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

We describe a case of multiple pathologic fractures in a woman with Cushing's syndrome during pregnancy. Pathologic fractures were seen in the pubic and ischial bones and in T12 and L1 of the vertebral body. These findings, accompanied by easy fatigue, amenorrhea without nursing, psychological disorder, and premature birth, were retrospectively compatible with those of Cushing's syndrome, not pregnancy-associated osteoporosis. After adrenalectomy, the pain in her groin and back ceased. Plain radiographs showed healing of the fractures and increased mineralization. This case demonstrates the need to be alert to the possible presence of metabolic bone disease, including Cushing's syndrome, when we encounter multiple pathologic fractures with osteoporosis in young patients, even if the patient is pregnant.
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PMID:Case report of a Cushing's syndrome patient with multiple pathologic fractures during pregnancy. 1218 67

The records of 99 dogs weighing over 20 kg with thoracolumbar disc disease were reviewed. Two types of disc disease were recognised: degenerative nuclear extrusion (n=63) and degenerative annular protrusion (n=36). Sixty-nine per cent of the affected discs were located between T12-T13 and L2-L3. Of the 63 dogs with degenerative nuclear extrusions, 35 were non-ambulatory and seven had no conscious pain perception at the time of presentation. Decompressive surgery was performed in 55 dogs, four dogs were managed non-surgically and three dogs were euthanased. A successful outcome was achieved in 49 (78 per cent) cases as assessed by the authors and in 53 (84 per cent) cases as assessed by the owners. Mean follow-up time was 11.7 months (range 1.5 to 48 months). Five dogs subsequently lost the ability to ambulate on their hindlimbs. Myelographic investigations in three of these dogs revealed a second thoracolumbar degenerative nuclear extrusion. Of the 36 dogs with degenerative annular protrusions, seven were non-ambulatory at the time of presentation. Fifteen cases had multiple protrusions. Twenty dogs were managed non-surgically, 12 surgically and four were euthanased. A successful outcome was achieved in eight (22 per cent) cases as assessed by the authors and in 19 (52 per cent) cases as assessed by the owners. Mean follow-up time was 9.2 months (range 1.5 to 30 months). The outcome of dogs with annular protrusions was significantly worse compared to the outcome of dogs with nuclear extrusions (P<0.001).
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PMID:Thoracolumbar disc disease in large dogs: a study of 99 cases. 1240 Jun 41

Although radical resection is the best treatment for local aggressive benign tumors or malignant tumors of the spine, total spondylectomy for lower thoracic vertebrae may cause anterior spinal artery syndrome. There are few reports in the literature in which this syndrome has been documented in association with thoracic spondylectomy, although this syndrome is the most common neurologic complication after abdominal aortic surgery. A 50-year-old woman with a giant cell tumor of the thoracic vertebrae was treated by posterior and anterior surgery. Thoracic segmental arteries from T10 to T12 had to be resected bilaterally to dissect the aorta free from the tumor. After resection of all feeding arteries to the tumor, the tumor and entire parts of T10, T11, and T12 were removed. Postoperative neurologic examination disclosed flaccid paralysis of the lower extremities and sphincter incontinence. Although pain and temperature sensation were absent, vibration and position sense were intact, showing anterior spinal artery syndrome. Intraoperative somatosensory-evoked potential monitoring only showed that transient deterioration failed to adequately reflect this neurologic injury. Major reconstructive surgery involving lower thoracic regions may cause anterior spinal artery syndrome. Somatosensory-evoked potential monitoring might not reliably predict overall neurologic outcome involving the blood supply of the lower thoracic regions.
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PMID:Anterior spinal artery syndrome after total spondylectomy of T10, T11, and T12. 1246 71

Delayed vertebral collapse after osteoporotic spinal fractures may cause progressive kyphosis, neurological deficits, and chronic back pain. We treated 14 consecutive patients with posterolateral decompression and posterior reconstruction and followed them over a period ranging from 24 to 54 months. The mean age was 67 (range: 62-72) years and the fracture level was T12 and L1. Seven patients were graded as Frankel stage C and seven as stage D. The mean segmental kyphotic angle was 22.6 degrees (7-29 degrees ) preoperatively, 4.4 degrees (1-6 degrees ) postoperatively, and 6.8 degrees (2-15 degrees ) at the final follow-up. The pain score on a visual analogue scale improved from 9.5 preoperatively to 2.7 postoperatively, and the neurological status improved in all patients. Bone fusion was present 9 months after operation. Of four surgical complications, two were dural tears, one a superficial infection, and there was one death due to an acute adrenal insufficiency. Posterolateral decompression with posterior reconstruction is a useful treatment for patients with delayed osteoporotic vertebral collapse.
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PMID:Delayed vertebral collapse with neurological deficits secondary to osteoporosis. 1270 Sep 26

