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

Chronic pancreatitis was a recognized clinical entity in the British Isles at the beginning of the twentieth century, but until little more than 30 years ago, it was considered to be a rare condition and received scant attention from British surgeons. During the second half of the twentieth century, the incidence of the disease in the British Isles has increased significantly and alcohol abuse has become, by far, the most important etiological factor. Per capita consumption of alcohol in the British Isles has increased very markedly in the past 30 years and alcohol abuse is becoming a major social problem, but, although chronic pancreatitis is more common now than it was 30 years ago, the increase in its incidence is a good deal less than might be expected. British surgeons are agreed that intractable pain is the cardinal indication for surgical intervention in chronic pancreatitis and success depends on selection of the operative procedure most appropriate to the pathological state of the pancreas and, in particular, of its ductal system. In recent years, British surgeons in highly specialized units have become more radical in their approach to the treatment of chronic pancreatitis with total pancreatectomy in selected patients currently being advised more frequently than in previous decades.
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PMID:Observations and surgical management of chronic pancreatitis in the British Isles: a review of the twentieth century. 240 34

Recent longitudinal studies have improved the knowledge of the natural history of chronic pancreatitis. This disease is mainly induced by alcohol abuse. Mean age at onset of the disease is 40 years. First symptoms are generally pain, often related to acute pancreatitis. Over the first five years of course, complications as pseudocysts or common bile duct stenoses can occur, often necessitating surgical treatment. In the late course, the disease becomes less symptomatic but the risk of diabetes mellitus increases. Occurrence of pancreatic calcifications is observed with time in the majority of patients. Chronic pancreatitis is associated with overmortality but the causes of death are mainly extrapancreatic (alcoholic liver disease and cancers). Abnormalities of pancreatic secretion induced by alcohol abuse play an important role in the pathophysiology of the disease: it is possible that the decrease of concentration of the "pancreatic stone protein" promotes formation of calcifications. Direct toxicity of alcohol is another possible factor.
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PMID:[The natural history and physiopathology of chronic pancreatitis]. 248 15

This study was performed to ascertain the role of serum markers and simple clinical data in detecting pancreatic cancer and in distinguishing this malignancy from chronic pancreatitis and other gastrointestinal diseases. Serum CA 19-9, tissue polypeptide antigen and carcinoembryonic antigen were measured in 38 control subjects, 37 patients with pancreatic cancer, 39 with chronic pancreatitis and 44 with extra-pancreatic diseases mainly of gastrointestinal origin. Clinical data recorded included age, sex, presence of pancreatic calcifications, weight loss, pain, jaundice, alcohol abuse, diabetes mellitus. Serum markers gave a correct allocation of the subjects in 48.1% of the cases with pancreatic cancer patients correctly predicted in 62.2%. Clinical data correctly diagnosed 74.2% of subjects. Chronic pancreatitis was identified in 84.6% of the cases and pancreatic cancer in 64.9%. The first clinical variables selected were pain and age. The addition of serum markers to clinical data did not enhance accuracy of the results. We conclude that the diagnosis of chronic pancreatic diseases should first be suspected on the basis of accurately recorded simple clinical data; serum markers seem to be only occasionally useful. Since indicative clinical data and serum markers become positive in the advanced phases of pancreatic cancer, early diagnosis of this malignancy still remains an objective to reach.
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PMID:[Role of serum markers and or various clinical parameters in the diagnosis of pancreatic carcinoma]. 248 91

Fifty patients with arachnoiditis were studied, and long-term follow-up ranging from 10 to 21 years was obtained on 36 (72%). Prior to developing arachnoiditis, 90% originally had intervertebral disc disease, Pantopaque (Alcon Surgical, Ft. Worth, Texas) myelography, and subsequent lumbar spine surgery. Pain and functional disability tended to remain the same as at the time of diagnosis, although severity of symptoms fluctuated. Increased neurologic deficits were more frequently due to surgical intervention than to the natural course of the disease. Urinary symptoms characterized by urgency, frequency, and occasional incontinence, with no other apparent cause, developed late in 23%. Although the majority were able to walk and drive a car without limitation, ability to return to previous full-time occupations was markedly limited. The majority depended on daily narcotic analgesics; a few admitted to alcohol abuse. There were two deaths by suicide. Although other deaths were not directly related to arachnoiditis, the average lifespan was shortened by 12 years. Treatment results were disappointing. Arachnoiditis may be disabling; however, longterm follow-up indicates that progression of symptoms and functional impairment are not the natural course of the disease.
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PMID:The long-range prognosis of arachnoiditis. 261 63

