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

The clinical course of 31 patients who underwent attempted excision of the filum terminale and tip of the conus for syringomyelia is summarized. Of these patients, 17 had had some previous surgical intervention. Eleven patients were continuing to deteriorate at the time of the operation. In three cases, marked postoperative improvement was reported, and objective improvement was thought to result from the conus excision. Eighteen more patients claimed improvement in their preoperative symptoms of loss of pain sensibility, deafness, or reduced motor function, although most of such claims were unverified by objective clinical assessment. Sixteen of the patients who improved have since proceeded to deteriorate. In five of the patients, there was a long-standing improvement of at least subjective phenomena. Thirteen patients were not improved even subjectively and some of these have continued to grow worse. Proof that the greater part of the syrinx was in communication with the conus or filum was difficult to obtain even when the conus was dilated. No correlations have been found to suggest that the operation might be more effective if the central canal was patent at the conus or the filum, nor was there a correlation between a good clinical result and either the age of the patient or the age of the syrinx as judged by the history. The operation did not seem to be more or less beneficial if previous surgery had been performed. The suggestion is made that for syringomyelia with hindbrain abnormalities, other than dense arachnoiditis (particularly if there is evidence of pressure dissociation at the foramen magnum), craniovertebral decompression remains the procedure of choice. In syringomyelia with marked hydrocephalus, drainage by a valved shunt may be the preferred first procedure. If myelotomy is planned it should probably be done where the syrinx is wide, and it is more likely to succeed if the syrinx is drained to a low-pressure area outside the theca, such as the peritoneum or pleura, rather than the subarachnoid space.
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PMID:A critical appraisal of "terminal ventriculostomy" for the treatment of syringomyelia. 684 75

Estimates of the need for neurologists must be based ultimately on the frequency of neurologic disease. Community-based population surveys for diseases or injuries that have come to medical attention provide annual incidence rates per 100,000 population, point prevalence rates per 100,000, and average duration in years. For 61 disorders, including for 8 only those fractions that were thought to require neurologic attention, the annual incidence rates summed to 2500 per 100,000 or 2.5% of the population. For 55 of these conditions, including for 6 only the neurologic fraction and excluding all mental retardation, blindness, deafness, or psychosis, the point prevalence rates summed to 9500 per 100,000 population. Even if we also excluded all headache, all trauma, all alcoholism, and all vertebrogenic pain states, 3.6% of the general population at any one time should be under neurologic care. Substracting all these exclusions from the incidence rates similarly leaves more than 1 person in every 100 who each year will have a new neurologic disorder that requires the attention of a physician competent in clinical neurology.
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PMID:The current neurologic burden of illness and injury in the United States. 689 Jan 53

This case seems worthy of attention for several reasons. To begin with, the process, which at first appeared to be concentrated in the orbital region, was triggered traumatically, with secondary glaucoma, lymphostasis and severe local pain in the left eye. Subsequently, diabetes insipidus developed, involving the hypophysis, while from the very beginning there was postchiasmatic hemianopia, later complemented by deafness and epileptiform attacks. All these complaints were most severe in the mornings, suggesting a vegetative disorder. Apart from the problem of interpreting the process the progression itself was remarkable, developing in the course of a few years from a "harmless" concussion to a complex cerebral syndrome, rendering the patient unfit for work.
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PMID:[Multifocal deficits following "banal" concussion (author's transl)]. 744 64

Van der Hoeve's syndrome is the all-round variant of Lobstein's disease (late osteogenesis imperfecta) and is characterized by the concurrent presence of osteoporosis, blue sclerae, and deafness. The literature has reported sporadic cases of a combination of algodystrophic syndrome and Lobstein's disease. Our case represents a classic example: a 50-year-old woman with blue sclerae since birth, bilateral deafness, major dental alterations, vitreous osteoporosis and a history of pathological fractures who, two years from the onset of menopause, complained of pain involving the right ankle. After admission to our Department, a diagnosis of algodystrophy combined with van der Hoeve's syndrome was made on the basis of her clinical history, objective signs and x-ray results. Treatment consisted of i.v. clodronate disodium at a dose of 300 mg daily in 250 ml saline solution for 7 consecutive days. At the end of the treatment cycle the patient reported an improvement in her symptoms with nearly total regression of right ankle pain, while swelling disappeared within a few weeks.
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PMID:Algodystrophy in conjunction with van der Hoeve's syndrome. 755 66

