Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Brief cerebral application of picotesla (pT) electromagnetic fields (EMF) has been demonstrated an efficacious, revolutionary treatment modality for the therapy of Parkinson's disease (PD) with clinical benefits being evident in all motor aspects of the disease as well as in nonmotor symptoms such as mood, sleep, pain, sexual dysfunction, autonomic regulation and cognitive functions. Since treatment with pT EMF has involved PD patients who were treated with dopaminergic agents at the time they received EMF there may have been a synergistic interaction between dopaminergic drugs and EMF. The present communication concerns a 49-year-old male Parkinsonian patient with stage 3 disability on the Hoehn and Yahr scale (1967) who, in response to brief extracranial applications of pT EMF, demonstrated a marked improvement in motor, depressive symptomatology and cognitive functions and was classified as stage 1 several weeks later. This case is remarkable in that the patient did not receive treatment with dopaminergic drugs prior to or during the course of EMF therapy. It suggests that (a) pT range EMF may be efficacious as a monotherapy for PD and should be considered also as a treatment modality for de novo diagnosed patients, and (b) application of these EMF improves Parkinsonism by a mechanism which involves, among others, augmentation of dopaminergic and serotonergic neurotransmission.
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PMID:A drug naive parkinsonian patient successfully treated with weak electromagnetic fields. 774 55

This review was undertaken to determine the efficacy of using dorsal root entry zone (DREZ) lesions to treat intractable pain caused by trauma to the conus medullaris and cauda equina. Traumatic lesions of this area are unique in that both the spinal cord and the peripheral nerve roots are injured. Although DREZ lesions have been shown to relieve pain of spinal cord origin in many patients, they have been shown not to relieve pain of peripheral nerve origin. Therefore, 39 patients with trauma to the conus medullaris and cauda equina who underwent DREZ lesioning for intractable pain were reviewed retrospectively. The results of this review demonstrate the efficacy of DREZ lesions in these patients. At a mean follow-up period of 3.0 years, 54% of patients were pain-free without medications, and 20% required only nonnarcotic analgesic drugs for pain that no longer interfered with their daily activities. Better outcomes were noted in patients with an incomplete neurological deficit, with pain having an "electrical" character, and with injuries due to blunt trauma. Operative complications included weakness (four patients), bladder or sexual dysfunction (three), cerebrospinal fluid leak (two), and wound infection (two), but overall, 79.5% of patients (31 of 39) were without serious complications. Complications were limited to patients with prior tissue damage at the surgical exploration site and were most prevalent in patients who underwent bilateral DREZ lesions. In conclusion, this preliminary report suggests that DREZ lesions may be useful in combating intractable pain from traumatic injuries to the conus medullaris and cauda equina, with some risk to neurological function that may be acceptable in this group of patients.
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PMID:Dorsal root entry zone lesions for intractable pain after trauma to the conus medullaris and cauda equina. 781 30

To assess the prevalence of sexual dysfunction after pelvic floor surgery for nonmalignant conditions, a retrospective survey was performed. Replies from a postal survey were received from 66 of the 200 women canvassed. Dyspareunia developed in 10 patients who had never had it before the operation, however of those who had it preoperatively the pain stopped completely in 12 of 23. Reduced libido was noted in 16 of 54 (29%), reduced lubrication in 21 (38%), and reduced genital sensation in 10 (18%). Lack of information about the potential effects of surgery on sexual function was identified as a major deficit and of considerable concern to 35 of the 66 women. Sexual function after surgery should be evaluated more intensively, and the subject discussed openly before any contemplated operation.
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PMID:Sexual function after pelvic surgery in women. 784 44

The improved prognosis with pelvic exenterative surgery for gynecologic malignancies has resulted in increasing concern for quality of life. Sexual dysfunction is a common sequel to pelvic exenteration and vaginal reconstruction should be considered in all these patients. This case review assesses our experience with three flap techniques for neovaginal construction. Medical charts were reviewed and survivors interviewed. Fourteen patients had vaginal reconstruction with gracilis myocutaneous (n. = 5), bulbocavernosus (n. = 3) or pudendal thigh fasciocutaneous (n. = 6) flaps at the time of pelvic exenteration. Partial or incomplete necrosis occurred in four (24%) and one (7%) patient had complete flap necrosis bilaterally, followed by an entero-vaginal fistula. Two patients developed recto-vaginal fistula in association with a low rectal reanastomosis (n. = 2) and tumor recurrence (n. = 1). Eight patients, seven of whom agreed to an interview and physical examination, are alive at a median of 15.5 months following pelvic exenteration. Three have stenotic and/or foreshortened vaginas. Two patients are apareunic by choice, four have discontinued vaginal intercourse because of dyspareunia and only one patient has satisfactory coitus. Other problems include vulvar pain (n. = 3), vaginal discharge (n. = 3), neovaginal hair growth (n. = 5) and protrusion of flaps (n. = 3). The functional results in this series are disappointing and better methods of vaginal reconstruction should continue to be developed. Patients undergoing neovaginal reconstruction at the time of pelvic exenteration require careful preoperative counselling and ongoing support after surgery with special attention to sexual dysfunction.
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PMID:Surgical and psychosexual outcome following vaginal reconstruction with pelvic exenteration. 800 48

