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)

Anterior displacement of the tibial tuberosity combined with shaving of the diseased cartilage was used as treatment for chondromalacia patellae in 32 knees in 28 consecutive patients and in one patient with chondromalacia femoris. The patients were aged 17 to 57 years. One patient had earlier sustained a serious injury to the ligaments of the knee, resulting in instability. All patients except one were unfit for work before the operation. Postoperative extra-articular wound infection was noted in two knees and venous thrombosis occurred in three legs. The postoperative observation period varied from 8 months to 2 years and 10 months. In one knee the anterior displacement of the tibial tuberosity was not maintained. In lateral radiographs the anterior displacement of the tibial tuberosity in the other knees varied from 10 to 23 mm. The relief from pain obtained by the operative treatment was estimated as good in all knees except three, which were unchanged. All patients became fit for work and/or sport.
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PMID:Anterior displacement of the tibial tuberosity in the treatment of chondromalacia patellae. 737 38

Metastatic malignant lesions involving the spine occasionally cause severe enough vertebral-body collapse to result in either spinal instability or neural compression, or both. Conventional decompressive laminectomy in such cases rarely results in neural improvement. It may, however, cause local instability of the spine, leading to a progressive kyphotic deformity and an increasing neural deficit. Anterior decompression allows excision of the focus of tumor and direct neural decompression. However, anterior stabilization by bone grafts usually does not succeed, as postoperative irradiation in dosages sufficient for tumor control may interfere with incorporation of the graft. Over a four and one-half-year period, fourteen patients with spinal instability secondary to metastatic pathological fractures of one or more vertebrae received anterior stabilization by replacement of the affected vertebral bodies with methylmethacrylate polymerized in situ. No postoperative external support was required, and the acrylic fixation achieved by this method was not affected adversely by subsequent irradiation averaging 4375 rads. There was only one soft-tissue infection, which did not involve the anterior stabilization. Twelve patients had major neural impairment preoperatively and required spinal cord or nerve-root decompression anteriorly prior to fixation. Nine had complete neural recovery postoperatively, two others were improved significantly, and one remained unchanged. None deteriorated neurologically. Five patients had undergone decompressive laminectomy before the anterior stabilization was attempted. None had improved neurologically, and all had increased spinal instability. There was one failure of fixation. The remaining thirteen patients had excellent relief of pain and restoration of spinal stability which did not deteriorate during the follow-up period, ranging from thirteen to forty-five months postoperatively.
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PMID:The use of methylmethacrylate for vertebral-body replacement and anterior stabilization of pathological fracture-dislocations of the spine due to metastatic malignant disease. 745 25

Anterior tarsal tunnel syndrome is a rare condition in which the deep peroneal nerve is trapped below the extensor retinaculum at the ankle. The authors report a variation of this condition: a 67-year-old woman who had anterior tarsal tunnel syndrome caused by entrapment of the deep peroneal nerve by the extensor hallucis brevis muscle. Conservative treatment was unsuccessful, but surgical decompression of the nerve provided immediate improvement, and by 2 weeks postoperatively she had no residual pain or paresthesia, although there was some numbness in the first web space.
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PMID:Compression of the deep branch of the peroneal nerve by the extensor hallucis brevis muscle: a variation of the anterior tarsal tunnel syndrome. 749 72

Anterior cruciate ligament (ACL) reconstruction is associated with significant postoperative pain, usually requiring parenteral narcotics. A prospective study of arthroscopically assisted autograft patellar tendon ACLR was initiated using Winnie's "three-in-one" femoral nerve block (FNB) as the primary means of postoperative pain control. Patient satisfaction and absence of parenteral narcotic use indicated clinical success. Of 24 patients studied, 92% had no parenteral narcotics administered following FNB. Ninety-five percent of patients believed FNB was beneficial and would request another. The average duration of pain control was 29 hours and the majority of patients (79%) believed discharge was possible within 23 hours. There were two patients who failed to respond to FNBs (8%) and no major complications. FNB is a safe, reliable, and effective form of analgesia following ACLR, eliminating the need for parenteral narcotics.
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PMID:Femoral nerve block as an alternative to parenteral narcotics for pain control after anterior cruciate ligament reconstruction. 757 71

Twenty-one patients underwent arthroscopic treatment for posterior impingement associated with degenerative elbow arthritis. Anterior debridement and removal of loose bodies was performed first. The posterior procedure consisted of three parts: removal of posterior loose bodies, removal of the posterior olecranon osteophyte, and removal of the osteophytes in the olecranon fossa to the point of fenestration. Patients were assessed for pain, strength, motion, stability, and function. They were classified as excellent, good, fair, or poor. Twenty-one of 25 patients were followed an average of 35 months. There was a statistically significant improvement in all criteria. There were 10 good and 11 fair ratings preoperatively; this improved to 14 excellent and 7 good results postoperatively (P = .0001). Arthroscopic treatment for posterior impingement in the degenerative elbow offers substantial improvement with minimal risk, provided proper intraoperative precautions are followed.
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PMID:Arthroscopic treatment for posterior impingement in degenerative arthritis of the elbow. 757 77

