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

Spondyloarthritis (Sp) is newly defined as arthritis that is clinically, pathologically, and genetically related to and predisposed to ankylosing spondylitis (AS) and Reiter's syndrome (RS) rather than to rheumatoid arthritis (RA). A diagnosis of Sp does not necessarily imply arthritis of the spine and does not depend on the demonstration of roentgenographic sacroiliitis that, in this conceptualization, is recognized not as the essential hallmark, but rather merely as a diagnostic "way station" on a continuum of disease, which may (but need not necessarily) begin with RS or be complicated during its course by AS or RS. Spondyloarthritis is distinctively characterized morphologically and clinically by disproportionate inflammation at the entheses, the sites of attachment of tendons and ligaments to bone. Family history or presence of enthesopathic pain, psoriasis, inflammatory bowel disease, uveitis, recurrent urethritis, prostatitis or cervicitis, keratoderma blennorrhagicum, HLA-B27, and asymmetric pauciarticular lower lower extremity arthritis without rheumatoid factor or rheumatoid nodules suggests a diagnosis of Sp rather than RA.
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PMID:Spondyloarthritis and enthesopathy. Current concepts in rheumatology. 621 89

Over the past several years, clinicians have become aware of the importance of maintaining a positive nitrogen balance in hospitalized patients. This has led to the widespread use of total parenteral nutrition (TPN). However, with increased experience with this form of nutrition, numerous potential complications have been uncovered. One of the complications demonstrated with increased frequency is that of abnormal liver function, manifested by elevated serum liver enzymes. This report describes a 44-year-old woman with rectal abscesses and possible inflammatory bowel disease who developed severe right upper quadrant pain, abnormally elevated liver enzymes, and elevated body temperature during her course of TPN therapy. These problems possibly were related to the TPN regimen. Once TPN therapy was discontinued, the patient's liver enzyme values and elevated body temperature began to return to baseline. She subsequently was discharged from the hospital. A follow-up visit to the physician's office revealed that all liver enzyme values had returned to normal, the pain had resolved, and she was recovering well.
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PMID:Acalculous cholecystitis and fever related to total parenteral nutrition. 643 83

Symptoms of 50 patients with the irritable bowel syndrome were compared with those of 49 with endoscopically proven peptic ulcer disease and 49 with radiologically or endoscopically proven inflammatory bowel disease using a questionnaire which was administered after the diagnosis was made. Symptoms of bowel dysfunction including pain related to bowel movements were more likely to occur in the irritable bowel syndrome than peptic ulcer disease. Only abdominal distension, straining at stool and scybala, however, were significantly more likely in the irritable bowel syndrome than inflammatory bowel disease. Four symptoms previously shown to be more common in irritable bowel syndrome than in organic abdominal disease were combined. The more of these symptoms that were present, the more likely were the patients to have the irritable bowel syndrome than peptic ulcer disease. Symptoms of gut dysfunction are highly discriminating between irritable bowel syndrome and peptic ulcer disease but less so between irritable bowel syndrome and inflammatory bowel disease.
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PMID:Gastrointestinal symptoms in the irritable bowel compared with peptic ulcer and inflammatory bowel disease. 647 83

Sixty-two patients less than 40 years of age were admitted with adenocarcinoma of the colon and rectum between 1967 and 1981 at the Methodist Hospitals of Memphis. These represented 3.2 per cent of a total of 1909 patients with the disease during the same time period. Eighty-one per cent presented less than 6 months after onset of symptoms; pain and bleeding being the most common complaints. Inflammatory bowel diseases and polyposis were uncommon. Fifty-eight per cent of the lesions were within reach of the sigmoidoscope. Localized disease was present in 37.9 per cent, with one-third presenting with distant metastases. Sixty-five per cent were considered curable at initial laparotomy. Only 2 per cent of the lesions were well differentiated, and mucin production was noted in 32.3 per cent of the specimens compared to 8.6 per cent in the total group. Vascular invasion was noted in 24 per cent and perineural invasion in 11 per cent. Five-year survival was only 17.6 per cent, although this increased to 33 per cent in those undergoing curative resection. Survival in the total group of 1909 patients was 35.5 per cent at 5 years. The poorer survival in the young patients does not seem to be on the basis of delay in diagnosis, premalignant states, or distribution of lesions, but rather it reflects an inherently more virulent lesion. This impression is supported by a greater incidence of mucinous tumors (a poor prognostic indicator) and higher incidence of advanced disease, especially in the second and third decades.
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PMID:Adenocarcinoma of the colon and rectum in patients less than 40 years of age. 669 26

A 17-year-old woman presented with orbital pain, diplopia, ptosis, and upper lid swelling due to an orbital pseudotumor involving the superior rectus-levator complex. Although she had no prior symptoms of chronic inflammatory bowel disease, diagnostic evaluation revealed Crohn's colitis. Diagnostic evaluation of patients with "idiopathic" orbital pseudotumor should include testing to rule out chronic inflammatory bowel disease.
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PMID:Orbital pseudotumor in Crohn's colitis. 671 71

