Gene/Protein Disease Symptom Drug Enzyme Compound
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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 recurrent postprandial amaurosis fugax (AF) associated with periorbital pain is described. Clinical and angiographic examination revealed moderate atherosclerosis of the cerebral vessels and narrow-angle glaucoma. Cerebral postprandial hypoperfusion combined with increased intraocular pressure probably precipitated the painful monocular blindness. The attacks of AF subsided partially after treatment of the glaucoma.
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PMID:Postprandial transient painful amaurosis fugax. 374 61

Giant-cell or temporal arteritis is a generalized vasculitis that predominantly affects large- and medium-sized arteries in people over 50 years of age. The illness is commonly characterized by the initial symptoms of headache, temporal artery tenderness or pulselessness, musculoskeletal pain, fever, and fatigue. The most dreaded consequence of giant-cell arteritis is visual loss, which is usually irreversible on presentation. Giant-cell arteritis may present with unusual clinical manifestations such as lip, scalp, and tongue necrosis, carpal tunnel syndrome, claudication of the limbs, strokes, angina pectoris, myocardial infarction, hematuria, cough, or other CNS symptoms. The etiology of the disease is unknown. Emergency physicians are usually familiar with the more common clinical symptoms but one must consider the unusual manifestations of the disease, because early recognition and initiation of therapy (steroids) decrease morbidity and can prevent blindness.
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PMID:Giant-cell arteritis. 379 80

10 cases are presented in which a posterior cerebral artery (PCA) deficit developed suddenly in dramatic fashion with headache, visual symptoms, sensory and motor deficits, and signs of 3rd nerve involvement. There were 9 females and 1 male, ranging in age from 18-51 years with 7 cases under age 35. In 9 of the 10 patients, headache was prominent at the onset; 6 patients reported being dramatically stricken with a severe, sharp localized pain in the forehead or occiput. Visual symptoms were prominent at the onset in 7 patients -- 4 patients experiencing blindness and 3 patients a hemianoptic deficit. Hemisensory symptoms or deficit occurred in 6 instances, a hemiparesis in 3, combined weakness and sensory deficit in 1. Evidence of a 3rd nerve palsy was found in 3 cases. A persisting neurologic deficit occurred in 10 cases -- visual field defect, 6 cases; hemiplegia, 1; slight weakness, 1; and a sensory deficit, 2. A movement disorder developed on the involved side in 7 cases. Evidence of infarction in 1 or both occipital lobes was obtained in 6 patients. 1 patient did not have impaired visual fields, and the other 3 were examined before the days of nuclear medicine and CT scanning. Conventional angiography was performed in 8 patients with the following results: retrothalamic occlusion of 1 PCA (1 patient); distal occlusion of 1 PCA (1 patient); retrothalamic narrowing of 1 PCA (1 patient); irregularity of the wall of the upper basilar artery and both PCAs (1 patient); and in 4 angiography was normal. A digital subtraction angiogram in 1 patient was normal; 1 patient did not have an arteriogram. A history of accompanied migraine was obtained in 3 patients. 1 patient was pregnant; 1 patient was 3 months postpartum. 1 patient was taking oral contraceptives; 1 patient had taken 1 contraceptive pill, and 1 patient was receiving injections of estrogen. These cases represent involvement of the territory of the PCA. They share the same features in varied combinations. The onset or evolution is dramatic, distinctive, or alarming. The cases do not fall easily into any commonly recognized category of cerebrovascular disturbances. The process that most likely applies to this group of cases is migraine. If that is so, the term "catastropic migraine" or "cataclysmic migraine" may have some currency. If it is assumed that the process is ischemic and since vascular obstruction was found in 2 cases, the possibility of using heparin therapy might be considered. In most of the present cases, steroid therapy was used to control brain swelling. If the pathologic process is temporary vasospasm, the use of hemodilution or hyperbaric oxygen could be an option.
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PMID:Unusual vascular events in the territory of the posterior cerebral artery. 395 50

Polymyalgia rheumatica, next to rheumatoid arthritis the most common inflammatory rheumatic disorder of the elderly, is a nonspecific clinical syndrome involving pain in the shoulder and pelvic girdles. Giant cell arteritis appears to localize in elastin-containing arteries and can cause similar myalgias. A relationship exists between the two diseases, as evidenced by their frequent coexistence in the same patient. The symptoms of polymyalgia rheumatica respond to low-dose corticosteroid therapy, while giant cell arteritis requires higher doses to prevent blindness due to involvement of the temporal artery. The key decision in therapy, therefore, concerns the dose and duration of use of steroid for polymyalgic symptoms. In this decision, prevention of the catastrophic complications of giant cell arteritis and avoidance of needless side effects of high-dose steroid therapy in the elderly are competing considerations.
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PMID:Polymyalgia rheumatica and giant cell arteritis. The dilemma of therapy. 400 Oct 42

The clinical and laboratory data recorded during a several month study of 90 patients with polymyalgia rheumatica are presented. Especially with elderly women who lack other symptoms it should be borne in mind that muscular and articular pain in the scapular and pelvic regions together with an excessive increase in the blood sedimentation rate--more than 100 mm during the first hour are frequent--may indicate this disease. It is often accompanied by an arteritis of the temporal vessels (giant cell arteritis), which increases the danger of uni- or bilateral loss of sight. In our case material unilateral loss of sight occurred in 3% of the patients, bilateral loss of sight was not observed. A general disturbance in the patients well-being, occasional attacks of fever, non-specific signs of inflammation in the haematological findings and symptomatic anaemia mask the clinical picture and make diagnosis difficult. Initial high doses of cortisonoid and following long-term therapy make all signs and symptoms disappear. The disease can last for several years. The prognosis is favourable. The cause is still unknown.
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PMID:[Polymyalgia rheumatica--clinical observations on 90 patients]. 408 88

