Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A study of 55 patients with heart disease suspected of being viral in origin was carried out a Medical College Hospital, Nagpur, over a period of 2 years. Virus studies as well as other routine tests were carried out on all patients. In 19 patients a virus aetiology of the heart disease was proved by isolation of one of the subtypes of Coxsackie B virus and/or on the basis of fourfold rise in neutralizing antibody titre in paired sera. Of these patients, 5 had acute myocarditis and 5 had acute myopericarditis; 3 had acute pericarditis; 3 had congestive cardiac failure of obscure aetiology; 2 had pleuropericarditis, and the remaining 1 developed post-partum heart failure with cardiogenic shock. All had electrocardiographic abnormalities. Thirteen had cardiomegaly; 1 had a right-sided pleural effusion and 2 had pericardial effusion. Virus could not be isolated from pericardial fluid or pleural fluid in these 3 patients. Follow-up studies up to 10 weeks from discharge revealed that 8 patients were clinically normal but 4 of these 8 had persisting ST-T wave changes, and in 4 the electrocardiogram had returned to normal. Of the remaining 11 patients, 3 had persistent chronic heart failure, 3 had vague symptoms of praecordial pain but no abnormal signs, and 5 patients were lost to follow-up.
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PMID:Heart disease caused by Coxsackie virus B infection. 12 98

Two hundred consecutive catheterized patients with unstable angina pectoris were reviewed to find clinical and noninvasive indicators of left main coronary artery disease (greater than or equal to 50% lesion). Thirty-five patients (17.5% of total) had left main coronary artery disease. There were no differences between patients with and without left main coronary artery disease in age, sex, results of resting electrocardiogram, congestive heart failure, dyspnea during pain, duration of longest pain, arrhythmias, response to medical therapy, or other risk factors. Crescendo angina pectoris (worsening of pre-existing angina), transient ST-segment depression with pain, simultaneous anterior and inferior ST changes during pain, and fluoroscopic calcification of the left main coronary artery were all significantly more common in patients with left main coronary artery disease. However, low sensitivity or low predictive value, or both, limit the usefulness of these clinical predictors. Left main coronary artery disease cannot be reliably predicted in patients with unstable angina pectoris before coronary arteriography.
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PMID:Clinical indicators of left main coronary artery disease in unstable angina. 15 94

The relationships between aortic stenosis, coronary artery disease, angina pectoris, and myocardial infarction were examined in 173 patients with isolated calcific aortic stenosis who had coronary arteriography as well as cardiac catheterization. All were over age 40 and had definite cardiac symptoms; 156 later had aortic valve replacement. Coronary lesions narrowing the lumen by 50% or more were present in 37% of patients aged 40 to 59 and 68% of those aged 60 to 82. Coronary disease was present in 64% of patients with angina pectoris and 33% of those without angina. Angina which occurred only in association with dyspnea on exertion was associated with coronary disease in 45% of instances, whereas angina which also occurred on exertion without any dyspnea or which occurred with emotional stress, after meals, during sleep, or at rest unprovoked was associated with coronary disease in 80% of instances. Patients with coronary disease without any chest pain or with atypical pain considered nonanginal were men, usually over age 60, with congestive heart failure as the predominant symptom. Electrocardiograms showing transmural inferior or anterolateral infarction nearly always indicated coronary disease, while QS patterns in Leads V1-2 occurred frequently with normal coronary arteries. Serum cholesterol was elevated in 23% of those with coronary disease and 8% of those without. A group of patients with moderate aortic stenosis could be identified, with aortic valve areas of 0.55 to 0.80 cm. per square meter, in whom coronary disease was the sole or chief cause of symptoms. The operative mortality rate with aortic valve replacement was 9.6% in those with coronary disease and 1.4% in those without significant coronary disease. Coronary disease is frequently present in patients with calcific aortic stenosis, particularly in those over 60, those with angina, and those with symptoms despite only moderate aortic stenosis. The type of anginal syndrome, the ECG evidence of transmural infarction, and the coronary risk factors provide additional clues for clinical diagnosis.
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PMID:Aortic stenosis, angina pectoris, and coronary artery disease. 30 Feb 16

