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

High cervical myelotomy was carried out on 10 patients. Commissurotomy was performed at the C1-3 level by a combined procedure of deep electrocogulation and sharp splitting of the posterior columns. The immediate results were excellent in all patients, but relapse of pain took place shortly in six of them; there was apparently no relation with the location of pain. No long-term favourable results were observed in this series. Only three patients exhibited a well-defined band of mild hypalgesia from C2 to T 10 dermatome, but it lasted for only three to four weeks. Transient lower or four limb ataxia was observed in seven patients. Different pain conducting systems seem to be affected by commissural myelotomy, but not to a sufficient extent to give permanent or long-lasting relief of pain. The indications for high cervical myelotomy are very limited: this procedure should be considered only in patients with unilateral or bilateral arm and/or upper chest pain, respiratory impairment, and short life expectancy.
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PMID:High cervical commissural myelotomy in the treatment of pain. 106 98

Angiographic changes in the coronary circulation were evaluated in 60 patients 1 year after aortocoronary bypass surgery, and their relation to the postoperative clinical status was examined. Of 124 grafts implanted, 26 were closed, 7 stenotic and 91 (74 percent) patent at 1 year. Progression of occlusive disease occurred in 21 of 57 (37 percent) nongrafted and 78 of 123 (63 percent) grafted vessels. On the basis of location and severity of progression, significant lesions bypassed and patency of grafts, postoperative coronary perfusion was considered optimal in 16 patients (Group I), better in 24 (Group III). Complete freedom from chest pain or lessening of pain (improvement by two New York Heart Association functional classes) occurred in 88 and 79 percent of patients in Group III. Positive preoperative treadmill stress tests became negative after surgery in five of six patients in Group I, five of eight in Grojp II and three of eight in Group III. This study demonstrates that when progression of disease, graft patency and extent of revasculariztion are considered in combination, the postoperative angiographic status of the coronary circulation correlates well with clinical improvement at 1 year. These findings support the hypothesis that improved blood supply to ischemic myocardium is a major factor contributing to relief of angina pectoris after saphenous vein bypass surgery.
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PMID:Aortocoronary bypass surgery: Correlation of angiographic symptomatic and functional improvement at 1 year. 108 39

Among 264 consecutive persons (142 men, 122 women) greater than or equal to 35 years of age presenting for multiphasic screening examination, 85 (54 men, 31 women) reported chest pain. In most, the pain was not typical of coronary artery disease. The two-step exercise electrocardiogram (ECG) was positive (greater than or equal to 0.5-mm ischemic ST depression) in 21% of the patients who reported pain and in 19.5% of 66 randomly selected, similarly examined controls without chest pain (36 men, 30 women) (difference not significant). Females with positive ECGs (5-mm or 1-mm depression) predominated over males greater than or equal to 5:1 in the chest pain group and greater than 3:1 in controls. This study indicates that the routine two-step exercise ECG is not helpful in detecting ischemic heart disease in persons reporting chest pain during their multiphasic screening examination.
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PMID:Two-step electrocardiogram for chest pain reported on multiphasic screening. 111 Mar 38

During one six-month period 11 patients were referred with a diagnosis of coronary artery disease, because of recurrent episodes of severe, prolonged retrosternal chest pain necessitating from one to seven hospital admissions per patient for "suspect myocardial infarction". In no instance was this diagnosis proved by electrocardiogram or serum enzyme changes, but 7 of the 11 patients had abnormal resting electrocardiograms. Selective coronary arteriograms were normal in 10 patients and revealed nonobstructive coronary artery disease in the 11th patient. Esophageal studies revealed hiatus hernia in 9 and mild to severe disordered motored activity of the esophagus in all 11. Acid perfusion into the esophagus reproduced the chest pain in nine patients and in the other two, the hiatus hernia was incarcerated. On direct questioning, all patients indicated that the pain was worsened by lying down and bending over, and in eight patients there was a history of pharyngoesophageal or gastroesophageal dysphagia. In this day when the problem of chest pain with normal coronary arteries is very topical, our report emphasizes the need to consider symptomatic esophageal disease in the differential diagnosis of this problem.
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PMID:Esophageal disease as a cause of severe retrosternal chest pain. 112 87

A review of 120 patients who had a discharge diagnosis of intermediate coronary syndrome showed 12 patients with documented transient ST elevation during spontaneous rest pain consistent with Prinzmetal's angina. Coronary arteriography showed severe proximal occlusive coronary atherosclerosis in nine of the patients, and normal or minimal disease in the other three patients. In two of these three, there was documented coronary arterial spasm with reproduction of symptoms during arteriography. Although a shorter history of chest pain, presence of an old myocardial infarction and a positive finding on electrocardiogram treadmill test tended to predict the patients with severe occlusive coronary artery disease, these methods were inadequate to select candidates for arteriography. All patients responded well to nitroglycerine while in the hospital. Five of the nine patients with coronary artery disease had coronary bypass operations, with two excellent, two fair and one poor result. One of the three patients with normal findings on coronary arteriograms died with refractory ventricular arrhythmia six months after study. The other two have had good-to-moderate relief of symptoms on long-acting vasodilators and propranolol. Current concepts of the syndrome of Prinzmetal's angina and ST elevation are reviewed. It appears that this syndrome has a wide spectrum of clinical presentations and coronary arteriographic anatomies.
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PMID:Prinzmetal's angina Clinical and anatomic aspects. 114 90

