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

An unusual, characteristic case of etiopathic achalasia of the esophagus is reported and the literature is reviewed. This disease has not previously been reported in the dental literature, but is well-known in the medical field. The case report illustrates the salient features of previosuly described achalasia in adults: vague history of asthma with respiratory symptoms of wheezing, obstruction to swallowing, regurgitation, intermittent pain, and peripheral neuritis in a thin patient who claims to be a light eater. The primary concern of the oral surgeon is the management of nutrition. In the case reported, to ingest food. After mobilization of the jaws, the patient could not longer eat the small amounts she could preoperatively. Suspected achalasiactic symptoms should be investigated thoroughly through proper work-up to rule out this disorder before elective surgery is performed. In nonelective cases, the practitioner must be prepared to manage the problems and complications and obtain the proper consultations.
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PMID:Esophageal achalasia after maxillofacial surgery. 28 92

The expression of cardiac dysfunction in pediatric patients with myocarditis may not be conspicuous. While older children with myocarditis may abruptly present with pleuritic or angina-like pain, infants and toddlers with fulminant disease are unable to verbalize such complaints. Cardiac compromise in preverbal children may only be inferred from variable examination findings that include gallop rhythm, tachycardia, malignant dysrhythmias, murmur, rub, and signs of congestive heart failure. The emergency physician is likely to overlook a cardiac origin for wheezing in a child with a past medical history of asthma. Therapeutic modalities chosen for reactive airway disease may adversely influence the outcome of a patient with myocarditis.
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PMID:The wheezer that wasn't. 160

Solid organ transplant recipients can experience serious disease and death from infection due to the parasitic roundworm Strongyloides stercoralis. This parasite lives in soil contaminated with human feces. Domestic dogs and cats may be another reservoir. Larvae can penetrate the skin, are carried hematogenously to the lungs, migrate up the bronchial tree, and then can be passed to the upper small intestine. Autoinfection occurs in the setting of immunosuppression when invasive larvae penetrate the gut wall and cause disseminated infection. Polymicrobial sepsis is sometimes seen due to enteric organisms adhering to the parasite. Transplant recipients are at highest risk during the first 3 months posttransplant. Many organ systems may be affected. Pulmonary symptoms include cough, wheezing, sputum production, dyspnea, hemoptysis, tachypneas, and pleuritic pain. Hyperinfection, an augmentation of the normal skin-lung-intestine life cycle, occurs in roughly two-thirds of infected transplant recipients, with dissemination in the remainder. Diagnosis is made primarily by examination of the stool or intestinal secretions for ova and parasites. Occasionally, parasites are noted in the sputum. New serologic tests show promise. The parasite may remain in the host for over 25 years before immunosuppression causes either dissemination or hyperinfection. Thiabendazole given for 3 to 7 days is the treatment of choice for organ transplant recipients. Repeat courses may be needed to eradicate infection.
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PMID:Strongyloides infections in transplant recipients. 234 6

Ultrasound is a new test proven to be sensitive in the demonstration of gastroesophageal reflux (GER). Following reflux seen with ultrasound various symptoms can be observed in physiological circumstances, and thereby a causal relationship between reflux and these symptoms can be observed in physiological circumstances, and thereby a causal relationship between reflux and these symptoms can be proven. We performed a study in 220 children suspected of GER to determine the incidence of sonographically demonstrated "symptomatic reflux" in different clinical groups: children with (1) vomiting only, (2) respiratory symptoms, (3) attack-like symptoms, and (4) pain and irritability. Overall, GER was demonstrated in 78% of all 209 children in whom technically satisfactory studies could be performed. This reflux was associated with symptoms in 32% of the cases. Symptomatic reflux was most frequent in group 3, which included children investigated for near-miss sudden infant death syndrome. The symptoms that were noted most frequently were vomiting, motor unrest, coughing, and wheezing. Apnea, bradycardia and attacks of unusual posturing could incidentally be related to reflux. Ultrasound is a cheap, simple, noninvasive, and physiological test to show clinically significant reflux.
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PMID:Symptomatic gastroesophageal reflux: diagnosis with ultrasound. 796 78

