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

Continuous ambulatory peritoneal dialysis (CAPD) is a relatively new blood purification method applicable as an alternative to intermittent hemodialysis in the treatment of end-stage renal disease. In this report we discussed the results of more than five years of CAPD in 32 children and adolescents aged 0.1 to 18 years treated for up to 22 months as well as the advantages and disadvantages of this technique in comparison to hemodialysis. Technical survival after one year of treatment increased from 48% in patients treated before 1983 to 84% in patients treated thereafter. Simplicity of technical procedure and lack of pain are considered the major advantages. Thus home dialysis can be performed even under adverse conditions (e.g. in infants). Infections of the abdominal cavity and the catheter tunnel are severe complications of CAPD. In the course of the last two years the frequency of peritonitis dropped to one episode per treatment year. We want to stress that successful treatment can be achieved by adequately training patients and their parents to perform home dialysis on their own and by surveying patients regularly according to standardized treatment guidelines in a pediatric nephrology unit.
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PMID:[Continuous ambulatory peritoneal dialysis (CAPD) in children and adolescents]. 370 90

Our data show that 1% of patients who required hospital treatment did so due to severe adverse reactions to analgesics. The most frequent adverse reaction was major gastrointestinal bleeding after aspirin, indomethacin, phenylbutazone or naproxen. Thrombocytopenia, second in frequency, was also mainly a complication of aspirin treatment, as was severe vertigo and tinnitus. Allergic reactions and leucopenia or agranulocytosis occurring in single cases only were associated with the use of pyrazolones. Patients with nephropathy were usually taking phenacetin or one of the close derivatives paracetamol or bucetin. Intensive monitoring for adverse reactions to drugs in 6,000 hospitalised patients in medical wards showed that analgesics, although frequently used, did not lead to life-threatening reactions. Gastrointestinal and neurological side effects were the most commonly observed reactions and these occurred more often after aspirin, indomethacin or pentazocine than after dipyrone or tilidine. Preliminary data of an international case-control-study on agranulocytosis and aplastic anaemia suggest that the incidence of agranulocytosis was in the order of 2 to 3 per million users of analgesics per year. Agranulocytosis occurred predominantly with pyrazolones, with a mortality of 1 to 2 per 10 million users per year. A cohort study on the treatment of colic pain in general practice showed that serious events most likely due to adverse reactions to analgesics were bronchospasm, shock fragments or shock. The incidence of these serious events was about 2 in 1,000 treated cases. The relative risk was not increased by treatment with pyrazolones, opioids or other drugs.
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PMID:Rare but serious risks associated with non-narcotic analgesics: clinical experience. 382 33

Over an 18-year period, renal involvement was diagnosed in 13 patients, who represent 1% of the total juvenile chronic arthritis population referred to us. All had severe arthritis. This study illustrates the importance of renal biopsy and indicates that renal involvement in juvenile chronic arthritis is a heterogeneous group of diseases, with a variety of causes. In eight patients with nephrotic syndrome, renal biopsy revealed amyloidosis. One rapidly died of diffuse amyloidosis and infection. The other seven received chlorambucil. Disappearance of proteinuria was noted in three of them. Four patients have persistent proteinuria but normal serum creatinine. It is suggested that, despite the long-term oncogenic risk of the drug, chlorambucil may be beneficial in patients with amyloid deposits. In one patient, the nephrotic syndrome was attributed to systemic lupus erythematosus, and in another, the chance association of an arthritis and nephrotic syndrome with minimal glomerular changes was considered. Although drug responsibility is difficult to determine in these patients receiving several medications in association, the renal involvement presented by the remaining three patients was probably related to drug(s). Moreover, it is possible that the effect of the association of medications is deleterious to the kidney. Drug-induced nephropathy is usually reversible when drugs are stopped. Unfortunately, because of persistent joint pain, these patients will continue to require pain-relieving drugs over prolonged periods.
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PMID:Renal involvement in juvenile chronic arthritis: clinical and pathologic features. 382 62

