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)

Eleven patients who underwent mandibular reconstruction with A-O plates were followed up for as long as 40 months. The patients underwent either immediate or delayed mandibular reconstruction. Nine patients had free cortical bone grafts included in the reconstruction. Complications in patients who underwent immediate reconstruction included loss of the bone graft due to infection, external and intraoral exposure of the reconstruction plate, pain, and infection. In the patients with immediate reconstruction, more than 50% of the bone grafts resorbed. There were less complications and minimal bone graft resorption in patients who underwent delayed reconstruction. The cosmetic results were initially good in both immediate and delayed reconstruction but deteriorated as more surgery was required for management of complications. At 40 months, 7 of 11 patients (5 of 9 with immediate reconstruction) had died of local recurrence, distant metastasis, or another primary tumor. No patients were rehabilitated prosthetically. We conclude that while A-O plating is technically easy and has a low perioperative morbidity rate, the long-term morbidity rate is high. This must be weighed against the benefits of the procedure and the probability that the patients will have a poor functional outcome.
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PMID:A critical analysis of immediate and delayed mandibular reconstruction using A-O plates. 200 22

Nineteen women with a mean age of 62 were treated for primary adenocarcinoma of the fallopian tube from 1960 to 1980. Common presentations were bleeding or discharge, pelvic mass, and pain. Cervical cytology was positive in five of eleven cases; endometrial curettings revealed adenocarcinoma in three of nine cases. Staging was by a system analogous to the International Federation of Gynecology and Obstetrics (FIGO) classification of ovarian carcinoma: 11% stage I, 44% stage II, 28% stage III, and 17% stage IV. Bleeding and abnormal cervical cytology were associated with earlier stage lesions and better prognosis. The most common treatment was excision of the primary tumor and gross intraperitoneal metastases. Total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed in 14 cases. Thirteen patients received 40-50 Gray of 2 MeV external beam pelvic radiation. Stages I and II had five-year survival of 100% and 63%. However, 38% of stage II patients had late extrapelvic relapses, and two early stage patients suffered serious complications of radiation therapy. All stage III and IV patients died of disease, 63% within the first 3 years. Based upon these results and review of other modern series, the importance of early diagnosis and complete surgical staging is emphasized, and stage-specific adjuvant therapy recommended.
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PMID:Primary adenocarcinoma of the fallopian tube. 267 90

Four patients were referred during the last year for treatment of an intradural metastasis. Primary sites were a bronchogenic carcinoma (one case), a prostatic carcinoma (one case) and in the two other cases the primary tumor was not found. In all cases Noot pain had lasted 1 to 5 months, despite CT examination during this painful period. Except in case n.4, diagnosis was not established until the onset of myelopathy. Surgical removal was complete in one case and subtotal in the three other cases, with complete postoperative relief of the pain in all cases and significative improvement of neurological status. The authors emphasize the importance of root pain as an early sign in these patients as well as the difficulty in establishing diagnosis. They discuss the different pathogenic mechanisms and the methods of treatment.
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PMID:[Intradural spinal metastasis from visceral neoplasms. Apropos of 4 cases. Review of the literature]. 269 80

Seven patients with supratentorial gliomas developed leptomeningeal gliomatosis (LMG) without symptomatic recurrence at the primary tumor site. In all, severe back and radicular pain, often simulating disc disease, preceded the development of spinal cord or cauda equina dysfunction. In 4 instances, intracranial hypertension due to hydrocephalus developed prior to spinal involvement. Cytological examination of the CSF revealed malignant cells in only 2/7 but a myelogram was diagnostic in all 7. All patients received spinal irradiation (RT) and 5 received chemotherapy. Two patients with low-grade gliomas improved transiently; 5 with malignant gliomas responded poorly, became paraplegic over 4 months and eventually died of LMG. When fatal LMG occurs in young adults suffering from supratentorial glioma, the primary tumor is often quiescent. Hydrocephalus is often the first manifestation of LMG and, when it is detected, a myelogram and CSF cytology study should be performed in the hope that diagnosis and treatment of spinal cord lesion at a very early stage will prove beneficial. Irradiation of the entire spinal canal is probably required as there is a high risk of rapid development of new lesions in non irradiated segments of the spinal canal.
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PMID:Leptomeningeal gliomatosis with spinal cord or cauda equina compression: a complication of supratentorial gliomas in adults. 271 19

