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

Interstitial cystitis is a pathological condition whose symptoms mimic urinary tract infection and include urgency, frequency, and moderate to severe pain. Many more women than men are affected, with antibiotic therapy being the usual first treatment approach based on symptomology. Some clinicians believe that chronic antibiotic therapy may play an etiological role in interstitial cystitis; however neither clinical nor experimental data support their opinion. The implied pathogenesis of antibiotic injury is an alteration of the bladder mucosa and its protective mucin coating to allow urine-mediated damage to the bladder wall. The purpose of this study is to evaluate rabbit urinary bladder function and morphology during chronic nitrofurantoin administration. The results demonstrate that up to twelve months of chronic nitrofurantoin administration produce no changes in 1) bacterial adherence to the rabbit bladder mucosa, 2) specific antibacterial adherence activity of the bladder mucin, and 3) ultrastructure of the mucosa, submucosa, and muscularis.
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PMID:Effect of chronic nitrofurantoin on the rabbit urinary bladder. 327 30

Patients with acute suppurative thyroiditis usually have pain or tenderness in the anterior part of the neck associated with erythema and dysphagia. An elderly man with none of these symptoms presented with fever and a urinary tract infection. When his systemic infection failed to respond to antibiotics, a search for an occult abscess was undertaken. An 111Indium leukocyte scan indicated a localized abscess in the right lobe of his thyroid from which Escherichia coli and Staphylococcus aureus coagulase positive were isolated. This case demonstrates that a thyroid abscess can occur in a completely asymptomatic patient without a clinically enlarged thyroid.
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PMID:Combined Escherichia coli and Staphylococcus aureus thyroid abscess in an asymptomatic man. 327 9

The management of the patient presenting to the Emergency Department with nephrolithiasis or renal colic should include evaluation of the patient for concurrent diseases, risk factors for stone formation, and possible etiologies for stones. Suspicion of ureterolithiasis is based on a cogent history and physical examination and reinforced by a finding of hematuria. Diagnosis should be based upon a promptly performed intravenous pyelogram, unless the patient is truly allergic to contrast media or has substantial risk of a contrast-induced renal failure. A solitary flat plate of the abdomen adds no useful information and is an unnecessary expense to the patient. Essential laboratory data include a urinalysis, CBC, and electrolyte, BUN, creatinine, and serum calcium levels. A urine culture should be obtained in all patients because urinalysis alone may not be sufficient to exlude a urinary tract infection. Initial treatment of the patient with an uncomplicated renal colic should include hydration, relief of pain, and reassurance. Evaluation by a consultant may be done as an outpatient on a nonemergent basis. If the colic has not resolved after 72 hours, hospitalization generally is recommended. If the patient has vomiting, dehydration, a complete obstruction, or a solitary kidney, hospitalization in indicated and urgent consultation recommended. If the patient has fever or other signs of infection, emergent consultation and immediate hospitalization are essential. Retained obstructing stones are generally managed by urologic consultants. It is in the care of the patient with the retained stone that greatest advances have been made in the past 10 years. Patients should be counseled that the retained stone no longer calls for extended hospitalization and convalescence.
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PMID:Nephrolithiasis. 329 30

Gross haematuria is one of the most important symptoms in urology, as one of its causes is neoplasm of the urinary tract. The other important causes are urinary stones, urinary tract infection, which may be acute or chronic, trauma, and chronic haemorrhagic radiation cystitis. The differential diagnosis of gross haematuria depends on the age and sex of the patient, and the associated symptoms. The most important associated symptom is pain.
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PMID:Surgical causes of haematuria--the diagnostic approach. 331 52

Delay in appendectomy occurs from failure to contact a physician, or from a physician's failure to make a proper diagnosis. In our study delay was due to physician error in 32 of 422 children who had appendectomy. Symptoms consistent with appendicitis were documented on the initial visit in each case, but 22 patients had a history of previous similar pain or recent viral illness to confuse the diagnosis. Misdiagnosis was responsible for the delay in 14 cases (gastroenteritis in ten and urinary tract infection in four). Antibiotics given before proper diagnosis in 22 instances increased diagnostic difficulty in 20. Late referral is increasing, perhaps because of a perceived innocuous nature of appendicitis. Complicated appendicitis was found in 26 children (81%), compared with 38% of the total experience. Their hospital stay averaged nine days, as opposed to 6.6 days in the nondelayed group. Failure of resolution of symptoms after therapy begins mandates reassessment to avoid progression of this common surgical disease.
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PMID:Delayed diagnosis in pediatric appendicitis. 333 98

Ninety-one patients with idiopathic scoliosis, who underwent posterior spinal fusion and instrumentation from January 1977 to December 1982, were reviewed. All patients were 20 years or older at the time of surgery and none had undergone a prior surgical procedure. Indications for surgery included pain, progressive deformity, and pulmonary symptoms. All patients had a posterior spinal fusion with Harrington instrumentation and autogenous iliac bone graft, with the addition of segmental wiring in only eight. No patient had an anterior fusion or fusion to the sacrum. Follow-up averaged 3.5 years (range: 2-7 years). The average correction at the time of surgery was 38%, and 32% at the time of last follow-up. Seventy-nine percent of the patients reported complete relief of the symptom(s) for which they had surgery. There were 34 complications in 30 (33%) patients. Pseudarthrosis occurred in 14 (15%), requiring 15 additional procedures to achieve a solid arthrodesis. Urinary tract infection occurred in 8 (9%) patients and Harrington hook dislodgement in 5 (5%). One patient sustained a partial paraparesis with recovery to a minimal deficit. No deaths occurred. Although largely successful, posterior fusion with Harrington instrumentation for adult scoliosis has a significant incidence of pseudarthrosis and instrumentation problems.
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PMID:Adult idiopathic scoliosis treated by posterior spinal fusion and Harrington instrumentation. 355 57

