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

We performed a computerized search on sulfadiazine-associated nephrotoxicity reported in human immunodefiency virus (HIV)-infected patients in the international literature. Including an original case report, we summarized 35 acquired immunodefiency syndrome (AIDS) patients from 1987 to 1995 in an analysis comparing their features to historical HIV-negative controls from the 1940s and 1950s. Likely due to a high prevalence of potential risk factors, incidence of sulfadiazine-associated renal impairment was 1.9%-7.5% in AIDS patients and 1%-4% in HIV-negative controls. Its occurrence appeared to be delayed in HIV-infected patients with a median of about 3 weeks of medication compared with about 10 days in HIV-negative subjects. Correspondingly, the cumulative sulfadiazine dose at manifestation doubled in AIDS patients with a median of 84 g versus 40 g in controls. Patients usually presented with flank or lumbar pain, oliguria, and (macro) hematuria. Urinalysis showed typical "sheaves of wheat" crystalluria, erythrozyturia, and, less commonly, leukozyturia and proteinuria. Echogenic (mostly peripelvic) densities, renal stones, and hydronephrosis are frequent findings on ultrasound examination, whereas X-ray examination possesses a low diagnostic sensitivity. The principle aim of therapy in these patients is to (re)institute the physicochemical urinary solubility of sulfadiazine and its metabolites. For this purpose, forced rehydration and, most importantly, urine alkalinization proved to be effective measures without an absolute need to withhold the drug. Provided prophylactic and therapeutic recommendations are complied with, outcome of this drug-related side effect is usually excellent, and rare relapses will similarly respond well.
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PMID:Sulfadiazine-associated nephrotoxicity in patients with the acquired immunodeficiency syndrome. 869 59

A 69-year-old female with a fourty-year history of rheumatoid arthritis visited Kobe University hospital with complaints of subcutaneous soft tumor on both hands and arthritic pain of both knees. She has been given 10 mg of predonisolone for several years and had a history of hydronephrosis. Her radiographs revealed periarticular calcification in the hands, shoulder joints and posterior thoracic wall. She had high titer of rheumatoid factor and both erythrocyte sedimentation rate (79 mm/hr) and C-reactive protein (12.79 mg/ml) were elevated. The examination of her serum showed the following values: Ca 7.9 mg/dl, P 5.0 mg/dl, 25 (OH) D3 < 3.6 pg/ml, 1 alpha-. 25 (OH)2 Vit D3 < 6.1 pg/ml, osmolality 974 mOsm/kg, BUN 61 mg/dl, creatinine 1.9 mg/ml, creatinine clearance less than 20 ml/min, indicating chronic renal failure. Intact PTH level was normal, although plasma parathyroid hormone-C (PTH-C) level increased. Together with these findings, it is suggested that metabolic disorders associated with chronic renal failure and tissue damages due to the severe rheumatoid arthritis led to the formation of diffuse soft tissue calcification.
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PMID:[A case report of systemic calcinosis associated with rheumatoid arthritis]. 877 93

Parapyelic cysts are not uncommon. There is usually no clinical expression of these cysts although development within the sinus can cause obstruction leading to acute nephretic colic. We observed two cases of intrasinus parapyelic cysts and another case of obstructive intrapyelic cyst. At ultrasonography, the only sign was hydronephrosis and a junction syndrome could not be eliminated. Intravenous pyelography demonstrated hydronephrosis and in one case a round intrapyelic mass. Computed tomography was required for diagnosis. Surgical exeresis was required due to the pain and compression damage to the parenchyma. This is a rare indication for surgical treatment of simple cysts of the kidney.
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PMID:[Acute pyelo-ureteral obstruction by an intrasinusal intra- and para-pyelic cyst. Apropos of 3 cases]. 879 79

