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

Conditions in the dancer's forefoot can be divided into five categories. Part II of our study presents two categories: acute conditions of the forefoot and conditions which masquerade as forefoot problems. Five hundred dancers were studied. Of those, some had conditions including muscle spasm, soft tissue trauma, fractures, dislocations, and abscesses, and were treated accordingly. The general health of the dancer was an important factor in treatment as well as difficulty in diagnosing the injury. Prolonged periods of healing were expected but did not prevent the return to dance class and rehearsal. The highly motivated, goal-oriented dancer often did not complain of systemic disease or pain and this prevented diagnosis until triggering tendons or muscle paralysis made it obvious. Such a sequence gave rise to prolonged convalescence or termination of the dancer's career.
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PMID:Forefoot conditions in dancers: part II. 714 60

Pain originating from ophthalmic disease has been well documented. A series of patients presenting with eye or periorbital pain attributed to cervical region dysfunction were diagnosed and treated with injections of subcutaneous lidocaine followed by triamcinolone acetonide. Twelve patients, 11 women and 1 man, ranging in age from 20 to 82 years had an evaluation including a complete eye examination, and laboratory tests and neuroimaging as dictated by the history to exclude structural abnormalities or systemic disease. All patients had marked focal suboccipital tenderness ipsilateral to the side of their headache and eye pain. A subcutaneous injection with 2% lidocaine followed by triamcinolone acetonide 40 mg was administered directly to the site of focal tenderness. After injection, five patients described total relief of pain, five patients described some degree of pain relief, and two patients had no relief of headache. Duration of pain relief ranged from several hours to 3 months. Patients may present with periorbital or eye pain as a result of disease affecting the cervical sensory roots with subsequent stimulation of the trigeminal apparatus. Subcutaneous injection of lidocaine and triamcinolone acetonide may be of help in the diagnosis of these patients and provide temporary relief.
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PMID:Referred ocular pain relieved by suboccipital injection. 767 65

The decision to perform surgical versus nonoperative palliation for unresectable pancreatic cancer is influenced by a number of factors. In most cases, patient symptoms clearly dictate the management. In patients with symptoms of duodenal obstruction at the time of presentation, surgery is the only option. In patients with obstructive jaundice alone, the options for management must be weighed against factors such as overall health status, projected survival, and procedure-related morbidity and mortality. A prospective multicenter trial recently analyzed factors influencing perioperative morbidity and mortality following both curative and palliative surgery for pancreatic cancer. This analysis demonstrated that preoperative diabetes, low Kanofsky's index, and liver metastases are significant risk factors in predicting perioperative morbidity and mortality in patients undergoing palliative procedures for pancreatic cancer. Another analysis focusing on tumor characteristics suggested that for patients with Stage I and Stage II disease (i.e., with no evidence of systemic metastases), survival and the potential for late duodenal obstruction favor surgical management. In summary, although patient management must be individualized, most patients with pancreatic cancer in good medical health and with no evidence of systemic disease are most appropriately managed with surgical palliation. This option affords patients the best chance of avoiding the late complications of recurrent jaundice, duodenal obstruction, and disabling pain. Surgical palliation can generally be completed with an acceptable perioperative morbidity and mortality and a hospital stay of approximately 2 weeks. Finally, only surgical exploration can offer full opportunity for resection for cure.
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PMID:Surgical palliation of unresectable pancreatic carcinoma. 754 19

Osteoarthritis OA is a disorder that confines itself to affected joints; however, impairment, functional limitation, and disability related to OA can reach far beyond the perimeters of articular cartilage and subchondral bone. OA often is compared to other arthritides and defined by what it is not: OA is not a systemic disease; OA is not a disease of primary inflammation; OA is not life threatening. Too often OA also has been considered not interesting, not important, and not responsive to conservative treatment. However, reports documenting the personal and socioeconomic impact of OA are increasing recognition of its importance [1] and recent advances in understanding its pathogenesis are stimulating research [2]. OA is characterized by specific changes in articular cartilage and subchondral bone. Cartilage shows fibrillations, increased water content, and loss of integrity. Underlying bone is less compliant and may exhibit microfractures, sclerosis, and osteophytes at joint margins [3]. These changes result in increased friction, decreased shock absorption, and greater impact loading of the joint. The traditional view of OA is that the disease process starts with an unrepaired injury to articular cartilage. There is also evidence, however, that reduced compliance in bone and periarticular structures may initiate degenerative processes [4,5]. Although radiographic evidence of joint space narrowing and osteophytes may help confirm a diagnosis of OA, the clinical criteria for classification and reporting of hip and knee OA are described in terms of pain and limitation of motion [6,7] Table 1. Radiographic and laboratory data add little to the accuracy of these criteria [6]. Moreover, there is no clear association between radiographic findings and function or pain [8].(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Exercise in the management of osteoarthritis of the knee and hip. 773 78

Many cases of work related compression neuropathy of the ulnar and median nerves at the wrist have been described. This report presents a case of bilateral distal neuropathy of the median and ulnar nerves in a parquet floorer, who laid wooden block flooring by hand and used the palms and volar surface of both hands to hit the blocks into place. He also used an electric sander and polisher. Bilateral numbness and paraesthesias in all fingers had been present for about one year. Clinical examination was normal; the neurological assessment indicated slight impairment in response to tactile, heat, and pain stimuli in all 10 fingers. Electroneurography showed increased distal motor latencies of median and ulnar nerves at both wrists, although the lower limbs were normal. The results of blood, urine, and instrumental tests excluded systemic disease or local factors that could cause compression neuropathy. After stopping work for three months, the clinical picture and electroneurographic results improved. These data support the hypothesis that the damage to the median and ulnar nerves had been caused by the patient's way of working, which provoked repeated bilateral microtrauma to his wrists. To diagnose work related multiple neuropathy can be difficult and an accurate work history is necessary. Preventive measures and diligent health care are required for this category of worker.
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PMID:Bilateral median and ulnar neuropathy at the wrist in a parquet floorer. 773 96

