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

The rarity of adrenocortical carcinoma prompted us to report a case who came with a history of swelling in the left flank associated with pain, weakness and loss of appetite. Ultrasonography revealed a left retroperitoneal mass which was removed by radical surgery along with the left kidney and spleen. On histopathological examination, a diagnosis of adrenocortical carcinoma was made. (Hough criteria score 2.97). The cells of the tumor were arranged in closely packed columns and cords supported by fibrovascular stroma. There was no evidence of metastasis.
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PMID:Nonfunctioning adrenocortical carcinoma. 130 21

A systemic necrotizing vasculitis of unknown etiopathogenesis may be termed juvenile polyarteritis syndrome (JPS). The syndrome has been recognized primarily in young Beagles used for toxicologic studies. We studied 9 young Beagles with JPS. Affected dogs had fever (40 to 41.5 C), anorexia, and signs of pain in the cervical area. They had a characteristic hunched stance, and were unwilling to move. Laboratory abnormalities in all dogs included nonregenerative anemia, hypoalbuminemia, and leukocytosis characterized by a mature neutrophilia. Analysis of CSF revealed a moderate to severe neutrophilic pleocytosis and a mildly high protein concentration in most dogs. Signs of disease resolved rapidly with high doses (2.2 mg/kg of body weight, PO) of prednisone. If untreated, clinical signs and laboratory abnormalities had a remitting and relapsing course in most dogs. Findings at necropsy included necrotizing arteritis with fibrinoid necrosis, periarteritis, thrombosis, and intimal proliferation that most frequently affected small- to medium-sized vessels in the cervical spinal cord, mediastinum, and heart. An immune-mediated pathogenesis for this disease is suspected.
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PMID:Systemic necrotizing vasculitis in nine young beagles. 136 39

Fifty-one patients with moderate (11/51) and severe (40/51) cancer pain were given a new non-narcotic analgesic -Tromadol HCL capsule (THC). In 42 of these patients, partial relief was obtained with an average relief time (ART) of 4.1 hours. The average starting time was 58 minutes. Pain relief rate (PRR) in moderate and severe pain was 82% (P = 0.945), and the ARTs were 7.4 hr. and 3.2 hr., respectively (P = 0.005). In 43 patients who were entered into a randomized study with control drugs of AT-237 (36 cases) or Anfendein (7 cases), the PRR was 60.4% (26/43), ART was 1.3 hours. The PRR and ART of THC and control drugs were statistically significant (P less than 0.001 and P = 0.023). Within adequate dose range, increase of THC dose could improve its analgesic effect (P = 0.011). The main side-effects were: somnolence (37.3%), nausea (35.3%), dizziness (33.3%), palpitation and anorexia (25.5%) and constipation (9.8%) which did not necessitate the suspension of THC administration.
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PMID:[Pain-relief effect of tramadol HCL capsule for moderate and severe cancer pain]. 139 64

This article discusses the findings of a study of pre-adolescent children to determine if the mode of presentation of appendicitis had changed over the past 10 years, if the incidence of perforations decreased with age, and if diagnosis related groups (DRGs) impacted the length of hospital stay. The charts of 42 children under the age of 12 years who were discharged from two inner-city hospitals with a diagnosis of acute appendicitis from 1980 to 1989 were reviewed. There were 20 blacks and 22 whites, 26 males and 16 females with an average age of 7.31 years (range: 2 to 11 years). Over 95% of patients presented with right lower quadrant pain, 78% with guarding, 80% with a positive psoas sign, 93% with a positive Rovsing's sign, and 65% with rectal tenderness. Over 85% of patients had a history of nausea, vomiting, and anorexia. The mean duration of pain was 52.8 hours and the mean temperature was 99.6 degrees F. The mean white blood cell count was 18,176 +/- 4682 for whites versus 14,615 +/- 5459 for blacks. At surgery 15/42 (36%) of patients had a perforation, 11 of whom had positive wound cultures. Escherichia coli was recovered in all 11 of these patients. The average duration of pain in the perforated group was 50.9 hours, and the average age was 7 years. Eleven of these patients had normal bowel sounds on admission. Only 31% of the total cohort had a fecalith identified by pathology. The average postoperative length of stay was 6.5 +/- 2.5 days before the initiation of DRGs and 7.5 +/- 3 days afterward.
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PMID:Appendicitis in children: a continuing clinical challenge. 140 59

