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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The incidence of both early postinfarction pericarditis and post-myocardial infarction (Dressler's syndrome) appears to be declining. Pericardial pain and pericardial friction rub define early postinfarction pericarditis and usually develop on day 2 or 3 after a transmural myocardial infarction. The clinical course is benign, and the prognosis of the patient is not altered by development of this complication. Pericardial effusions have been found in as many as 28% of patients after acute MI. Asymptomatic pericardial effusions do not require specific therapy nor do they absolutely contraindicate the use of anticoagulation as was previously thought. The preferred form of therapy for early postinfarction pericarditis is aspirin. Avoidance of corticosteroids and NSAIDs must be considered carefully because of the reported complications of these agents. The post-myocardial infarction syndrome develops usually during the second or third week after acute MI but may be seen as early as 24 hours and as late as several months after the MI. Whether this syndrome is the result of autosensitization to myocardial antigens released into the circulation during infarction remains uncertain. Alternative hypotheses for the causation of the syndrome include the release of blood in the pericardial space and simply that the syndrome represents a prolonged and exaggerated form of early postinfarction pericarditis. Clinically, post-myocardial infarction syndrome is manifested by fever, malaise, chest pain, and the presence of a pericardial and possibly pleuropericardial friction rub. Pericardial effusion is frequently large, and, rarely, cardiac tamponade may develop and require pericardiocentesis. Treatment consists of aspirin, NSAIDs, or corticosteroids.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pericardial involvement in acute myocardial infarction. 224 14

The most common background for recurrent pericarditis is that of acute nonspecific pericarditis. Relapsing pericarditis also may follow cardiac trauma, cardiac operations, myocardial infarction, and intrapericardial bleeding. The exact recurrence rate after initial attacks of idiopathic pericarditis is unknown but appears to be in the range of 15% to 32%. The mechanism of recurrent pericarditis is uncertain. An autoimmune response has been proposed, but this concept is unproved. Yoneda and coworkers, in a case of pericarditis due to coxsackie B virus, found no rise in antibody titer to this virus during recurrences. The prognosis, except for disabling pain and malaise, is good, and constrictive pericarditis, chronic myocardial disease, and cardiac tamponade are unusual complications. Although constrictive pericarditis may follow an initial attack of idiopathic pericarditis, it was reported in neither two other series of patients with relapsing pericarditis nor in this series. Cardiac tamponade has been reported as an occasional complication of relapses but did not occur in our patients. None of our patients died. Most patients with recurrent pericarditis respond to adrenal steroid therapy, but many times there is difficulty in weaning the patient from the drug. Because it is suspected that adrenal steroids may prolong attacks and promote tendency to further recurrences, initial therapy should be offered with aspirin or NSAIDs, and adrenal steroid therapy should be used only when there is no response to these agents. Recurrences may take place over a period lasting as long as 15 years, and patients with as many as 19 recurrences have been described.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Recurrent pericarditis. 224 16

A double-blind, parallel-group clinical trial was carried out in 25 patients with post-herpetic neuralgia to determine the efficacy and tolerability of a mixture of gangliosides ('Cronassial') compared with placebo. Patients were allocated at random to receive treatment with either 'Cronassial' (100 mg in 2 ml buffered solution) or placebo given by 11 subcutaneous injections over a period of 27 days, and their symptoms assessed on entry and after 2, 4 and 8 weeks. The four aspects of pain considered (overall pain, hyperaesthesia, stabbing pain and constant ache) all showed maintained reductions in severity with 'Cronassial' treatment, but not with placebo. In the case of hyperaesthesia, this difference between treatments was statistically significant (both during and after the course of injections), even with the relatively small number of patients in this study. Sleep patterns showed significant sustained improvements with 'Cronassial', but not with placebo treatment. Other psychological assessments (general psychological state, appetite and mood) showed little difference between 'Cronassial' and placebo treatment. Although 'Cronassial' was well tolerated systemically, 1 of the 12 patients was withdrawn because of general malaise, and 5 patients had local pain at the injection sites. Two of these 5 patients were withdrawn from the study. There were no withdrawals in the placebo group. It is suggested that further studies employing greater numbers of patients should be carried out to confirm the efficacy of gangliosides in improving symptoms of patients with post-herpetic neuralgia.
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PMID:Double-blind, placebo-controlled clinical trial of a mixture of gangliosides ('Cronassial') in post-herpetic neuralgia. 227 91