During the last 10 years, 90 penile prostheses were implanted in 82 patients with spinal cord injury. Surgery was done 1 month to 25 years (average 4.8 years) after the injury. The follow up period ranged from 1 to 10 years (average 4 years). A prosthesis was implanted for urinary management in 51 patients (62%), for sexual dysfunction in 10 patients (12%) and for both purposes in 21 patients (26%). Ninety-three per cent of the patients who used the implant for urinary management and 64% of the patients who used it for sexual dysfunction were satisfactory. We experienced three extrusions and nine surgical removals due to pain, difficulty of catheterisation and infection (the complication rate was 13.3%). Generally speaking, a penile prosthesis improves the quality of life of patients with spinal cord injury significantly; however, extrusion and infection are still significant problems.
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PMID:Penile prostheses for the management of the neuropathic bladder and sexual dysfunction in spinal cord injury patients: long term follow up. 805 51

Sexual sterilization is the major form of fertility control in women who are more than 30 years old. Clinicians usually use laparoscopy to perform female sterilization. They may occlude the fallopian tubes with a clip or ring or coagulate the tubes using bipolar diathermy. It is usually performed on an outpatient basis. Nonsteroidal anti-inflammatory drugs can generally control the postoperative pain. A serious immediate but rare complication is death, which is often associated with the anesthesia. Complications related to the experience of the surgeon include damage to bowel or blood vessels and tearing of mesosalpinx. Obesity or pelvic adhesions often necessitates either laparotomy or abandonment of sterilization. Some long term complications are hysterectomy and menstrual disorders. Presterilization counseling needs to examine the possibility of regret and to discuss failure rates and complications. Reasons for regret are young at time of sterilization, psychosexual disorder, change of partner, change in financial circumstances, sterilization performed at time of crisis, and death of a child. The failure rate for the Filshie clip is 0.1%. Reasons for failure include pregnant at the time of the procedure, clips placed across the round or ovarian ligament, incomplete occlusion, and fistula formation and recanalization. Failure rates are higher when the sterilization is done during pregnancy because the tubes are thicker and more vascular. Vasectomy involves severing and ligating the vas deferens in both scrotums. Immediate complications are hematoma and infection. Vasectomy patients need to bring 2 semen samples for sperm counts 3-4 months after the procedure. Azoospermia signals a successful vasectomy. If sperm are still present 5-6 months after the procedure, the surgeon should conduct exploratory surgery under general anesthesia. Long term side effects include testicular discomfort and perhaps prostate cancer. The evidence is unclear about the link between vasectomy and prostate cancer, however.
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PMID:Male and female sterilisation. 807 40

The presence of dyspareunia as a specific complaint should be a routine part of the gynecologic history. Even if the patient does not present with this as a chief complaint, the regular inclusion of the question of whether the patient has pain during intercourse can address emotional and physical concerns the patient may leave unspoken unless given the opportunity. Once identified, the symptoms should be dealt with by the clinician potentially as both an organic and as a sexual problem. This will allow the clinician to keep in mind that secondary sexual dysfunction can arise from initially simple organic problems. Patients should be advised at the onset that the process is ongoing and that therapy may be more than just one single treatment approach. Dyspareunia that occurs after a period of good sexual adjustment may be more amenable to an office-based counseling and educational approach, assuming that the patient and her partner are comfortable and cooperative in approaching the problem. Dyspareunia of long standing or in a more complicated relationship may require skills possessed by more highly trained professionals.
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PMID:Dyspareunia. A special type of chronic pelvic pain. 811 91

