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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 (ADPKD) is an important cause of medical morbidity in the United States that affects one-half million persons and accounts for ESRD in about 10% of the chronic dialysis population. In addition to its effects on the kidney, the disease has important manifestations in the cardiovascular system (aneurysms, hypertension) and the gastrointestinal tract (hepatic cysts). Clinically important renal complications can develop as the disease progresses that require specialized attention, such as urinary tract infection, pain, and nephrolithiasis. The underlying cellular defect that causes ADPKD has eluded investigators thus far, but abnormalities in cellular proliferation, the tubular basement membrane, and cell fluid secretion appear important in pathogenesis. Factors that mediate progressive interstitial fibrosis and failure of renal function are undefined, although rigorous control of blood pressure appears to be an important therapeutic measure. Recent advances in molecular biology have localized the abnormal gene to chromosome 16 in 90% of families, making early genetic screening of asymptomatic family members possible in many cases. A positive diagnosis may have important effects on employment status, as well as health insurance, so that family members sometimes refuse to be assessed for the presence of the disease. Because of such complex social factors, counseling of an asymptomatic individual by his or her physician is required when considering the use of screening tests for ADPKD. Inadequate patient education may still represent an impediment to early detection, genetic counseling, and timely treatment of disease complications.
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PMID:Autosomal dominant polycystic kidney disease. 849 Jan 15

One hundred and four dogs with clinical signs of urinary tract infection were selected by 15 practitioners in a multicentric, controlled and randomised study. The clinical diagnosis was confirmed by urinalysis and imaging. Each dog received either marbofloxacin (2 mg/kg orally once daily or 4 mg/kg by subcutaneous injection every four days) or amoxicillin-clavulanic acid tablets (12.5 mg/kg twice daily) for 10 or 28 days, depending on the clinical diagnosis. Rectal temperature, general condition, appetite, urinary signs, defecation disorders and pain on abdominal palpation were monitored at each visit, the timetable depending on diagnosis: three urinalyses and at least three examinations per case were performed. Side effects were also thoroughly sought at each examination. Marbofloxacin and amoxicillin-clavulanic acid both yielded good bacteriological cure rates (96.2 per cent versus 85.0 per cent, respectively) and clinical cure rates (83.3 per cent versus 69.7 per cent). Fewer relapses were observed in those dogs that received marbofloxacin. Few mild side effects were recorded with both products.
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PMID:Comparative study of marbofloxacin and amoxicillin-clavulanic acid in the treatment of urinary tract infections in dogs. 855 66

Postoperative micturition difficulties, considered as minor complications, have a high incidence. Acute urinary retention can follow all types of anaesthetics or operations. Surgical trauma to the pelvic nerves or to the bladder, postoperative oedema around the bladder neck, and pain-induced reflex spasm of the external and internal urethral sphincters may play a role in the development of urinary retention. Acute urinary retention is the most common complication of surgery for benign anorectal disease. The incidence of urinary retention is more likely to occur in old male patients. Preoperative urinary symptoms are not a prerequisite for developing postoperative urinary retention, although they are considered to be a risk factor. The type of anaesthetic, postoperative pain and its management may have little effect on the occurrence of postoperative urinary dysfunction. Studies on the urodynamic effects of various anaesthetic agents are rare. The parasympatholytic drugs increase bladder capacity, decrease the rate of bladder contractions and cause downward trends in urethral resistance. The barbiturates and halothane produce similar effects on urethral resistance. The anaesthetic agents decrease the intrabladder pressure and inhibit the micturition reflex. Halothane decreases bladder contractions and increases its capacity measured by the cystometrogram. Urinary retention is a side effect of opioids, particularly after intrathecal or epidural administration. Epidural morphine relaxes the detrusor muscle with a corresponding increase in the maximal bladder capacity. Spinal opioids influence the function of the lower urinary tract, by direct spinal action on the sacral nociceptive neurons and autonomic fibres, as well as by an effect on supraspinal centres. Naloxone increases detrusor pressure, decreases bladder capacity, and causes a need to void. Urinary retention is less common after a short-acting (lidocaine 5%) than after a long-acting agent (bupivacaine 0.5%). After spinal anaesthesia, detrusor strength and the ability to void restarts with the return of sacral sensation to pinprick. A single episode of bladder overdistention can result in significant morbidity. Overfilling of the bladder can stretch and damage the detrusor muscle, leading to atony of the bladder wall, so that recovery of micturition may not occur when the bladder is emptied. On the other hand, the excessive use of an indwelling catheter can lead to urinary tract infection, urethral stricture and prolonged hospital stay. Short-term prophylactic catheterisation is recommended in patients with obstructive symptoms. Patients at risk for urinary retention should be stimulated to void and provided a quiet environment in which to do so. They should be encouraged to seat, stand or ambulate as early as possible. The alpha 1 adrenergic receptor blocking agents have been used for treatment of organic or functional urinary retention. It is essential to make sure the bladder empties regularly in the postoperative period, especially in day-case surgery or in patients receiving opioid analgesia or after epidural anaesthesia.
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PMID:[Effects of anesthesia on postoperative micturition and urinary retention]. 857 90