The question of whether the HELLP syndrome exists as a distinct entity or is part of a spectrum of pregnancy complications, which have in common hemolysis, elevated liver enzymes, and thrombocytopenia, has long been a source of speculation and debate among obstetricians and internists. A review of the literature indicates a definite need for a uniform definition, diagnosis, and management of this syndrome. Patients manifesting this syndrome usually are seen before term (less than 36 weeks' gestation) complaining of malaise (90%), epigastric or right upper-quadrant pain (90%), and nausea or vomiting (50%), and some will have nonspecific viral-syndrome-like symptoms. Hypertension and proteinuria may be absent or slight. Thus some of these patients may have a variety of signs and symptoms, none of which are diagnostic of classic preeclampsia. In consideration of the high maternal and perinatal mortality and morbidity reported with the presence of this syndrome, I recommend that all pregnant women having any of these symptoms should have a complete blood cell count with platelet and liver enzyme determinations irrespective of maternal blood pressure.
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PMID:The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): much ado about nothing? 240 34

During holidays in Suriname a six year old boy fell ill with high fever, general malaise, pain in the extremities and abdomen and vomiting. Because of a tentative diagnosis of acute rheumatism or bacterial enteritis amoxicillin and salicylates were started. After his return to the Netherlands an increased ESR and impaired renal and hepatic functions were found. The history revealed contact with sewage water. Further analysis established the diagnosis of Leptospirosis. This comparatively rare clinical entity, seldom mentioned in paediatric literature, is discussed.
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PMID:[A patient with fever and pain in the extremities]. 237 42

Both the systemic and local reactions caused by the immunization with the vaccine against diphtheria, tetanus and whooping cough were studied. Side-effects, 48 hours after the vaccination were determined in 730 children between the ages of two months and five years and 11 months. Over 13% of the children were free from side-effects. Eighty-seven percent of the children immunized showed the following side-effects in percentages of frequency: fever, 66.0%; malaise, 37.8%; loss of appetite, 25.0%; sleep disorders, 20.4%; vomiting, 7.9%; and continuous crying, 7.6%. With respect to local disturbances: pain, 41.6%; reddening, 28.0% and subcutaneous nodules, 20.1%. None of the children had convulsions, hypotonic episodes or immediate neurological damage. Two types of DTP vaccines, one from the Connaught (Canadian) Laboratory and another from the National Institute of Hygiene (Venezuelan) were used. No significant differences were found in the appearance of the side-effects between the both, except for localized pain (P less than 0.01) with the national vaccine. The results obtained in relation to age and the number of doses were: there was a significant increase of localized pain as ages increased (P less than 0.01). There were significantly greater number of localized pain and subcutaneous nodules with greater numbers of doses (P less than 0.01).
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PMID:[Side effects of the vaccine against diphtheria, tetanus and whooping cough]. 239 Jan 82

Diarrhea affects approximately 330,000 travelers from industrialized nations each year. Diarrhea is a reflection of inadequate hygiene or waste disposal in the countries visited, usually developing countries. The greatest incidence occurs in 20-29 years olds who take the most dietary risks. Some foods that pose the greatest risk in descending order include raw oysters, steak tartare, ice cubes, washed vegetables, cold milk, puddings, and sandwiches with mixed fillings. 40% of all travelers have a self limiting and rarely grave diarrheal illness caused by local enterotoxigenic Escherichia coli (ETEC). Following an incubation period of 5-9 days, symptoms appear (cramps, fever, and 10 or more diarrheal episodes/day). 5% are infected with Giardia lamblia and 4% with Entamoeba histolytica. Giardiasis occurs worldwide and is characterized by grumbling diarrhea, cramps, and flatulence. E. histolytica causes a severe illness characterized by colitis with bloody stools, anorexia, malaise, sweats, weight loss, and epigastric pain. Only 10-100 Shigella bacteria are required by cause shigellosis. Symptoms include blood and mucus in the diarrhea and malaise. A traveler who ingests food with 100,000 Salmonella bacteria in it most likely will fall ill 48 hours after eating the contaminated food. Typhoid and paratyphoid fevers have an incubation period of about 12 days and may be fatal. Initial symptoms consists of headache, malaise, fever, and pain and 2 weeks later bloody diarrhea appears. Additional common diarrheal illnesses include cholera, post infectious tropical malabsorption, and those caused by Vibrio parahaemolyticus and Campylobacter species. Another disease common in areas of poor hygiene is poliomyelitis with fever, sore throat, and headache present in mild forms. If the virus invades the central nervous system, however, paralysis occurs.
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PMID:Exotic diarrhoeal problems and poliomyelitis. 259 59