1. To explore the feasibility of a visual prosthesis for the blind, human visual cortex has been stimulated during a series of surgical procedures on conscious volunteers undergoing other occipital lobe surgery.2. Area no. 17 seems the most effective locus for such stimulation, at least in sighted or recently hemianopic patients.3. Changes in electrode size and configuration, or in stimulus parameters, have little effect on subjective sensation.4. Thresholds do vary depending on parameters, but not electrode size, and these effects have been studied.5. Painful effects are associated with stimulation of the dura, but not of the calcarine artery and associated vessels.6. Stimulation of a single electrode usually produces one phosphene, whose size ranges from tiny punctate sensations like ;a star in the sky' up to a large coin at arm's length. Very large elongated phosphenes, like those seen by Brindley's second patient, have not been reported despite the number of patients, electrodes, and combinations of stimulus parameters tested. These large phosphenes may be an effect of prolonged blindness.7. Stimulation substantially above threshold may produce a second conjugate phosphene, inverted about the horizontal meridian.8. Stimulation of a single electrode may also produce multiple phosphenes with no differential threshold.9. Chromatic effects and/or phosphene flicker may, or may not occur. This can vary from point to point on the same patient.10. Phosphenes fade after 10-15 sec of continuous stimulation.11. All phosphenes move proportionately with voluntary eye movements, within the accuracy of our mapping techniques.12. Brightness modulation can easily be achieved by changing pulse amplitude.13. The position of phosphenes in the visual field corresponds only roughly with expectations based on classical maps showing the projection of the visual field onto the cortex.14. Patients can usually discriminate phosphenes produced by 1 mm(2) electrodes on 3 mm centres, although this seems to be close to the limit of resolution.15. Patterns of up to four phosphenes produced by four electrodes have been recognized. However, a variety of complex interactions have been reported.16. Multiple phosphenes are co-planar, although patients are unable to estimate their distance.17. Phosphenes appear immediately when stimulation is begun, and disappear immediately upon cessation of stimulation.18. Future work must concentrate on blind volunteers to explore possible differences in subjective sensation produced after prolonged blindness, and to explore more complex pattern presentation which requires substantial periods of time with any given patient.
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PMID:Phosphenes produced by electrical stimulation of human occipital cortex, and their application to the development of a prosthesis for the blind. 444 74

If the theoretical advantages of krypton laser over argon laser are proven clinically, this modality will be an important adjunct in the management of many of the leading causes of blindness. Our preliminary observations in over 400 cases treated with krypton laser correlate well with the theoretical and histopathologic observations of others. Possible advantages of krypton laser therapy for choroidal neovascularization (CNV) include its ability to penetrate foveal xanthophyll and retinal blood vessels and to minimize damage to the nerve fiber layer. Krypton also penetrates the xanthochrome in nuclear sclerotic cataract. The major disadvantage is increased choroidal hemorrhage. In proliferative retinopathies krypton penetrates moderate vitreous hemorrhage. It may minimize both epiretinal membrane changes and continuation of vitreo-retinal traction. It can be used after fluorescein injection. Disadvantages include increased choroidal hemorrhage and increased pain, often requiring retrobulbar anesthesia. Krypton laser cannot close surface neovascularization or stop bleeding by photocoagulating its source. The role of argon laser in CNV or how it benefits proliferative retinopathies is still not understood. The Macular Photocoagulation Study will help define the role of argon and krypton laser for CNV. A similar clinical trial to compare the efficacy of krypton laser to the proven efficacy of argon laser in the treatment of proliferative diabetic retinopathy is still anticipated.
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PMID:Red krypton laser therapy of macular and retinal vascular diseases. 618 65

Since the beginning of 1980 the authors have performed upper-abdominal ultrasound examination immediately preceding percutaneous needle biopsy (after Menghini), previously performed "blind". Knowledge of the particular liver topography made it possible to perform reliably punctures with only a small number of multiple punctures (6.4%) being required, suitable biopsies more often being obtained than under laporoscopic control. Compared with 354 consecutive blind liver biopsies, guided biopsy caused pain from the puncture in 1.9% (previously 5.9%), with a reduction of need for analgesics from 4.5% to 1.1%. The rate of more serious complications was reduced from five (1.4%) to one (0.2%), although as a result of ultrasound the indications for percutaneous liver biopsy were more frequent, since numerous "classical" contra-indications could be ignored. Blind liver biopsy should thus be abandoned for ultrasound-guided percutaneous puncture.
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PMID:[Sonographically assisted liver biopsy--replacement for blind needle biopsy?]. 621 80

Orbital involvement is a rare complication of myeloma usually presenting as unilateral proptosis without pain. A case is reported of a woman with bilateral orbital infiltration without proptosis, who became blind within three months of the onset diplopia. The blindness was due to visual field obstruction, with eyelids covering both corneas; the eyes themselves remained normal. This is the first case of orbital myeloma reported in Australia and only the second case of bilateral primary orbital infiltration with myelomatosis to be reported in the world literature.
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PMID:Multiple myeloma with bilateral orbital infiltration and polyneuropathy. 625 77

Carmustine (BCNU) has been used extensively to treat glioblastomas by injection through a catheter placed in the cervical internal carotid artery. The technique causes severe pain to the eye and has resulted in ipsilateral blindness. The use of a latex calibrated-leak balloon positioned above the ophthalmic artery in the internal carotid artery or in one of its branches appears to circumvent the ocular complications mentioned. At an infusion rate at 125 ml/hr the balloon does not inflate and does not occlude the artery. This new technique has been used to treat 10 patients without complications.
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PMID:Superselective injection of BCNU through a latex calibrated-leak balloon. 641 Jul 55


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