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)

Health status measures in rheumatoid arthritis that have been extensively validated for use in clinical trials are generally used also in correlative studies, e.g. to predict future health status. This application requires stability (repeatability of measurements). The purpose of our study was to determine the stability of commonly used health status measures. Two measurements at an interval of 6 months were then in 99 patients. High stability (alpha = 0.78 to 0.94) was observed for five biomedical measures (grip strength, walking time, platelet count, haemoglobin and erythrocyte sedimentation rate) and five self-report measures (mobility, self care, impact daily activities, anxiety and cheerful mood). Moderate stability (alpha = 0.65 to 0.72) was observed for joint scores, pain, C-reactive protein and depressive mood. The highly stable measures most adequately reflect individual differences, may be applied most reliably in correlative studies and appear to have the largest clinical utility with regard to long-term prediction of health status.
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PMID:Stability of health status measurement in rheumatoid arthritis. 860 59

The purpose of the investigation was to examine the diagnostic value of various symptoms, clinical findings, erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) in acute maxillary sinusitis using the aspiration of purulent or mucopurulent from the sinus of a patient with a pathological CT-scanning as the golden standard. Of 174 patients with suspected acute maxillary sinusitis seen in general practice we found 70% to have a pathological CT-scanning and 53% to have pus or mucous pus in the sinus aspirate. Only the ESR and CRP level were found to be significantly and independently associated with a positive diagnosis as defined by the golden standard. A clinical criterion based on either an elevated ESR and/or CRP level in a patient with pain related to the maxillary sinus region had sensitivity of 0.82, a specificity of 0.57, a positive predictive value of 0.68 and a negative predictive value of 0.75, and was diagnostically superior to the clinical examination. The investigation also confirms that this disease is most likely overdiagnosed in general practice.
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PMID:[Clinical criteria for acute maxillary sinusitis in general practice]. 868 51

Anemia is often associated with neoplastic disorders. Blood transfusions are used to alleviate the discomfort of anemic cancer patients. Of 246 terminally ill cancer patients admitted to our palliative care unit from October 1991 to December 1993 (128 women and 118 men), 31 patients (12.6%) (17 men and 14 women; age, 69.5 +/- 12 years) received on average 2.8 units of packed red blood cells (PRBCs) (range, 2-7 units/patient) in 35 separate admissions. PRBCs were transfused in the presence of low hemoglobin (Hb) levels ( < or = 8 g/dL) and/or severe fatigue or dyspnea. Pre-transfusion performance status, cognitive function, dyspnea, and fatigue at rest (evaluated by a four-point scale), complete blood count, serum albumin, and C-reactive protein were determined. The day after transfusion, subjective well-being was recorded as "yes/no" improvement in comparison with the pre-transfusion day. Improved subjective well-being after blood transfusion was reported in 51.4%, without significant relationship to pre-transfusion Hb levels or performance status. The influence of blood transfusion on subjective well-being was not related to the severity of dyspnea or fatigue. Twenty-one patients (60%), including seven with subjective improvement, died during the same hospitalization, a median of 49 days after transfusion. Pre-transfusion Hb level did not differ significantly in patients who benefited and did not benefit from transfusion, whereas time before death was significantly (P < 0.001) shorter in patients who did not benefit. In the discharged patients (40%), the median interval between transfusion and discharge was 13 days and the frequency of subjective improvement in well-being was 78.6%. Our data suggest that two main areas should be investigated, namely the relation between low Hb levels and symptoms and signs in terminally ill cancer patients, and the correct timing for effective blood transfusion. A combination of criteria is needed for effective transfusion; they must include not only Hb levels but also type and severity of anemic symptoms and signs. Furthermore, the identification of reliable prognostic indicators for survival would be useful.
J Pain Symptom Manage 1996 Jul
PMID:Use of red blood cell transfusions in terminally ill cancer patients admitted to a palliative care unit. 920 50