The safety of intravenous (i.v.) infusion of large doses of phentolamine as an outpatient diagnostic tool for sympathetically maintained pain was studied retrospectively in 100 consecutive patients (73 females and 27 males) with chronic pain. All patients were pretreated with i.v. fluids followed, in most cases, by propranolol, 1-2 mg i.v. (n = 95). Ten minutes later the phentolamine infusion commenced, lasting for 20 min. In 90 patients, the dose of phentolamine was 35 mg. Two patients received 25 mg, and 8 patients received larger doses of 50-75 mg. No major complications occurred during or after the test, and only small changes in arterial blood pressure or heart rate were observed. All patients developed mild nasal stuffiness, but no decline in oxygen saturation was observed. Five patients developed one of the following minor complications for a brief duration, that resolved spontaneously: sinus tachycardia, premature ventricular beats, dizziness, or wheezing. We conclude that i.v. phentolamine administration is safe in patients with neuropathic pain.
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PMID:The safety of intravenous phentolamine administration in patients with neuropathic pain. 848 98

The clinical and radiological pulmonary manifestations in the initial phase of schistosomiasis mansoni were studied in thirty previously healthy individuals who were simultaneously infected. The findings were compared with those concerning a control group and related to possible pathogenetic factors. The respiratory manifestations were of light or of moderate intensity, the dry cough being the most common symptom. The significant radiological alterations were: thickening of bronchial walls and beaded micronodulation, predominantly localized in the lower pulmonary fields. It was observed significant association between wheezing and IgE levels, estimated by the area of immediate intradermal reaction, as well as between the number of blood eosinophils and the occurrence of radiological changes. Moreover, there was correlation between the worm burden and the presence of wheezing, thoracic pain and beaded micronodulation. Thus, the clinical and radiological pulmonary manifestations described are significant part of the initial phase of schistosomiasis mansoni and present the worm burden, eosinophilia and levels of IgE as probable pathogenetic factors.
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PMID:Pulmonary manifestations in the initial phase of schistosomiasis mansoni. 859 59

To evaluate the efficacy of continuous administration of 50% nitrous oxide in oxygen for reducing pain during flexible fiberoptic bronchoscopy 32 children aged 3-60 months were randomly assigned to an experimental or a control group. Indications for endoscopy included persistent atelectasis (6), wheezing (10) cystic fibrosis (2) pneumonia (11) persistent cough (3). All patients received Midazolam (0.3 mg/kg) atropine (20 mcg/kg) intra rectaly 20 minutes before the procedure. The flexible fiberoptic bronchoscope (Olympus BF3C4) was inserted transnasally through a face mask. Topical anesthesia with 1% lidocaine hydrochloride (3 mg/kg) was applied to the nose, larynx, trachea and bronchial tree over 15 minutes through the suction chanel of the bronchoscope. All patients were monitored with a pulse oximeter and a cardiac monitor. The experimental group (n = 16) received 50% nitrous oxide in oxygen prior (3 minutes) and during flexible fiberoptic bronchoscopy, the control group (n = 16) received only oxygen. We measured pain of the children by a behavioral observation scale (Children's Hospital of Eastern Ontario Pain Scale: CHEOPS) at each phase of topical anesthesia during bronchoscopy in the two groups. At the end of bronchoscopy physician's satisfaction was scored by a visual analogue scale (VAS 0-100) in which 0 corresponded to absence of satisfaction. Nitrous oxide was associated with lesser pain scores than those with oxygen. Physician significantly preferred these procedure compared with oxygen. No complication occurred during procedure. Combined with local anesthesia midazolam and atropin the administration of 50% nitrous oxide in oxygen seems a better choice for flexible fiberoptic bronchoscopy in children and should be used routinely.
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PMID:[Bronchial endoscopy under local anesthesia and pain in children. The value of a nitrous oxide-oxygen combination]. 960 88