Patients with single-vessel disease, with normal or mildly abnormal ventricular function (EF greater than 40%), have a good prognosis both for natural survival and long-range symptomatic improvement; therefore medical therapy is strongly recommended. Surgery is considered only if symptoms persist after aggressive medical therapy. It is possible that single-vessel left anterior descending disease is a special variant of this group, and surgery may, with further reports, show an increased survival. However, no adequately designed study has yet suggested this, and it is currently our opinion that patients with single-vessel disease do not have an improved survival following surgery. It is not clear whether surgery improves survival in patients with multivessel disease and normal or mildly abnormal ventricular function (EF greater than 40%). Consequently, cardiologists are divided as to whether to advise surgery in these patients solely for survival. Currently, it is our opinion that these patients should have surgery only for improvement of symptoms after failure of medical therapy. In left main coronary disease the evidence favoring improved survival after surgery has convinced most cardiologists, including ourselves, to recommend surgery. Patients with poor ventricular function (EF less than 30%) secondary to coronary artery disease often have congestive heart failure and not angina as their chief symptom. Surgery is usually not advisable for these patients, because of the increased operative mortality and lack of improvement in ventricular function. Patients with poor ventricular function with angina are not usually significantly improved by surgery. In patients with moderately abnormal ventricular function (EF = 30-40%), relief of angina is frequently obtained, but with some added surgical risk. We recommend surgery in these patients after aggressive medical therapy has failed. Patients with unstable angina are initially medically stabilized, after which they are generally managed as stable angina. Patients with persistence of pain at rest in spite of vigorous medical therapy are usually managed by early catheterization and surgery.
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PMID:Critique of coronary artery bypass surgery. 32 63

Patients requiring a major amputation for ischemia are frequently gravely ill. Physiologic amputation obtained by freezing the leg, usually with a tourniquet, will permit delay and intensive preoperative therapy. In an efficient, safe, and convenient method which we have developed and used in 46 patients, a pump circulates antifreeze solution through a specially constructed boot. The last 32 patients so treated have been analyzed as to indications and results. Advantages obtained control of sepsis, correction of diabetic coma, dialysis for chronic renal failure, improvement in congestive heart failure, and improvement in pulmonary function. Four patients had successful below-knee amputations after control of infection that had previously seemed to dictate above-knee amputation. The control of pain and odor, the resultant appreciation of the family, and the lessened demand on nursing staff offer worthwhile benefits in many of the patients, even in some in whom advanced systemic disease prevented survival.
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PMID:Freezing an extremity in preparation for amputation. 68 74

The hemodynamic response to nitroglycerin administration, to sublingual or oral administration of isosorbide dinitrate, or to a placebo was evaluated and compared in 37 patients with unstable angina pectoris under resting, pain-free conditions. Patients with congestive heart failure were not included in this study. Serial measurements of mean arterial blood pressure (MAP), pulmonary arterial end-diastolic pressure (PAEDP), cardiac index (CI), and heart rate (HR) were obtained for one hour following nitroglycerin administration and for four hours following sublingual or oral administration of isosorbide dinitrate. Echocardiographic end-diastolic volume (EDV) measurements were obtained for the groups receiving isosorbide dinitrate or placebo. There was a significant (P less than 0.05 or less than 0.1) reduction of the MAP (5 to 10 mm Hg) that persisted for more than four hours following both sublingual and oral administration of isosorbide dinitrate. The changes in the PAEDP, HR, and CI following sublingual or oral administration of isosorbide dinitrate were small and not significant. In the group receiving isosorbide dinitrate sublingually, the EDV was reduced by more than 30 ml below the placebo group (P less than 0.1) for up to four hours. The effects of nitroglycerin administration were similar in magnitude but of much shorter duration (three to four hours for sublingual and oral administration of isosorbide dinitrate vs 15 to 30 minutes for nitroglycerin). These data demonstrate that the duration of the hemodynamic effects of sublingually and orally administered isosorbide dinitrate in patients with unstable angina pectoris and normal resting hemodynamics is 8 to 12 times longer than that of nitroglycerin.
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PMID:Hemodynamic effects of isosorbide dinitrate vs nitroglycerin in patients with unstable angina. 81 27

The conditions associated with prolapse of the posterior leaflet of the mitral valve are multiple. The mechanisms of mitral valve prolapse as well as the pathogenesis of pain and ectopic impulse formation are reviewed. Propranolol appears to be the drug of choice for the symptomatic treatment of patients with this syndrome since it decreases myocardial oxygen demand and wall tension thus reducing or abolishing the discrepancy between myocardial oxygen demand and supply within the mitral apparatus. It has also been reported to modify the auscultatory findings associated with this condition. The frequency of this mitral valve abnormality in patients with obstructive coronary artery disease is reviewed. It appears that prolapse of the posterior leaflet scallops in patients with significant obstructive coronary artery disease represents an intermediate stage before mitral insufficiency occurs. This group of patients with papillary muscle dysfunction includes those with prolapsed leaflets without mitral insufficiency, those with systolic murmurs and compensated heart failure and others with progressive cardiac decompensation and severe mitral regurgitation.
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PMID:Mitral valve prolapse. Recent concepts and observations. 93 60