We sought to determine whether levels of interleukin-6 and soluble interleukin-2 receptor were correlated with clinical parameters including functional capacity indices such as Steinbrocker's class and the Juvenile Arthritis Functional Assessment Report (JAFAR) score, with tests for inflammation, and/or with immunological parameters in 24 patients with active polyarticular or pauciarticular juvenile chronic arthritis. Levels of interleukin-6 and soluble interleukin-2 receptor were significantly higher in juvenile chronic arthritis patients than in healthy controls (p < 0.005 and p < 0.00005, respectively). Interleukin-6 levels were correlated with the following parameters: number of painful joints (p < 0.025); Ritchie's index (p < 0.025); visual analog scale pain score (p < 0.025); Steinbrocker's class (p < 0.025); JAFAR score determined by patients (p < 0.05); JAFAR score determined by parents (p < 0.05); erythrocyte sedimentation rate (p < 0.0002); and serum levels of C-reactive protein (p < 0.0003), hemoglobin (p < 0.05), albumin (p < 0.025), and alpha 2-globulins (p < 0.025). Levels of soluble interleukin-2 receptor did not correlate with any of the parameters studied. Levels of interleukin-6 and soluble interleukin-2 receptor were not correlated with each other. Abnormal levels of interleukin-6 or soluble interleukin-2 receptor were not significantly associated with the presence of antinuclear antibodies, IgM-rheumatoid factor, IgA rheumatoid factor or anticardiolipin antibodies. Our findings suggest that interleukin-6 is a useful parameter for assessing juvenile chronic arthritis and that the potential clinical value of elevated levels of soluble interleukin-2 receptor in this disease needs to be further evaluated in longitudinal studies.
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PMID:Interleukin-6 and soluble interleukin-2 receptor in juvenile chronic arthritis: correlations with clinical and laboratory parameters. 873 Dec 31

A 69-year-old female with a fourty-year history of rheumatoid arthritis visited Kobe University hospital with complaints of subcutaneous soft tumor on both hands and arthritic pain of both knees. She has been given 10 mg of predonisolone for several years and had a history of hydronephrosis. Her radiographs revealed periarticular calcification in the hands, shoulder joints and posterior thoracic wall. She had high titer of rheumatoid factor and both erythrocyte sedimentation rate (79 mm/hr) and C-reactive protein (12.79 mg/ml) were elevated. The examination of her serum showed the following values: Ca 7.9 mg/dl, P 5.0 mg/dl, 25 (OH) D3 < 3.6 pg/ml, 1 alpha-. 25 (OH)2 Vit D3 < 6.1 pg/ml, osmolality 974 mOsm/kg, BUN 61 mg/dl, creatinine 1.9 mg/ml, creatinine clearance less than 20 ml/min, indicating chronic renal failure. Intact PTH level was normal, although plasma parathyroid hormone-C (PTH-C) level increased. Together with these findings, it is suggested that metabolic disorders associated with chronic renal failure and tissue damages due to the severe rheumatoid arthritis led to the formation of diffuse soft tissue calcification.
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PMID:[A case report of systemic calcinosis associated with rheumatoid arthritis]. 877 93

We performed a phase Ia/Ib trial of chimeric anti-GD2 monoclonal antibody 14.18 (ch14.18) in combination with recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) to determine the maximum tolerated dose as well as immunologic and biologic responses to the regimen. Sixteen patients with metastatic malignant melanoma received escalating doses of ch14.18 (15-60 mg/m2) administered intravenously for 4 h on day 1. Twenty-four hours later, subcutaneous injections of rhGM-CSF were administered daily for a total of 14 days. Significant side effects were related to ch14.18 infusion and consisted of moderate to severe abdominal and/or extremity pain, blood pressure changes, headache, nausea, diarrhea, peripheral nerve dysesthesias, myalgias, and weakness. Dose-limiting toxicity was observed at 60 mg/m2 and consisted of severe hypertension, hypotension, and atrial fibrillation in one patient each, respectively. Significant increases in white blood cell count, granulocyte count, eosinophil count, and monocyte count occurred after rhGM-CSF treatment. Significant enhancement of in vitro and in vivo monocyte and neutrophil tumoricidal activity and antibody-dependent cellular cytotoxicity along with significant elevations in C-reactive protein and neopterin were observed. Despite these immunological and biological changes, no antitumor activity was seen. In short, the combination of ch14.18 and rhGM-CSF resulted in toxicity similar to that observed with ch14.18 alone without improvement in tumor response.
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PMID:Phase Ia/Ib trial of anti-GD2 chimeric monoclonal antibody 14.18 (ch14.18) and recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) in metastatic melanoma. 881 95

A prospective study was carried out to determine the usefulness of 99TCm-human immunoglobulin G (HIG) scintigraphy in the assessment of the severity of joint inflammation. Twenty-four patients with rheumatoid arthritis were studied. The presence or absence of pain and/or swelling was evaluated in 34 joints and a clinical index taking into account the surface area of each joint was calculated. We measured the following biological markers of inflammation activity: erythrocyte sedimentation rate, C-reactive protein, haemoglobin, platelet count, serum levels of IL-6, TNF-alpha and soluble receptors of IL-2. Scintigraphic was performed 4 h after the injection of 740 MBq 99Tcm-HIG. The scans were evaluated by visual and quantitative analysis and the scores in each joint were weighted for joint size. Pathological uptake of the radiopharmaceutical was noted in 46% (24/52) of joints evaluated as painful, 89% (146/164) of swollen joints and 94% (78/83) of both painful and swollen joints. Both the visual and the quantitative scintigraphic indices correlated significantly with the clinical index, the number of painful joints, the number of swollen joints and several biological markers of inflammation. A very high correlation was also found between the visual and the quantitative scintigraphic indices (r = 0.91, P < 0.0001). In conclusion, 99Tcm-HIG scintigraphy is an objective test to detect synovitis and to assess the severity of inflammation. A careful visual analysis of scans is good enough for routine evaluations and computer quantitative analysis should be used when more accurate intra-individual variation is required.
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PMID:Scintigraphic evaluation of the severity of inflammation of the joints with 99TCm-HIG in rheumatoid arthritis. 882 52