The purpose of the study was to evaluate pyeloplasty a.m. Anderson-Hynes in the treatment of hydronephrosis in a large series of patients. In 175 patients, consecutively operated for ureteropelvic junction obstruction, we found 24 (14%) with minor postoperative complications, mostly urinary tract infection. Six patients (3%) were reoperated because of continued pain and obstructed drainage postoperatively. There was a small, but statistically significant increase in renal functional share on the operated side. We found a highly significant correlation between postoperative changes in total GFR and single kidney GFR on the operated side, which suggests a real improvement in renal function, rather than a simple reallocation of function between the two kidneys. We conclude that newer treatment modalities known as "minimally invasive surgery" must give comparably good results in order to be an acceptable alternative to traditional dismembered pyeloplasty.
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PMID:[Anderson-Hynes pyeloplasty in hydronephrosis]. 898 55

In this study, the diagnostic yield of ultrasonography (US) in the early phase of acute urinary obstruction was retrospectively assessed and compared with that of clinical examination. 351 patients were admitted to our emergency department because of suspected renal colic over an 11 months' period: urinary obstruction was subsequently confirmed with other examinations in 76 of them, who were all submitted to renal US within 2 hours of the onset of symptoms. Emergency US results were then retrospectively compared with clinical and laboratory data and the cost of each US exam was calculated. Thirty-nine of 76 patients had negative US findings (51.3%). In the extant 37 patients, US showed hydronephrosis (which was mild in 13 patients and moderate in 6) and renal stones (in 18 patients). Hydronephrosis was associated with renal stones or increased parenchymal echogenicity in 5 and 6 patients, respectively. Pain, which was always severe, was not a useful sign for diagnostic purposes. In contrast, all the 37 patients with abnormal US findings (hydronephrosis, renal stones and increased parenchymal echogenicity) exhibited specific clinical and laboratory abnormalities such as hematuria, ketonuria and marked blood pressure increase (diastolic pressure > 100 mmHg). The same abnormalities, although less severe (mild hematuria and ketonuria and increased diastolic pressure not exceeding 100 mmHg) were nevertheless present in all the 39 patients with negative US findings and yet having a renal colic. The cost of each emergency US exam (calculated on the basis of literature tables and reference cost) was approximately It. L. 104,000. The corresponding total cost for submitting to US all the 76 patients with renal colic was approximately It. L. 7,900,000. In the early phase of urinary obstruction, the association of hematuria, ketonuria and increased blood pressure was more reliable than US findings-the latter method yielding a 51.3% false-negative rate. The presence and severity of the above clinical and laboratory abnormalities might thus represent a criterion to select the patients who are less likely to have positive US findings. This should allow the cost of medical and non-medical staff, equipment and materials to be reduced. As for our personal series, It. L. 28,000,000 was the estimated additional cost of performing US routinely in all the remaining (275) patients with suspected renal colic.
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PMID:[Early and systematic use of ultrasonography in emergency patients with renal colic: analysis of the actual diagnostic efficacy]. 904 44

Acute myocardial infarction after the use of intravenous radiographic contrast medium (RCM) is rare. There is only one reported case in the literature; this is the second case. A 65-year-old woman complained of pain in the right costovertebral area, and abdominal ultrasonography showed hydronephrosis. She had insulin-dependent diabetes and hypertension. Intravenous pyelogram, using renographin, was performed. Within 5 minutes, she felt bad and became hypotensive and diaphoretic. Laboratory studies and electrocardiography confirmed the diagnosis of acute myocardial infarction. Generally, elderly and diabetic patients with abnormal renal function are considered to be at high risk for adverse reactions to RCM. Renal function was normal. It has also been reported that high R osmolality RCM such as renographin, is associated with a greater risk of adverse reactions compared with the use of low-osmolar RCM. This case should raise awareness regarding acute myocardial infarction as a complication after the use of intravenous RCM.
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PMID:Acute myocardial infarction after intravenous radiographic contrast medium. 925 15

A clinical study was conducted on the intermittent hydronephrosis in children. Of 78 children with hydronephrosis due to ureteropelvic junction obstruction operated between 1991 and 1995, 5 had intermittent hydronephrosis. All 5 patients were boys between 6 months and 6 years of age. Presenting symptoms were intermittent flank pain and vomiting. Ultrasonography performed during pain attack demonstrated dilation of the renal pelvis in all patients. Diuretic renography demonstrated obstruction in 4 of the 5 children and deterioration of renal function on the affected side in 2. The cause of ureteropelvic junction obstruction was aberrant vessels in 2 cases, fibrous band in 1, ureteral kinking within adventitia in 1 and a ureteral polyp in 1. Postoperatively, all patients have been relieved from the pain. In summary, ultrasonography at the time of symptom attack as well as diuretic renography are useful for the diagnosis and observation of intermittent hydronephrosis.
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PMID:[A clinical study of intermittent hydronephrosis]. 939 4

