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

A case report is presented of toxic shock syndrome associated wtih diaphragm use. The patient, an 18-year old white woman, gravida 1, para 1, was in good health prior to the reported episode. She had a low transverse cesarean section for fetal distress 3 months prior to admission and had not yet resumed menstruation. 48 hours prior to admission, after unprotected intercourse, she developed a vaginal discharge requiring the use of a pad. 12 hours later she used a diaphragm, left it in place overnight, and failed to remove it the next morning. During the day pelvic and lumbar pain developed, followed by vomiting and a fever as high as 103 degrees Farenheit. That evening, 12 hours before admission, the diaphragm was removed with drainage of copious purulent discharge. The edges of the diaphragm and the discharge were blood streaked. She also developed a diffuse macular blanching rash, sparing only the circumoral region. At the time of admission the following morning her blood pressure was 60/0mmHg; pulse, 180 beats/minute; and temperature, 102 degrees Farenheit. Significant physical findings included the rash, conjunctivitis, a pharyngeal infection, and a lack of adenopathy. Pelvic examination showed a vaginal discharge, a very tender, slightly enlarged warm uterus, and normal adnexa. Cultures of the vaginal discharge were positive for Staphylococcus aureus, resistant to penicillin and ampicillin, and sensitive to methicillin, cephalothin, erythromycin, colistin, chloramphenicol, tetracycline, sulfisoxazole, and aminoglycoside antibiotics. The white blood count rose from 11,000/mm on admission to a high of 13,000/mm with a left shift the next day. The patient received 1.2 million units of intravenous penicillin every 4 hours, 80 mg of gentamicin every 8 hours, and 300 mg of clindamycin every 6 hours, as well as fluid replacement of 2 g of methylprednisolone followed by 1 g every 6 hours. The shock, fever, and rash resolved in the following 48 hours. 2 days after admission there was circumoral exfoliation. The discharge and electrolyte and renal abnormalities cleared in 3 days. Laboratory abnormalities corrected in 24-48 hours except for liver function tests. After 8 days in the hospital, the patient was discharged on 500 mg of cloxacillin every 6 hours. This particular case is unusual because it began with development of a vaginal discharge without vaginal obstruction, developed during a 24-hour period when a diaphragm was in place, and was not associated with menstruation. Whether the discharge represented staphylococcal infection is unknown, but the diaphragm certainly seems to have contributed to the course of events.
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PMID:Toxic shock syndrome associated with diaphragm use. 682 38

Lyme disease, caused by a tick-transmitted spirochete, typically begins with a unique skin lesion, erythema chronicum migrans. Of 314 patients with this skin lesion, almost half developed multiple annular secondary lesions; some patients had evanescent red blotches or circles, malar or urticarial rash, conjunctivitis, periorbital edema, or diffuse erythema. Skin manifestations were often accompanied by malaise and fatigue, headache, fever and chills, generalized achiness, and regional lymphadenopathy. In addition, patients sometimes had evidence of meningeal irritation, mild encephalopathy, migratory musculoskeletal pain, hepatitis, generalized lymphadenopathy and splenomegaly, sore throat, nonproductive cough, or testicular swelling. These signs and symptoms were typically intermittent and changing during a period of several weeks. The commonest nonspecific laboratory abnormalities were a high sedimentation rate, an elevated serum IgM level, or an increased aspartate transaminase level. Early Lyme disease can be diagnosed by its dermatologic manifestations, rapidly changing system involvement, and if necessary, by serologic testing.
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PMID:The early clinical manifestations of Lyme disease. 685 26

We reviewed a group of 30 patients with Hashimoto's thyroiditis who underwent thyroidectomies for suspicion of cancer. A prominent nodule was present in all of the patients; compression symptoms were present in 13 and pain in the thyroid in six. The nodule was cold on scan in 21 patients. Lack of responsiveness to suppressive therapy or nodule enlargement occurred in 18 patients. In addition to the nodule, operative findings included adherence to surrounding tissues in seven patients, lymphadenopathy in seven, increased vascularity in four, and extension to distant cervical structures in two. Pathologic findings in the nodule were similar to those in the rest of the gland; they consisted of lymphocytic infiltration, fibrosis, and variable follicular size. Examination of lymph nodes demonstrated lymphoid hyperplasia. We emphasize the similarities between chronic thyroiditis and carcinoma of the thyroid; the occasional coexistence of these two conditions stresses the need for newer methods in the differential diagnosis.
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PMID:Hashimoto's thyroiditis simulating cancer of the thyroid. 689 33

