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

The aim of the study was to assess the surgical outcome of elective infrarenal abdominal aortic aneurysm (AAA) repair and the clinical and surgical factors that may predict this outcome. The series comprises 174 consecutive patients who underwent elective surgery for infrarenal AAA. Factors found to be predictive of early hospital death (4.5%) were aneurysm size (> 5 cm), ischaemic heart disease, chronic obstructive pulmonary disease (COPD), preoperatively elevated C-reactive protein (CRP) and a history of aneurysm-related pain preoperatively. The outcome was also very poor if the bacterial culture from the aneurysm sac was positive. On the whole, the abdominal aortic aneurysm operation effectively controls the disease and can be safely employed electively.
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PMID:Outcome of elective infrarenal abdominal aortic aneurysm repair--an analysis of 174 consecutive patients. 895 Apr 46

Fifty-five patients with psoriatic arthritis were treated with a low dose of cyclosporin A (CyA) (mean dose 2.7 mg/kg per day) for a period of 6 months to investigate the efficacy of CyA on disease parameters. Significant improvement in the joint complaints and inflammation parameters was observed including a decrease in the number of painful (-46%) and swollen (-45%) joints, tenderness (Ritchie Index: -50%) and degree of swelling (-46%), patient's assessment of pain (-35%), the duration of morning joint stiffness (-37%), as well as a decrease in C-reactive protein (-52%). A 50% reduction of joint complaints required a total of 24 weeks, whereas a 50% reduction of skin involvement was achieved after 5-6 weeks of treatment. Four patients left the study due to adverse events: creatinine level increase in two patients, hypertension in one patient and gastroenteritis in the fourth patient. Joint scintigraphy in 18 patients indicated an improvement or stable condition in 61% of cases after a mean follow-up of approximately 8 months. The results of this prospective study show that low-dose CyA effectively improves not only skin lesions, but also joint complaints in psoriatic arthritis.
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PMID:Anti-inflammatory efficacy of low-dose cyclosporin A in psoriatic arthritis. A prospective multicentre study. 897 76

The adult patient who complains of anterior hip pain is a dilemma frequently encountered by the primary care physician. Detailed history taking, physical examination, and plain x-ray films are indicated for the initial evaluation. Anterior hip pain is often diagnosed as musculoskeletal strain/sprain and treated with a conservative regimen represented by the acronym NICER (nonsteroidal anti-inflammatory drugs, ice, compression, elevation, and rest) with or without physical therapy. On occasion, this therapy fails to eradicate the symptoms. When these symptoms are refractory to diagnosis by conventional means, a more comprehensive evaluation of the etiology is warranted. Refractory pain is defined in the authors' practice as pain that persists after 4 weeks of initial conservative management. This subsequent evaluation includes the use of such laboratory tests as complete blood cell count with differential count, Chem 20 health profile, erythrocyte sedimentation rate, and an arthritic panel (assessment of rheumatoid factor, antinuclear antibody, C-reactive protein). Ancillary radiologic tests warranted include a nuclear bone scan, a magnetic resonance imaging scan, a computed tomography arthrogram with hip aspiration, and/or a scan of white blood cells labeled with indium 111. The test chosen depends on the etiology most suspected. A useful diagnostic algorithm for the investigation of anterior hip pain in the adult is provided. An illustrative case presentation of carcinoma of an unknown primary site presenting as anterior hip pain demonstrates the algorithm as it applies in the authors' practice.
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PMID:Anterior hip pain in the adult: an algorithmic approach to diagnosis. 931 47