The increase in major cardiac operations performed in the United States has been accompanied by an increase in the incidence of postpericardiotomy syndrome. Family physicians must be able to recognize the clinical picture, since patients may present several weeks postoperatively. Symptoms include malaise, pleuritic pain, dyspnea, myalgias, arthralgias and anorexia. Signs include fever, rales, friction rubs, effusions and leukocytosis. Anti-inflammatory drugs are effective.
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PMID:Postpericardiotomy syndrome. 264 88

Clinical details and present day problems encountered in 425 cases of falciparum malaria (PF) are reported. 10.11% had taken chloroquine prior to reporting to us. Parasitic count done in 23.05% cases lacked correlation with severity of disease. Pattern of fever varied markedly but 5.4% were afebrile throughout and presented only with bodyache and malaise. Apyrexial spell was noted in 5.64%. 28.70% had typical facial looks of anaemia and sallow complexion. Cerebral symptoms were noted in 3.05%. Other symptoms were severe headache 33.4%, pain abdomen 3.29%, gastroenteritis 5.64%, jaundice 2.58% and bronchitis in 7.50%. We encountered subconjunctival haemorrhages with purpura and/or urticaria in four cases, symptoms suggestive of shock lung in 3, pulmonary oedema in 2, severe anaemia (HB less than 4 g%) in seven pregnant ladies, extrapyramidal symptoms in follow up period in 5 and congenital malaria in 2 cases. 83.25% were cured with chloroquine and oxytetracycline. 8.47% (who deteriorated despite the above treatment) were treated with quinine for 6 days. 5.17% (with severe disease) were also given quinine as first line drug. 2.82% (unresponsive to chloroquine and oxytetracycline but with mild disease) were treated with pyrimethamine-sulphamezathine combination for 5 days. One case who did not respond to quinine was treated with quinidine. Recrudescence was seen in 3.67% of patients treated with chloroquine and oxytetracycline. There was no case with renal failure, haemolysis due to G6PD deficiency and black water fever. There was only one death (0.23%) in our series. Self-medication, haphazard therapy and the slogan "Fever may be malaria-take chloroquine" can lead to problems in falciparum malaria.
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PMID:Falciparum malaria--present day problems. An experience with 425 cases. 269 36

Child abuse, a clinical condition in young children who have received serious physical abuse, is a frequent cause of permanent injury or death. The first case is a 7-year-old boy suffering from abdominal distension and pain for 3 days. He was beaten by his mother as a result of inadequately learning his lessons. Sonogram and CT of the abdomen showed massive ascites and a pseudocyst of the pancreatic body about 3 x 3 cm in diameter. The second case is a 4-year-old girl who developed a semicomatose state after her father impulsively struck her with a chair. CT of the brain revealed subdural hematoma over the left fronto-temporal region and midline shift to the right. She expired 5 days later. The third case, a 2-year-old girl, suffered from headache, seizure, vomiting and general malaise. CT of the brain showed severe brain swelling over the right side and midline shift to the left. She expired 1 month later. Psychiatric factors are probably of prime importance in the pathogenesis of the disorder, but our knowledge of these factors is limited. Parents who inflict abuse on children do not necessarily have psychopathic or sociopathic personalities or come from borderline socioeconomic groups, although most published cases fall into one of these categories. It is clearly the responsibility of all physicians serving children to be aware of, to recognize, and to properly manage any child who has been the victim of abuse.
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PMID:[Child abuse: report of three cases]. 270 Feb 79


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