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

A case of haematogenous Serratia marcescens endophthalmitis in an HIV-infected intravenous drug addict is described. The patient was admitted with fever, ocular pain and visual loss in the right eye following an i.v. injection of pulverized buprenorphine. A vitreous humor culture grew S. marcescens. The patient was treated with i.v. ceftriaxone (2 g b. i. d.), i.v. amikacin (500 mg b. i. d.) and p. o. fosfomycin (1 g q. i. d.) for three weeks. The ocular infection was cured, although the visual function was lost, leading to blindness. To our knowledge, this is the second case in the reviewed Anglo Saxon literature of S. marcescens endophthalmitis in parenteral drug addicts.
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PMID:Haematogenous Serratia marcescens endophthalmitis in an HIV-infected intravenous drug addict. 217 36

A variety of rheumatologic disorders affect the elderly. Some of these problems are seen almost exclusively in the elderly, such as temporal arteritis and pseudogout. Because of underlying chronic diseases, these patients are also at increased risk for joint infection and resultant sepsis. Evaluation of synovial fluid from the inflamed joint is important. Light microscopy evaluation with a red polarizing compensator can help diagnose crystal-mediated disease, such as gout or pseudogout. Examination of Gram stains can help diagnose infectious arthritis. Thus, appropriate processing of synovial fluid is mandatory for the diagnosis of many rheumatologic disorders that occur in the elderly. A variety of metabolic disorders are associated with pseudogout and should be searched for on laboratory evaluation. Appropriate laboratory evaluation and follow-up following the acute episode are important in the care of these patients. For example, temporal arteritis with resultant blindness is a feared disorder in the elderly. Transient blindness, headaches, jaw claudication, and an elevated Westergren sedimentation rate suggest this diagnosis. Aches and pain in the neck and shoulder area, especially in the morning, are typical of polymyalgia rheumatica. Polymyalgia rheumatica may also be a symptom of temporal arteritis.
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PMID:Acute rheumatologic disorders in the elderly. 218 87

Carotid arterial disease may result in a variety of ischemic ocular problems that can eventually lead to permanent blindness. From 1984 to 1988, 18 patients underwent reconstruction of the carotid artery in an attempt to restore normal retinal arterial flow and, thereby, reverse or prevent progression of ischemic oculopathy. During a mean period of 21 months after carotid arterial reconstruction, subjective improvement in vision as well as a resolution in eye and periorbital pain was reported in 87.5 per cent of the patients. Measured visual acuity improved or stabilized in 94.4 per cent; macular photostress recovery times improved in 87.5 per cent, funduscopic examinations noted improvement or resolution in ischemic signs in 93.3 per cent and intraocular pressures improved in two of three patients. One patient experienced recurrent episodes of amaurosis fugax, which resolved after two weeks and did not recur. A second patient experienced an increase in intraocular pressures with visual deterioration, required laser photocoagulation after which the condition of the patient stabilized but only after significant visual impairment. Carotid arterial reconstruction is effective for the treatment of ischemic oculopathy and is most beneficial if performed early, before the onset of irreversible neovascular glaucoma.
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PMID:Carotid endarterectomy for chronic retinal ischemia. 224 84

In this double-blind trial in 70 athletes with superficial overuse injuries, the effect of topically and systemically administered indomethacin was compared with a placebo control. The treatment period was 2 weeks and blindness was secured by the double-dummy technique. The basic data of the patients showed no significant differences on entry to the study. The majority of cases were acute or subacute, the mean duration of symptoms being 7.4 weeks. The results showed a marked therapeutic effect after 3-7 days of treatment and statistically significant differences between the topical formulation and the placebo were reached in the parameters patients assessment of improvement and pain in connection with daily activity within the first week of treatment. However, during the second week the statistical significances were lost. Only in the topically treated patients local adverse reactions were observed. In the oral indomethacin group all reactions were systemic, GI- and CNS-complaints being predominant. The results on efficacy as well as adverse reactions favour the use of topical indomethacin in superficial overuse injuries in athletes.
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PMID:Topical indomethacin in overuse injuries in athletes. A randomized double-blind study comparing Elmetacin with oral indomethacin and placebo. 226 33

13 men and 27 women patients from an outpatient pain unit participated in the study. Blind to the research worker they were diagnosed by the responsible physicians as suffering from either primary somatic or secondary psychosomatic pain. The study explored whether manifest anxiety and number of primitive psychological defense signs could be used to classify patients into the two categories. Analysis indicated that with respect to manifest anxiety this was possible for the women but not for the men in that psychosomatic women exhibited raised manifest anxiety. Both men and women, diagnosed as psychosomatic, exhibited more primitive defense signs than patients diagnosed as somatic. Theoretical and clinical implications were discussed.
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PMID:Psychological defense mechanisms and manifest anxiety as indicators of secondary psychosomatic body pain. 238 18

A group of 159 dogs divided in 8 sub-groups were studied, in regard to pancreatitis, the purpose of the study was to investigate the participation of the automatic nervous system in the course of acute pancreatitis. The procedures and the results were as follows: 1. Pancreatitis was induced in two forms: a) Injection of gallbladder bile, from the same animal to the pancreatic duct. b) Blind duodenal loop with exclusion of the distal duodenum through the pylorus. In both cases acute pancreatitis was obtained. Fat necrosis was predominant in type a, and hemorrhagic lesions in type b. 2. The anesthetic block of the celiac plexus controlled the pain and shock. The animals were in good general conditions but there were no changes in the pathological process of the pancreas. The same results were noted in surgical resections of splanchnic trunks. 3. When the surgical resections of splanchnic nerves was followed by a waiting period of 20 days from the production of pancreatitis there were no changes in the gland. 5. Vagotomy previous to pancreatitis does not have protector effects in the induction of pancreatitis. 6. Continuous perfusion of E.V. novocaine was of extreme utility. The animals remained without pain and the process remained stable when it was given in the initial face of edema. 7. The enzyme inhibitor (Trasylol) given in the first 24 hs. does not prove to be valuable. Due to the fermentative derangement the condition of the animals was better maintained in relation to the comparative animals.
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PMID:[Acute pancreatitis. Neurovascular and microcirculatory changes. Pathogenic and therapeutic study]. 246 25