Deliberate self-lacerations by rebellious or delinquent adolescent girls, known by them as "carving," may be erroneously diagnosed as a suicide gesture. Carving is an important physical sign suggesting possible drug and alcohol abuse during adolescence. Eighty-five adolescent female patients in a long-term outpatient, self-payment, therapeutic community-type of adolescent drug treatment program, participated in a descriptive survey of "carving" behaviors. Forty-one girls (48%) admitted to deliberate cutting of their own wrists, arms, or other body parts without suicidal intent. Fifteen of the 85 girls (18%) cut themselves six or more times. Many girls had scarified their bodies with their boyfriends' initials as a visible means of demonstrating their affection and loyalty. They also carved rock group symbols or a Christian cross. Large and disfiguring scars were noted on 14 patients. The girls explained the behavior as a method of dealing with depressed affect, anger, emotional pain, or emptiness. Suicide attempts, usually by purposeful overdose of medication, had been made by 24 (59%) of 41 girls who carved themselves. Multiple suicide attempts were associated with habitual carving. Epidemics of carving, led by one or more angry, depressed, or lonely adolescents, may occur in closed facilities such as correctional institutions and drug abuse treatment facilities.
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PMID:Self-harm behaviors (carving) in female adolescent drug abusers. 278 59

Pain drawings were obtained from two groups of patients and one of nonpatients, in a total of 264 subjects, all suffering from back pain. The pain drawings were rated in four grades according to the degree of nonorganic and extended pain. The reliability was excellent with an intra- and interrater agreement of 80 and 70%, respectively. Three quarters of the nonpatient group had dull aching pain in the lower back only, whereas widespread or nonanatomical pain was prevalent in patients responding poorly to treatment. A correlation was also found to ethnic background and social situation but not to alcohol abuse or psychiatric illness. Pain drawings afford an important clue to nonorganic factors in the assessment of back pain.
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PMID:Pain drawings in chronic back pain. 297 Jan 23

Between 1966 and 1985, 994 patients with chronic pancreatitis were treated at a University Surgical Department, 346 by drainage or diversion procedure, 339 by resection and 309 conservatively. The most frequent non-resecting procedures were: pancreatic pseudocyst drainage in 146, biliary-digestive tract anastomosis in 80, gastro-enterostomy in 15, biliary-tract revision in 58 and pancreatic duct drainage in 7 patients. More than half the patients had previously been operated on at least once. Overall postoperative death rate was 6.6%. Of those operated on up to 1983, whose subsequent course was analysed retrospectively, 16% had died (mean observation period 4.6 years). As many as 29% of patients had further bouts of pancreatitis. Weight remained steady or increased in 82%, the number of those with diabetes increased by 6%. All but 12% remained free of pain postoperatively or had only minor and occasional symptoms. Alcohol abuse decreased markedly. If alcohol consumption remained moderate (less than 50 g daily), late mortality rate was definitely decreased. Drainage or diversion procedures and pancreas resection are not competitive but complementary methods in chronic pancreatitis. Imaging techniques have helped the trend towards more conservative management.
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PMID:[Surgery in chronic pancreatitis. II. Late results following non-resection operations]. 310 63

