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

Autosomal dominant polycystic kidney disease is the third cause of end-stage chronic renal failure (CRF) requiring dialysis and transplantation. Over a 5-year period we collected 21 cases of that disease. The patients' mean age at the time of diagnosis was 48 years and the sex ratio 1.1. Pain was the most frequent signal symptom, being present in 43 p. 100 of the patients. Varying degrees of renal impairment were found in 61 p. 100 of the cases, and arterial hypertension in 38 p. 100. The diagnosis, suspected on clinical grounds, was confirmed by ultrasonography in 95 p. 100 of the patients. Beside CRF and hypertension, the main complications were microscopic haematuria (38 p. 100) and urinary tract infection (24 p. 100). In two patients the disease was associated with hepatic polycystosis. Treatment was symptomatic for CRF (4 patients were put on periodical haemodialysis) and for the other complications. On the basis of this series, we discuss the profile and prognosis of polycystic kidney disease in our environment, and notably its effects on renal function, and we underline the usefulness of familial investigations and the need for genetic counselling.
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PMID:[Dominant renal polycystic disease]. 252 23

Three haemodialyzed chronic renal failure patients with histologically proven osteomalacia due to aluminium toxicity were treated with repeated injections of desferrioxamine, a potent chelator of aluminium. The drug, in doses of 3 or 6 g, was administered intravenously once a week for 5 to 11 months, at the end of a dialysis session. Treatment was well tolerated. Dramatic clinical improvement was observed, with rapid regression of pain and functional impairment. There was a 65% increase in alkaline phosphatase and a rise of immunoreactive parathyroid hormone (terminal C fragment). Healing of fractures was confirmed by radiology, and a second bone biopsy in the 3 patients after double tetracycline labelling showed regression of morphological and dynamic signs of osteomalacia, considerable reduction in stainable aluminium deposits and strong increase in bone remodelling compatible with the development of hyperparathyroidism. It is concluded that a moderate dose of desferrioxamine administered once a week is effective against osteomalacia due to aluminium toxicity.
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PMID:[Desferrioxamine treatment of osteomalacia caused by aluminum poisoning]. 293 57

A 36-year-old woman was admitted for initiation of hemodialysis for chronic renal failure. Two days after catheter placement the patient developed a fever that persisted and resulted in subsequent removal of the catheter. Although blood cultures were negative, cultures of the catheter tip were positive for Staphylococcus epidermidis. An initial vancomycin dose was well tolerated, but the patient later experienced numbness and tingling of her lower back accompanied by pain ten minutes after initiation of the second dose. Symptoms abated when the vancomycin infusion was discontinued, and the drug was subsequently well tolerated when reinstituted at a slower infusion rate. Similar symptoms were observed five minutes into a vancomycin infusion a week later that also resolved after decreasing the infusion rate. Patients on hemodialysis receiving vancomycin should be carefully monitored during drug administration for the development of paresthesia and spasmodic lower back pain.
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PMID:Paresthesia and back pain in a patient receiving vancomycin during hemodialysis. 297 72

We recently treated three patients with chronic renal failure who required subclavian vein cannulation with Uldall catheters following thrombosis of their arteriovenous fistulae. New arteriovenous fistulae were created in each patient following removal of the Uldall catheters. The patients were seen subsequently with massive, painful edema in the ipsilateral upper extremities from one to 10 weeks following creation of the arteriovenous fistulae. Radiographic studies documented stenosis or occlusion of the ipsilateral proximal subclavian vein. The arteriovenous fistula was ultimately ligated in each patient, which promptly resolved the pain and edema. Because subclavian vein thrombosis following temporary hemodialysis through an indwelling catheter is frequently asymptomatic until an arteriovenous fistula is constructed, venography should be considered in patients requiring upper extremity vascular access procedures. Demonstration of subclavian vein stenosis or occlusion would either preclude use of the upper extremity for an arteriovenous fistula or would require a concomitant procedure to relieve the venous obstruction.
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PMID:Massive upper extremity edema following vascular access surgery. 322 42

We evaluated musculoskeletal complaints related to arthropathy in 28 patients with end stage renal failure receiving maintenance dialysis. Twenty-three of 28 patients had arthritic complaints and 14 had an arthropathy. Six of 14 patients with arthropathy had a pattern resembling calcium pyrophosphate dihydrate deposition (CPPD) disease, 4 patients had moderately severe osteoarthritis, 3 had calcific periarthritis, and 1 patient had acute arthritis with intermittent pain and swelling. Factors which predispose to metabolic arthropathies were observed as follows: 29% elevated ferritin; 39% history of hyperparathyroidism; 68% elevated parathormone; 54% hyperphosphatemia; 36% hypercalcemia, 29% HLA haplotypes A3, B7, or B14; and 60% hyperaluminemia. The arthropathy group had more abnormalities per patient (mean 3.6) than the group without arthropathy (mean 2.7) (p less than 0.05). Our data suggest that (1) arthritic complaints occur frequently in patients receiving dialysis; (2) arthropathy accounted for 61% of the complaints; (3) 43% of patients with arthropathy had CPPD-type; (4) renal osteodystrophy caused 17% of arthritic complaints; and (5) in patients receiving dialysis, there is a high incidence of metabolic abnormalities that are known to be associated with arthropathy.
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PMID:Musculoskeletal symptoms related to arthropathy in patients receiving dialysis. 323 May 70

