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

One hundred patients with severe cerebral palsy (total body involvement) and dislocated hips were examined to determine their level of pain, sitting ability, pelvic obliquity, scoliosis, nursing care difficulties and complications of decubitus ulcers and fractures. 50 of the patients had undergone surgical procedures to treat the hip; 50 had received no treatment. No significant differences were found in the frequency of pain or other complications between the two groups. Nursing care difficulties and the ability to sit did not depend on the status of the hip. Pelvic obliquity and scoliosis were related to the severity of neurological damage rather than to hip stability. These findings suggest that surgical treatment of already dislocated hips of patients with severe cerebral palsy is not helpful.
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PMID:Treated and untreated unstable hips in severe cerebral palsy. 210 51

Motor and sensory function must be assessed during surgery of scoliosis so as to avoid possible damage to the spinal cord. The intraoperative awakening by a specific benzodiazepine antagonist, flumazenil, was studied prospectively in 20 patients (mean age 17 years) undergoing surgery for severe scoliosis. Premedication consisted in 0.02 mg.kg-1 atropine and 0.15 mg.kg-1 midazolam. Anaesthesia was induced with a mean dose of 0.42 +/- 0.1 mg.kg-1 midazolam, 1.6 +/- 0.6 micrograms.kg-1 fentanyl and 0.1 mg.kg-1 pancuronium. Maintenance was obtained with a continuous infusion of 0.22 +/- 0.1 mg.kg-1.h-1 midazolam, 66% nitrous oxide in oxygen, and fentanyl (1.6 +/- 0.5 micrograms.kg-1.h-1). Nitrous oxide and midazolam were respectively stopped 10 and 1 min before giving the antagonist (5 micrograms.kg-1 flumazenil) if required (17 out of the 20 patients). Eye opening occurred a mean 42 +/- 32 s after giving the antagonist. At this time, there was a significant increase in mean arterial blood pressure (+ 11 mmHg) and heart rate (+ 7 b.min-1). Thiopentone, 66% nitrous oxide in oxygen and 0.5% halothane were given to re-induce and maintain anaesthesia for completion of the procedure. The day following surgery, 19 patients were unable to remember the period of intraoperative awakening. One patient, although remembering the episode, did not experience any pain or any other disagreement in relation to it. Two patients were given a second dose of flumazenil at extubation so as to improve the quality of their recovery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Flumazenil and peroperative awakening in surgery of scoliosis]. 210 58

One hundred forty-three patients who received radiation therapy for childhood tumors, and survived to the age of skeletal maturity, were studied by retrospective review of oncology records and roentgenograms. Diagnoses for the patients were the following: Hodgkin's lymphoma (44), Wilms's tumor (30), acute lymphocytic leukemia (26), non-Hodgkin's lymphoma (18), Ewing's sarcoma (nine), rhabdomyosarcoma (six), neuroblastoma (six), and others (four). Age at the follow-up examination averaged 18 years (range, 14-28 years). Average length of follow-up study was 9.9 years (range, two to 18 years). Asymmetry of the chest and ribs was seen in 51 (36%) of these children. Fifty (35%) had scoliosis; 14 had kyphosis. In two children, the scoliosis was treated with a brace, while one developed significant kyphosing scoliosis after laminectomy and had spinal fusion. Twenty-three (16%) patients complained of significant pain at the radiation sites. Twelve of the patients developed leg-length inequality; eight of those were symptomatic. Three patients developed second primary tumors. Currently, the incidence of significant skeletal sequelae is lower and the manifestations are less severe than reported in the years from 1940 to 1970. The reduction in skeletal complications may be attributed to shielding of growth centers, symmetric field selection, decreased total radiation doses, and sequence changes in chemotherapy.
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PMID:Skeletal sequelae of radiation therapy for malignant childhood tumors. 213 23