Clinical measurement in rheumatoid arthritis (RA) has focused on articular problems. Although measures like the Health Assessment Questionnaire (HAQ) are widely used to determine functional impairment, there is a need to determine the overall effect of RA on general health status. We evaluated the relationship of a generic health status measure-the Nottingham Health Profile (NHP)-to the clinical, laboratory and radiological changes in the EULAR core data set for RA. Two hundred consecutive out-patients with RA were recruited. Their mean age was 58.9 yr and mean disease duration 11.3 yr. Patients completed the NHP and the following assessments were made: the EULAR Core Data Set, the duration of morning stiffness, the Disease Activity Score (DAS), rheumatoid factor (RF) levels, and Larsen's score for X-rays of hands and wrists. RA patients had higher scores on the NHP than both a random population sample and a second sample of patients with a variety of common diseases. NHP scores were not related to age or disease duration in RA. There was little relationship between perceived distress and the Larsen score, RF, ESR and C-reactive protein levels. Moderate associations were seen between NHP scores and disease activity measures, including the number of tender and swollen joints, pain and the duration of early morning stiffness, and also with a disability measure-the HAQ. NHP scores were highly related to disease activity measured by DAS. High DAS scores were associated with high scores in the energy level, pain and sleep sections of the NHP. The NHP gives relevant information about RA patients. They have high scores for pain, physical mobility and energy level sections, and also have high distress for sleep and emotional reactions.
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PMID:The Nottingham Health Profile as a measure of disease activity and outcome in rheumatoid arthritis. 911 79

Attention has been drawn to elevated laboratory tests of inflammation as indicators of a possible reaction to silicone breast implants. These patients have complaints of joint pain, pain, and myalgia that were possibly caused by a reaction to silicone. This study is a retrospective review of 100 consecutive patients (79 female, 21 male) who were evaluated because of a purported industrial injury to the upper extremity. Patients were examined by a single examiner and all had laboratory screening for indicators of inflammation (sedimentation rate, anti-nuclear antibody levels, C-reactive protein, anti-streptolysin, rheumatic factor), endocrine abnormalities (thyroid panel), and serum glucose. None of the patients had any history of breast augmentation with any implant. Of the 79 female patients, 50 had an identifiable clinical diagnosis and 18 of them had elevation of at least one of the indicators of inflammation. The remaining 29 did not have an identifiable diagnosis and 21 of them had elevation of at least one indicator of inflammation (P < 0.01). There were 74 out of 79 females with subjective complaints of upper extremity pain, joint pain, and aching. Forty-five of these patients had an identifiable diagnosis and 17 of them had elevation of at least one inflammatory indicator. Of the 74 female patients, 29 had no identifiable diagnosis and 21 of them had elevation of at least one inflammatory indicator (P < 0.01). In summary, there were a high number of female patients with complaints of upper extremity symptoms with no prior exposure to silicone from breast implantation. There was a statistically significant correlation in these patients who had no identifiable diagnosis and elevated indicators in inflammation. This study suggests these markers of inflammation should not be used as indicators of a reaction to silicone from breast implantation in patients with upper extremity subjective complaints.
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PMID:Breast implantation and the incidence of upper extremity somatic complaints. 914 25

A total of 274 patients with abdominal aortic aneurysms due to atherosclerosis (AAA) and 16 patients with inflammatory abdominal aortic aneurysms (IAAA) were reviewed to compare and contrast the clinical characteristics of the 2 groups. The AAA group comprised 243 men and 31 women with a mean age of 69.2 +/- 0.4 (range 51-86) years. The IAAA group comprised 15 men and 1 woman with a mean age of 67.4 +/- 2.0 (range 53-81) years. Most patients with IAAA (12/16; 75.0%) had pain at presentation, whereas only 37 out of 274 patients (13.5%) with AAA had pain (p < 0.001). Fifty out of 274 patients (18.2%) with AAA were asymptomatic, the most common principal complaint being a pulsatile tumor, which was found in 150 out of 274 patients (54.7%; p < 0.005 vs IAAA). Regarding laboratory findings of inflammation, preoperative erythrocyte sedimentation rate values were elevated in 15 out of 16 (93.8%) patients, and C-reactive protein values were elevated in 13 out of 16 (81.3%) patients with IAAA. The incidence of perioperative complications was similar in the 2 groups. The 30-day postoperative mortality among AAA patients was 6.2% (17/274 cases), including 12 cases of non-ruptured and 5 cases of ruptured AAA; in contrast, no early deaths occurred among patients with IAAA. The cumulative 5-year survival rate was 80.2% for IAAA patients and 74.6% for AAA patients (NS). The results of our review suggest that careful diagnosis and intra- and postoperative management could lead to patients with IAAA having a similar survival rate to those with AAA.
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PMID:Inflammatory abdominal aortic aneurysms and atherosclerotic abdominal aortic aneurysms--comparisons of clinical features and long-term results. 915 71