In a retrospective study on 239 patients irradiated for osseous metastases in 578 different skeletal areas, the therapy effect was evaluated in dependence on the frequency of metastases, the sites of metastases, and the histology of the primary tumors. Furthermore the duration of improved findings was verified. The primary tumor was a mammary carcinoma in 186 patients, a bronchial carcinoma in 21 patients, a renal cell carcinoma in 20 patients, and a prostatic carcinoma in 12 patients. In patients with bronchial carcinoma the relief of pain by radiotherapy was not as good as in other tumor types. However, a significant correlation between subjective therapy effect and histology of the primary tumor was not demonstrated. Remineralization was found in 55% of all irradiated skeletal areas and an unchanged X-ray picture of bone metastases in 35%. A dependence of the objective therapy effect from the histology of the primary tumor was not statistically demonstrated (recalcification rate in mammary carcinoma 62%, in prostatic carcinoma 57%, in bronchial carcinoma 28%, and in renal cell carcinoma 11%). Significant differences of remineralization were found in solitary bone metastases (68%) and in multiple skeletal metastases (56%). A significant correlation between sites of metastases and objective irradiation effect was proved by the fact that osteolytic destructions of spine and pelvis showed a better remineralization than lesions situated in the extremities. The average duration of the objective, radiologically verified amelioration of findings was 16 months in patients with mammary carcinomas and 12 months in patients with prostatic carcinomas, bronchial carcinomas, and renal cell carcinomas.
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PMID:[The radiotherapeutic effect on bone metastases in relation to the frequency of metastases, sites of metastases and histology of the primary tumor]. 272 92

A non-randomized prospective trial in which radiotherapy (RT) alone played the major role in the treatment of metastatic spinal cord compression (MSCC) is reported. Diagnosis was formulated on myelography and/or myelography plus computed thomography (CT). Of 51 cases treated, 48 are evaluable. The therapy consisted of radiation alone (42 cases) or decompressive laminectomy followed by radiotherapy (6 cases). Surgery was performed when the site of the primary tumor was unknown. The group of patients who received radiotherapy alone (42 of 48 evaluable cases) are analysed in this report. Medium to high doses of steroids were administered to all patients depending on the gravity of the case. Patients with chemo- or hormone-responsive primary tumors also received chemotherapy and/or hormone therapy. Pain relief, assessed by comparing use of narcotics and minor analgesics before and after treatment, was achieved in 54% cases (confidence limits, CL = 38-69%). In 36% (CL = 22-51%) of patients back pain diminished to the point when only milder analgesics were necessary (partial remission). Motor performance, based on patients' ability to walk, improved in 48% cases (CL = 31-65%). The 19 patients who were ambulatory before RT, did not deteriorate after treatment. Sphincter function, evaluated by patient's need for indwelling catheter, improved in 3 of 7 automatic dysfunction cases. It was found that early diagnosis was more important than primary tumor type for predicting a good was found that early diagnosis was more important than primary tumor type for predicting a good prognosis. In fact, all ambulating patients responded to treatment independent of the radiosensitivity of the tumor histology.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Role of radiotherapy in metastatic spinal cord compression: preliminary results from a prospective trial. 277 51