The clinical, radiological and hepatic histological features of 51 patients with hepatobiliary fibropolycystic disease were reviewed. Many of the patients had more than one of the diseases; the combination of both congenital hepatic fibrosis (CHF) and Caroli's disease was most striking. Twelve patients with CHF (50% male) presented at 6 +/- 2 years of age (mean +/- SEM) with hepatosplenomegaly or variceal bleeding. Their main problems were recurrent variceal bleeds and renal disease. Polycystic kidneys and renal stones were present in 79% and chronic renal failure in 30%. Six of the 8 patients with Caroli's disease were male (75%) and presented later (aged 37 +/- 8 years) with hepatomegaly or cholangitis. Recurrent cholangitis developed in most (7/8) and 2 had polycystic kidneys. Twelve patients had a combination of CHF and Caroli's disease presenting with hepatosplenomegaly, bleeding or cholangitis. As in Caroli's disease, most (83%) were male, but the age of presentation (15 +/- 4 years), and the incidence of polycystic kidneys (42%) and renal failure (8%) was intermediate between CHF and Caroli's disease. In these patients, bleeds always predated cholangitis. Histologically, acute cholangitis was superimposed on the changes of CHF. Adult polycystic liver disease (10 patients) presented later (43 +/- 3 years) in females (90%) with pain, a mass or incidentally; polycystic kidneys were present in 33%. Microhamartomas (10 patients), which were usually incidental findings, were diagnosed latest (50 +/- 6 years). Three choledochal cysts were seen. The hazard of cancer in these diseases was reflected by 2 bile duct cancers and 1 pancreatic cancer (incidence 6%). This study has confirmed that hepatobiliary fibropolycystic diseases form part of a family and are often associated together. However, the diseases are of greatly differing severity and the prognosis in an individual patient is determined by the fibropolycystic diseases present.
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PMID:Hepatobiliary fibropolycystic diseases. A clinical and histological review of 51 patients. 395 71

Neuromuscular manifestations of children's collagenosis are revised. The incidence varies in different entities, from exceptional to constitute the main clinical characteristic of the disease. They are owed to inespecific inflammatory infiltration, vasculitis and following ischemy-infarction lesions, compressive or vicinity phenomenons, iatrogenic factors or to other pathology from the basal disease, mainly nephropathy. Muscular pathology is manifested as weakness, pain, edema atrophy, retractions and possible calcification. The neurological pathology, less important according to our experience from that described in the literature, becomes conditionated essentially by the ischemic factor, in the shape of vascular disturbances in peripheric or C.N.S. transitory or with permanent sequels.
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PMID:[Neuromuscular manifestations in children's collagenosis (author's transl)]. 611 53

Chronic pancreatitis appears to be increasing likely because increase in alcohol consumption and improved diagnostic tools. So the diabetes due to chronic pancreatitis is gaining importance. In order to obtain a better understanding of that particular secondary diabetes, 179 patients with chronic pancreatitis were studied from 1970 to 1981. 154 patients were male and 25 female. Average admission age was 45, ranging from 25 to 86. All the patients underwent medical therapy, based on diet, pancreatic enzymes, pain control. 99 of them underwent even to surgery. The follow-up is ranging from 6 months to 10 years: during this period 18 patients died, 41 went lost. 120 patients are still under observation. Diabetes was found in the family history of 27 patients (15%). At hospital admission 41 patients (23%) had high fasting glycemia, 23 of them even glycosuria. Other 74 showed diabetic oral glucose tolerance test. During the follow-up time 27 became clinically diabetic, 3 died because hyperosmolar coma and 8 had to be readmitted more than once because diabetic metabolic decompensation. Among the 120 patients at the moment under control, 66 (55%) show abnormal fasting glycemia, 10 developed high blood pressure, 12 inferior limbs vasculopathy with paresthesias and intermittent claudication, 2 myocardiosclerosis and atrial fibrillation, 1 myocardial infarction, 2 chronic nephropathy, 1 diabetic retinopathy. Whereas surgery or medic therapy may relieve chronic pancreatitis typical symptoms, they appear to be useless remedy against the under lying diabetes. As the time goes on more and more patients develop glucose intolerance, quite early became insulin-dependent, are disposed to severe diabetic metabolic decompensation and can show vascular, cardiac or renal complication.
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PMID:[Chronic pancreatitis and diabetes]. 633 49

