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)

Over a period of 2 months an 88-year-old man developed progressively more severe breathing-related pain under the right shoulder blade, loss of appetite, general weakness, depressive mood, sub-febrile temperature and nocturnal sweating. Various inflammation parameters were raised (sedimentation rate 43 mm in the first hour; C-reactive protein 26 mg/dl; white cell count 12,500/microliters). There also were pleural effusion and signs of mild nonspecific hepatitis. Antibiotics were administered because bacterial pneumonia was suspected. But the patient's condition deteriorated and he developed nightly periods of disorientation. There was no evidence for any advanced malignancy. Immunological tests pointed towards older-onset systemic lupus erythematosus: titre for antinuclear antibodies markedly raised to 1:20 480; anti-DNA titre moderately raised to 1:125 IU/ml. The patient's general condition and the pleuritic pain improved within 2 days under treatment with prednisone (50 mg daily); the depression, disorientation and fever receded within a week. The anti-DNA titre fell to 47 IU/ml after 8 weeks. He was able to resume his usual social activities and was kept on a maintenance prednisone dose of 5.0 mg daily.
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PMID:[Lupus erythematosus in old age]. 820 42

The cases with pustulosis palmaris et plantaris associated with lesions in sterno-cost clavicular region, spine and ilio sacral joint have been in the previous literatures. We encountered four rare cases of this pustulosis in association with femoral lesion. We mainly reported their radiological and pathologic findings. Three cases had lesions in the diaphysis of the femur, while one case had lesion in the lesser trochanter. The average age was 55.5 years (range 53-60) All patients complained of thigh pain. Three cases suffered sterno cost clavicular pain also. Laboratory data showed the elevation of white blood cell number, ESR and tested positive for C-reactive protein. The radiological findings showed osteolytic lesions of the femoral cortex at the onset of the disease, followed by thickening and sclerosis in the cortex. A biopsy was performed in three cases and the pathological results showed no malignancy. The specimens showed only chronic inflammation. Pathological results and radiological abnormalities suggested that femoral lesion of pustulosis palmaris et plantaris originated from the periostenum or the cortex of bone.
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PMID:[Osteolytic and osteosclerotic lesion of the femur associated with pustulosis palmaris plantaris]. 825 65

C-reactive protein (CRP) and alpha-1-acid glycoprotein (AGP) levels were studied in the sera of 107 patients with chronic arterial ischaemia of the lower limbs. Depending on the degree of ischaemia, patients were divided into four groups: (i) intermittent claudication--20 patients; (ii) rest pain and ankle pressure above 50 mmHg--12 patients; (iii) rest pain and ankle pressure below 50 mmHg--25 patients; (iv) peripheral necrosis--50 patients. Reconstructive surgery was performed in 84 patients and primary major amputation in 23 cases. Levels of CRP and AGP increased with the severity of ischaemia. In uncomplicated cases, CRP and AGP concentrations decreased to normal values 7-10 days after surgery. In a group of 23 patients with postoperative necrotic complications, significant increases in CRP and AGP levels were found 7-10 days after surgery. These proteins, especially CRP, may be clinically useful in monitoring patients during the postoperative period with a CRP level greater than 50 mg/l predictive of complications with a sensitivity of 83% and a specificity of 94%.
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PMID:C-reactive protein and alpha-1-acid glycoprotein in monitoring of patients with chronic arterial occlusion of the lower limbs. 827 63

Systemic necrotizing vasculitis or a polyarteritis nodosa-like clinical presentation, is an unusual complication of immunotherapy (hyposensitization therapy). We describe a patient who developed features of vasculitis several years after beginning hyposensitization treatment for allergic rhinitis. In the 7 months preceding the onset of the vasculitis he experienced 4 episodes of anaphylaxis immediately after receiving desensitization injections. The vasculitis was characterized by the abrupt onset of pain and discoloration of the middle 3 digits of his right hand. Cyanosis and small areas of frank necrosis of these digits were present. Erythrocyte sedimentation rate and C-reactive protein were elevated and total serum complement was decreased. The development of digital vasculitis following hyposensitization is clearly illustrated in this patient.
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PMID:Digital vasculitis following allergic desensitization treatment. 830 89