Cachexia occurs in the majority of cancer patients before death. It is the result of major metabolic changes produced by tumor-released substances as well as by cytokines and some endogenous peptides. The most significant clinical manifestation is profound anorexia. Aggressive parenteral nutrition has not been able to increase patient survival or produce any significant symptomatic improvement. Recent research, therefore, has focused on drugs that might result in symptomatic improvement, even if no significant nutritional changes are detected. Corticosteroids have been shown to increase appetite for a brief period of time, but they do not appear to improve caloric intake or nutritional status. In addition to appetite stimulation, corticosteroids also improve a number of other symptoms transiently. Progestational drugs have been found in a number of studies to increase appetite, caloric intake, and nutritional status. The most effective type and dose of progestational drugs have not been clearly established. Cyproheptadine, hydrazine sulfate, and cannabinoids have all been suggested to have beneficial effects on appetite; their effectiveness, however, needs to be confirmed in prospective, controlled trials. Some of these trials are currently under way. Current data suggest that megestrol acetate or other progestational agents could be useful--because of effects on not only appetite but also overall nutritional status--in patients who have profound anorexia as the main manifestation of cachexia, provided expected survival can be measured in weeks or months. In patients with shorter expected survival or those who have problems tolerating progestational drugs, a brief course of corticosteroids may provide short-term symptomatic effects. Future studies should focus on (1) improving understanding of both the pathophysiology of cancer cachexia and the interaction of some of the major syndromes of terminal cancer--e.g., pain, cachexia, and cognitive failure--and (2) characterizing the symptomatic effects of different drugs more completely.
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PMID:Clinical management of anorexia and cachexia in patients with advanced cancer. 146 26

This prospective study aims to determine whether specific symptoms or group of symptoms could positively discriminate the etiology of patients who present with dyspepsia. Two hundred and eight patients were studied and 111, 55, 35 patients were classified as non-ulcer dyspepsia, peptic ulcer disease and hepatobiliary disease, respectively. All patients completed a structured history questionnaire by personal interview and completed investigation with complete blood count, stool examination, liver function test, HBsAg, HBsAb, ultrasonography of the abdomen and endoscopy. Variable of interest and variables of statistical significance by univariate analysis were put into discriminant function of logistic model for discrimination. The results suggest that anorexia and no periodicity of epigastric pain significantly discriminated non-ulcer dyspepsia from peptic ulcer disease and hepatobiliary disease, pain occurring before a meal or when the patient was hungry and nocturnal epigastric pain significantly discriminated peptic ulcer disease from hepatobiliary disease.
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PMID:The study of discriminant values of dyspeptic symptoms for identifying the etiology of dyspepsia. 148 82

Records of 11 patients undergoing biliary reconstruction after laparoscopic cholecystectomy are reviewed. Ductal injuries resulted from failure to define the anatomy of Calot's triangle. Risk factors include scarring, acute cholecystitis, and obesity. Presenting findings included anorexia, ileus, failure to thrive, pain, ascites, and jaundice. All patients required hepaticojejunostomies, which were multiple and above the hepatic bifurcation in four patients. Given the extensive nature of these injuries and the frequent need for intrahepatic anastomosis and early stenosis of repairs by referring physicians, we recommend reconstruction be undertaken by an experienced hepatobiliary surgeon. To avoid injuries, a greater appreciation of risk factors and anatomic distortion and variance and strict adherence to principles of dissection and identification of anatomic structures are suggested. The use of cholangiography and a low threshold for conversion to the open procedure are advised.
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PMID:Laparoscopic bile duct injuries. Risk factors, recognition, and repair. 153 9