The objectives of this study were to describe the clinical and radiological features at presentation, and the natural history of HIV-related bronchopulmonary Kaposi's sarcoma. A retrospective review of medical records and chest radiographs was performed in 106 HIV-infected homosexual men with bronchopulmonary Kaposi's sarcoma diagnosed at bronchoscopy between September 1988 and November 1994. The majority of patients had evidence of advanced HIV disease at diagnosis (median CD4 cell count was 15 x 10(6)/l, range 0-288), and 93% had had a diagnosis of cutaneous Kaposi's sarcoma for a median duration of 11 months prior to diagnosis of their bronchopulmonary disease. The most frequent symptoms at presentation were cough (92%), dyspnoea (69%), pleuritic pain (20%), haemoptysis (13%) and wheezing (10%). The most common radiological finding in 73% of our series was of poorly defined and confluent opacities, with predominant middle and lower zone involvement. Median survival was 4 months (range 0-37 months) from diagnosis and 9 months (range 1-25) from the onset of symptoms. Treatment with either chemotherapy or radiotherapy was associated with a significantly reduced risk of death (hazards ratio (HR)=0.48, 95% CI=0.26-0.87). Factors associated with a poor survival, after adjustment for treatment effect were older age (HR=1.79, 95% CI=1.22-2.84) for each 10-year increase in age; a history of pleuritic pain (HR=2.97, 95% CI=1.39-6.32); presence of pleural effusion on X-ray (HR=2.01, 95% CI=1.13-3.59) and a prior diagnosis of cutaneous Kaposi's sarcoma (HR=1.8, 95% CI=1.00, 3.24). Bronchopulmonary Kaposi's sarcoma occurs mainly in patients with advanced HIV disease and a prior history of cutaneous disease. Survival is poor, and adverse prognostic factors include older age at diagnosis and the presence of pleural disease.
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PMID:Bronchopulmonary Kaposi's sarcoma in 106 HIV-1 infected patients. 976 35

Unemployment is considered to be a public health concern since deterioration in the health of the unemployed is often anticipated. However, for some groups, such as miners, unemployment might improve health due to a cessation of potentially harmful occupational exposures. This study evaluates the health of 79 miners in one Swedish iron-ore mine, and 226 age-matched controls from the general population, during one year after the closure of the mine. The participants received a questionnaire regarding medical history and subjective symptoms at the beginning of the study period, and after one year. Statistically significant negative effects on self-reported health attributable to unemployment were not found, although neuropsychiatric symptoms were more common among the unemployed miners. The miners reported a statistically significant improvement in grip force (p = 0.031). They had a significantly higher prevalence of symptoms associated with mining related exposures when compared with the population controls; pain in the upper extremities [relative risk (RR) = 2.27, 95% confidence interval (CI) = 1.44-3.59), back pain (RR = 1.84; CI = 1.23-2.75), vasospastic disease of the fingers (RR = 2.05; CI = 1.18-3.57) and obstructive respiratory symptoms (attacks of dyspnea and wheezing: RR = 3.67; CI = 1.16-11.6).
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PMID:Self-reported health problems among Swedish miners one year after unemployment. 987 12

A 67-year-old woman presented to a community emergency department in Orange County, CA, after she was stung by a scorpion identified as Centruroides limbatus from Central America. She developed local pain and systemic symptoms, including parasthesias, flushing, hypertension, and wheezing. Envenomation by this genus of scorpion has not previously been reported in Orange County. Scorpions have been reported to be accidentally transported to areas where they are not indigenous, and patients may present anywhere with envenomation by dangerous scorpion species. Physicians should recognize general identifying characteristics of dangerous scorpions and serious signs of envenomation. Almost all dangerous genera of scorpions (including Centruroides sp.) are in the family Buthidae, which can be identified by a triangular sternal plate. Severe systemic signs of envenomation by Centruroides sp. may include respiratory difficulty, somatic neuromuscular dysfunction, and cranial nerve dysfunction. Patients stung by dangerous scorpions may require airway support, extended observation, antivenin, and avoidance of respiratory depressive medications.
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PMID:Envenomation by the scorpion (Centruroides limbatus) outside its natural range and recognition of medically important scorpions. 1056 Mar 10


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