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)

Sixty-one Thai patients with ankylosing spondylitis (AS), diagnosed in accordance with Rome and New York criteria for AS, were studied. The cases includes idiopathic AS (46 cases), Reiter's syndrome AS (8 cases) and psoriatic spondylitis (7 cases). The vast majority of patients were male (Male:Female = 11.2:1), and in over three-fourths the age of onset was between 10 and 39. Low back pain and peripheral arthritis as the initial manifestations were observed in 78.68 and 55.73% of patients respectively. Peripheral arthritis was evident during the course of illness in 72.13% of cases, oligoarticular arthritis being predominant (68.97%). Heel pain, tendonitis and plantar pain were noted in 19.67, 4.92 and 3.28% respectively. Most patients had lumbosacral and thoracic spine involvements, and only 49.18% showed involvement of the cervical spine. Bilateral sacroiliitis was noted in 98.36%. Uveitis was evident in 11.47% while evidence of aortic insufficiency was noted in 3.28%. An association with HLA-B27 was encountered in 91.07% of all cases. In general, the clinical features of AS in Thai patients are similar to those reported elsewhere, but an association with inflammatory bowel disease and Behcet's disease are notably absent.
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PMID:Clinical study of Thai patients with ankylosing spondylitis. 315 30

The clinical features of primary sclerosing cholangitis were studied in 46 consecutive patients. Jaundice was the most common symptom (57%), followed by pruritus (28%), pain (24%), and fever (15%). Thirty-three per cent of the patients had no symptoms, merely laboratory changes. No significant relationship was observed between a numerical score of radiological bile duct changes at diagnosis and the clinical picture, or the clinical course during follow-up. If clinical deterioration occurred, this seemed to happen within the first eight years after the clinical presentation. Patients with only intra-hepatic bile duct changes (n = 10) did not differ clinically from those with extrahepatic changes as well. Forty-three out of 44 patients examined had inflammatory bowel disease, usually ulcerative colitis, with total colitis in 84%. Radiological bile duct changes had a significantly higher score in patients who had to be treated with a combination of sulfasalazine and steroids, suggesting a weak relationship between severity of bowel disease and bile duct disease.
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PMID:Forty-six patients with primary sclerosing cholangitis: radiological bile duct changes in relationship to clinical course and concomitant inflammatory bowel disease. 321 25

A 32 year-old male presented to his general practitioner for a routine health check. Microscopic haematuria was noted in an otherwise asymptomatic and fit patient. Subsequent investigation was normal apart from abnormal liver function tests for which no cause was found. A cholecystectomy was performed for gallstones which were detected by ultrasound after the patient complained of upper right quadrant pain. Wedge biopsy of the liver at operation was suggestive of cholangitis. A barium enema was performed which revealed ulceration of the transverse colon suggestive of Crohn's disease. The association of cholangitis and inflammatory bowel disease is discussed.
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PMID:An unusual presentation of inflammatory bowel disease. 325 41

PSC is an unusual disease of unknown etiology. In fact, sclerosis of the bile ducts may be the result of multiple factors, including autoimmune, bacterial, congenital, drug, or viral agents. The most commonly associated diseases are ulcerative colitis and chronic pancreatitis. Except for the earliest stages of the disease, liver histology is not specific. Most patients present with jaundice, pain, and pruritus, although an increasing number of asymptomatic patients with inflammatory bowel disease and abnormal liver function are being diagnosed. Cholangiography is the key to the diagnosis and is usually pathognomonic except in the unusual case where PSC is confused with cholangiocarcinoma. Multiple forms of medical therapy have been tried, including steroids, azothiaprine, D-penicillamine, colchicine, cholestyramine, and antibiotics. To date, however, none of these medications has altered the course of this disease. In recent years, balloon dilation of biliary strictures has been accomplished via endoscopic and percutaneous transhepatic approaches. However, in patients with PSC these nonoperative manipulations must be done repeatedly, may require multiple general anesthetics, and are difficult to perform. A direct surgical approach to the biliary tree with prolonged transhepatic stenting is indicated in patients with severe hilar or extrahepatic stricturing, persistent jaundice and/or recurrent cholangitis, and no evidence of cirrhosis. Hepatic transplantation should be reserved for patients with PSC who have well-established cirrhosis and in whom other therapeutic options have failed.
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PMID:Sclerosing cholangitis. 331 16

A 16-year-old boy with chronic ulcerative colitis developed unexplained increasingly intractable abdominal pain and rectal bleeding over several months during a period when acute colitic attacks were quiescent. No abdominal mass was palpable. The cause of symptoms was subtotal colonic obstruction due to the development of massive or giant inflammatory (pseudo) polyposis, which had caused nearly complete obliteration of the lumen of the transverse colon. The radiological and histopathological findings are presented; this case confirms the conclusion drawn in a recent retrospective surgical pathology report that giant inflammatory polyposis may produce distinct symptoms, especially pain, independent of the existence of relatively quiescent underlying inflammatory bowel disease. This unusual complication of inflammatory bowel disease deserves greater clinical awareness.
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PMID:Giant inflammatory polyposis causing partial obstruction and pain in "healed" ulcerative colitis in an adolescent. 333 75