Common causes of acute scrotal pain include testicular torsion, epididymo-orchitis and trauma. Epididymitis in adult men is typically associated with a history of urinary tract infection or prostatitis. Testicular torsion typically presents in young adults with a sudden onset of severe scrotal pain and, frequently, a history of recurrent episodes that have spontaneously resolved. With scrotal trauma, ultrasound may demonstrate testicular fracture, hematoceles and areas of hemorrhage or testicular infarction. Since both epididymitis and testicular torsion present with scrotal pain and swelling, and may be accompanied by fever and pyuria, Doppler ultrasound or radionuclide imaging may be necessary to make the diagnosis. In acute testicular torsion, color Doppler ultrasound shows absent flow to the epididymis and testis, while nuclear imaging shows central photon-deficient areas in the ischemic hemiscrotum. In epididymo-orchitis, color Doppler ultrasound shows increased flow to the epididymis and testis, while nuclear imaging shows increased perfusion of the affected testis and hemiscrotum.
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PMID:Diagnostic imaging of patients with acute scrotal pain. 862 98

Despite much research on FUS, there still is no consensus regarding its cause, or even its definition. We recently have demonstrated that some cases of FUS are similar to interstitial cystitis in human beings. Exclusion of anatomic defects, behavior abnormalities, neoplasia, urolithiasis, urethral obstruction, and urinary tract infection leads one to the diagnosis of interstitial cystitis in cats. This diagnosis suggests the need for new approaches to treatment, including pain management and environmental modification.
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PMID:Interstitial cystitis in cats. 871 67

The experience with 14 patients affected of abscess of the psoas iliac muscle, attended at a general hospital through 1983-1995 is analized. This is a disease difficult to diagnose; it is usually diagnosed after a long delay (average of 45 days); it affects mainly women (rate F/M 11: 3), with a mean age in our patients of 50.4 years (14-79). The most frequent sign was fever (86% of the patients). Pain involving the thigh was present in 57%, and the psoas' sign in 36%. Even when this sign was present it did not always orient to the correct diagnosis. In two cases, the abscess was considered primary and in twelve it was associated to osteomyelitis, urinary tract infection or tumor (cancer of colon, metastasis in small bowell, melanoma and cancer of cervix). Gram smears and cultures of the material obtained by puncture were useful for detecting the causal germ, but blood cultures were inferior in yielding it (1 positive in 8 cases). Gram positive germs were predominant (Staphylococci coag. + in 4, Staph. coag.--in one, beta hemolytic Streptococci, 1). Gram negative germs were associated with urinary tract infections and staghorn lithiasis. In one case the etiology was TBC. Abdominal TAC was diagnostic when correlated with clinical data in 100% of the cases; ecography was diagnostic in only 2 of 11 cases. Patients were treated with antibiotics and percutaneous drainage; the only deaths occurred in patients with cancer.
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PMID:[Ileopsoas muscle abscess]. 893 63

The purpose of the study was to evaluate pyeloplasty a.m. Anderson-Hynes in the treatment of hydronephrosis in a large series of patients. In 175 patients, consecutively operated for ureteropelvic junction obstruction, we found 24 (14%) with minor postoperative complications, mostly urinary tract infection. Six patients (3%) were reoperated because of continued pain and obstructed drainage postoperatively. There was a small, but statistically significant increase in renal functional share on the operated side. We found a highly significant correlation between postoperative changes in total GFR and single kidney GFR on the operated side, which suggests a real improvement in renal function, rather than a simple reallocation of function between the two kidneys. We conclude that newer treatment modalities known as "minimally invasive surgery" must give comparably good results in order to be an acceptable alternative to traditional dismembered pyeloplasty.
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PMID:[Anderson-Hynes pyeloplasty in hydronephrosis]. 898 55