To develop a reliable experimental model of vascular headache, we studied the dose-response relationship between headache and i.v. nitroglycerin (NTG) in 10 healthy subjects. NTG was infused intravenously over periods of 10 min separated by wash-out periods. Doses of 0.25, 0.50, 1.00 and 2.00 micrograms/kg/min were applied successively with one placebo infusion and wash-out period inserted randomly and double blindly. The subjects scored their headache intensity on a scale 0-10. After 1-8 weeks a retest was performed. Nine subjects developed headache already at 0.25 microgram/kg/min, whereas one had no headache at any dose. Headache severity did not increase with doses above 0.5 microgram/kg/min. This ceiling effect was reproducible. The headache was moderate, usually throbbing, bifrontal and not associated with other migrainous features. It reached maximum within 2.5-5.5 min (medians) at various doses and declined rapidly after NTG discontinuation. Wash-out periods of 10-20 min were sufficient. The reproducibility of headache intensity and character was satisfactory in the retest experiment. There were no unpleasant side effects and no visible flushing. Thus blindness was maintained. I.v. NTG is suitable as an experimental headache model. A constant infusion of 0.5 microgram/kg/min will be suitable for studies of arterial diameter, pulsations, blood flow, etc. Comparative studies of sensitivity should use the present infusion schedule but with the two highest doses substituted by 0.06 and 0.125 microgram/kg/min.
Pain 1989 Jul
PMID:Intravenous nitroglycerin as an experimental model of vascular headache. Basic characteristics. 250 3

Nonspecific aortoarteritis is a systemic autoimmune disease eventuating in gradual stenosis of the aorta and the main vessels with ischemia of the respective organs. Ophthalmologic symptoms have been examined in 54 patients with nonspecific aortoarteritis. Subjective disorders of vision (short-term binocular blindness, metamorphopsia, pain behind the eye, amaurosis fugax) have been detected in 52% of the examinees. Organic lesions of the eye have been diagnosed in 60% of the patients: hypertensive angiopathy (22%), venous stasis retinopathy (17%), occlusion of the central retinal artery (1%), etc. Three possible mechanisms of the development of ocular symptoms have been established: (1) a result of symptomatic hypertension, (2) chronic ocular ischemia, (3) acute hemodynamic ocular circulation insufficiency.
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PMID:[Ophthamologic pathology in non-specific aortoarteritis]. 256 80

Direct surgery on aneurysms in the cavernous sinus is a formidable technical procedure. The intimate relationship of the intracavernous carotid artery to the venous structures and to the cranial nerves make surgical access difficult at best. Thirty-two of 356 aneurysm patients presented with symptomatic aneurysms originating from the intracavernous internal carotid artery. Twenty-one patients had aneurysms contained entirely within the cavernous sinus, and in 11 others the aneurysms arose within the cavernous sinus and extended into the subarachnoid space. Of the purely intracavernous aneurysms there were five small aneurysms (less than 25 mm) and 16 giant (greater than or equal to 25 mm) aneurysms. Fifteen patients with purely intracavernous lesions had a superior orbital fissure syndrome, and six had a variety of other symptoms. Of 11 patients with subarachnoid extension, five had a subarachnoid hemorrhage (Grade I or II), five had ipsilateral visual loss, and one had periorbital pain. The aneurysms were treated as follows: Group 1 received progressive ligation of the internal carotid artery in the neck with a Selverstone clamp and a surface superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis (purely intracavernous in nine, and with subarachnoid extension in one); Group 2 underwent trapping of the internal carotid artery and a deep STA-MCA anastomosis (purely intracavernous in seven); and Group 3 had direct clipping of the aneurysm (purely intracavernous in five, and with subarachnoid extension in 10). The cavernous sinus was entered directly through its roof by a pterional craniotomy with radical removal of the optic canal, lesser sphenoid wing, and lateral and superior orbital walls. Proximal control of the internal carotid artery was obtained through a cervical incision. Two patients in Group 1 developed transient neurological deficits, which resolved. Two patients in Group 2 developed a cerebral infarction, one of whom died; in both of these patients, the anastomosis was completed after the internal carotid artery occlusion. Two patients in Group 3 progressed from marked visual loss to blindness of the same side, and one developed an intraventricular hemorrhage during induction of anesthesia and died without surgery. It is proposed that a direct approach to symptomatic aneurysms in the cavernous sinus is the best initial alternative. When this approach is not feasible, a trapping procedure preceded by a high-flow extracranial-intracranial anastomosis may be considered. Although the authors have been able to clip aneurysms of various sizes, this has not been possible in all patients. Further work is needed in this area.
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PMID:Surgical alternatives in the treatment of cavernous sinus aneurysms. 235 19

A 65-year-old patient treated for pain of apparent odontogenic origin did not respond to appropriate dental treatment. While the signs and symptoms mimicked a dental problem, further diagnostic evaluation determined the "culprit"--cranial arteritis. Proper treatment immediately after diagnosis is advised as the complications of cranial arteritis can include the rapid onset of blindness.
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PMID:Cranial arteritis mimicking odontogenic pain: report of case. 260 62


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