Analysis of questionnaire responses of 70208 persons undergoing multiphasic health checkups showed a greater proportion of cigarette smokers than nonsmokers (excesses averaging 1.6-fold in white men, 1.3-fold in white women) admitting to nine types of chest pain. This excess in smokers was greater in younger individuals, and applied about equally to anginalike and nonanginalike pain. The smoking/chest pain association was not explained by greater alcohol or coffee consumption, diminished pain tolerance, or less reliability among smokers; nor did it appear to be mediated chiefly by excess cough, shortness of breath, coronary disease, or musculoskeletal complaints in smokers. Although smokers averaged more complaints than nonsmokers, chest pain resembled clearly smoking-related symptoms, such as cough, when the number of each subject's complaints was considered. Although more smokers had chest pain no type of pain was unique to smokers, suggesting that the "tobacco angina" concept be discarded or reserved for rare patients with coronary heart disease in whom smoking clearly provokes angina pectoris.
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PMID:Cigarette smoking and chest pain. 114 21

In a consecutive series of 1,000 women under age 50 examined by coronary cinearteriography principally for evaluation of chest pain, 236 had at least 50 percent narrowing of one or more coronary arteries. The youngest, and the only patient who died, was 26 years old. The anterior descending coronary artery was the vessel most frequently involved; the right coronary artery was most often totally occluded. The amount of arterial involvement seemed to be related to the duration of symptoms. Only 10 percent of women with serum cholesterol levels under 200 mg/100 ml had significant coronary artery disease, whereas 44 percent of those with levels over 275 mg/100 ml had significant disease. Electrocardiographic evidence of myocardial infarction was uncommon in women with single vessel disease, but left ventriculograms disclosed that additional patients had areas of decreased contractility. Eleven of 46 women with electrocardiographically diagnosed myocardial infarction had no significant coronary artery disease. The cause of the electrocardiographic finding remained obscure in some. Although there was an excellent correlation of clinical diagnoses with arteriographic findings in women thought not to have angina pectoris, only half of those thought to have angina pectoris had significant coronary artery disease. This finding may be a major reason for recommending coronary arteriography for the evaluation of angina-like pain in women under age 50.
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PMID:Coronary arteriographic findings in 1,000 women under age 50. 116 16

Seventeen subjects ranging from 36 to 58 years of age presented with chest pain suggestive of myocardial ischemia. Each patient had a positive double Master's two-step test with ST segment depression of 0.5 mm. or more in the postexercise ECG. In each case coronary angiography and left ventriculography were normal. Hemodynamic and metabolic investigations were carried out during sinus rhythm and atrial pacing. Thirteen patients experienced pain during pacing but only one showed an abnormal hemodynamic response. Two patients showed abnormal myocardial lactate metabolism during the control period and four during pacing-induced tachycardia. The increase in ejection fractions in this group suggests hyperdynamic ventricular contraction which could result in increased oxygen requirements and thus induce ischemic pain in the absence of arteriographically demonstrable coronary artery disease.
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PMID:Angina pectoris with normal coronary arteriograms: hemodynamic and metabolic response to atrial pacing. 119 32

A 45-year-old Caucasian female patient with a clinical rehistory and ECG's conforming to the syndrome of variant angina as characterized by Prinzmetal is presented. ECG's recorded during spontaneous pain demonstrated ST-segment elevation and symmetrical peaking of the T-waves in the lateral precordial leads and short runs of ventricular tachycardia. Similar ECG changes were recorded during treadmill exercise- and hand-grip exercise-induced chest pain. An echocardiogram recorded during angina induced by hand-grip exercise demonstrated progressive flattening of septal motion. Multiple views of the coronary system by selective coronary cineangiography were normal with the patient at rest. Angina was then induced by hand-grip exercise and a repeat right anterior oblique view of the left coronary system revealed marked spasm of the left anterior descending artery proximal to the first septal perforator.
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PMID:Coronary angiographic, echocardiographic, and electrocardiographic studies on a patient with variant angina due to coronary artery spasm. 119 41

Hemodynamic and metabolic responses to pacing from either the coronary sinus or right atrium were evaluated in 41 patients with chest pain and normal coronary arteriograms. A group of patients (group II) with angina, lactate production, or significant ST segment depression had a significantly higher mean pulmonary capillary pressure on peak pacing or angina than did a group of patients considered to have a normal pacing response (group I). In 6 of 9 group II patients, the left ventricular end-diastolic pressure either rose abnormally with pacing or was greater than 14 mm Hg immediately after pacing and resembled that of a group of patients with coronary artery disease; Patients with a prolapsing mitral valve (group III) also had a significantly higher pulmonary capillary pressure on peak pacing as compared to those of group I, although abnormal left ventricular pressure responses occurred in only 2 of 9 of these patients. The stroke index was significantly lower in group III on peak pacing while group II was no different from group I. Lactate production occurred in 6 of 9 group II patients. However, only 1 of 6 patients with a prolapsing mitral valve who were studied for lactate production was found to produce lactate, suggesting a different mechanism for their pain.
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PMID:Hemodynamic and metabolic responses to pacing in patients with chest pain and normal coronary arteriograms. 120 72


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