Prior to undergoing diagnostic coronary angiography, 94 men responded to tests for the coronary-prone behavior pattern, anxiety, depression, and neuroticism. Independently, cardiologists rated cineangiograms by the percent of atheromatous luminal obstruction in four major coronary arteries. The patients with greater atheromatous obstruction scored significantly higher than those with lesser disease on all four scales of the test for the type A coronary-prone behavior pattern. Those with more seriously diseased vessels also scored significantly higher on anxiety and depression scales but significantly lower on a denial scale. Men rated as having more frequent and intense angina pain scored significantly higher on hypochondriasis, depression, and admission of symptoms than men less subject to ischemic pain. Multivariate statistical analyses revealed that the findings regarding extent of atherosclerosis are independent of anginal pain or congestive heart failure.
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PMID:Psychological correlates of coronary angiographic findings. 98 97

Forty patients with acute myocardial infarction and pericarditis (AMI-P) were encountered over a three-year period. The incidence of AMI-P was 7.2 percent (40 of 554 patients). Fifty consecutive patients with acute transmural infarction without pericarditis (AMI-C) were used as a control group. There were no significant differences between the AMI-P and AMI-C groups regarding age, sex, infarct location, hospital stay or mortality. Painful symptoms of pericarditis were experienced by 37 patients (92 percent), all of whom had developed symptoms by the fourth hospital day. The pericardial friction rub lasted three days or less in 34 patients (85 percent), but an occasional rub could be heard for up to eight days. Twenty patients with AMI-P (50 percent) developed pleural effusions and/or parenchymal pulmonary infliltrates. Twenty-eight AMI-P patients (70 percent) were thought to have had congestive heart failure (CHF) on the basis of their symptoms and physical findings. Radiographic examination could confirm only 13 cases of CHF among the 28 patients in whom the diagnosis was made clinically. Glucocorticoids were given parenterally to 31 of the 37 patients (84 percent) who had symptomatic pericarditis and was felt to be effective in ameliorating painful symptoms. Followup data was obtained on 28 of the 32 surviving patients. Five patients (15 percent) had seven episodes of the postmyocardial infarction syndrome (PMIS). Pericarditis is generally a shortlived complication of acute myocardial infarction. Pleural and parenchymal pulmonary abnormalities are common and probably account for the tendency to "overdiagnose" CHF in patients with AMI-P. PMIS appears to occur more frequently in patients who have had pericarditis at the time of the acute myocardial infarction.
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PMID:Pericarditis of acute myocardial infarction. 112 19

12 patients (8 males and 4 females) operated on for intramedullary hemangioblastomas, using microsurgical techniques are presented. Special consideration is given to the clinical and pathological aspects. The results of surgery are discussed. The family history is positive in 4 cases. Clinical aspect : a) the initial symptoms is usually pain (9 patients) motor deficits were present in 2 cases. Only 1 patient presented visual disturbances at the beginning of the disease. b) the interval of time between the first symptom and the fully developped clinical picture is shorter than 1 year in 4 patients and longer (up to 18 years) in 8 patients. c) the full clinical picture consists of motor deficit, sensory disturbances (especially dorsal columns), cerebellar signs, raised intracranial pressure, sphincter disturbances, retinal angiomas, arterial hypertension and psychoorganic syndrome in decreasing order of frequence. Pathological findings at opsurgery : There are. a) 3 cases of hemangioblastomas at the bulbo-cervical junction b) 5 cases of cerebello-medullary hemangoblastomas. c) 4 cases of medullary hemangioblastomas. 1 patient had renal and pancreatic cysts. 2 patients had pheochromocytomas with arterial hypertension. Operative technique. Microsurgical techniques, bipolar coagulation, and continuous irrigation of the operative field are of primordial importance. The tumor must be approached from the periphery and never from the center. One should coagulate the afferent vessels first and the efferent vessels only at the end. Results of surgery. In 1 case, only a partial removal was possible and the patient did not improve. A complete removal was possible in 11 patients with the following results : -- 4 patients are in excellent condition and have a normal socio-professional life. -- 5 patients improved and are independant. The are able to perform partial time-work. -- 1 patient, with bulbar extension of the tumor improved from the motor point of view, but he presents a permanent. deficit of the IX, X, XI cranial nerves. He has a permanent tracheal canula. -- 1 patient improved following surgery, but he died 12 months later (stress ulcer and cardiac decompensation). The autopsy revealed a recurrence of the cerebellar tumor.
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PMID:[Microsurgical experiments in 12 cases of intramedullary hemangioblastomas]. 124 11


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