We report a 74-year-old man with a lung cancer, who developed right leg weakness, neurogenic bladder, and multiple cranial nerve palsies. The patient was well until December of 1992, when he was 74-year-old, when he noted transient double vision; in February of 1993, he noted numb sensation and weakness in his right leg. Later in the same month, he developed overflow incontinence of urine and weakness in his right face. He also noted deafness in his left ear (he had a marked loss of hearing in his right ear since childhood because of otitis media). His weakness in his right leg had progressed, and he was admitted to our service on March 19, 1993. On admission, he was afebrile and BP was 130/50 mmHg. General physical examination was unremarkable. On neurologic examination, he was alert and oriented to all spheres; no dementia was noted nor were detected aphasia, apraxia, and agnosia. His optic fundi were unremarkable; ocular movement appeared normal, however, he complained of diplopia in far vision. Sensation of the face was intact. He had right facial palsy of peripheral type; he was unable to close his right eye, and Bell's phenomenon was observed on attempted eye closure. On the left side, he had facial spasm. He had marked bilateral deafness. He had no dysarthria or dysphagia. The remaining of the cranial nerves were intact. Motor wise, he was unable to stand or walk alone; weakness did not appear to account for his difficulty in gait; manual muscle testing revealed 4/5 weakness in his tibialis anterior muscle, 1/5 in the peroneus longus, 0/5 in his extensor hallucis longus and extensor digitorum longus, all on the right side. Brachioradial and quadriceps femoris reflexes were increased to 3/4; plantar response was equivocal on the right side, and flexor on the left. Sensory examination revealed loss of touch and pain sensation in the L5 and S1 distributions in his right leg: vibration and position sensations were also diminished in his right foot. He had overflow urinary incontinence with loss of bladder sensation. Marked nuchal stiffness was noted, however, no Kernig's sign or eye ball tenderness was present. Pertinent laboratory findings were as allows; WBC 8,100/microliters, Ht 42.5%, platelet 326,000/microliters, TP 6.8 g/dl, BUN 16 mg/dl, creatinine 0.54 mg/dl, glucose 95 mg/dl, Na 136 mEq/l, K 4.4 mEq/l, Cl 100 mEq/l; liver profile was normal; CEA 436.6 ng/ml, CA19-93 U/ml; urinalysis was normal.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[A 74-year-old man with urinary incontinence, right leg weakness and multiple cranial nerve palsies]. 766 22

In 98 out-patients who visited our pain clinic, we evaluated their psychological status before the first examination and one month after the treatment, using self-rating depression scale (SDS) and state-trate anxiety inventory (STAI). SDS, state anxiety, and trate anxiety scores were significantly higher in the patients with pain (trigeminal neuralgia, neck-shoulder-arm pain syndrome, lumbago and psychological pain, n = 55) compared with the patients without pain (sudden deafness and facial nerve palsy, n = 43) (P < 0.01, 0.05, 0.01). Of the patients with pain, patients with psychogenic pain showed the highest score in every test. The scores of SDS and state anxiety became significantly lower one month after the treatments compared with ones before the first examination (P < 0.01). It was considered that the decline in every score was due to the treatments in our pain clinic. In patients whose score of trate anxiety before the first examination was more than 50 points, the SDS and state anxiety showed high scores even one month after the treatments. This finding suggests that these patients need psychosomatic managements.
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PMID:[Psychological evaluation of out-patients in our pain clinic using self-rating depression scale and state-trate anxiety inventory questionnaire]. 774 89

The association of the severity of temporomandibular arthropathy to ear, nose, and throat symptoms in patients with temporomandibular disorders has been poorly investigated in spite of its importance in clinical practice. The aim of this study was to see whether persons with more severe arthropathy have more ear, nose, and throat symptoms. Anamnestic and clinical evaluations were obtained at admission for 815 subjects with signs and symptoms of temporomandibular disorders of arthrogenic origin in physical tests. The severity of arthropathy was evaluated by a clinical index scoring joint sounds, tenderness to temporomandibular palpation, and pain severity in the temporomandibular joint region. Univariate analysis showed that the severity of arthropathy was significantly associated with ear, nose, and throat symptoms as a whole (P < .001) and specifically with deafness (P < .001) and dizziness (P < .05); however, tinnitus and earache were not statistically significantly associated. Multiple analysis showed deafness to be the only ear, nose, and throat variable independently associated with severity of arthropathy (P < .01). These findings lead to the conclusion that there is a considerable association between temporomandibular disorders of arthrogenic origin and ear, nose, and throat symptoms, especially deafness. They also suggest that further investigations should be done to compare the specific roles of craniocervical arthritis versus temporomandibular disorders in the etiology of ear, nose, and throat symptoms related to craniomandibular and craniocervical joint involvement.
J Orofac Pain 1994
PMID:Ear, nose, and throat symptoms in patients with TMD: the association of symptoms according to severity of arthropathy. 781 27