A 32-year-old man presented with left hypochondrial pain and myalgia. On examination he was found to have widespread lymphadenopathy and splenomegaly, and lymph node biopsy revealed diffuse lymphocytic lymphoma of the small cleaved cell type. There was hypereosinophilia (20 x 10(9)/1). The patient was initially treated with chlorambucil and prednisone, which controlled the lymphoma for 9 months but did not affect the eosinophilia. He then developed thrombocytopenia with further lymph node enlargement which was managed with a combination of bleomycin, vincristine and prednisone; this again controlled both spleen and lymph node size without affecting the eosinophilia. Six months after presentation the patient developed refractory cardiorespiratory failure due to endomyocardial fibrosis and fibrosing alveolitis. The cardiac failure was thought to be related to the hypereosinophilia resulting from the lymphoma, while the respiratory insufficiency was attributed to the bleomycin. This case illustrates the rare association between lymphocytic lymphoma and eosinophilia and shows that cardiac damage can be associated with these cells.
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PMID:Lymphocytic lymphoma, hypereosinophilia and endomyocardial fibrosis. 689 45

The patient was an eight-year-old black male who presented to the Children's Hospital of Philadelphia (CHP) in June 1977 with foot pain. Abnormal findings on physical examination were diffuse shotty lymphadenopathy without hepatosplenomegaly. Examination of the extremities was normal. There was no evidence of increased bruising or bleeding. Laboratory data revealed a hemoglobin of 11.2 gm/dl, white blood cell count of 26,200/cu mm, and platelet count of 21,000/cu mm. Serum uric acid level was 4.2 mg/dl. The remainder of the laboratory findings were within normal limits. Bone marrow examination revealed a hypercellular marrow replaced with lymphoblasts. Immunologic evaluation showed these cells to have no surface immunoglobin and no rosette formation with sheep red blood cells. The patient received vincristine 1.5 mg/M2 daily, oral prednisone at 40 mg/M2 daily, L-asparaginase 6,000 IU/M2 for nine intramuscular doses, and methotrexate 12 mg intrathecally. After 28 days, bone marrow aspiration showed that the leukemia was in remission. He then received 2,400 rad cranial irradiation over three weeks, along with four more doses of intrathecal methotrexate, given once weekly. Maintenance consisted of monthly pulses of vincristine (1.5 mg/M2), prednisone (40 mg/M2 for five days), daily oral 6-mercaptopurine (75 mg/M2), and weekly oral methotrexate (20 mg/M2). After six months of maintenance, the patient was given a scheduled course of reinduction therapy with vincristine, prednisone, and L-asparaginase. Eleven months after diagnosis both testes were noted to be enlarged on physical examination. Wedge biopsy of both testes revealed leukemic infiltration. Examination of the bone marrow and cerebrospinal fluid (CSF) at that time were unremarkable. The patient was treated with vincristine, prednisone, and L-asparaginase again for four weeks and received intrathecal methotrexate as central-nervous-system (CNS) prophylaxis. Twenty-four hundred rad were given to both testes at 200 rad/day with decrease in testicular size. Maintenance consisted of monthly pulses of vincristine and prednisone with oral methotrexate and 6-mercaptopurine. Seven months after his testicular relapse the patient had a bone marrow relapse. He expired eight months later with disseminated leukemia.
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PMID:Proceedings of the tumor board of the Children's Hospital of Philadelphia. Testicular leukemia: incidence and management results. 694 80

Twenty-nine patients had sonographic evaluation of the femoral triangle because of pain or swelling. The entities diagnosed by sonography were abscesses (seven), cellulitis (three), hematoma (five), nodal enlargement (four), aneurysm of the femoral artery (three), and thrombophlebitis of the femoral vein (seven). Both abscesses and hematomas were poorly defined primarily anechoic masses. Soft-tissue swelling but no distinct masses were present in cellulitis, and all cases of adenopathy were well defined anechoic masses. Aneurysms were also primarily well defined, pulsatile, anechoic masses except mycotic aneurysm, which may present as a primarily solid mass. The sonographic features of thrombophlebitis which has received scant attention in the sonographic literature are stressed. Findings suggest a dilated anechoic vein is characteristic of this entity. Although the sonographic findings or clinical data of many of these entities may be nonspecific, when used in combination, the correct diagnosis can usually be obtained.
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PMID:Disease in the femoral triangle: sonographic appearance. 698 16