A new oral dosage form of diclofenac sodium, enabling the single administration of the daily dose of 150 mg, has been tested for treatment of 20 patients suffering from osteoarthritis of the spine. A control group of 20 patients with the same diagnosis instead received 3 enteric-coated tablets/day, each containing 50 mg of the drug. Treatments lasted in both groups one month. Clinical efficacy was monitored by evaluating the changes in the disease's symptoms and signs (pain, cramps, alterations of function capacity, morning stiffness) and in some laboratory parameters (ESR, C-reactive protein, Rheuma test). Treatment tolerability was evaluated through the routine laboratory blood and urine tests, and by registering any complaint at the gastrointestinal level, as well as any adverse event. The two posology schemes were equally effective in favourably reducing the disease's clinical and laboratory manifestations. Also systemic and local tolerability were superimposable and on the whole good: only a few episodes of mild epigastralgia were reported (3 cases in each group), as expected during a treatment course with NSAIDs.
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PMID:Effective treatment of osteoarthritis with a 150 mg prolonged-release of diclofenac sodium. 917 25

On hospitalization, the clinical examination of a 64-year-old female with polyarthralgia and an elevated fever revealed leukocytosis, an increased lactic acid dehydrogenase level, and a positivity for the C-reactive protein. Subsequently, the patient developed muscular pain in the lower limbs. Thus, a muscle biopsy was performed and B-cells with atypia were detected in the arteriolar lumen within the muscle. This led to the diagnosis of angiotropic lymphoma (AL). A combination chemotherapeutic regimen was initiated, and the patient's symptoms disappeared. AL is difficult to diagnose before death, but in this case, muscle biopsy facilitated an early diagnosis and subsequent chemotherapy resulted in the disappearance of the AL. We thus feel this report may be of value.
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PMID:Angiotropic lymphoma diagnosed by muscle biopsy. 918 72

A 77-year-old man was referred to our hospital on October 2, 1995 because of fever and left mandibular pain beginning three months before admission. His blood pressure was 90/60 mmHg. A grade III/VI pansystolic murmur was heard over the cardiac apex. The liver was palpable 4 cm below the right costal margin. Lower extremity edema was present bilaterally. White blood cell count was 7,030/mm3 and C-reactive protein was 2.54. Enterococcus faecalis was identified by the blood culture. The diagnosis was infective endocarditis associated with congestive heart failure. He was treated by administration of antibiotics and diuretics. Mitral valve replacement and tricuspid annuloplasty were performed on October 19 because of progressive congestive heart failure with oliguria. The surgical intervention was successful despite the presence of multiple risk factors: high age, emergency, congestive heart failure and active infection. His condition improved dramatically after the operation and he was discharged two months later. Surgical intervention for infective endocarditis was a significant high-risk procedure in this uncontrollable and elderly case. This successful result suggests the indication for the timing of surgery.
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PMID:[An elderly patient with infectious endocarditis complicated with congestive heart failure due to mitral and tricuspid regurgitation]. 921 Nov 14

It is difficult to identify characteristics of patients with unstable angina that are predictive of a high likelihood of developing clinical events. However, several features have been recognized. Patients with a clinical history of previous stable exertional angina symptoms who began to experience rest pain appear to be at risk and tend to have more extensively underlying coronary disease. When the ischemic episodes are accompanied by rates, a new or worsening mitral regurgitation murmur, or hypotension, there is a high likelihood of significant coronary artery disease and one should triage these patients to early cardiac catheterization and prompt revascularization. An angiographic feature that carries a high risk is a lesion in the proximal left anterior descending or in the left main coronary artery. Certain typical ECG patterns are very suggestive for a critical narrowing in these coronary arteries. If chest pain and ST-segment changes recur on vigorous medical management, early invasive evaluation should be strongly considered. Even so, the left ventricular function is very important prognostically. According to serologic tests, the level of C-reactive protein and serum amyloid A protein suggesting that there may be active inflammation predicts an early poor outcome. However, these serologic abnormalities do not have much clinical value. An increased platelet activation and a reduced fibrinolytic capacity play a role in the pathogenesis of unstable angina, but thrombolytic therapy does not improve the prognosis in patients with unstable angina.
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PMID:Unstable angina: are we able to recognize high-risk patients? 922 83


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