Postoperative spondylodiscitis (POD) is a rare but severe complication of lumbar disc surgery. There were five patients with POD among 875 patients undergoing surgery for herniated lumbar discs, in the last 16 years. For detecting risk factor of discitis, a POD group of 5 patients was matched to a control group of 870 patients with respect to sex, age, disc type and operation. In five patients with POD follow-up evaluation of clinical symptoms, laboratory data were obtained, and magnetic resonance (MR) imaging was performed. A significant difference between the POD group and the control group was confirmed in sex, operation time and the volume of bleeding during operation. However, there was no significant difference confirmed due to age, disc type, disc level and operative procedure. In the case of males or prolonged operation time or increase of the volume of bleeding, POD may be more frequently observed. All five patients had a period of pain relief after their operations and then reported increasing low back pain with no focal signs. At diagnosis of POD all patients had an erythrocyte sedimentation rate (ESR) greater than 30 per hour and C-reactive protein (CRP) higher than 2.5. After treatment by antibiotics, low back pain gradually receded along with decrease of ESR and CRP. About 40 days later, these patients were almost free of back pain and ESR and CRP were within normal range. MRT1-weighted image during the acute phase demonstrated remarkably decreased signal intensity with loss of distinction between vertebral body and disc space. T2-weighted image showed increased signal intensity in the adjacent vertebral bodies and end-plates. Gadolinium-enhanced T1-weighted image had homogenous enhancement of vertebral body and disc space. During the subacute phase, however, T1-weighted image demonstrated moderately decreased signal intensity noted in the posteroinferior portion of the L5 vertebral body and the narrowed L5/S1 disc space. T2-weighted image showed iso signal intensity in L5 and S1 vertebral bodies. Gadolinium-enhanced T1-weighted image had mild homogenous enhancement in the posteroinferior portion of the L5 vertebral body. Three months after treatment of POD, there was major signal change in neither T1 nor T2 weighted images, though T2 showed subtle abnormalities with decreased signal intensity adjacent to the L5/S1 disc space.
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PMID:[Spondylodiscitis after operation for lumbar disc herniation]. 884 75

Poststreptococcal reactive arthritis (PSRA) is a clinical syndrome of reactive arthritis. It is associated with recent streptococcal infections, but could not fulfill the revised Jones criteria for acute rheumatic fever (ARF). The incidence of PSRA cardiac complications to develop was as high as the ARF's developing into rheumatic heart disease. A 9-year-old boy presented with limping gait. He had pain in his left knee for 4 days but no fever. His right knee was swelling with a limitation of movement. A throat culture showed positive growth for group A streptococcus, and consequently antistreptolysin-O serum titer and C-reactive protein were elevated. A synovial fluid examination was turbid but sterile. After 3 days the arthralgia subsided rapidly. A cardiac color Doppler and electrocardiogram showed no evidence of valvular disease. Under the threat of high incidence of rheumatic heart disease in PSRA, we treated this patient with prophylactic antibiotics as acute rheumatic fever. A clinic follow up one year later showed neither sequels nor heart murmur on physical examination.
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PMID:Poststreptococcal reactive arthritis: report of one case. 885 55

The symptoms of right-sided renal colic mimic sometimes acute appendicitis. A prospective comparative study of 188 patients with ureteral stone and 188 patients with acute appendicitis was performed to evaluate the features of differential diagnosis. Appendicitis caused more often nausea (81 vs 11%), fever and localized pain in the McBurney (97 vs 59%) than renal colic. The patients with ureteral stone had tenderness in 16% in the right lower quadrant. The mean values of C-reactive protein (41 mg/l) and blood leukocytes (14 x 10(9)/l) were elevated in appendicitis, but not in renal colic (14 mg/l and 10 x 10(9)/ l). Urinanalysis revealed red cells in 92% of ureteral stones compared with 26% in appendicitis. Only one of 188 patients with appendicitis was first misdiagnosed to have renal colic. A mistake of appendicitis for ureteral stone is clinically rare occurring only once or twice per year in the hospital where 700-800 emergency appendectomies are annually performed.
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PMID:A chance of misdiagnosis between acute appendicitis and renal colic. 893 24


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