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)

We studied forty patients with CT-proven thalamic infarcts without involvement of the superficial territory of the posterior cerebral artery. The delineation into four arterial thalamic territories (inferolateral, tuberothalamic, posterior choroidal, paramedian) corresponded clinically to four different syndromes. The most common etiologies were lacunar infarction, large artery atherosclerosis with presumed artery-to-artery embolism, cardioembolism, and migrainous stroke. We found no risk factor other than age or oral contraceptive use in six patients. One patient died in the acute phase. During follow-up (45.6 months), the stroke or death rate was 7.4% per year. Delayed pain developed in three patients and abnormal movements in three. Late disability was mainly secondary to persisting neuropsychological dysfunction (thalamic dementia).
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PMID:Thalamic infarcts: clinical syndromes, etiology, and prognosis. 336 64

Following a brief presentation of the clinical picture of major depression, attention is directed to different forms of missed diagnosis. The clinical picture of major depression is characterized by marked uniformity and includes 2 highly typical disturbances: pronounced diurnal fluctuations and early or very early awakening. Other central features include a feeling of hopelessness, the disappearance of all prospects for the future, and feelings of guilt sometimes assuming absurd proportions. In addition, there are many other accompanying manifestations. Yet, despite this, it is not easy to recognize depression, particularly since the patient's gloomy and dejected mood often occupies the background of the picture. Cross-cultural psychiatric studies reveal that in non-Western cultures expression often mainfests itself in the form of a wide variety of somatic complaints, including pain. The term "masked depression" has come into common use to describe what are cases where, in the presence of predominantly physical signs and symptoms, an underlying depressive state goes unrecognized. This applies particularly to syndromes of which headache and pains in the chest, abdomen, and limbs are prominent features. It is unclear as to what extent somatic manifestations of depression are on the increase in the Western world. Yet, clearly, many patients deny that they suffer from depression and cling firmly to their physical complaints. Although depression may lurk behind a series of poorly defined physical complaints, essential characteristics of genuine depression emerge upon further diagnostic exploration. Secondary accompaiments to depression include periodic abuse of alcohol or medicines and disturbances affecting sexual behavior. In the elderly, the differential diagnosis of dementia and depression may give rise to confusion. Anxiety emerges as a frequent accompanying manifestation in depressive patients, yet all anxious patients do not suffer with depression. Additionally, many manifestations of anxiety and depression closely resemble one another, adding to the confusion. There is limited awareness of phobic and compulsive phenomena as manifestations of depression. These phenomena may disappear in response to treatment for the depression and are by no means always related to a premorbid compulsive personality structure. The issue of the application of the term "depression" to conditions that most likely are not depressive are considered from the standpoints of endocrinopathy and of pharmacology. The problem posed by depressive syndromes occurring in oral contraceptive (OC) users is more complex. When the progesterone content is high in relation to the estrogen component, the patient may sometimes suffer from loss of libido and loss of pleasure in sex or life in general. These changes respond favorably to a change in the type of OC.
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PMID:Depression--a diagnosis sometimes missed and sometimes mistaken. 357 25

All identified Israeli patients with amyotrophic lateral sclerosis (ALS) with onset of the disease from 1959 through 1975 (n = 318) were evaluated clinically. Most of our patients (63%) presented with weakness; only 10% presented with atrophy and 3% with fasciculations. In 31% of the cases, the onset of the disease was focal and 22% of the patients presented with bulbar signs, but only 6 patients presented with emotional lability (pseudo-bulbar). Twelve per cent of the patients presented with muscle cramps, pain or paraesthesia. Atypical signs such as motor cranial nerve lesion, dementia, sphincter disturbance and deep sensation loss are discussed. A relatively high proportion of our patients suffered from malignant tumour, but with no association with any specific tumour. The median survival time was 3 years. Patients with onset of their disease with bulbar signs had a shorter life expectancy (2.2 years): Twenty nine per cent of our patients survived for more than 5 years and 16% for more than 10 years.
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PMID:Amyotrophic lateral sclerosis. A study of its presentation and prognosis. 405 36

In the first study of combined chemotherapy and radiation therapy for small cell lung cancer by the Southwest Oncology Group, 17 patients survived more than five years after treatment was initiated (4.6 percent). Late relapse, or a second primary malignancy three to six years after diagnosis, accounted for death in five of these patients. Late recurrences involved the chest, bone, and liver; none occurred in the central nervous system. Disease-free survival continues in 10 patients (6 percent of those with limited disease and 1 percent of those with extensive-stage diseases) at a minimal follow-up in excess of six years. One definite case of chronic treatment-related toxicity occurred: congestive cardiomyopathy after 450 mg/m2 of doxorubicin, successfully managed with digitalis and diuretics. One severe neurologic problem (orthostatic hypotension with preterminal dementia) and two less severe neurologic complications (occasional falling episodes without documented cause and cerebrovascular accident) may be treatment-related. Progressive pulmonary disability, post-herpetic pain syndromes, organic brain syndrome, and hematologic abnormalities have not been observed to date. Nitrosourea administration and/or co-administration of a nitrosourea or methotrexate during the induction phase of treatment with radiotherapy to the brain may account for the higher incidence of complications observed by others in long-term survivors.
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PMID:Long-term survival and toxicity in small cell lung cancer. Southwest Oncology Group study. 608 60