Anterior cingulate cortex (ACC) has one of the highest densities of opioid receptors in the CNS and it has been implicated in acute and chronic pain responses. Little is known, however, about which neurons express opioid receptors in their dendrites and axon terminals. The present studies employed experimental techniques to remove afferent axons or classes of projection neurons from rat ACC area 24 followed by coverslip autoradiography to localize changes in binding of [3H]Tyr-D-Ala-Gly-MePhe-Gly-ol (DAMGO) to mu receptors and 2-[3H]D-penicillamine-5-D-penicillamine-enkephalin (DPDPE) to delta receptors. Removal of all afferents to area 24 with undercut lesions did not alter DPDPE binding, but significantly reduced binding of DAMGO in layers I, III, and V. In contrast, removal of all cortical neurons with the excitotoxin ibotenic acid almost abolished DPDPE binding in all layers. The same lesions reduced DAMGO binding in most layers; however, there was a postlesion bimodal distribution in binding with high levels of binding in layer I and moderate levels in layer VI. These data suggest that delta receptors are expressed by cortical neurons, while mu receptors are expressed by both cortical neurons and afferent axons. To explore the distribution of postsynaptic receptors, immunotoxin lesions were made in area 24 by injection of OX7-saporin into the caudate and/or thalamic nuclei. Almost complete removal of projection neurons to these targets in layers Vb and VIa did not alter DPDPE binding, while the lesions reduced DAMGO binding in all but layer II. Removal of layer Vb corticostriatal projection neurons with caudate OX7-saporin injections reduced binding only in this layer. It is proposed that opioidergic circuits in area 24 are organized according to an input/output model for mu opioid regulation. In this model mu receptors regulate axon terminal activity from the thalamus in layer Ia and the locus coeruleus in layers Ic and II, whereas cortical outputs to the thalamus are modulated via postsynaptic receptors expressed in all layers by thalamocortical projection neurons with somata in layer VI. These opioidergic circuits in ACC are of particular importance because they may regulate responses to chronic nociceptive activity and associated pain perceptions.
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PMID:Localization of Mu and delta opioid receptors to anterior cingulate afferents and projection neurons and input/output model of Mu regulation. 758 27

We treated 50 adult patients with tuberculous spondylitis surgically and followed them for a mean of 5 (2-8) years. All had persistent back pain, 32 had neurologic deficit, and 13 had gibbus deformity. Anterior debridement and fusion were the main operative procedures. Additional posterior stabilization was performed in 14 patients who had loss of a vertebral body or for correction of severe kyphosis. 30 of the 32 patients with neurological impairment had an improvement of 1-3 Frankel's grades after operation. All patients had some relief of pain. Solid bony union of the fusion was found in 46 patients and 4 had nonunion after anterior operation only. The average correction of the kyphotic angle was 10 degrees.
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PMID:Surgical treatment of tuberculous spondylitis. 50 patients followed for 2-8 years. 862 87

MR imaging is sensitive in the detection of occult stress and posttraumatic fractures in and around the knee joint. In some patients, the pain from these bony injuries can mimic that of meniscal tears. The abnormality of the bone may explain completely the patient's symptoms and obviate the need for any further work-up. The types of injuries detected by MRI include bone bruises, stress or insufficiency fractures, and osteochondral fractures. Bone bruises or contusions are characterized by a diffuse or localized pattern of low signal intensity on T1-weighted images without a defined fracture. Blood, edema, hyperemia, and perhaps microfracture of the trabeculae may all contribute to the marrow signal alterations. Anterior cruciate ligament injuries often are accompanied by a characteristic bone contusion pattern, such as hemorrhage or edema in the posterior aspect of the lateral tibial plateau, as well as the anterior aspect of the lateral femoral condyle.
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PMID:Bone bruises: their patterns and significance. 780 74

Anterior pericardiocentesis was performed under ultrasound guidance using indwelling pigtail catheters in nine patients with malignant pericardial effusions and cardiac tamponade. Symptoms were alleviated in all cases and there were no deaths attributable to the procedure. Catheters remained in place for a median of 24 h (range 8-168 h). Complications were minor: asymptomatic left-sided or bilateral pleural effusions (n = 3), atrial fibrillation (n = 2), transient pericardial pain (n = 1) and erratic drainage (n = 1). Recurrence of the pericardial effusion was limited to a single case and occurred after 5 months of effective palliation. The procedure was successfully repeated with no further recurrence. One patient who went on to surgical fenestration 11 days after pericardiocentesis died 24 h post-operatively. The remaining patients died of the underlying malignant disease without further cardiac complication. Survival following the procedure ranged from 3 to 8 months. Ultrasound-guided pigtail catheter drainage is a minimally invasive, safe and effective method for the palliation of cardiac tamponade in patients with malignant pericardial disease.
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PMID:Ultrasound-guided pigtail catheter drainage of malignant pericardial effusions. 783 68

T lymphocytes play an important role in the pathogenesis of rheumatoid arthritis (RA). Murine monoclonal antibody OKT-3 (IgG2a), known to be specific for T lymphocyte 20 kD glycoprotein CD3 receptor was labelled with 5 mCi 99Tcm and given intravenously (i.v.) to seven RA and two psoriatic arthritis patients following informed consent to identify inflamed synovium. Anterior and posterior whole body scans and specific regional imaging was commenced 20 min later. At 1 h, approximately 20% of 99Tcm was associated with the lymphocytes. In these patients, all 41 asymptomatic joints and 43 joints with mild pain or minimal tenderness had normal scans. All 34 joints with moderate to severe pain had moderate to marked uptake of radioactivity. Two patients experienced shaking chills for 20-30 min within an hour of 99Tcm-OKT-3 infusion. These results suggest that 99Tcm-OKT-3 imaging serves as an objective surrogate for joint inflammation and could be useful as a measurement of therapeutic effectiveness in RA and other diseases with inflamed synovium. The side effect profile may limit the utility of 99Tcm-OKT-3 but other forms of antibodies directed toward lymphocyte subsets may be useful.
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PMID:Imaging rheumatic joint diseases with anti-T lymphocyte antibody OKT-3. 783 46


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