It is reported that most of the causative organisms of suppurative arthritis complicating rheumatoid arthritis (RA) is Staphylococcus aureus and that Streptococcus pneumoniae is rare, representing less than 5% of cases of suppurative arthritis complicating RA. We here report two cases of pneumococcal septic arthritis complicating RA. Both were female, and 68 and 64 years old, respectively. They had active, long-standing RA with destructed changes. Infected joints included both knees (case 1) and right knee (case 2). Pain and loss of motion in the septic joints were prominent. On admission, the physical examination showed severe redness, swelling and tenderness of the septic joints and the range of motion of those was markedly decreased. The radiograph of affected joints showed stage III. Laboratory data showed markedly elevated ESR of 127 mm/hr (case 1) and 142 mm/hr (case 2) and C-reactive protein of 49.91 mg/dl (case 1) and 30.36 mg/dl (case 2). Aspirate of the left knee of case 1 showed numerous neutrophils. Cultures of the joint fluid grew S. pneumoniae. Grossly purulent material was aspirated from the right knee of case 2 and cultures also grew S. pneumoniae. They were started on intravenous antibiotics with a good response and the function of involved joints returned to preseptic condition. The source of infection on case 1 was presumed to be otitis media because she had discharge from left ear concurrently with the exacerbation of joint symptoms. Case 2 had productive cough and cultures of sputum also disclosed S. pneumoniae when pain of right knee joint developed. The suggested source of infection was upper respiratory tract.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Two cases of pneumococcal septic arthritis complicating rheumatoid arthritis]. 831 8

Endoscopic retrograde cholangiopancreatography (ERCP) is complicated by acute pancreatitis in up to 12% of the examinations. One possible mechanism for this complication is the cannulation-induced sphincter of Oddi spasm with temporary pancreatic duct obstruction. Nifedipine is known to relax the sphincter of Oddi, thus possibly inhibiting or reducing post-ERCP +/- endoscopic sphincterotomy (EST) pancreatic irritation. To test this hypothesis 166 adult patients undergoing ERCP +/- EST were randomized to receive nifedipine (n = 82) 20 mg 3 times at 8-hour intervals during the day of ERCP +/- EST or placebo (n = 84) in a double-blind manner. Clinical pancreatitis developed in 6 patients (4%), in 3 patients in each group. Necrotizing pancreatitis developed in 3 patients, 2 (2%) in the nifedipine group and 1 (1%) in the placebo group. Overall 60 patients (36%) needed medication for post-ERCP +/- EST epigastric pain, 27 (33%) in the nifedipine group and 33 (39%) in the placebo group. Of the 87 patients, who did not need any pain medication before ERCP +/- EST, 34 (39%) needed pain medication after ERCP +/- EST. 14/47 (30%) in the nifedipine group and 20/40 (50%) in the placebo group (p = 0.044). Serum total amylase activity (median) increased from 189 U/l (range 39-11,950 U/l) before ERCP +/- EST to 299 U/l (range 43-11,824 U/l) at 12 h (p < 0.001) and 247 U/l (range 34-15,950 U/l) at 24 h (p < 0.001), with no differences between the two groups. Median serum C-reactive protein concentration and blood leukocyte count remained unchanged in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prospective randomized trial of the effect of nifedipine on pancreatic irritation after endoscopic retrograde cholangiopancreatography. 831 38