A questionnaire was sent to 206 consecutive patients who were operated on for idiopathic scoliosis by Dr. Paul R. Harrington between 1961 and 1963. Eighty-three per cent of the patients responded to the questionnaire, which consisted of five sections: demographic data, activities of daily living, back symptoms (pain and fatigue), a history of personal and family health, and a personal assessment of the back. One hundred and eleven patients also sent recent radiographs. A control group, comprising 100 individuals who did not have scoliosis and had been matched for age and sex, was given the same questionnaire. The study group had more pain in the interscapular and thoracolumbar regions compared with the control group, but there was no difference with respect to pain in the lumbosacral area or the low back. Neither pain nor fatigue was related to the type of curve, the preoperative degree of curvature, the degree of curvature as seen on the most recent radiograph, the extent of fusion into the lumbar spine, or the presence of a broken rod. Twenty-one years after the operation, the patients were functioning quite well compared with the control subjects.
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PMID:Harrington instrumentation and arthrodesis for idiopathic scoliosis. A twenty-one-year follow-up. 214 36

Clinical and radiologic features of 75 cases of osteoblastoma of the spine were reviewed. In addition to pain, which was the most frequent complaint, 18 patients demonstrated objective neurologic deficit, while scoliosis was observed in 17 patients. Aspirin yielded pain relief in 13 patients. Pathologic fracture was not encountered. The radiologic and histologic characteristics of osteoblastoma of the spine are indistinguishable from those arising in other sites. The typical lesion exhibited a well-defined, geographic margin with a sclerotic, frequently lobulated border. Approximately one half of the cases were predominantly lucent, the remainder displaying varying degrees of matrix mineralization. Distribution of the osteoblastomas through the spinal axis was as follows: cervical-29, thoracic-16, lumbar-17, sacral-13. Other significant findings included posterior element involvement in 73 of 75 cases, and a striking male to female ratio of 2.5 to 1.
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PMID:Osteoblastoma of the spine. A review of 75 cases. 214 6

Idiopathic scoliosis has a negative impact on the heart and lungs in the deformed chest, its creates a cosmetic defect, i.e. asymmetry of the paravertebral prominence, shortening of the trunk, asymmetry of the shoulders and protruding scapulae. Later it may cause pain and nervous disorders. In a group of 46 patients aged 15.5 years with thoracic right-sided idiopathic scoliosis the effect of operation by Harrington's instrumentation and spondylodesis on improvement of the curvature and the cosmetic effect were investigated. Preoperative curvature of 69 degrees according to Cobb improved to 35 degrees (by 50%) and the prominence from 38 mm before operation to 23 mm after operation (by 32%). The operation had also a positive effect from the cosmetic aspect which is of great psychological importance for the patients, in particular girls.
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PMID:[The esthetic effect of surgical treatment of idiopathic scoliosis]. 223 41

The reliability of distinguishing central, musculoskeletal, and syringomyelic pain by two points of history: (1) pain quality and (2) pain location relative to the level of paralysis in spinal cord injury patients was tested by (1) physical examination, and (2) by radiographic imaging. Fifty five incidents of chronic pain (median duration 10 years, range 3 weeks-42 years) were found in a survey of 66 spinal cord injured patients. Central pain was suggested in 24 patients on the basis of a predominant 'neurogenic' pain quality: burning, stabbing, needles and pins, or numbness; and a location at or distal to the level of paralysis. Neurogenic pain was not associated with structural pathology in these patients. Musculoskeletal pain was suggested in 20 instances on the basis of predominantly aching pain and a location at or distal to the level of paralysis. Aching pain was associated with degenerative joint disease (11 each); scoliosis, shoulder dislocation, contractures (2 each); fracture, soft tissue calcium deposit (1 each) in 19 patients. Syringomyelic pain was suggested in 11 instances solely on the basis of pain location above the level of paralysis. Magnetic resonance imaging revealed extensive syringomyelia in 8 patients. It is proposed that the quality and location of chronic pain can quickly suggest confirmatory examinations, sometimes revealing correctable causes.
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PMID:Chronic pain after spinal cord injury: an expedient diagnostic approach. 225 Sep 89

