Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Over a period of 13 years 21 patients between the ages of three weeks and 13 years presenting to this centre had a vascular ring. A double aortic arch was present in 11 cases, a right aortic arch with a retroesophageal left subclavian artery in five cases, a right aortic arch with a normal left innominate artery, a Kommerell's diverticulum and a left ligamentum arteriosum encircling the trachea and oesophagus occurred in two cases and an aberrant left pulmonary artery arising from the right pulmonary artery occurred in three cases. The majority (19/21) presented with a history of chronic stridor, although other significant associated symptoms included: recurrent respiratory infection, wheeze, cyanotic episodes and difficulty or pain on swallowing. The barium swallow was the most useful method of investigation and was diagnostic in all of the 95% of cases in which it was performed. Nineteen patients underwent surgery uneventfully although stridor often remained a problem for some time following repair. Six patients (28%) had associated congenital heart disease. Three (14%) patients who did not have surgery died.
 ...
PMID:A review of vascular rings 1980-1992. 786 Feb 61

Trauma to the cricoarytenoid joint represents a rare but serious complication of endotracheal intubation. Subluxation and luxation of the arytenoid cartilage may occur during difficult but also following uncomplicated intubation. Forces on the arytenoid cartilage exerted by the laryngoscope blade or by the distal part of the endotracheal tube may cause anterior and inferior displacement of the arytenoid cartilage. Due to the conventional intubation technique the left arytenoid cartilage is affected most frequently. Posterolateral subluxation is attributed to the pressure exerted on the posterior glottis by the convex part of the shaft of the tube. Systemic diseases (e.g. terminal renal insufficiency, bowel diseases, acromegaly) may cause degeneration of the cricoarytenoid ligaments, thus making the cricoarytenoid joint more susceptible to traumatic dislocation. Persisting alterations of voice, sore throat and pain on swallowing may hint to the diagnosis of arytenoid dislocation. However, stridor and shortness of breath have also been observed. If pharyngo-laryngeal complaints persist, evaluation by laryngologists is mandatory. In addition to indirect and direct laryngoscopy, computerised tomography and electromyography of the larynx play an important role in differentiating arytenoid dislocation from true vocal cord paralysis due to nerve damage. Early operative reposition results in fair prognosis, whereas delayed diagnosis may lead to ankylosis of the cricoarytenoid joint with permanent impairment of the voice and possibly compromised airway protection.
 ...
PMID:[Intubation trauma of the larynx--a literature review with special reference to arytenoid cartilage dislocation]. 876 39

Gastroesophageal reflux and pulmonary disease have become causally associated owing to reports of improved pulmonary function in patients with asthma or stridor following antireflux pharmacotherapy or surgery. Mechanisms by which reflux causes pulmonary disease include direct aspiration and neural reflex arcs. A novel additional mechanism for acute life-threatening episodes implicates increased beta-endorphin levels resulting from acid-mediated esophageal pain in the depression of respiratory drive. Diagnostic modalities used in the evaluation of reflux have often been inadequate to demonstrate a cause-and-effect relationship between reflux and pulmonary disease. Recent studies using multiple site pH-metry have attempted to provide evidence for cause and effect but have achieved mixed results. Aggressive antireflux pharmacotherapy and, sometimes, surgery help those patients with chronic pulmonary disease mediated by gastroesophageal reflux.
 ...
PMID:Evaluation and management of gastroesophageal reflux and pulmonary disease. 881 96

Tracheobronchial ruptures are rare but potentially lifethreatening events. We report on the case of a 34-year-old suicidal unrestrained car driver, who developed subcutaneous and mediastinal emphysema and right-sided haematothorax following blunt thoracic trauma. Fibreoptical inspection of the tracheobronchial system revealed a rupture (approximately 2 cm in length) of the pars membranacea of the trachea ending shortly above the carina. CT-scan confirmed the diagnosis of mediastinal emphysema, tracheal rupture and, in addition, left-sided pulmonary contusion. A repair of the tracheal tear was performed by right-sided thoracotomy using a double-lumen tube. The left-sided double-lumen tube was used postoperatively to achieve respirator ventilation with low pressure on the tracheal lumen and on the suture of the tracheal tear. On the other hand, sufficient airway pressure with PEEP for the left lung showing contusion could be provided, using the endobronchial tube. The postperative course was without complications. The patient was on respiratory support for three days due to his-pulmonary contusion. Following final endoscopic control of the trachea he was discharged from the ICU one week after the trauma. The clinical and radiological signs of tracheobronchial ruptures are discussed (respiratory distress, haemoptysis, cyanosis, localised pain, hoarseness, coughing, dysphagia, stridor, subcutaneous emphysema and pneumothorax, tension pneumothorax, mediastinal emphysema). Fibreoptic bronchoscopy is the present gold standard for confirming the diagnosis. The surgical and anaesthesiological approach to the management of tracheobronchial ruptures is described reviewing the current literature.
 ...
PMID:[Diagnosis and therapy of tracheal rupture after blunt thoracic trauma]. 928 31