Infectious arthritis is mostly caused by hematogenous spread of Gram-positive bacteria, which often infects a previously damaged joint. During the past 20 years there has been a notable increase in joint infections caused Gram-negative bacteria. They develop mostly in patients with systemic diseases, such as malignancy, cirrhosis or HIV infection, which cause an immune deficient state. We present an 84-year old man admitted because of fever and a diagnosis of pneumonia. During hospitalization he complained of pain in his right knee. On physical examination there was evidence of local inflammation. Infection with E. coli originating in the urinary tract was diagnosed, based on synovial fluid, blood and urine cultures. He was treated with antibiotics intravenously, the knee was surgically drained, and he was discharged 4 weeks after admission. There was no underlying systemic disease in this case that could have caused an immune deficient state, which could promote the Gram-negative joint infection. The case is presented to draw attention to the possibility of infectious arthritis in an elderly patient presenting with fever. In such cases the location of the infection may not be obvious if the infected joint is deeply located parts of bones such as those of the hip, shoulder, or vertebrae. In these cases the diagnosis may be overlooked or delayed and irreversible damage to the infected joint may result.
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PMID:[Bacterial arthritis with E. coli in an elderly patient]. 781 26

A 19 year old man presented with unilateral testicular swelling and pain. An initial diagnosis of epididymo-orchitis was modified to a presumed testicular neoplasm following ultrasonography. The final diagnosis of isolated testicular vasculitis was established following histological examination of the orchidectomy specimen. Staining for antineutrophil cytoplasmic antibodies was negative. Despite immunosuppressive treatment, the patient developed further symptoms affecting the remaining testis one year later. He responded well to an increase in immunosuppressive therapy and has remained asymptomatic 18 months from diagnosis. Symptomatic vasculitis confined to the testis is extremely rare, but must be considered in the differential diagnosis of testicular swelling and may be the presenting feature of a systemic vasculitis such as polyarteritis nodosa. The risk of progression to systemic disease in such cases is unknown. Immunosuppressive therapy must be considered carefully and long term follow up is important.
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PMID:Isolated testicular vasculitis mimicking a testicular neoplasm. 762 3

We report on the case of a 31-year-old male patient with focal testicular vasculitis as the only clinical manifestation of endangiitis obliterans (Winiwarter-Buerger disease), who presented with acute scrotal pain and swelling suggestive of a testicular tumor. Doppler sonography revealed significantly increased vascularization at the borders of the lesion, which rather indicated a vascular process; however, the presence of solid areas meant that the possibility of testicular cancer could not be excluded. Left inguinal orchiectomy was performed. The surgical specimen revealed histological patterns compatible with endangiitis obliterans; Raynaud phenomenon was the only sign of systemic disease, and no other organs were found to be affected. Despite the high sensitivity and specificity of ultrasound/Doppler sonography, in the differential diagnosis of an unexplained testicular mass surgical exploration is still mandatory. The different types of focal vasculitis are described and discussed with reference to the literature.
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PMID:[Focal necrotising vasculitis of the testis. Testicular manifestations of immunologic diseases in differential diagnosis of testicular cancer]. 794 Nov 80

For older patients with uveitis, defined as any inflammation of ocular structures--including the uvea--there are four typical etiologies: infection, "masquerade syndromes," systemic disease, and idiopathic. Uveitis is associated with a systemic cause in about 40% of cases. It manifests in a number of ways, but common symptoms include sudden onset of pain, redness, and sensitivity to light, chronic floaters, or a gradual decrease in vision. Diagnosis is aimed at finding an underlying cause. Depending on the symptoms, useful diagnostic tests include syphilis serology, chest x-ray, Lyme antibody titer, PPD skin test, and skin test for anergy. Treatment, including the use of corticosteroids or antibiotics, is based on the underlying etiology.
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PMID:Uveitis: role of the physician in treating systemic causes. 803 26

Myelopathy is a complex diagnostic problem with many possible causes. Diagnosis rests on recognition of a constellation of symptoms consistent with central nervous system pathology involving trunk, arms, and legs and, in general, sparing the head. Symptoms of cerebral and neuromuscular disease may mimic myelopathy and require brain imaging or electromyography. Pain, most commonly over the site of the lesion, is one of the cardinal complaints of patients with spinal cord disease. Complaints of motor abnormalities caused by myelopathy may include sudden weakness and paralysis, clumsiness, fatigability; sensory complaints such as paresthesias, numbness, deadness, dysesthesias, and bladder symptoms are also characteristic. General examination may point to systemic disease associated with myelopathy. Neurological examination excludes cerebral disease. Motor and sensory examination may define the level of the lesion. Physical examination localizes not only the level of the spinal cord lesion but the anatomic distribution of the lesion within a given level. When tumor or paraspinal infection are diagnostic possibilities, emergent imaging of the spine is required.
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PMID:The clinical diagnosis of myelopathy. 806 Jun 75


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