The clinical presentation, radiological features, and results of surgical treatment were analyzed in 17 cases of hydrosyringomyelia associated with a Chiari malformation, in children and adolescents younger than 20 years of age. The initial symptoms were a skeletal abnormality (71%), such as scoliosis (11 patients) or pes cavus (1 patient), pain or numbness (24%), and motor weakness (6%). Frequently seen signs on admission were sensory deficit (100%), scoliosis (85%), muscle weakness (64%), muscle atrophy (35%), and lower cranial nerve palsy (35%). The characteristic neurological findings were unilateral sensory and motor deficits (65%) with decreased or absent deep tendon reflexes on the same side. The localization of the syrinx on the axial section varied according to the level, even in the same patient. In 11 patients with unilateral sensory disturbances or unilateral sensory and motor deficits, the syrinx was located in the region corresponding to the posterolateral portion on the same side as that of sensory disturbance at the cervical or thoracic level. On the other hand, in 6 patients with bilateral sensory and motor deficits, the syrinx was located in the central portion and extended into the posterolateral portion of the more affected side. A syringosubarachnoid shunt was placed in 16 patients, foramen magnum decompression without closure of the obex was performed in 1 patient, ventriculoperitoneal shunt in 1 patient, terminal syringostomy in 1 patient, and foramen magnum decompression with terminal syringostomy in 1 patient. In 15 of 17 patients (88%), the neurological symptoms improved after an average follow-up of 4 years and 1 month. We think that as a surgical treatment, placement of a syringosubarachnoid shunt is effective.
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PMID:Hydrosyringomyelia associated with a Chiari I malformation in children and adolescents. 233 80

The clinical presentation and radiological features were analyzed in 30 cases of syringomyelia associated with Chiari malformation. None of the patients had spinal dysraphism. The age on admission ranged from 6 to 59 years with a mean of 27 years. Syringomyelia was diagnosed by CT myelography and or MRI from 1982 to 1988. The initial symptoms were skeletal abnormality (43%) such as scoliosis (12 cases) or pes cavus (one case), unilateral pain or numbness (40%) and unilateral motor weakness (17%). Frequently seen signs on admission were sensory deficit (100%), scoliosis (57%), muscle weakness (57%), muscle atrophy (37%) and lower cranial nerve palsy (40%). The neurological findings were asymmetrical in all patients. The characteristic neurological findings in the cases presenting under 20 years of age were unilateral sensory and motor deficits (61%) with decreased or absent deep tendon reflex on the same side. The localization of the syrinx in axial section varied according to the level even in the same case. In 15 cases with unilateral sensory disturbance or unilateral sensory and motor deficit, the syrinx was located in the region corresponding to the posterolateral portion on the same side as that of sensory disturbance in the cervical or thoracic level. On the other hand, in 15 cases with bilateral sensory and motor deficit, the syrinx was located in the central portion and extended into the posterolateral portion of the more affected side.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical and neuroradiological features of syringomyelia associated with Chiari malformation]. 233 91

The data on 98 new patients with osteoblastoma were studied. The clinical features of pain, scoliosis, and neurologic deficit were largely consistent with those in previous reports. Osteoblastoma is usually a lytic lesion originating in the medulla of bones with matrix ossification and mild surrounding sclerosis. Osteoblastoma of the spine demonstrated better tumor delineation in the vertebrae, and a bony rim on the soft-tissue side was seen less frequently than previously observed. Osteoblastoma of the talus frequently appears as a blister on the surface of the bone and is accompanied by osteoporosis. In the hands and feet, the radiographic appearance is often very similar to that of aneurysmal bone cyst and giant cell tumor. In the skull it strongly resembles a button sequestrum of bone. The origin and extent of the tumor, the presence of matrix mineralization, and tumor delineation depicted as a thin bony shell are often better appreciated on computed tomographic (CT) scans. In addition, CT can demonstrate both edema and atrophy of the surrounding soft tissues. At magnetic resonance (MR) imaging, osteoblastoma demonstrates signal intensities similar to those of other bone neoplasms. In addition to the advantages offered by CT, MR imaging can help differentiate tumor tissue from accompanying edema.
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PMID:Osteoblastoma: clinical and radiologic findings in 98 new cases. 234 30


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