Marked changes have occurred in the formulation and treatment of sexual disorders in the past 2 decades. Emphasis has shifted to the role of biomedical and organic factors in the etiology of sexual dysfunction, along with the growing use of medical and surgical treatment interventions. Multidimensional assessment models are widely used, particularly in the evaluation of male erectile dysfunction and sexual pain disorders. Integrated treatment approaches have also been developed, as cognitive-behavioral and couples' therapy procedures are increasingly combined with traditional sex therapy techniques. This article reviews existing data regarding the etiology and treatment of male and female sexual dysfunctions. Despite the conceptual and technological sophistication of current approaches, treatment outcome is less than satisfactory in several areas. Further research is needed on the etiology and treatment of sexual disorders.
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PMID:Treatment of sexual disorders in the 1990s: an integrated approach. 854 11

The Stockholm Spinal Cord Injury Study (SSCIS) is an extensive evaluation of a sample of 353 subjects with traumatic SCI, constituting 93% of the known regional prevalence population with this diagnosis. In a previous analysis of this group, symptoms such as pain, incontinence, sexual dysfunction and neurological deterioration, as well as secondary complications, such as decubitus ulcers, urinary tract infections, spinal deformity and fractures, were found to be common. In the present report, we investigate associations between a few commonly used patient characteristics, ie gender, age at injury, duration of injury and extent of neurological compromise, and the occurrence of such problems, to assess differences in vulnerability in SCI subgroups. Results generally indicate an increased vulnerability in subjects with extensive neurological deficits, as well as a cumulation of complications with the increasing duration of injury. However, some exceptions are found, possibly indicating differences in temporal patterns of the occurrence of various complications, as well as certain gender-, age-, and lesion-associated variations in vulnerability. Symptoms directly related to the spinal cord lesion, eg neurogenic pain and neurological deterioration, seem to present rather soon post-injury. Males are more prone to experience excessive spasticity and sexual problems. Females experience more fractures and spinal deformity. Younger age at injury is associated with more spinal deformity but less severe pain problems. Higher age at injury is not found to be associated with more medical problems, with the exception of neurogenic pain, among post-acute, post-discharge survivors. The latter finding does not, however, preclude more such problems in the acute stage, since the present study neither addresses the pre-discharge period, nor includes information about mortality. Finally, the ASIA/IMSOP Impairment Scale Grade E-rated subjects were found to report problems to an extent that underlines the restricted sensorimotor sense in which this rating reflects recovery.
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PMID:The Stockholm Spinal Cord Injury Study: 2. Associations between clinical patient characteristics and post-acute medical problems. 884 13

Twenty-five patients underwent an expansive cervical laminoplasty for nontraumatic cervical spondylosis with myelopathy during the period from June 1990 to November 1994, and all had a minimum of 18 months of follow-up review. The open-door laminoplasty procedure presently reported consisted of the same approach evaluated by Hirabayashi in 1977, except that the authors of this report used three rib allografts to anchor the "open door," rather than spinous process sutures or autologous bone grafts. Posterior foraminotomies and decompression were performed in patients with clinical radiculopathy and radiographic evidence of foraminal stenosis. Preoperatively, gait disturbance was present in all patients. All 25 patients (100%) had long-tract signs on presentation. Nondermatomal upper-extremity symptoms (numbness, tingling, weakness, and pain) were quite common in this group of patients. Bowel, bladder, and/or sexual dysfunction was found in 13 (52%) of 25 patients. Preoperative radiographic studies showed a mean midline anteroposterior diameter spinal canal/vertebral body (SC/VB) ratio of 0.623 and a mean compression ratio (sagittal/lateral diameter ratio x 100%) of 37%. This procedure was quite successful in relieving preoperative symptoms and few complications occurred. Gait disturbance was improved in 21 (84%) of 25 patients and hand numbness and tingling were improved in 13 (87%) of 15 patients. Bowel or bladder function improved in 10 (77%) of 13 patients. Radiculopathy, when present, was alleviated in all four patients after the decompressive procedure. The postoperative SC/VB ratio, as measured by plain lateral radiographs and/or computerized tomography scans, was improved to 0.871, a 38% improvement. In a comparison with the preoperative SC/VB ratio using the two-tailed t-test, alpha was less than 0.001. The compression ratio improved to 63% postoperatively, which yielded an alpha of less than 0.005 according to the two-tailed t-test. Only one postoperative complication, an anterior scalene syndrome, was encountered. Various predictors of surgical outcome based on gait improvement were evaluated. Age greater than 60 years at the time of presentation, duration of symptoms more than 18 months prior to surgery, preoperative bowel or bladder dysfunction, and lower-extremity dysfunction were found to be associated with poorer surgical outcome. Even when these conditions were present, gait improvement was noted in at least 70% of the patients.
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PMID:Modified open-door cervical expansive laminoplasty for spondylotic myelopathy: operative technique, outcome, and predictors for gait improvement. 898 83


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