Twenty patients with active systemic lupus erythematosus (SLE) were treated with methyl prednisolone pulse therapy (MPPT) and followed up for up to 24 weeks (mean 18 weeks). Beneficial effects of MPPT were observed principally on arthralgia, pleuritic pain, vasculitic skin rash, pyrexia, and lymphadenopathy. The serological tests showing the most improvement were ds DNA binding and the serum C3 level. MPPT was found to be both safe and easy to administer. It may be of value in treating patients with SLE whose disease is not controlled by moderate doses of corticosteroids and may also enable the dose of maintenance corticosteroids to be reduced appreciably.
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PMID:Methyl prednisolone pulse therapy in the treatment of systemic lupus erythematosus. 711 16

Seventy-seven cases of adenocarcinoma of unknown origin were studied retrospectively. Pain was the most common presenting symptom and lymphadenopathy was the most common finding on physical examination. Tumor involved several organs in two thirds of the patients, the lung being the most frequently involved. Complete surgical resection was possible in only four of 27 patients with single organ involvement. All four patients had lymph node dissections and remain free of disease after one to three years. Four patients with tumor confined to the liver received infusion of antitumor agents through the hepatic artery which resulted in objective tumor regression in all, and regression of greater than 50% in two. Forty-three trials of systemic intravenous chemotherapy were administered to 38 patients with nonresectable tumor resulting in greater than 50% tumor regression in eight. Responses were more frequent with regimens containing adriamycin plus either cyclophosphamide or cis-platinum. Median survival of all patients in the study was 31 weeks. Patients who received chemotherapy survived significantly longer (median 41 vs 26 weeks, P = 0.005). Similarly, patients who responded to chemotherapy survived significantly longer than nonresponders (median 54 vs 27 weeks, P less than 0.02). Our results indicate that early treatment of patients with adenocarcinoma of unknown origin improves their prognosis.
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PMID:Adenocarcinoma of unknown primary origin: impact of chemotherapy on survival. 719 91

A total of 678 cases of soft chancre were treated in one hospital between 1973 and 1979. The majority of the patients were males (97 p. cent), and most of them came originally from Maghreb or Black Africa. Contamination was from prostitution (61 p. cent) or chance acquaintances (29 p. cent). The genital ulceration was often clinically atypical, frequently syphiloid; pain was present in only 59 p. cent of cases, and adenopathy, noted in 63 p. cent of patients, had the appearance of an inflammatory bubo in only 23 p. cent. The present high frequency of soft chancres, and their misleading clinical characteristics, makes it sometimes difficult to establish the clinical differential diagnosis from syphilitic chancre, but confirmation of the latter is supplied by direct examination and culture to search for Ducreys bacillus, this being indispensable for establishing the correct diagnosis. Treatment with sulfamethoxazole trimethopin or streptomycin prevents complications and cures the affection in one or two weeks.
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PMID:[Reappearance of soft chancre: comments on the current epidemic in Paris (author's transl)]. 722 51

Although synovial cysts are most commonly associated with rheumatoid arthritis and osteoarthritis, they may occur in many other conditions. The clinical manifestations of these cysts are numerous and may result from pressure, dissection or acute rupture. Vascular phenomena occur when popliteal cysts compress vessels, and result in venous stasis with subsequent lower extremity edema or thrombophlebitis. Rarely, popliteal cysts may cause arterial compromise with intermittent claudication. Neurological sequelae include pain, paresthesia, sensory loss, and muscle weakness or atrophy. When synovial cysts occur as mass lesions they may mimic popliteal aneurysms or hematomas, adenopathy, tumors or even inguinal hernias. Cutaneous joint fistulas, septic arthritis or osteomyelitis, and spinal cord and bladder compression are examples of other infrequent complications. Awareness of the heterogeneous manifestations of synovial cysts may enable clinicians to avoid unnecessary diagnostic studies and delay in appropriate management. Arthrography remains the definitive diagnostic procedure of choice, although ultrasound testing may be useful.
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PMID:Clinical manifestations of synovial cysts. 723


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