THIP (4,5,6,7-tetrahydroisoxazolo[5,4-c]pyridin-3-ol) is a potent and specific GABA receptor agonist which does not influence the GABA uptake system or GABA metabolizing enzymes. The specificity for the GABA receptor is also demonstrated by lack of action on monoaminergic, cholinergic, histaminergic or opiate receptors. Since in recent years GABA receptor stimulants-among others THIP--have become available many have speculated as to what clinical indication GABA-ergic stimulation might be an important element. The first suggestion was that GABA-ergic drugs by an inhibitory effect on the dopamine neurons would improve the antischizophrenic effect of neuroleptics and improve tardive dyskinesia. Furthermore, studies on brains of deceased Parkinson and Huntington's chorea patients have demonstrated a low level of GABA and its synthesizing enzyme glutamic acid decarboxylase (GAD) in the basal ganglia. Also in epilepsy and diseases with dementia a deficit in the GABA system has been proposed. Therefore a therapeutic strategy for these diseases may be supplementary treatment with drugs which increase GABA receptor activity. Furthermore, recent results in humans have shown that GABA agonists perhaps also could be of benefit in mania and depressions. When considering the neurophysiological elements of nociception and muscle tone it is also reasonable to suggest that GABA-ergic stimulation may reduce pain perception and muscle tone.
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PMID:Pharmacodynamic effects and possible therapeutic uses of THIP, a specific GABA-agonist. 629 18

We report a 59 year old woman who presented with double vision, nuchal pain and mild dementia. On neurological examination she demonstrated third, sixth and seventh nerve palsies and ataxia. Following intravenous ACTH and oral prednisone therapy she showed a remarkable recovery which left her with only a left facial weakness. She remained well for two years. She then developed bulbar palsy and profound dementia. Pathological examination revealed progressive supranuclear palsy (PSP). This patient demonstrated a greater variability in the course of PSP than has previously been recognized.
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PMID:An atypical case of progressive supranuclear palsy. 632 50

During the second winter of the war (1937-38) most of the patients showed a picture of classic pellagra, with a number of neurological disorders which in same cases appeared with no other manifestations of Pellagra. The clinical picture was dominated by the appearance of famine edema, with less manifestations of specific vitamin deficiencies, with neurological manifestations called similar to those "burning feet" syndrome and described by us as Paresthetic and Paresthetic-causalgic syndrome. The prominent features were: acroparesthesia, dysestesia dolorosa, sensation of cold, sensation of wetness, hyperpathia and causalgic pain. Treatment with nicotinic acid was very effective for the classical manifestations of Pellagra (dermatitis, diarrhea and dementia), but had no significant effect on the neurological manifestations. No effect of vitamin B1 was observed, but some improvement following the administration of autoclaved brewers yeast. It was concluded that the neurological manifestations often associated with the classical picture of Pellagra are not due to nicotinic acid deficiency, but to the deficiency of some component of the vitamin B complex which was neither vitamin B1, nor vitamin B2.
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PMID:Vitamin deficiencies during the Spanish Civil War in Madrid: a reminiscence. 675 Oct 52

Three principal diagnostic problems were encountered in a group of 81 elderly patients with epileptic seizures: Post-ictal paresis (Todd's palsy) occurred in 13 patients (16%), of whom seven had evidence of past or present cerebral infarction, and six no such evidence. The paresis lasted up to 4 days, and could be confused with recurrent infarction or a transient ischaemic episode. Ictal and post-ictal confusional states of 24 h or more duration (up to 7-8 days) were noted in 11 patients (14%). They occurred in association with normal intellectual function as well as with pre-existing dementia, and required to be distinguished from other causes of delirium. Two patients presented paroxysmal sensory phenomena of ictal type. The differential diagnosis of episodic pain in hemiplegic limbs is discussed.
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PMID:Epileptic seizures in the elderly: II. Diagnostic problems. 680 29

We have studied plasma and cerebrospinal fluid vasopressin (CSF-AVP) and osmolality in 28 patients with cervical or lumbar pain syndromes (control patients), 11 patients with normal pressure hydrocephalus (NPH) and in 5 patients with benign intracranial hypertension (BIH). Vasopressin concentration in lumbar CSF to a high extent reflected the actual ventricular CSF-AVP concentration. In all groups CSF-AVP was lower than plasma AVP. Mean CSF-AVP in the control group was 1.3 pg/ml +/- 0.1 (SEM). In the NPH patients, who all suffered from severe dementia, CSF-AVP level was not different from that found in the control group (1.4 pg/ml +/- 0.2). In contrast to the findings in the two other groups CSF osmolality in BIH patients was higher than plasma osmolality (P less than 0.0). CSF-AVP in the BIH patients, characterized by an elevated intracranial pressure (ICP), was higher than in the control group (2.7 pg/ml +/- 0.4, P less than 0.001).
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PMID:Vasopressin in the cerebrospinal fluid of patients with normal pressure hydrocephalus and benign intracranial hypertension. 711 92

To assess the psychiatric knowledge of medical housestaff, the authors devised an oral examination based on two simulated clinical encounters and administered it to 26 medical residents. The case material embodied those psychiatric problems known to be common in medical populations, namely depression, delirium, dementia, and "psychogenic" pain. The standardized simulations were punctuated by standardized "open" questions with followup probes. A panel of experienced clinicians developed rating criteria for each question such that responses could be categorized ad "good," "adequate," "inadequate," or "poor," in terms of "what an internist needs to know." Blind raters of the exam achieved an interrater reliability of 0.08. The results indicate major deficits in the knowledge needed for assessment and treatment of these common problems. Only 16% of answers were "good," where as 42% were "inadequate" or "poor". For example, 88% of the doctors could not name three factors that help distinguish organic from "functional" psychosis, and 88% could not list three side-effects of tricyclic antidepressants. The doctors' level of experience was not correlated with test scores, either overall or question by question. These results, together with measures of attitude and skill, have been used to develop a needs-based liaison psychiatry curriculum and to evaluate the effectiveness of that curriculum.
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PMID:An oral examination of the psychiatric knowledge of medical housestaff: assessment of needs and evaluation baseline. 711 26


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