One hundred forty-eight patients with gastrointestinal disease, 50 patients with the irritable bowel syndrome (IBS) and 49 each with peptic ulcer and inflammatory bowel disease, were interviewed to determine if they had proctalgia fugax (PF) and if the symptom was associated with the IBS. One-third of the patients had PF. It occurred in 51% of females and 12% of males (p less than 0.001). When corrected for sex, PF was no more prevalent in IBS than in peptic ulcer or inflammatory bowel disease. Only two of six previously described IBS symptoms were more prevalent in the PF patients. Attacks occurred in the day in 94%, and one-third of sufferers related them to defecation. The pain was localized in the anus in 90%, occurred less than five times a year in 51%, and lasted less than 1 min in 57%. In most, activity was not interrupted by this pain and only 20% had ever reported it to a physician. PF is very common among patients with abdominal symptoms, but is not related to the IBS. Since it is infrequent, benign, and transient, PF is usually not mentioned to the physician.
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PMID:Proctalgia fugax in patients with the irritable bowel, peptic ulcer, or inflammatory bowel disease. 673 18

A prospective study was undertaken in 100 patients with diarrhoea to identify the causes and to better define the prevalence of the irritable bowel syndrome (IBS) and to determine if there was a diagnostic symptom complex evident in patients with IBS. A diagnosis of IBS was made in 28 patients and in this group the prevalence of lactase deficiency was found to be 40%. Pain in association with urgency was usual and urgency occurring in the absence of pain was more likely to be found in association with an organic colonic lesion. The two most important symptoms which distinguish IBS from other causes were blood in the motions and weight loss. Giardia lamblia were found in nine patients and 15 patients responded to an empirical course of either metronidazole or tinidazole, without a positive diagnosis of giardiasis being made. Fourteen patients had inflammatory bowel disease and a variety of drugs were responsible for diarrhoea in 10% of patients. Sigmoidoscopy and small bowel biopsy were the most valuable diagnostic investigations.
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PMID:A prospective study of persistent diarrhoea. 695 35

Colorectal disorders were analysed from a radiology practice, where specific data were indexed at the time of each examination. Among 1118 consecutive adults examined by air contrast barium enema, 49 were found to have colorectal cancer, 49 polyps, 35 inflammatory bowel disease and 395 diverticular disease. The 267 patients under the age of 40 showed no carcinoma, two with polyps, 18 with inflammatory bowel disease and 16 with one or more diverticula. Carcinoma, polyp, and inflammatory bowel disease were detected no more frequently in patients with diverticular disease than without. Complicated diverticular disease was rare. An analysis of specific symptoms with uncomplicated diverticular disease showed patterns of bowel habit, pain or bleeding, no different from patients with negative barium enemas. Of the 44 colon carcinomas, 28 were located in the sigmoid; bleeding was the major presenting symptom in 11, while two others were anaemic. The importance of sigmoidoscopy in assessing abdominal symptoms and rectal bleeding is stressed, along with the need for radiology in patients over, rather than under, 40 years of age.
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PMID:Large bowel diseases in New Zealand based on 1118 air contrast enemas. 695 79

The case of a 14-year-old girl with painful periostitis and ulcerative colitis is reported. The association of chronic inflammatory bowel disease with osteoarthropathy is rare and has previously been reported in eight patients. The periosteal reaction found in association with inflammatory bowel disease is apparently related to a chronic disease course and may cause extreme localized pain.
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PMID:Hypertrophic osteoarthropathy of chronic inflammatory bowel disease. 716 19

The clinical presentation, treatment, and results of 405 patients with mechanical small intestinal obstruction admitted to the Montefiore Hospital and North Central Bronx Hospitals were reviewed. The etiology of obstruction was adhesions 74%, malignancy 8.6%, hernia 8.1%, inflammatory bowel disease 5.2%, and miscellaneous causes 4.1%. The overall mortality rate for the series was 6.7%, and the incidence of bowel strangulation was 10.1%. Strangulation occurred in 33.3% of the hernia group, 9.0% of the adhesions group, and 2.8% of the malignancy group. The largest single cause of death was related to malignant disease--12 cases (44.4%). Six deaths (22.2%) were caused by bowel strangulation. Of the patients who received more than 24 hours of nonoperative therapy, 46% had relief of obstruction. There was no statistically significant difference in successful results between patients managed with long tubes compared to patients managed with nasogastric tubes. Conservative therapy for malignant obstruction was not successful in 85% of cases. The presence of bowel strangulation shows a positive correlation with age (greater than 70 years), feculant vomiting, peristaltic sounds, and a white blood cell count higher than 18,000/mm3. It shows no correlation with onset, localization or type of pain, duration of symptoms, temperature, tachycardia, or x-ray findings. The results of the study indicate that accurate criteria for small bowel obstruction therapy have not been clearly defined except in patients with incarcerated hernias. Nonoperative management is successful in a significnt percentage of patients.
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PMID:Small bowel obstruction: the role of nonoperative treatment in simple intestinal obstruction and predictive criteria for strangulation obstruction. 720 87


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