Methotrexate (MTX) is an effective anti-rheumatic drug. Despite its frequent use, the relationship between different MTX doses and clinical effects remain unclear. In a randomized double-blind study in patients with RA, the effects of four MTX doses (5 to 20 mg) was studied. MTX (5 mg) induced a significant effect on the Ritchie joint index, morning stiffness, pain, ESR and C-reactive protein. The effect of MTX on those variables was related to the dose in the range from 5 to 20 mg MTX weekly. Interindividual differences in dose-response curves were observed. The study shows that MTX doses should be adjusted individually for each patient in order to improve efficacy and decrease dose-dependent side effects.
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PMID:Methotrexate--the relationship between dose and clinical effect. 834 81

Sinusitis is a common problem in general practice, but diagnosis is often difficult. The greatest clinical challenge is to distinguish between purulent and nonpurulent sinusitis. This differential diagnosis has consequences for treatment. A questionnaire was sent to a randomized sample of Norwegian general practitioners and to all ear, nose and throat specialists in private practice. 79% of the general practitioners felt that diagnosis is more uncertain for sinusitis than for otitis media. When anamnestic questions and clinical findings were grouped, it was shown that general practitioners consider pain to be much more relevant in the differential diagnosis than purulent secretion. The ear, nose and throat specialists consider pain and purulent secretion to be equally important in the differential diagnosis. Pain in cheek and forehead, and pain in the upper teeth are regarded as the most relevant single anamnestic symptoms. Duration of illness is considered to have little differential diagnostic relevance. Among supplementary tests only C-reactive protein is regarded as helpful. X-ray and erythrocyte sedimentation rate are evaluated as far less relevant.
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PMID:[Sinusitis in general practice--a diagnostic challenge]. 846 32

Changes in clinical and laboratory measures of disease activity were studied prospectively in 12 European centers. Altogether 282 rheumatoid patients were evaluated during 6 months of therapy with slow-acting drugs. Patients' global assessment was taken to indicate overall response. The number of swollen joints and number of tender joints correlated highly with this. The erythrocyte sedimentation rate (ESR) correlated less well but was more uniform across centers. Grip strength, C-reactive protein and hemoglobin performed poorly between centers. There were cultural and linguistic difficulties using the Health Assessment Questionnaire in a European setting. Physician's global assessments were similar to the patient's global assessments and provided redundant information. The best measures are: the number of swollen joints, the number of tender joints, the ESR, and the patient's global assessment. It may also help to measure articular pain.
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PMID:A simple index to assess disease activity in rheumatoid arthritis. 847 79

To determine the impact of the HLA B27 antigen on the expression of spondylarthropathies, we conducted a retrospective cross-sectional study of the 116 spondylarthropathy patients whose HLA B27 phenotype was determined during a stay in the Morvan Hospital rheumatology department, Brest, France, between January 1, 1986, and December 31, 1994. Age at disease onset was younger in the HLA B27-positive patients (31.5 +/- 14 years versus 40 +/- 15 years; p = 0.008), who were more likely to have buttock pain (odds ratio, 4.84; p < 0.001) and roentgenographic evidence of sacroiliitis (odds ratio, 5.34; p < 0.001) and less likely to have psoriasis (odds ratio, 0.15; p < 0.0001), as compared with their HLA B27-negative counterparts. Peripheral arthritis occurred in similar proportions of patients with and without the HLA B27 antigen. Presence of HLA B27 was of little value for the diagnosis of spondylarthropathy in patients with inflammatory joint disease involving peripheral joints (sensitivity 50%, specificity 92%, positive predictive value 53%, negative predictive value 91%). Higher mean values of the erythrocyte sedimentation rate (40.3 versus 30.6 mm/h; p < 0.05) and serum C-reactive protein level (29.8 versus 16.8 mg/L, p < 0.005) were seen in patients with the HLA B27 antigen. Our data from patients with any form of spondylarthropathy show that the HLA B27 antigen is associated with earlier-onset disease, involvement of the sacroiliac joints and more severe inflammation.
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PMID:The HLA B27 antigen-spondylarthropathy association. Impact on clinical expression. 857 9


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