Autopsy or surgical specimens from six patients with primary cardiac angiosarcoma seen at the Mayo Clinic (all in men) between 1939 and 1988 were studied (patients' ages, 31 to 80 years; mean 50 years). The symptoms were nonspecific and included dyspnea and thoracoabdominal pain in six; anorexia in five; fatigue, hemoptysis, or orthopnea in four; nausea and vomiting, fever, or weight loss in three; and night sweats in two. Cardiomegaly was present in five, and a pericardial effusion or density, a mass adjacent to the heart, or nonspecific ST-T wave changes were present in three. All six neoplasms arose from the right atrium and exhibited epicardial or endocardial extension; three produced obstructive intracavitary right atrial masses. Pulmonary metastatic lesions were noted in five patients. The cardiac neoplasm was diagnosed by computed tomography or magnetic resonance imaging in the three most recent patients, and surgical resection was performed in two of them. Mean survival was 6 months after presentation. Causes of death were pulmonary hemorrhage in three, thoracic metastasis in two, and hemopericardium in one. The diagnosis of primary cardiac angiosarcoma was established at operation in two patients and at autopsy in four. Despite diagnosis by noninvasive imaging procedures and aggressive early surgical intervention, survival was less than 6 months. Thus optimal therapy is unclear.
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PMID:Primary cardiac angiosarcoma: a clinicopathologic study of six cases. 154 8

A 63-year-old white woman was admitted to the hospital for bilateral total knee arthroplasty. She was given prophylactic subcutaneous heparin therapy postoperatively. Three days later, she had a brief hypotensive episode and an unexplained drop in hemoglobin level. Seven days postoperatively, she became confused and disoriented while complaining of pain in her right side and, later, under her left breast. She also had nausea, vomiting, anorexia, and a vague feeling of "illness." Her condition deteriorated progressively, with blood pressure falling to 65/40 mm Hg and a temperature of 39.7 degrees C. Blood, urine, and cerebrospinal-fluid culture samples showed no evidence of infection. A diagnosis of acute adrenal insufficiency was made. Following corticosteroid therapy, the patient's condition improved markedly. Of interest in our patient was that she had had no antecedent hypotension, sepsis, fever, or surgical complications. Acute adrenal hemorrhage is often overlooked because the symptoms are attributed to other conditions, especially to sepsis. Acute adrenal hemorrhage should be suspected in any stressed patient in whom an abrupt deterioration associated with back or abdominal pain, hypotension, and unexplained fever are noted. Suspicion should be raised regarding those patients who are receiving anticoagulant therapy (including subcutaneous heparin prophylaxis) at the time of deterioration. With increased awareness, more cases of acute bilateral adrenal hemorrhage and subsequent adrenal insufficiency can be recognized ante mortem and treated.
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PMID:Prophylactic subcutaneous heparin therapy as a cause of bilateral adrenal hemorrhage. 155 45

Diabetic neuropathic cachexia is characterized by neuropathic pain and severe weight loss of unknown aetiology. We describe four patients with diabetic neuropathic cachexia who were found to have malabsorption. Four diabetic patients presented with neuropathic pain, anorexia, depression and weight loss of 16 (range 10-21) kg. None complained of diarrhoea. There were three males and one female, median age 54 (46-67) years. A butterfat test showed a serum turbidity difference of 9 (6-10) light scattering units (normal greater than 60 units). The median serum xylose was low and there was delayed urinary xylose excretion. Urinary indicans, small bowel histology, liver function tests, and thyroid and renal function were normal. Ultrasound scans of liver, gall bladder and pancreas, and endoscopic retrograde cholangiopancreatogram were normal. The patients were treated with pancreatic supplements and a high calorie diet. Three have completely recovered and the other patient is improving. Thus these cases of diabetic neuropathic cachexia appeared to be associated with malabsorption which may be due to pancreatic dysfunction. It is suggested that the management of diabetic neuropathic cachexia should include the investigation and treatment of malabsorption.
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PMID:Diabetic neuropathic cachexia associated with malabsorption. 156 56


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