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

Three patients with complete lumbar spondyloptosis and 8 patients with fourth-degree spondylolisthesis suffering from radicular signs and symptoms are reported. There were 8 female and 3 male patients in the study. A high incidence of neurogenic intermittent claudication was noted in this condition. Decompressive laminectomy and foraminectomy were performed on all patients followed by transabdominal console fusion. Length of follow-up varied from 3 to 17 years, with a mean value of 13.5 years, and results are reported. Radicular signs and symptoms had completely subsided in all cases. Nine of 11 patients are free from signs and symptoms and 2 suffer from residual pain, although less severe than before surgery. All 3 males fathered children after surgery, which is in contrast to the opinion that anterior lumbosacrial fusion is followed by infertility in males. Special attention was given to individuality of remodeling of the lumbosacral junction over the course of time. Solid fusion was obtained in 10 of the 11 patients, while the console fusion collapsed because of failure to follow instructions after surgery in 1 patient.
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PMID:The treatment of lumbar spondyloptosis or impending lumbar spondyloptosis accompanied by neurologic deficit and/or neurogenic intermittent claudication. 43 18

The effect of supervised training was studied in 68 patients with intermittent claudication. Maximal walking distance was measured on a treadmill. Eight of the patients had resting pain in the leg when recumbent (group A), 25 had an initial walking distance of less than 500 m (group B), 11 had an initial walking distance of 500--1 000 m (group C), 24 had coronary insufficiency (group D). The study shows that training should be undertaken for at least three months. In some patients with resting pain, training led to relief of pain and surgical treatment was not necessary. Almost all patients without signs of coronary insufficiency increased their walking distance, compared to only 14 of the 24 patients with coronary insufficiency. Walking distance increased significantly in groups B and C and no significant difference was found between patients and proximal or distal arterial stenosis.
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PMID:Effect of physical training on different categories of patients with intermittent claudication. 50 97

These 53 operated patients were divided into 2 groups: 29 had an intermittent claudication as Verbiest first described it soon as 1949, whereas 24 had permanent radicular pain in legs as Epstein emphasized it. We think emulsified Duroliopaque myelography to be the best investigation to make sure the diagnosis and to forecast the operative tactics: we gave up Dimer X myelography which occasioned serious complications in 2 cases and gas myelography which seems to us inadequate to this radicular pathology. Total-Body Scanner is rather an elegant method but a discontinuous one. The radiographic and operative findings have shown the stenosis of the lumbar canal to be congenital in 5 cases, development in 20 cases, degenerative in 27 cases (with 15 pseudo-spondylolisthesis) and tabetic in one case. A disc herniation was found in 25 cases over 53. The extent of the bone resection has been in relation with clinical picture, myelography and mainly operative findings, aiming at a "cut-to-measure costum". In every case the initial laminectomy was made easier by trenching the thickened laminae on each side of the spinal process prior to remove it. Only soft disc hernations were removed; the dura was never opened; no vertebral fusion was performed; for 2 years we have tried to avoid the "laminectomy membrane" by interposing an autogenous fat and aponevrotic graft between the dura and the overlying paraspinal muscles. The operative results are satisfactory with 75% of excellent and good; they are much better in patients with intermittent claudication than in those with permanent radicular pain. It is a question of functional surgery in one case, of pain surgery in the other. The major trick seems to us to be that of the associated disc hernation with the risk of missing the narrow canal.
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PMID:[The narrow lumbar canal: 53 operated cases (author's transl)]. 54 93

Lower extremity pain caused by exercise but relieved by rest is usually a reliable symptom of chronic arterial insufficiency. However, similar discomfort often occurs in patients with neurospinal compression. Furthermore, arterial occlusive disease and demonstrable spinal stenosis may be present simultaneously. Fifty-two patients with symptoms suggesting intermittent claudication comprised the study group. All were proven to have a nonarterial cause of their complaint. The study consists of a retrospective analysis of the diagnostic methods used in confirming the proper diagnosis. Conclusions reached suggest a rational approach to solution of individual patient problems. The nonvascular origin of the symptoms was suggested initially by clinical evaluation in 19 patients, and by noninvasive arterial evaluation in an additional 22. The neurospinal origin of symptoms was obscured in 11 patients because of the presence of significant arterial occlusive disease, as demonstrated by nominvasive arterial testing. Seven of the 11 patients underwent arterial reconstruction, which failed to relieve their symptoms. Subsequently, the neurospinal origin of these symptoms was proven by appropriate treatment. This experience has shown that the errors in diagnosis and treatment could have been avoided by using a combined diagnostic approach, correlating results of an accurate clinical evaluation with noninvasive arterial testing as well as the findings shown on lumbosacral spine films.
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PMID:Rational approach to the differentiation of vascular and neurogenic claudication. 71 94

