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

In this paper we presented the different theories and opinions regarding the development of pain. After a very brief historical review including the ideas of Homer, Hippocrates, Aristoteles, St. Thomas Aquinas, we reviewed the 19th century's theories including Whytt, Brodie, Inman and Austie. From the modern period we emphasized the "gate theory" introduced originally by Melzack and Well. The psychological aspects has been also examined and the patient as "a dental patient" also described.
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PMID:[Pain. Evaluation of the developing pain theories. The psychological factor]. 213 Mar 28

Subacute osteomyelitis is a chronic low-grade infection of bone characterized by a lack of systemic manifestations. The onset is insidious. Pain is the most common symptom, and has usually been present for several months before the initial evaluation. Swelling and tenderness over the area of involved bone may also be seen. Laboratory evaluation is unrevealing, with a normal white blood cell count and differential. The erythrocyte sedimentation rate may also be normal. The most common organism cultured from a subacute osteomyelitis is a staphylococcus species. Twenty-five percent of subacute bone infections are sterile. The most common manifestation of a subacute osteomyelitis in a child is a geographic lytic metaphyseal lesion (Brodie's abscess). Treatment of a culture positive infection includes surgical debridement and antibiotic therapy. A sterile abscess can be treated conservatively without antibiotics, provided the patient's symptoms are improving and the lesion is regressing radiographically.
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PMID:Subacute osteomyelitis. 217 15

"Herniation pit" is a benign bone affection described first in 1982 by Michael J. Pitt et al. It is located typically in the proximal anterior and upper quadrant of the neck of the femur and develops as a result of the mechanical action of pressure of the adjacent articular capsule and synovialis. On the X-ray picture it is seen as a lighter spot which is relatively well defined, surrounded by a narrow margin of sclerotic bone; it is either round or oval and usually not more than 1 cm in diameter. In the authors' group of 100 patients selected at random from patients who had an X-ray picture of the hip joint taken during the last three years for different indications a herniation pit was found in six patients--4 women and 2 men. In one patient the finding was bilateral. This result is practically consistent with the 5% in the normal adult population, as reported in the world literature. In clinical practice the herniation pit is in the majority asymptomatic and is only an incidental finding during X-ray examination of patients with unexplained pain in the hip joint. Its importance is thus above all that it may be mistaken for other usually oncological bone affections such as osteoid, osteoma, Brodie's abscess, intraosseous ganglion or skeletal metastases of carcinoma.
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PMID:[Herniation pits]. 812 12

Two case histories are presented. In the first, a 49 year-old man fell on his right hip. He was able to walk, but because of pain he came to our emergency room. Radiographics gave an impression of an undislocated intertrochanteric fracture, scintigraphy confirmed the suspicion. There were no signs of infection. On starting osteosynthesis with the drilling of a hole in the lateral cortex, discharge of pus was observed and curettage of the abscess cavity was performed. In the second, a 21 year-old man hit his right knee against a table. Because of pain he was admitted to hospital. Primary signs of a lesion of the lateral meniscus were found and arthroscopy was scheduled. When readmitted we found signs of an infection and X-ray revealed a Brodie's abscess in the proximal tibia. The abscess cavity was opened and curettage was performed. Radiographics, scintigraphics, blood parameters and pathological and microbiological investigations revealed primary chronic osteomyelitis in both patients. Antibiotic therapy was instituted and six weeks after primary operation bone transplantation was performed. The further course was uncomplicated.
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PMID:[Brodie abscess. Primarily misinterpreted as traumatic lesion]. 855 90

A 42-year-old male patient presented with a history of persistent pain in the right femur without trauma of 2 months, duration and an episode of bloody stools 3 months earlier with no clinical findings upon examination. X-rays and CT scan revealed a circumscribed lesion with sclerosis and periostal reaction in the right proximal femur. A three-phase bone scan showed a massive hot spot in this area. Primarily differential diagnoses included a Brodie's abscess and/or a tumor. An excisional biopsy of the area was performed and revealed the coexistence of a bone infraction and the metastasis of an adenocarcinoma of unknown origin. The lesion in the bone was resected, filled with autogenous cancellous bone and stabilized with a plate. Further intensive screening with CT of the abdomen, gastroscopy and colonoscopy led to the primary tumor, an adenocarcinoma at the rectosigmoidal junction. No other metastases were detected. This patient presented with severe pain an radiologically divergent findings: a presumably benign process on radiography, but a massive hot spot on scintigraphy. Further procedures such as a CT scan and/or MRI had to be undertaken. If the analysis includes the differential diagnosis of a malignant process, a biopsy must be obtained, and if this reveals a metastasis, the primary tumor must be sought.
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PMID:[Coincidence of bone infarct and aggressive bone metastasis]. 913 57

