57. She had atrophy and disturbance of movement of the tongue, along with difficulty in swallowing at age 62. At the age of 66, she felt diplopia when she looked toward the left, followed by difficulty of ocular movement. These manifestations progressed and at age 72, she was found to have mild ptopsis, mild to moderate disturbance of almost all extraocular muscles, moderate to severe disturbance of facial, masseter, pharyngeal, tongue and neck muscles. She also had slight weakness and atrophy of the limb and truncal muscles together with slight loss of pain and vibratory sensations in the distal parts of the limbs. FAP IV has sometimes been called cranial amyloidosis, but motor disturbance is limited to the middle and lower cranial nerve territories in the majority of the reported cases, and manifestations of the extraocular muscles are quite rare. According to the present investigation of the world literature, this is the second case of FAP IV with extraocular muscle involvement.
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PMID:[Familial amyloidosis of the Finnish type (FAP) with extraocular muscle involvement]. 856 42

We describe a case of primary amyloidosis (AL) with severe factor X (FX) deficiency in an amateur cyclist presenting with muscular pain at rest and ecchymoses in his legs. No circulating inhibitor of FX was found by mixing studies and there was no deficiency of other vitamin K-dependent coagulation factors and inhibitors or of alpha 2-antiplasmin. Thrombin-time and reptilase time were abnormally prolonged and were not corrected by mixing with normal plasma. Administration of plasma or prothrombin complex concentrate (PCC) were unsuccessful in controlling bleeding: the apparent half-life of transfused FX was 6 minutes. Resting resulted in cessation of muscular pain and bleeding. Renal and cardiac deterioration led the patient to death 3 years after presentation. No further bleeding manifestations did occur during this period. FX levels remained consistently below 3%, but prothrombin fragment 1.2 and thrombin-antithrombin complex--measured at distance from PCC administration and prior to deterioration of renal and cardiac function--were markedly elevated. At autopsy, disseminated amyloidosis was found with sparing of the skeletal muscles and of the skin. This is the first report of increased in vivo prothrombin activation and activity in AL-associated FX deficiency.
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PMID:Unusual bleeding manifestations in a case of primary amyloidosis with factor X deficiency but elevations of in vivo markers of thrombin formation and activity. 858 46

By definition, monoarticular arthritis means one-joint involvement, even though, in fact, such a condition is often an oligoarthritis because as many as two or three separate joints will be involved. Arthritis is often limited and may regress, so that it is frequently misdiagnosed. Sometimes, a monoarticular condition may be a polyarthritis onset (i.e., rheumatoid arthritis). Monoarticular arthritis can be caused by many factors, such as infections (septic arthritis), nonspecific inflammatory processes (reactive arthritis), crystals deposition (gout, CPPD crystal deposition disease), trauma, neoplasm (pigmented villonodular synovitis), immunologic conditions (amyloidosis) and hormonal changes (parathyroid disease). Its onset is usually acute and sometimes dramatic, with fever, pain and joint swelling, so that a decision must be made promptly to stop rapid illness evolution and to prevent the irreversible destruction of cartilage and bone (especially in septic arthritis). Diagnostic studies are performed with mono-bilateral radiographs of the joint. Radiographic findings (i.e., soft tissue swelling, joint effusion, widening and thinning of joint spaces, bone erosions and destruction of bone surface) are typical of the disease, but some findings (e.g., type of evolution and progression), laboratory tests, synovial biopsy and arthroscopy can differentiate infectious from inflammatory forms. Scintigraphy can depict isotopic joint uptake, before articular abnormalities are demonstrated with radiography, thanks to its high sensitivity; nevertheless, because of its low specificity, scintigraphy may miss some kinds of lesions (including osteoarthritis) and cannot easily differentiate osteomyelitis from septic arthritis. CT and MRI play a secondary, though not negligible, role, especially to study such deep infections as psoas abscesses, which may mimic arthritides.
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PMID:[Monoarthritis]. 868 51