Between 1973 and 1983, 27 patients with acute femoral neck fractures were treated at the UCLA Medical Center with total hip arthroplasty. These cases were selected on the basis of age, high activity level, and degenerative changes in the acetabular cartilage. The average age was 72 years. There were 19 women and eight men. The average follow-up period was 3.8 years with a range of one to ten years. Methods used included analysis of clinical data, roentgenograms, final pain ratings, walking ratings, and activity levels using the UCLA rating system. Pain relief and overall functional results were better than that of most series of acute femoral neck fractures treated with hemiarthroplasty and similar to that of total hip arthroplasty series. The complication rate was slightly less than both authors' elective total hip series, and considerably less than most hemiarthroplasty series. Complications included a superficial wound infection, a urinary tract infection, and a perforated colon diverticulum. Four patients died within one year from causes unrelated to the hip arthroplasty. There were no deep infections, dislocations, or reoperations. Total hip arthroplasty in selective cases of acute femoral neck fractures can give more consistent pain relief and better functional results than hemiarthroplasty, without an increase in complications.
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PMID:Treatment of acute femoral neck fractures with total hip arthroplasty. 356 98

84 patients with 126 megaureteres, are studied. There are some clinical differences depending on the type of megaureter and the patient's age. The number of asymptomatic cases is increasing due to ultrasonography during fetal and neonatal period. The younger the patient the more unspecific the symptomatology. Fever, anorexia, failure to gain weight and vomits are the most frequent symptoms in babies. In patients over 6 years of age a more specific symptomatology is present, such as dysuria and lumbar pain. Failure to gain weight is more frequent in cases of refluxing megaureter, especially when they are caused by obstructive uropathy, and when they are bilateral. A urological check up is recommended during fetal ultrasonography: in babies with failure to thrive; in all cases of urinary tract infection; and in micturition disorders.
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PMID:[Clinical aspects of infantile megaureter]. 360 79

The characteristics features of right-sided endocarditis are summarized in this case report of a 30-year-old female admitted with a history of high grade, continuous, fever, breathlessness, and dry cough over a 10-day period. The patient had had an incomplete abortion 15 days earlier for which dilatation and curettage was performed. On examination, the patient was toxic, febrile with a pulse of 118/minute and respiration 36/minute. Her blood pressure was 110/70 mm Hg. There was soft, tender hepatomegaly and soft splenomegely. There also were scattered coarse crepitations over both lungs. The vaginal examination revealed posterior fornicial bogginess and tenderness. Urine and cervical pus swab showed growth of klebsiella. The blood culture was negative. A plan chest X-ray revealed multiple, small, basal, pulmonary infiltrates. Posterior colopuncture revealed a small quantity of clear, yellowish fluid. Abdominopelvic ultrasonography revealed an ill-defined haziness in the parauterine region. The patient was treated with ampicillin, gentamycin, and metronidazole, but she continued to deteriorate. An urgent exploratory laparotomy was performed. The patient died on the 2nd postoperative day. The autopsy findings revealed that the heart was normal in size and shape. The tricuspid valve showed a large vegetation projecting into the ventricle. Microscopic examination revealed polymorphonuclear infiltration with clumps of gram-negative bacillifocal areas of myocarditis also were seen. In lungs the right lower lobe showed a small, hemorrhagic infarct. Both the liver and spleen were congested. Kidneys showed multiple petechiae on the external surface and on the cut section. Endocarditis during pregnancy may be because of perinatal infections, urinary tract infection, or septic thrombophlebitis of pelvi veins. Septic abortion of pelvic infection secondary to IUD also can provide portal of entry for bacteria. The common organisms are streptococcus, staphylococci, and occasionally bacteroides and gram negative bacilli. Clinical suspicion of right-sided endocarditis is justified in any patient with prolonged fever, cough, pleuritic pain, tachycardia, and multiple pulmonary infiltrates. Heart murmurs are usually absent and if present are soft and may be heard at atypical sites.
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PMID:Tricuspid valve endocarditis following septic abortion. 371 Oct 12

During the period between February 1970 and December 1973, 149 Charnley total hip arthroplasties were performed at UCLA Medical Center. Fifty-seven percent have a follow-up period of at least four years, and 21% have a follow-up period of ten years or more. The peri- and postoperative complication rate was high, with an incidence of 32.6% urinary tract infection (UTI), 4% peroneal nerve palsy, 4% cardiopulmonary, 2% pulmonary embolism, 1.3% myocardial infarction, and 6.0% other. Eleven patients (7.3%) required revision at a mean of 75 months after operation, while an additional three patients were experiencing substantial pain. Clinical improvement after this procedure is similar to that reported by other authors. Survivorship analysis suggests that being young and/or having a diagnosis of osteonecrosis or failed hemiarthroplasty places a patient at a higher risk of failure due to revision surgery or pain.
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PMID:The UCLA Charnley experience: a long-term follow-up study using survival analysis. 376 57


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