A 53-yr-old woman presented with a 2-yr history of recurrent episodes of severe abdominal pain and nausea. Multiple investigations by a general surgeon, a urologist, and a gastroenterologist failed to identify the cause. She was referred to our Biliary Service for ERCP and sphincter of Oddi manometry. However, a detailed history was inconsistent with biliary pain, and the patient, having discussed the risks and benefits, elected not to proceed with ERCP. The patient was asked to come to the hospital during an acute attack of her pain for assessment. When this was done, transabdominal ultrasound revealed right hydronephrosis; intravenous urography showed obstruction at the level of the ureteropelvic junction, consistent with the presence of an aberrant artery. The syndrome of episodic abdominal pain and hydronephrosis caused by extrinsic pressure from such an artery is known as Dietl's crisis. In our patient, the diagnosis was confirmed at surgery, when the ureteric obstruction was dealt with by pyeloplasty. She made an uneventful recovery and remains asymptomatic 12 months later. The keys to diagnosing Dietl's crisis are awareness of the entity, taking a detailed pain history, and timely cross-sectional abdominal imaging during an attack.
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PMID:Dietl's crisis: a syndrome of episodic abdominal pain of urologic origin that may present to a gastroenterologist. 939 72

The authors report a retrospective study of 34 cases of blunt renal trauma affecting a pathological kidney out of a total of 156 cases of renal trauma. The patients were between the ages of 3 and 60 years, with a male predominance (sex-ratio: 2.4). The predominant cause of trauma was a household accident, in 15 cases (44%). The clinical features were dominated by haematuria and pain. The underlying renal disease was dominated by renal stones (15 cases, 44%) and ureteropelvic junction (UPJ) abnormality (10 cases, 29%). Twelve patients with benign trauma and minimal underlying renal disease were treated conservatively. Surgery was indicated in the remaining 22 patients, but only 20 were actually operated. Nephrectomy was performed in 9 patients and partial nephrectomy was performed in 3 patients. Treatment consisted of UPJ plasty in 2 cases, uretero-caliceal anastomosis in one case, stone surgery in 4 cases and suture of ruptured renal pelvis in one case. The postoperative course was marked by the development of a urinary fistula in 1 patient, cured by drainage and deterioration of hydronephrosis in one patient. Lastly, one patient died from Wilms' tumour. This disease therefore tends to have a fairly benign course, which nevertheless depends on the underlying renal disease.
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PMID:[Contusions to the pathologic kidney. A retrospective study, apropos of 34 cases]. 948 Jun 28

Eosinophilic cystitis (EC) is a rare form of bladder inflammation characterized by massive eosinophilic infiltration of the bladder wall. The most frequent signs and symptoms are pollakiuria, urgency, macroscopic haematuria and hypogastric pain: the involvement of the ureters may cause hydronephrosis and renal failure. Eosinophilia and eosinophiluria are present in 35% and in 50% of the cases respectively. EC may evolve towards sclerosis up to the anatomoclinical picture of small retracted bladder, which requires to be differentiated from tubercular cystitis, interstitial cystitis and cancer. Imaging techniques are not definitely diagnostic. Diagnosis can be reached only by biopsy with the microscopic demonstration of eosinofilic infiltration of the whole bladder wall in the early and acute stages, while fibrosis with poor cellularity predominates in the chronic stages. Etiology is unknown and the hypothesis of an allergic origin is unproved even though remissions or recoveries induced by steroidal therapy have been reported. Surgical therapy of EC, as in our observation, is absolutely required to correct urgency and incontinence and to prevent renal failure when the urinary upper tract has been primarily or secondarily involved.
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PMID:Augmentation ileocystoplasty in a case of eosinophilic cystitis. 955 6


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