Carpal tunnel syndrome (CTS) is characterized by burning pain, numbness and tingling sensation in the thumb, index and middle fingers and the lateral half of the palm and progressive atrophy of the thenar muscles by compression of the median nerve within the carpal tunnel due to a variety of etiologic factors. Surgical intervention usually successfully relieves symptoms of CTS. Recently CTS has been regarded as one of the major clinical manifestations of dialysis-related amyloidosis due to beta 2-microglobulin deposition and recognized with increasing frequency in patients undergoing long-term hemodialysis. We report a case of carpal tunnel syndrome due to dialysis-related amyloidosis in patients undergoing long-term hemodialysis, confirmed by electromyography and biopsy in transverse carpal ligament and median nerve.
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PMID:A case of carpal tunnel syndrome due to dialysis-related amyloidosis in a patient undergoing long-term hemodialysis. 915 43

A common sign of distal small fibre neuropathy is dysesthesias, especially burning sensation distally in the extremities. These symptoms are often difficult to treat with conventional analgesics. In the course of the disease, the patient may become less sensitive to pain and changes in temperature, but clinical signs may nevertheless be minor and often difficult to detect by clinical examination. Dysautonomic features are also common. Selective affection of small fibres may occur in the form of pure small fibre neuropathy, but this may also be an early manifestation of general sensorimotor polyneuropathy. Common causes are diabetes mellitus, alcoholism, and amyloidosis. Abnormalities in small diameter fibres may be detected by quantitative sensory testing of temperature and pain thresholds, and by autonomic tests. We describe four patients with polyneuropathy with a predominance of small fibre involvement.
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PMID:[Small fiber neuropathy]. 919 25

We evaluated the clinical and laboratory features of multiple myeloma in our patients and reviewed the factors that affected their survival. The study included 36 patients (12 women and 24 men) with multiple myeloma whom we followed up until death between October 1978 and June 1995. The age range was 34 to 75 years (mean age, 53.9). The chief complaints on admission were lumbar pain and pain in the extremities (77.8%) and generalized weakness (61.1%). The most common laboratory findings were severe anemia (hemoglobin < 8.0 g/dl) (50%), elevated erythrocyte sedimentation rate (75%), monoclonal spike in the serum protein electrophoresis (44.4%), and lytic skull lesions (72.2%). Twenty-three (64%) patients had a monoclonal IgG, 9 (25%) had IgA, 1 had IgD, 2 had light chain disease, and 1 was nonsecretory. Localized plasmacytoma was detected in 4 patients and 4 patients had amyloidosis in rectal and gingival biopsies. According to the Durie-Salmon staging system, 2 patients were in stage 1, 8 were in stage 2, and 26 were in stage 3. The mean survival was 31.4 +/- 4.3 months (range: 1 to 96). The 5-year survival rate was 11%. Sex, age at diagnosis, stage of the disease, hemoglobin level, platelet count, level of serum calcium, creatinine, serum paraprotein, and type of paraproteinemia were tested as prognostic parameters. We could not establish a statistically meaningful effect of these parameters on survival time. The first and second most common causes of death were renal failure and infection, respectively.
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PMID:Multiple myeloma in the region of Bursa, Turkey: a retrospective analysis. 921 19

Localized laryngeal amyloidosis is a rare laryngeal disease which accounts for less than 1% of all benign laryngeal tumors. The symptoms depend on where the amyloid deposit is located in the larynx. When the vocal cords are involved there may be some hoarseness; pain or increasing difficulty in inspiration may arise when, respectively, the aryepiglottic fold or subglottic space are involved. The present paper reports a case of laryngeal amyloidosis without any sign of systemic disease. It also deals with the principle diagnostic procedures to follow. After a review of the literature, emphasis is placed on how important it is to recognize laryngeal amyloidosis in order to achieve an appropriate diagnosis and plan therapy properly. Surgery is the main treatment using either endoscopy or an external neck approach. Recently CO2 laser surgery has been used successfully. Prognosis depends on both the size of the amyloid deposit and whether there is some simultaneous overall involvement.
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PMID:[Localized amyloidosis of the larynx]. 938 25


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