We studied 40 patients undergoing surgical removal of at least two third molar teeth under general anaesthesia. Patients were allocated randomly to one of two groups: group B (n = 20) received bupivacaine up to 2 mg kg-1, infiltrated around the inferior alveolar nerves bilaterally, and group K (n = 20) received ketorolac 10 mg i.v. at the start of surgery. There were no significant differences between the two groups in postoperative pain scores measured at 1 h using a visual analogue scale. Group K had a significantly lower incidence of side effects related to intraoral anaesthesia. Swallowing, speech and oral continence were significantly better. Group K scored higher for overall patient satisfaction, measured using a visual analogue scale. We failed to demonstrate any difference in early postoperative recovery (coughing, laryngospasm, stridor or arterial oxygen desaturation) between the groups. We conclude that the use of 0.5% bupivacaine infiltration was no more effective than a single 10-mg injection of ketorolac while giving rise to a higher rate of "minor" airway complications and lower patient acceptability.
 ...
PMID:Local anaesthetic infiltration for surgical exodontia of third molar teeth: a double-blind study comparing bupivacaine infiltration with i.v. ketorolac. 992 22

Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded the Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient, support to caregivers, and encourages the healing process. The Center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. The case presented is of a young man dying of recurrent epithelioid hemangioendothelioma, distressed with stridor and severe pain, whose poorly controlled symptoms were successfully treated with an infusion of propofol, titrated to provide effective comfort in the last few hours of the patient's life. The tenet of double effect, which allows aggressive treatment of suffering in spite of foreseeable but unintended consequences, is reviewed. The patient's parents were invited and contributed to the Rounds, providing compelling testimony to the power of the presence of clinicians at the time of death and the importance of open communication about difficult ethical issues.
 ...
PMID:Sedation for intractable distress of a dying patient: acute palliative care and the principle of double effect. 1070 50

More attention has been given to vocal cord dysfunction (VCD) in the past years. Even though the disease is known since 1983 and was brought to mind at least casuistically through the years, often VCD was not diagnosed as such, being mistaken for bronchial asthma - at times with grave consequences for the patient. VCD causes the acute onset of stridulous respiration with acute dyspnea making the differential diagnosis of asthma quite suggestive. The inspirational stridor and a peracute progression of the disease should cause doubts as to the diagnosis of asthma. We collected case reports and describe the symptoms and diagnostic approaches to VCD as well as showing discriminating findings towards bronchial asthma. We report on five children suffering from VCD (4 girls, 1 boy) aged from 2 to 13 years. It could be shown that VCD is caused by a multifactoral pathomechanism, which has both somatic and psychological aspects. A surprising find was that all of the children were diagnosed with a pathological gastroesophageal reflux, partly in serious dimensions, without showing the typical symptoms such as retrosternal pain, stomach-ache or recurrent vomiting (so called silent reflux). Since there is a multitude of pathomechanisms involved and the disease often coincides with allergic asthma, an individual therapy plan is needed for each patient.
 ...
PMID:[Vocal cord dysfunction in children and adolescents]. 1150 89

Reduction of postoperative pain is an important goal in the perioperative management of tonsillectomy patients. This is particularly the case for children, who often exhibit resistance to intramuscular or rectal administration of drugs. Peritonsillar bupivacaine infiltration, a relatively safe method of pain control, is in some centers frequently used by otolaryngologists for pain relief. We present the case of a 5-year-old girl who developed bilateral vocal cord paralysis following preoperative peritonsillar bupivacaine infiltration. After an uneventful tonsillectomy and extubation, stridor and respiratory distress developed. Bilateral vocal cord paralysis was seen on laryngoscopy. The patient was reintubated and five hours later was successfully extubated without further sequelae. Anesthesiologists and surgeons should be aware of this uncommon complication than can occur with the use of peritonsillar bupivacaine infiltration for pain control in tonsil surgery.
 ...
PMID:Vocal cord paralysis as a consequence of peritonsillar infiltration with bupivacaine. 1157 59

Significant distress is experienced by patients, families, and caregivers when a symptom or disorder, such as an agitated delirium, becomes an intractable, or a catastrophic event, such as irreversible stridor. When palliative sedation is indicated for these patients, midazolam is usually the preferred drug. In some cases, however, midazolam fails to provide adequate sedation. Two cases are presented to illustrate this phenomenon and explore the possible mechanisms underlying this lack of response. These mechanisms appear to be multifaceted. The heterogeneity of the GABA(A) receptor complex and the alterations that this complex can undergo functionally can explain, to some degree, the diversity of the physiological and pharmacological outcomes. Other factors responsible for the diversity in response may include concomitant medications, age, concurrent disease, overall health status, alcohol use, liver disease, renal disease, smoking and hormonal status. Evidence-based guidelines on alternative treatment options should midazolam fail are required. In the interim, a lower threshold for adding an alternative drug, such as phenobarbital, or substituting midazolam with another drug, such as propofol, should be considered in these circumstances.
J Pain Symptom Manage 2002 Mar
PMID:When midazolam fails. 1188 23

A music medicine practice affords a unique opportunity to diagnose and treat laryngeal music performers. Strobovideolaryngoscopic (SVL) and external video examination of the voice professional or brass instrument player may focus on the vocal folds, yet abnormalities of the supraglottis, neck, and thorax should be appreciated and documented. Laryngoceles are uncommon laryngeal disorders but may occur in up to 5% of benign laryngeal lesions. While many laryngoceles are asymptomatic, they may cause a cough, hoarseness, stridor, sore throat, pain, snoring, or globus sensation. In particular, musicians who play brass instruments are at high risk for laryngocele development. We highlight two patients with symptomatic laryngoceles to present anatomical, historical, classification, epidemiological, diagnostic, and management considerations.
 ...
PMID:Bilateral mixed laryngoceles: simultaneous strobovideolaryngoscopy and external video examination. 1215 Mar 78


<< Previous 1 2 3 4 5 Next >>