This study characterizes by functional and electrophysiological methods changes following photochemically induced injuries to the spinal cord in adult rats. The spinal cord was exposed by laminectomy and bathed with 1.5% rose bengal solution for 10 min (T12-L1 vertebrae). The excess dye was removed by saline rinse and the spinal cord was irradiated with "cold" light for 0, 1, 2.5, 5, and 10 min in different groups of rats. During the first 15 days postlesion, locomotion activity, pain sensibility, motor and somatosensory evoked potentials, and motor and nerve action potentials were evaluated. Graded locomotor and nociceptive recovery was observed in irradiated rats depending on the photoinduction time. At 15 days, the amplitude of motor and sensory evoked potentials was significantly lower in irradiated groups with respect to control rats. The amplitude of compound muscle action potentials and of reflex H wave after sciatic nerve stimulation decreased significantly in irradiated animals with respect to control rats, while the latency did not show significant differences. In irradiated groups, significant differences were seen between pre- and postoperative values for most functional and electrophysiological parameters analyzed. A significant negative relationship was found between the area of cystic cavity of the spinal cord and the functional and electrophysiological impairment.
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PMID:Functional and electrophysiological characterization of photochemical graded spinal cord injury in the rat. 1280 81

The aim of the study was to evaluate parenteral clodronate (CLD) compliance in patients with postmenopausal osteoporosis and intolerance to aminobisphosphonates. Moreover, we have also assessed the effects of CLD on bone mineral density (BMD) and bone turnover. Eighty-four consecutive postmenopausal women with osteoporosis (range 62-74 years) were enrolled and randomly allocated to three groups: group A included 26 women who received CLD i.v., 300 mg/2 weeks and oral supplemental calcium carbonate (500 mg x 2/day) and vitamin D3 (400 IU x 2/day); group B included 28 women who received CLD i.m., 100 mg/week, and the same dose of calcium and vitamin D3 administered to group A; group C, the control group, included 30 women receiving only calcium and vitamin D3 at the same doses as the other two groups. The lumbar spine (L1-L4) and femoral neck (FN) BMD were measured by dual energy X-ray absorbiometry at time 0 (T0) and after 6 (T6), 12 (T12), 18 (T18) and 24 (T24) months. At the same time, the serum bone specific alkaline phosphatase and amino-terminal telopeptide of type I collagen normalized by creatinine (NTx/cr) were determined at T0, T6, T12, T18, and T24. Eighty (95.2%) women completed the study, 24 in group A, 27 in group B and 29 in group C. In groups A and B, after 6 months of treatment we found a significantly greater (p < 0.05) increase in the L1-L4 BMD with respect to group C. After 12 months of therapy, in group A the L1-L4 BMD (1.8 +/- 0.5%) was significantly higher (p < 0.05) than that in group B (0.9 +/- 0.3%). At the end of the study, in groups A (1.2 +/- 0.5%) and B (1.1 +/- 0.4%) the percentage increase in the FN BMD was significantly greater (p < 0.05) than in group C (0.6 +/- 0.5%). After 24 months of therapy, there was no difference in the FN BMD between groups A and B. Since the sixth month, both the bone specific alkaline phosphatase and NTx/cr were found to be more markedly and significantly decreased (p < 0.05) in groups A and B with respect to group C. After 18 months, in group A (NTx/cr -16.7 +/- 0.8%) we observed a significantly reduced (p < 0.05) bone resorption with respect to group B (NTx/cr -11.0 +/- 0.5%). In group B, only 3 patients (11.2%) referred pain at the site of drug administration. Our data demonstrate that compliance to parenteral CLD is satisfactory and that this drug reduces bone turnover, increases the L1-L4 BMD and decreases the FN BMD loss. Parenteral CLD administration can represent an effective alternative treatment for postmenopausal women with osteoporosis, especially those who do not tolerate oral aminobisphosphonates.
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PMID:[The use of parenteral clodronate in elderly women with postmenopausal osteoporosis: compliance, effects on bone mineral density and on bone turnover]. 1288 26

A paraganglioma is a rare tumor, composed of chromaffin cells, groups of cells associated to the autonomous system. When the tumor occurs in the adrenal gland, it is called pheochromocitoma. The malignant paraganglioma is a very rare presentation; it is diagnosed by local recurrence after total resection of the primary mass, or findings of distant metastases. We present a case report of a 29-year-old woman with cervico-brachial pain. In 1995 she underwent a carotid body tumor resection. Magnetic resonance imaging (MRI), plain X-rays and computerized tomography scan revealed multiple lesions in C5, T5 and T12. She underwent a surgical procedure to correct the cervical lesion. The histological and immunohistochemical assays revealed a malignant paraganglioma. She received adjuvant radiotherapy, showing clinical improvement after treatment, presenting no symptoms after one year. The therapeutic approach is based on the total resection of the tumor. The treatment of distant metastases can be made with adjuvant measures such as conventional radiotherapy, I 131-MIBG, or chemotherapy, especially in malignant pheochromocitomas.
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PMID:Malignant paraganglioma with vertebral metastasis: case report. 1289 86