Inflammation in ulcerative colitis is concentrated in the mucous membrane. Therefore, increased frequency of perianal and anal lesions is not to be expected and therapy does not differ from that in patients without inflammatory bowel disease. This study concentrates mainly on Crohn's disease and provides an overview on skin disorders, skin tag, fissure in ano, fistulae and abscess, stenosis, incontinence and the management of these conditions. A decision is necessary between four approaches to treatment: 1. Wait and see regarding the natural course. 2. Treatment of intestinal manifestations. 3. Conservative therapy concentrating on the anal lesion. 4. Local or extensive surgery. The indications for surgery should not be aggressive (except for abscesses and fistulae causing pain and discharge). However, excessive complications need not be feared if an experienced surgical team is involved.
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PMID:[Anal and perianal operations in ulcerative colitis and Crohn's disease]. 338 72

Four cases of giant inflammatory polyps were found in a series of 86 consecutive colectomies for inflammatory bowel disease. Two presented a distinctive clinical syndrome of abdominal pain and chronic iron-deficiency anemia due to blood loss. Secondary ulceration of the heads of the polyps accounted for the bleeding and anemia, and the size of the polyps accounted for the abdominal pain. In both cases unusually long portions of colon were involved by the giant polyps. The third and fourth cases had rare complications--reactivation of an enterocutaneous fistula and perforation of an acquired diverticulum. These cases demonstrate that giant inflammatory polyps may produce symptoms independently of the underlying inflammatory bowel disease. In reported cases of giant inflammatory polyps, approximately two-thirds had Crohn's disease and one-third had ulcerative colitis. The transverse colon was the commonest location, pain was the commonest symptom, and the polyps were localized to a short segment of colon in the majority of cases. More than 50% of cases mimicked neoplasm on barium enema. Giant inflammatory polyps may produce a variety of distinctive signs and symptoms and deserve independent recognition.
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PMID:Giant and symptomatic inflammatory polyps of the colon in idiopathic inflammatory bowel disease. 371 97

Every physician managing patients with inflammatory bowel disease should be alert to the possibility of the development of hepatobiliary disorders, especially in patients with extensive colonic involvement. There is the question concerning type of follow-up study to be instituted in patients with IBD. Elevation of the level of serum alkaline phosphatase appears to be the most useful and consistent biochemical indicator of hepatic dysfunction (101). This should be estimated at six monthly intervals. A persistent elevation of the level of serum alkaline phosphatase or more overt clinical manifestations, such as pain in the right upper quadrant, hepatomegaly, obstructive jaundice or weight loss, would all indicate the need for further investigations. This would normally take the form of roentgenologic investigation of the biliary tree and biopsy of the liver. Once a patient with IBD has been diagnosed as having one or more hepatobiliary disorders, what is the appropriate management? Each instance should be treated individually according to the nature of the disorder. In general, most of these conditions are histologic abnormalities and are of little clinical importance. There is the question of whether or not there is a role for prophylactic colectomy. There has been conflicting evidence to both support and refute the rationale that colectomy will prevent the development of, or arrest, existing disease of the liver. In the view of the authors, based upon a large experience with the management of these patients, the indication for colectomy should be based upon the severity and extent of colonic disease and almost never upon the existence of associated hepatobiliary disorders.
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PMID:Hepatobiliary disorders in inflammatory bowel disease. 388 36

Nine patients who had chronic perineal sinuses following proctectomy for inflammatory bowel disease underwent wide excision of the sinus and split-thickness skin grafting. All patients had persistent pain and discharge. All but one had undergone multiple surgical procedures previously. Fibrous tissue was excised from the sinus tract and the wound was grafted either immediately (six patients) or at a later date (three patients). Five patients had complete healing of the wound initially while four required further procedures. Eight patients have been followed up for an average of 4.6 years (range from 5 months to 12 years). Complete healing was achieved in seven patients; all are free of pain and can work or are unrestricted in their daily activities. One patient is improved but still requires analgesia and is disabled by the persistent pelvic pain.
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PMID:Management of chronic perineal sinuses by wide excision and split-thickness skin grafting. 389 66

To better characterize Crohn's disease in the elderly, 24 patients ranging in age from 64 to 85 years were reviewed and compared with a younger group (20 to 61 years of age) matched for sex and duration of disease. Forty-one variables encompassing clinical, laboratory, and radiologic data and medical and surgical aspects of treatment were analyzed. The older group was characterized by a longer delay in diagnosis, more hematochezia, and a higher incidence of diverticular and cardiovascular disease. Elderly patients had less pain, less often a palpable abdominal mass, less small-bowel disease, less drug treatment, and no family history of inflammatory bowel disease. Otherwise, the disease in the two groups had similar manifestations, and no discriminating features to enable easy diagnosis in the elderly were found. Crohn's disease must be considered when evaluating older patients with diarrhea, abdominal pain, weight loss, and bleeding.
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PMID:Crohn's disease in the elderly. A statistical comparison with younger patients matched for sex and duration of disease. 396 58


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