One hundred and forty-five patients on hemodialysis for periods of 1 month to 16 years were examined clinically for carpal tunnel syndrome (CTS). Typical symptoms and clinical manifestations of symptomatic CTS, either unilaterally or in both hands, were detected in 21 of these patients (15%). In contrast to the classic form of CTS, hemodialysis CTS in our patients was frequently accompanied by Raynaud's phenomenon of those digits supplied by the median nerve. A highly significant correlation was established between the incidence of CTS and the duration of dialysis (p less than 0.001). The association of CTS with analgesic nephropathy was significantly higher (52%) than with other kidney diseases (p less than 0.034). Immediate relief of pain was achieved after carpal tunnel release (11 releases) in 8 of the 21 patients. Sensory and motor function was gradually, but often only partially, restored. Unoperated CTS progressed to loss of sensory and motor function within 1 to 4 years after the onset of symptoms. CTS should be considered a major late complication in patients on chronic hemodialysis.
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PMID:Carpal tunnel syndrome: a major complication in long-term hemodialysis patients. 648 95

Analgesic drug abuse led to end-stage renal disease in 31% of 122 patients in a cross-sectional investigation at our center. Addiction to analgesics and tranquilizers remained a serious problem in these patients even after they were placed on chronic hemodialysis. There is strong evidence that drug addiction leading to end-stage renal disease and chronic hemodialysis correlates with a special type of personality typified by the 60-year-old depressive woman suffering from chronic headache.
Pain 1983 Sep
PMID:Analgesic dilemma in chronic hemodialysis patients. 663 15

145 patients on haemodialysis for 1 month to 16 years were examined for carpal tunnel syndrome. Typical signs and symptoms of the syndrome, mostly in both hands but more pronounced on one side, were seen in 21 patients (15%). In these cases carpal tunnel syndrome was frequently (19%) accompanied by Raynaud's phenomenon of the digits supplied by the median nerve. There was a significant correlation between the incidence of carpal tunnel syndrome and the duration of dialysis. The association of carpal tunnel syndrome with analgesic nephropathy was significantly higher than with other kidney diseases. Immediate relief of pain was achieved after carpal tunnel release in eight patients (11 hands). Sensory and motor function was gradually, but often only partially, restored. Unoperated carpal tunnel syndrome progressed to loss of sensory and motor function within 1 to 4 years after onset of symptoms. Carpal tunnel syndrome should be considered an important late complication of chronic haemodialysis.
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PMID:[Carpal tunnel syndrome, a late complication in chronic hemodialysis]. 669 18

Among 100 patients treated by chronic hemodialysis, 12 developed a carpal tunnel syndrome (CTS). After surgery, improvement was dramatic with regression of pain and paresthesiae within a few hours. Recovery of motor and sensory deficits was longer (2-3 weeks). No relationship could be established between CTS and the type of nephropathy, severity of polyneuritis, Ca and PO4 metabolism, the presence of vascular access and efficacy of dialysis. The bilaterality of the lesions in 7 patients suggests general pathogenic mechanisms superimposed to the presence of the vascular access. While only 3 out of 65 patients treated for less than 4 years complained about CTS, 9 out of 35 treated for more than 4 years were symptomatic.
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PMID:Carpal tunnel syndrome: a frequent, invalidating, long-term complication of chronic hemodialysis. 672 17


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