In countries where population-based data on health problems are scarce, the extent of reproductive morbidity can be estimated from replies in structured interviews as a complement or as an alternative to reports from physician's examination and laboratory tests. We examined the sensitivity and specificity of detected morbidity based on these replies as compared to medical diagnoses and explored the consistency of replies when the questionnaire was administered twice, by two types of interviewers in different environments. Data were collected in a cross-sectional survey in Istanbul. The presence or absence of five morbidities, reproductive and urinary tract infections (RTI and UTI), menstrual disorders, pelvic relaxation and anaemia was determined by algorithms based on the replies, and by the physician's diagnosis. Except with anaemia, questionnaire replies were more specific than sensitive in detecting morbidity, probably partly due to many morbid conditions being accepted as normal. Sepcificity exceeded 80% for home reports of menstrual disorders (93.0%), pelvic relaxation (95.7%), RTI (abnormal discharge and pain) (81.2%) and UTI (80.7%), with the corresponding figure for anaemia at 41.7%; the best sensitivity results were for anaemia (58.3%), RTI (abnormal discharge only) (49.3%) and menstrual disorders (45.4%) with figures for pelvic relaxation and UTI reaching only 17.3 and 13.0%. Reliability between the interviews (assessed by the K coefficient), was highest at 66.1% for pelvic relaxation and lowest at 39.9% for menstrual disorders. Reliability varied between the two lay interviewers, suggesting the interviewer and the interview conditions are important. Questionnaire-based information on this type of morbidity is most useful for ascertaining perceived ill-health and only of limited use for the corresponding medically defined conditions.
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PMID:Asking questions about women's reproductive health: validity and reliability of survey findings from Istanbul. 901 2

Reported is the case of a 17-year-old US boy who developed acute urinary retention due to severe urethral inflammation, secondary to absorbance of a nonoxynol-9-based contraceptive. He had a recent history of unprotected intercourse with his regular sex partner until she used, for the first time, a vaginal suppository containing nonoxynol-9. During intercourse on this occasion, the adolescent experienced severe burning pain in the urethra and was subsequently unable to void. He denied any prior history of urinary tract infection, sexually transmitted diseases, or urethral discharge prior to this episode. The only significant clinical findings at examination were an inflamed meatal mucosa and severe tenderness to palpation 2 cm proximal to the glans. Flexible cystourethroscopy revealed gross mucosal erythema and inflammation in the distal urethra and navicular fossa. A French Foley catheter was easily inserted into the bladder and 1000 cm of clear urine were drained. An indwelling catheter was kept in place for 48 hours until the patient voided successfully. This is the first reported case of severe urethritis and obstruction in a young male. In this case, urethral absorption of nonoxynol-9 caused a severe inflammatory reaction sufficient to obstruct the distal urethra. When evaluating young men with acute urinary retention, clinicians should inquire about recent use of contraceptive inserts.
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PMID:Acute urinary retention secondary to urethral inflammation from a vaginal contraceptive suppository in a 17-year-old boy. 909 78

The incidence and predisposing factors of urinary calculi are generally the same in both pregnant and non pregnant women, but anatomic changes during pregnancy make diagnosis and treatment a more challenging issue. We reviewed 16 patients (22 stones) of urinary stone during pregnancy between 1986 and 1996 at Kyung Hee Medical Center. The most common symptom was flank pain, seen in 81.3% of patients, while 68.8% of patients were displayed microscopic hematuria. In all cases, diagnosis was made by abdominal ultrasound, there was no need for other harmful investigate procedures. Forty point nine percent of the total stones (9/22) were passed spontaneously, double J stenting was carried out in three cases because of persistent pain or urinary tract infection (UTI), ureteroscopic stone removal was performed in one case. Based on our experience and a review of the literature, abdominal ultrasound should be performed first and in all cases appears sufficient for the diagnosis of a stone. In case of persistent pain or urinary tract infection, a double J stent is more effective than percutaneous nephrostomy.
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PMID:Management of urinary calculi in pregnant women. 914 58


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