The Royal College of Radiologists (RCR) has published guidelines concerning indications for imaging investigations. These include plain radiography of the knee, the indications for which are locking or signs of restricted movement. This audit consisted of 1153 knee radiographs in a 9 month period, results of a questionnaire sent to general practitioners (GPs), analysis of radiological reports and returned questionnaires (55% of cases), and subsequent comments from the GPs on receiving these results. Only 50% of cases fall within RCR guidelines, 90% of radiographs were normal or showed degenerative change. In 42% of cases, knee radiographs were requested to confirm previously expected degenerative change, and in 30% patient pressure was a significant factor. Most knee radiographs (87%) result in no significant change in management apart from continuation of symptomatic measures. Application of current guidelines, however, would miss some important diagnoses manifest clinically by persistent pain or effusion, for example loose body or Brodie's abscess. In cases of locking, where a radiograph may miss significant soft tissue abnormality, there was concern that reassurance was often gained by a normal examination. This audit shows that many knee radiographs are unnecessary. The guidelines appear appropriate with the proviso that persistent pain and effusion should be included as indications for investigation. Many GPs report medico-legal considerations as important reasons for unnecessary referrals, although the application of guidelines should be protection against this. The referral rate for knee radiographs before and after the communication of these results has not altered.
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PMID:An audit of knee radiographs performed for general practitioners. 916 50

We present a case of a 13 year old girl with swelling and pain of the right lower leg persisting for four months. The radiological and histological diagnosis is osteofibrous dysplasia. Osteofibrous dysplasia is a rare bone lesion predominantly affecting the cortex of the tibia. Almost all patients are younger than ten years at presentation. Swelling is a typical clinical manifestation. Radiologically and even histologically the distinction between the osteofibrous dysplasia and the more aggressive adamantinoma can be difficult. Other bone lesions potentially mimicking osteofibrous dysplasia include: fibrous dysplasia, osteoid osteoma, osteosarcoma, osteoblastoma and intracortical Brodie's abcess. The natural course of the disease is unpredictable. Lesions with typical radiological appearance are considered to be "no touch lesions". In equivocal cases block resection (with both a diagnostic and therapeutic purpose) should be performed.
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PMID:[Osteofibrous dysplasia and its differential diagnosis]. 1056 55

The authors describe a juvenile patient with an osteoid osteoma in the foot-a relatively rare location for this type of lesion. The appearance of this lesion in a juxtaarticular location is even more rare. An 11-year-old boy with a 6-month history of limping secondary to subtalar joint pain presented with a juxtaarticular osteoid osteoma located within the calcaneus. The lesion was present beneath the sinus tarsi and the subtalar joint region. Plain radiographs showed equivocal changes; however, magnetic resonance imaging clearly showed a central nidus. The lateral aspect and midbody of the calcaneus showed a spherical focus of diminished signal on both the T1- and T2-weighted images. This focus had a surrounding rim of significantly diminished signal on all sequences. Thus, findings were most consistent with an osteoid osteoma, although a Brodie abscess could not be ruled out. Surgical excision was performed and led to complete resolution of pain and limping. The pathology report confirmed the diagnosis of osteoid osteoma.
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PMID:Osteoid osteoma causing subtalar joint arthralgia: a case report. 1270 Oct 77

Brodie abscess is a rare, localized type of subacute or chronic pyogenic osteomyelitis, usually of staphylococcal origin. Imaging with standard radiographs, bone scintigraphy, and MRI has been described in the literature. We present the case of a 28-year-old patient with pain in the right knee. Whole-body FDG-PET/CT scan showed a solitary FDG-active (SUV max 5.2) intracortical lesion in the meta-/epiphysis of the proximal tibia. CT demonstrated a sclerotic rim around the lesion. A Brodie abscess was considered a possible diagnosis. Multifocality could be excluded. CT-guided transosseous biopsy and curettage was performed and the diagnosis of a Brodie abscess was confirmed.
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PMID:PET/CT of a brodie abscess. 1655 16

Primary subacute osteomyelitis is difficult to diagnose, because of its insidious onset, mild symptoms, lack of a systemic reaction, and similarity with tumoral conditions. This condition is seen mostly in the epiphysis or metaphysis of tibia. Although it has been reported at various bones, its occurrence in the greater trochanter is rare. We describe two patients, 4 and 14 years old, with mild pain of the hip joint and limping without history of acute bone infection. Radiography showed a lytic lesion in the greater trochanter resembling Brodie abscess. Both patients were treated completely with antibiotics.
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PMID:Primary subacute osteomyelitis of the greater trochanter. 1719 65


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