The development of shock initiates a cascade of responses in an effort to reestablish homeostasis. Three of the most important hormonal and neurohumoral changes are the secretion of glucocorticoids, catecholamines, and vasopressin. Regulation of adrenal function is much more complex than originally thought. Hemorrhage is a potent stimulus for cortisol release, and both ACTH and ACTH-independent mechanisms have been described. The ACTH response to its releasing hormone, corticotropin releasing hormone (CRF), is itself amplified by vasopressin, which appears to have intrinsic CRF properties. Because ACTH is synthesized as part of a large precursor molecule (pro-opiomelanocortin) containing the amino acid sequences for several important proteins, stimulation of ACTH release has far-ranging effects, the specifics of which are just being clarified. Norepinephrine and epinephrine levels increase manyfold above baseline within minutes of the onset of hemorrhagic shock. Only patients experiencing cardiac arrest or the rare patient with a very active pheochromocytoma have higher concentrations. The levels reached are far in excess of those required to cause both cardiovascular and metabolic alterations. Because of the presence of the endogenous opiates leucine and methionine enkephalin in the neurosecretory granule, it is very likely that the enkephalins are coreleased with the catecholamines, modifying their cardiovascular effects and producing analgesia. Hypovolemia is also a potent stimulus for vasopressin secretion, which overrides hypotonicity, presenting a clinical picture quite compatible with the syndrome of inappropriate antidiuretic hormone secretion, from which it must be differentiated. Vasopressin also is released by pain, nausea, and hypoxia, all of which are likely to be present in the patient with shock.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Endocrinology of shock. 353 88

We report 4 cases of nontuberculous psoas abscess occurring in patients with end stage renal disease. Fever and pain were the presenting symptoms but diagnosis was delayed. A computerized tomography scan of the abdomen was the critical test that led to the correct diagnosis. Therapy involved drainage and antibiotics, and was successful in 3 of the 4 patients.
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PMID:Psoas abscess in chronic dialysis patients. 354 35

Familial Mediterranean fever (FMF) has been observed in a Swiss child without ethnic predisposition. The case is analyzed and the current literature briefly reviewed. Recurrent attacks of fever, accompanied by abdominal pain, colic and arthritic symptoms, and often by pleuritic pain and a transitory skin rash, are the hallmarks of FMF, which is predominantly seen in ethnic groups of the Mediterranean area, notably Sephardic Jews, Turks and Armenians. However, it rarely occurs among individuals without an ethnic predisposition. Its most ominous manifestation is amyloidosis, which leads to chronic renal failure within a matter of years. Thanks to colchicine treatment, which is now widely accepted, patients often lead normal lives, and it appears that amyloidosis can be prevented.
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PMID:[Familial Mediterranean fever. Study of a Swiss child]. 356 45

A 79-year-old Armenian-born woman with stable, long-term familial Mediterranean fever had progression of chronic renal failure concurrently with two types of skin lesions. One lesion resembled erysipelas, which is quite common in familial Mediterranean fever, whereas the other was panniculitis, only occasionally described in familial Mediterranean fever. The unique histopathologic features of the latter are presented. The onset of acute cutaneous disease in this patient coincided with worsening renal disease and preceded a flare of disease activity in other sites after a 14-year period of quiescence. The severe and unremitting pain from the skin lesions and their tendency to form nonhealing ulcers were substantial causes of morbidity in this patient with familial Mediterranean fever.
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PMID:Panniculitis in familial Mediterranean fever. Case report with histopathologic findings. 356 36

The joint disorders associated with osteodystrophy of 124 regularly haemodialysed patients are reviewed. The most common signs and symptoms of uraemic osteoarthropathy are summed up. It is pointed out that in osteoarthropathy accompanying chronic renal failure or haemodialysis the bones are generally affected first, arthropathy being secondary to this process. In addition to the classic signs and symptoms of arthropathy (calcification, pain, stiffness) capsulitis, carpal tunnel syndrome and in 3 cases avascular necrosis were observed. The laboratory findings included hypocalcaemia, hyperphosphataemia and hypersecretion of parathormone. The current preventive and therapeutic measures are reviewed and in this context the benefits of combined local lidocaine, and steroid iontophoresis are emphasized in the light of personal observations.
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PMID:Arthropathy in haemodialysed patients. 360 87


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