Misoprostol, a synthetic methyl ester analogue of prostaglandin E1 (PGE1) is both a powerful inhibitor of gastric secretion and is able to protect the gastroduodenal mucosa from damage produced by alcohol, aspirin, naproxen and tolmetin. The results of 12 double-blind, randomized, placebo- and cimetidine-controlled trials involving 4000 patients have been reviewed here and show that misoprostol, given in a dosage of 800 micrograms daily in two or four divided doses, is able to produce rates of complete ulcer healing and pain relief in both gastric and duodenal ulcer which are significantly superior to placebo therapy and comparable to those achieved with high or conventional doses of cimetidine. One further large trial has shown that misoprostol is able to heal a significant proportion of duodenal ulcers refractory to treatment with H2 receptor antagonists. In the compromised patient, two trials have suggested that misoprostol is able to abolish the adverse effects of smoking on duodenal ulcer, although this effect was not apparent in the gastric ulcer trials or in other duodenal ulcer trials. Similarly, while in volunteers pretreatment with misoprostol is able to protect the gastric mucosa from alcohol damage, there is little clinical evidence to support improved ulcer healing in the patient who abuses alcohol. Further studies in these areas should be conducted. Misoprostol could well have an important role to play in the protection of the gastroduodenal mucosa from damage produced by non-steroidal anti-inflammatory drugs (NSAIDs) in arthritic patients compelled to take these drugs for long periods. A series of double-blind placebo-controlled trials in healthy volunteers have shown that pretreatment with, or simultaneous administration of, 800 micrograms daily of misoprostol, reduces significantly mucosal damage produced by aspirin, tolmetin and naproxen. Two controlled clinical trials in a large number of arthritic patients have shown firstly, that misoprostol 800 micrograms daily is able to reduce significantly aspirin-induced mucosal bleeding as compared with placebo and secondly, in an endoscopically, placebo-controlled trial that it reduced significantly the frequency and severity of aspirin-induced mucosal lesions, accelerated the healing of erosions and ulcers and in other patients was able to protect the undamaged mucosa from injury. Misoprostol is well tolerated--a dose related, usually self limiting, diarrhoea occurred in a small proportion of patients but only rarely enforced withdrawal. Because of its uterotropic effects misoprostol should not be given to women of child bearing age unless they are taking adequate contraceptive measures. It has no other systemic effects and no clinically significant adverse haematology or biochemical abnormalities, or drug interactions have been reported. It does not seem to induce hypergastrinaemia. Misoprostol is, therefore, a safe and effective drug in the treatment of chronic peptic ulcer and could have a beneficial action in duodenal ulcers refractory to treatment with H2-receptor antagonists. It could benefit compromised groups of ulcer patients who are smokers or alcohol users amd certainly has been shown to protect the gastroduodenal mucosa against damage induced by NSAIDs in healthy volunteers and arthritic patients.
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PMID:The therapeutic efficacy of misoprostol in peptic ulcer disease. 313 82

Lead poisoning is uncommon in the adult population, but must be considered in the differential diagnosis of patients with abdominal pain of obscure etiology. In this paper we present a 38-yr-old male with abdominal pain, a history of alcohol abuse, and exposure to the virus responsible for acquired immunodeficiency syndrome. The cause of pain was elusive until his occupation as a housepainter was appreciated. The diagnosis of lead poisoning then was considered and confirmed by an elevated blood lead level and symptomatic response to therapy. With the increase in renovation of old buildings, it is likely that the incidence of lead poisoning will become more common.
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PMID:Inorganic lead poisoning in an adult. 336 17

The management of pancreatic pain is a controversial subject and the treatment recommended varies from one extreme to the other. Some authorities advise simply waiting for chronic pancreatitis to 'burn out', while others practise removal of the entire gland. In this paper we present 141 patients who underwent surgery for chronic pancreatitis at the Mayo Clinic. The main indication for operation was pancreatic pain and the choice of operation was based on anatomical abnormalities in the gland. The long-term results of the policy are reviewed (mean follow-up 8.5 years). Length of history, aetiology of disease, pancreatic dysfunction and pathology, time after operation and continued alcohol abuse were computer analysed for a statistically significant influence on pain relief, ability to work, pancreatic function and survival. There was one operative death (mortality rate 0.7 per cent). Continued drinking was not shown to affect postoperative pain relief but 10-year survival was significantly less in alcoholics than in those with non-alcoholic pancreatitis (P less than 0.02). Dilated ducts and duct calculi were associated with good results for pain relief although this association did not achieve statistical significance. Parenchymal calcification and time after operation did not influence the results of surgery. When the operation failed to relieve pain, spontaneous remission occurred in a few cases only. Seventy-seven per cent of patients had lasting relief of pain and operations selected on the basis of gross pathology were equally effective in relieving pain. Longitudinal pancreaticojejunostomy in those with dilated ducts and a Whipple operation for disease of the pancreatic head gave good results.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Surgical management of chronic pancreatitis: long-term results in 141 patients. 339 Jun 81


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