A 40-year-old male presented with a 2-month history of sudden hearing loss and tinnitus in his left ear. Mild vertigo was present initially but disappeared spontaneously without treatment. Facial nerve paralysis and retroauricular pain appeared 3 months after the onset of hearing loss on the same side. Computerized tomography and magnetic resonance imaging demonstrated a 1-cm mass in the left internal auditory canal. Translabyrinthine removal of tumor revealed metastatic adenocarcinoma. The patient died 3 months postoperatively from multiple metastatic deposits. A primary tumor was never found. The course of illness in this patient differs significantly from the typical course of other conditions involving the internal auditory canal. A metastatic work-up should be considered for patients with a similar history before a craniotomy is performed.
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PMID:Metastasis from an unknown primary presenting as a tumor in the internal auditory meatus. 280 95

Forty patients with cancer pain receiving intermittent narcotics were admitted to a prospective study designed to assess the cognitive effects of narcotics. Twenty patients had undergone no change in narcotic dose or type greater than or equal to 7 days (stable dose, SD, group), and 20 patients had undergone an increase of greater than or equal to 30% in dose less than or equal to 3 days before (increased dose, ID, group). Age, primary tumor, type, dose and route of narcotic were not different between the SD and ID group. Cognitive tests (finger tapping, FT, 10 and 30 sec, arithmetic, A, reverse memory of digits, RM, and visual memory, VM) were performed in all patients before and 45 min after their morning dose of narcotics for 2 consecutive days. Mean percentual change in FT 10 sec, FT 30 sec, A, RM, and VM after the narcotic dose were 97 +/- 9%, 100 +/- 14%, 100 +/- 13%, 100 +/- 15%, 98 +/- 19%, in the SD group, vs. 77 +/- 14% (P less than 0.001), 83 +/- 13% (P less than 0.001), 124 +/- 21% (P less than 0.001), 60 +/- 21% (P less than 0.001) and 68 +/- 21% (P less than 0.001) in the ID group, respectively. Our results suggest that patients who undergo a significant increase in the dose of intermittent narcotics experience significant cognitive impairment, that disappears after 1 week of the increase. More research is needed to better characterize the cognitive toxicity of intermittent narcotics, and to determine the cognitive effects of long acting narcotics, continuous infusions, or of the addition of amphetamines.
Pain 1989 Oct
PMID:The cognitive effects of the administration of narcotic analgesics in patients with cancer pain. 281 50

A 51-year-old man was hospitalized with complaints of gross hematuria and terminal micturition pain. Cystoscopy revealed a low columnar tumor at the dome of the bladder. Ultrasonography and X-ray CT also demonstrated the same shape of tumor and no evidence of invasion to adjacent organs. Gastrointestinal examination, including upper gastrointestinal series and barium enema failed to reveal any primary tumor. The serum CEA level was 2.3 ng/ml, which was not elevated. Total cystectomy with ileal conduit and adjuvant chemotherapy consisting of cyclophosphamide, adriamycin and cisplatinum was performed. He died of a recurrent tumor 2 years and 2 months after the operation. Besides our experience of primary signet ring cell carcinoma of the urinary bladder, a review of the literature is reported.
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PMID:[A case of signet ring cell carcinoma of the urinary bladder]. 282 84

A total of 81 transhepatic fine needle aspiration (FNA) biopsies were performed on 78 patients to rule out focal or diffuse neoplastic disease; 87.6% were performed with ultrasound guidance, 6.1% with CT guidance, 3.7% intraoperatively and 1 using fluoroscopy during percutaneous transhepatic cholangiography. Smears of the aspirated samples were cytologically evaluated with clinical and radiologic correlation; in addition, histologic examination of cell blocks was performed in 46% of the cases, ultrastructural examination in 34% of the cases and peroxidase-antiperoxidase staining in 3 cases. Ultrastructural definition of the type of malignancy was possible in 24 cases (29%). Minor complications in two patients were pain and tenderness at the puncture site. The sensitivity for malignancy was 91%, the specificity was 100%, the predictive value of positive results was 100%, and the predictive value of negative results was 73%. This series demonstrates that FNA biopsy with ultrasound guidance can provide an accurate diagnosis of malignancy and may preempt a lengthy workup in the search for a primary tumor.
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PMID:Fine needle aspiration of the liver. 282 16


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