Intermittent claudication from peripheral vascular disease is sometimes difficult to distinguish from similar claudication due to degenerative disease of the lumbar spine. In the present study 26 patients with vascular disease were compared with 23 patients with lumbar degenerative disease. Assessment was by clinical and radiological examination. In the vascular group characteristic distinguishing features were: abnormal foot pulses, arterial bruits, relief of symptoms by standing, a constant claudicating distance and stocking sensory loss. In the lumbar group typical findings were: discomfort on lifting, bending, coughing or sneezing, pain on standing, history of back injury, variable claudicating distance and segmental sensory loss.
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PMID:Neurogenic and vascular claudication. 73 Dec 61

The authors repeat part of their report to the 79th French Congress of Surgery, presented in September, 1977. They recall that chronic obstructive arteriopathies affect from 1.5% to 4% of the population, and that in half of the cases, the symptoms are those of a simple intermittent claudication. Atheromatosis is the main cause, but to this must be added many other risk factors, smoking and metabolic disorders, especially glucidic and lipidic ones. There is spontaneous worsening in only half the cases. Other vascular and coronary ailments and problems of the cerebral vessels are responsible for most of the deaths of patients affected by arteriopathies of the lower limbs. The precise pain mechanism of the intermittent arterial claudication, its physio-pathological significance, like the mechanisms of vasomotricity and the development of the collateral circulation, are not yet completely clear. A therapeutic attitude can only be taken keeping in mind these developmental and physiopathological data: claudication is a symptom that does not necessarily mean that the limb is threatened.
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PMID:[Intermittent claudications of arterial origin: some epidemiological and physiopathological features]. 74 Jul 21

Forty-five patients suffering from intermittent claudication were admitted to a double-blind non-crossover study. Three groups were constituted at random and treated for 2 months with either 100 mg suloctidil t.i.d. or 1.5 mg dihydroergotoxine methylate t.i.d. or placebo. From the results of measurements of pain-free walking distance and venous occlusion plethysmography recordings, suloctidil was shown to be active and significantly superior to dehydroergotoxine and placebo: in the two latter groups a decrease in calf blood perfusion after 2 months was also noted. The physician's overall assessment of response to treatment showed that suloctidil and dihydroergotoxine were significantly superior to placebo, and that suloctidil was significantly better than dihydroergotoxine.
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PMID:Medical treatment of intermittent claudication: a comparative double-blind study of suloctidil, dihydroergotoxine and placebo. 79 78

Two cases of neural muscular atrophy of the Charcot-Marie-Tooth-Hoffmann type with strain-dependent pain in the leg similar to intermittent claudication are reported. While the pathogenesis of a neurogenic intermittent claudication appears to be reasonably explained by a pathological narrowness of the lumbar spinal duct, this question must remain open in the cases of neurospinal systemic disease described.
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PMID:[The concept of neurogenic intermittent claudication. A rare form of intermittent limping in neurologic system disease]. 81 12

The authors describe a simple clinical adjunct to the routine neurological examination of patients with intermittent cauda equina compression syndrome. The "bicycle test" helps exclude intermittent claudication due to vascular insufficiency and frequently confirms the relationship of posture to radicular pain.
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PMID:"Bicycle test" of van Gelderen in diagnosis of intermittent cauda equina compression syndrome. Case report. 84 55

216 limbs in 180 patients were operated upon for aorto-iliac atherosclerosis during the period of 1967 to 1974. 45% were operated on for rest-pain or gangrene, while 55% had intermittent claudication. Four year patency following semi-closed end-arterectomy was 85% whereas 83% and 74% 4 year patencies were observed after open endarterectomy and synthetic by-pass grafting. However, synthetic by-pass grafts were used in patients with the most extensive atherosclerosis. Femoro-femoral and axillo-femoral subcutaneous by-pass grafts may be useful alternatives when contraindication exists against direct reconstruction of the aorta or the iliac arteries. The operative mortality was 6.7%. Eleven patients were reoperated for bleeding and 10 for early reocclusion. A good result was obtained in 14 of these cases. The indications for the different operative techniques are discussed. It is concluded that both prosthetic by-pass grafting and endarterectomy have a definite place in the treatment of aorto-iliac atherosclerosis.
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PMID:Surgical treatment of aorto-iliac atherosclerosis. 85 53


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