According to the authors' clinical experience, malocclusion accompanied by temporomandibular joint disorder involves mainly cross bite, open bite, deep overbite or axillary protrusion. However, it is possible that the symptoms of this disorder are associated with other types of malocclusion or even with nearly normal occlusion. In fact, it can be said that temporomandibular joint disorder may develop with any type of occlusion. This paper reports a case of open bite accompanied by temporomandibular joint disorder occurring in a patient who visited our hospital because of pain in the left temporomandibular joint region, vertigo and partial deafness. In this patient, the temporomandibular symptoms disappeared after orthodontic treatment. The patient received no particular treatment thereafter because follow-up observation confirmed that the therapeutic results were favorable without any relapse of the symptoms of temporomandibular disorder. The positions of the temporomandibular joint and mandibular condyle were determined in lateral-oblique radiograms obtained using our radiographic system, by which the mandibular condyle is radiographed using a projection consistent with its long axis.
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PMID:A case of open bite accompanied by temporomandibular joint disorder. A comparison of occlusal conditions before and after treatment in lateral-oblique radiogram. 798 64

A 56-year-old woman of short stature (148 cm) was medically examined after applying for a disability pension on account of chronic back-pain. She gave a history of primary amenorrhoea (not examined further), slowly increasing deafness, type IIb diabetes mellitus, hyperlipoproteinaemia, hypothyroidism and osteoporosis. Physical examination showed hypoplasia of both breasts, shield chest and slight webbing of the neck. Ultrasonography of the thyroid revealed late stage of Hashimoto thyroiditis. Vaginal ultrasonography confirmed absence of uterus and adnexae. All these findings were compatible with the diagnosis of Turner's syndrome, which was confirmed by chromosomal examination of 50 analysable metaphases showing chromosomal mosaic 45,X/46,X, i(Xq), as well as two cells with 47 chromosomes, two with isochromosomes for the long arm of the X-chromosome. Treatment consisted of administration of L-thyroxin (75 micrograms/d) and oestrogen. There was no follow-up.
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PMID:[Diagnosis of an Ullrich-Turner syndrome in pension evaluation]. 807 Mar 32

We report a 24-year-old man who presented unilateral multiple cranial nerve involvements followed by progressive paraplegia. The patient expired after developing DIC and pneumonia. Post-mortem examination revealed Ewing's sarcoma originated in the pubic bone with extensive metastases including the clivus which was responsible for his cranial nerve lesions. The patient was well until 24 years of age when he noted an onset of pain and a mass in the pubic region. The histology of the biopsy specimen of the tumor suggested Ewing's sarcoma. He was treated with chemotherapy and local radiation. A year after, he noted an onset of nuchal pain, difficulty in tongue movement, dysarthria, deafness in the left ear, and diplopia. On admission to our hospital in July 1990, neurological examination revealed an alert and intelligent Japanese male in no acute distress. The olfactory to the trigeminal nerves appeared intact. He showed complete abducens nerve palsy, facial weakness, mild deafness, and weakness of the soft palate, the sternocleidomastoid muscle and the tongue, all on the left side. The remainder of the neurological examination was unremarkable except for dysesthesia along the left C8 and Th1 dermatoms. Radiological examination revealed a 10 x 10 cm sclerotic mass in the public bone and a high signal mass lesion between the clivus and the pons in the T2-weighted MRI. His clinical course was complicated by acute paraplegia with anesthesia below the Th4 dermatom, DIC, and respiratory distress due to plural effusion. Post-mortem examination revealed a necrotic and hemorrhagic tumor in the pubic bone. The histology was consistent with Ewing's sarcoma.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A 24-year-old man presenting Garcin syndrome and paraplegia]. 847 71


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