To verify the effectiveness and the incidence of complication in the transcutaneal celiac plexus block with CT-guided in the patient with intractable upper abdominal cancer, using alcoholic solutions to different concentrations (50% and 96%), previous insertion of the peridural catheter. From December 1997 to June 2002, studies were carried out on 24 patients with CT-guided percutaneous coeliac plexus neurolysis including 17 men and 7 women with inoperable abdominal malignancy and two with chronic pancreatitis. The patients were affected by very intense pain controllable only with high doses of analgesic narcotics. Before the procedure a catheter was installed in the peridurale space between L1-T12. To avoid general anesthesia, 40 mL of marcaine 0.5% was injected to relieve the back pain sometimes reported after the neurolysis, caused by the diffusion of alcohol in the coeliac plexus. This technique requires a posterior percutaneous procedural transaortic approach CT scan guided, to determine the correct position of the needle tips and the spread of neurolytic solution (40 mL of 96% + 3 mL of contrast medium) around the origin of the coeliac trunk's anatomical center of the plexus. The first 10 patients have received 40 mL of 50% ethyl alcohol + 3 mL of contrast medium. To evaluate the rate of the analgesia relief, a visual analogue pain score (VAS) was used before and 48 hours after the neurolysis. The percutaneous neurolysis of the celiac plexus is useful to relieve the pain in patients affected by cancer developing in upper abdomen. The CT-scan guide of the needle allows an omogeneous distribution of the contrast medium. The insertion of the peridural catheter made a complete analgesia and reduced the incidence of complications. Our method provided an excellent control of the pain in all patients. In our experience the pain relief was almost complete in patients treated with 96% ethyl alcohol solution (VAS from 8 before the treatment to 1, 48 hours after the treatment). The alcohol administered in elevated concentrations (96%), does not increase the incidence of complications.
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PMID:[Percutaneous neurolysis of the celiac plexus under CT guidance in the invasive treatment of visceral pain caused by cancer]. 1290 23

Spinal lamina I neurons expressing the substance P receptor (SPR) have been shown to play a role in the transmission of somatic inflammatory and neuropathic pain. To evaluate their involvement in visceral nociception in both the noninflamed and inflamed colon, we examined the expression and ligand-induced internalization of the SPR in the rat spinal cord after distention of the noninflamed colon and in rats with inflammation induced by intracolonic instillation of zymosan (3 hours). In the noninflamed animal, acute noxious but not non-noxious colorectal distention induced SPR internalization in lamina I neurons at the thoracolumbar (T13) and lumbosacral (S1) spinal levels, whereas SPR internalization was not detected in lamina I neurons at spinal lumbar segment L4. Although zymosan-induced colorectal inflammation alone did not induce SPR internalization in lamina I neurons, there was an increased number of SPR-expressing lamina I neurons showing SPR internalization in segments T12 through S2 of the spinal cord after colorectal distention. These results show that acute noxious visceral stimuli induce activation of spinal lamina I neurons expressing the SPR and, that after visceral inflammation, there is a marked increase in both the number and rostrocaudal extent of lamina I SPR neurons activated in response to both normally non-noxious and noxious distention of the colon.
J Pain 2002 Feb
PMID:Activation of lamina I spinal cord neurons that express the substance P receptor in visceral nociception and hyperalgesia. 1462 48

Unsuccessful recognition of the origin of testicular pain and a high failure rate of surgical interventions lead to poor outcomes, psychologic distress, and increased costs of care. A frequently overlooked cause of testicular and buttock pain is irritation of the T10-L1 sensory nerve roots, the genitofemoral nerve, and the ilioinguinal nerve. We present the case of a 36-year-old policeman with a 5-year history of back pain and testicular pain of unknown origin. Physical examination of the thoracolumbar region revealed that active movement provoked the patient's buttock symptoms, and local mobility restrictions were present in the thoracolumbar region. A central disk protrusion at T12-L1 was noted on upper lumbar spine magnetic resonance imaging, which supports dysfunction of this region. The diagnosis of thoracolumbar stiffness led to implementation of passive and active mobilization of that region and to specific hip stretching and strengthening exercises. After a course of direct and guided physical therapy, the patient attained complete symptom resolution. The patient returned to full work duties as a police officer and resumed his full recreational activity. The excellent outcome achieved in managing this patient was attributed to identifying the origin of referred pain from the thoracolumbar junction.
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PMID:Treatment of testicular pain using conservative management of the thoracolumbar spine: a case report. 1466 1


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