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

Tumors of the duodenum are relatively rare, accounting for about 1-2% of all gastrointestinal neoplasms. Nevertheless diagnosis and therapy are important, as 50% of all duodenal neoplasms are malignant. In the period 1987-1992 we treated 14 patients with duodenal neoplasms (11 men, 3 women, age 30-81 years [median 60.4]). 5 patients had undergone previous treatment for malignant tumors (4 genito-urinary tract, 1 rectum). The main symptoms were pain (43%), malaise (43%), weight loss (43%), anemia (28%), jaundice (28%), obstruction (22%), nausea and/or vomiting (22%). Diagnostic investigations were upper endoscopy (93%), computed tomography of the abdomen (72%), angiography or duplex-sonography (22%). Preoperative histology was malignant in 43%, benign in 22% and unclear in 35%. Surgery consisted of the following: duodenopancreatectomy (Whipple procedure) in 4 (31%), segmental resection in 2 (15%), local resection in 2 (15%), transduodenal excision of the ampulla of Vater in 1 (7.5%), modified Finney pyloroplasty in 1 (7.5%), gastroenterostomy in 2 (15%) and choledocho-jejunostomy in 1 (7.5%). One patient refused surgery or chemotherapy. The definitive histologies in the 13 operated cases were adeno-carcinoma in 8 (62%), leiomyosarcoma in 1 (8%), leiomyoma in 2 (15%), and tubulo-villous adenoma in 2 (15%). The tumors were located in pars I in 3 (22%), in pars II in 9 (64%) and in pars III in 2 (14%). There were no postoperative complications in 9 patients (70%). 2 patients had an abscess of the abdominal wall or multiple entero-cutaneous fistulas, and 2 patients died from multiple organ system failure. The 30-day mortality was 15.4% (2/13).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Duodenal tumors]. 793 16

In recent years the syndrome of hemolysis, elevated liver enzymes and low platelets (H-ELLP) has attracted increasing interest in obstetrics as a serious complication of pregnancy, either alone or in combination with the classical symptoms of EPH-gestosis or eclampsia. In 1993, we observed 3 cases of severe HELLP syndrome in a total of 1126 deliveries. We present the clinical characteristics and the laboratory findings in these cases. A common symptom was general malaise and upper abdominal discomfort or pain. All patients were delivered by cesarean section of healthy infants. We conclude that it is no longer sufficient to emphasize edema, proteinuria and hypertension, but that the signs and symptoms of the HELLP syndrome present a new and increasingly important challenge in obstetric practice.
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PMID:[HELLP syndrome in routine obstetrical care. Three case reports]. 794 27

Gastroesophageal reflux (GER) is the movement of gastric contents retrograde into the esophagus. Sometimes the refluxate is seen as emesis, but often reflux is "silent," meaning that there are no discrete symptoms during an episode. In adults, the most common symptom of GER is heartburn, whereas in infancy excessive crying and malaise are symptoms that prompt investigation for GER, with or without esophagitis. Symptoms of esophagitis in infancy may include arching (hyperextension) of the torso and refusal of feedings. Tube feedings may be required to treat infants with failure to thrive who refuse oral feedings. Paradoxically, tube feedings increase the number of GER episodes. A hypothetical explanation for refusal of food in infancy is that pain with swallowing (odynophagia) or heartburn are consequences of peptic esophagitis. As a result, infants will learn to refuse food if it hurts or if they fear that it will hurt to eat. Another possible mechanism is visceral hyperalgesia, a neuropathic condition in which prior experience changes sensory nerves so that previously innocuous stimuli are perceived as painful. Some infants may have especially sensitive sensory nerves in the upper gastrointestinal tract, which predisposes visceral hyperalgesia to develop. Thus pain occurs from luminal distension or acid reflux in the absence of tissue damage. The evaluation of babies who won't eat includes a careful history and physical examination to exclude the possibility of chronic systemic illness. Refusal to feed is an unusual manifestation of a common condition: GER disease. The initial tests for GER usually include a barium swallow study to assess the upper gastrointestinal anatomy, endoscopy and esophageal biopsy to assess esophagitis, and an intraesophageal pH study, which is useful in "silent" reflux to quantitate the duration of esophageal acid exposure and to correlate discrete symptom episodes with periods of reflux. The treatment of infants and toddlers who refuse to eat because of pain resulting from visceral hyperalgesia or reflux esophagitis involves removing the pain associated with eating and making eating a pleasurable experience. Treatment for esophagitis may include maintaining an upright posture after meals and thickened feeds, medication to improve gastrointestinal motility or to decrease acid secretion, or fundoplication.
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PMID:Gastroesophageal reflux: one reason why baby won't eat. 798 64

A Plasmodium falciparum circumsporozoite protein (PfCSP) recombinant fusion protein, R32NS1(81), formulated with monophosphoryl lipid A, cell wall skeleton of mycobacteria, and squalane (Detox) was administered to 12 volunteers. One volunteer had malaise and self-limited painful induration at the injection site after the second dose and declined further immunization. The other 11 volunteers tolerated the three doses of 1,230 micrograms of vaccine, but most complained of sore arms; in five cases the pain or malaise was severe enough to interfere with work or sleep. Two weeks after the third dose of vaccine, four of the 11 immunized volunteers had > or = 14 micrograms/ml of antibodies to the repeat region of the PfCSP in their serum. Two of these four volunteers did not develop P. falciparum parasitemia when challenged by the bite of five mosquitoes carrying P. falciparum sporozoites. The seven volunteers with lower levels of antibodies and 11 of 11 controls developed parasitemia. These data are consistent with other studies, and indicate that vaccine-induced antibodies against the repeat region of PfCSP can prevent effective sporozoite infection of hepatocytes in humans. The challenge is to improve the immunogenicity of PfCSP-based vaccines, and to develop methods for including PfCSP peptides as components of multitarget malaria vaccines.
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PMID:Safety, immunogenicity, and efficacy of a malaria sporozoite vaccine administered with monophosphoryl lipid A, cell wall skeleton of mycobacteria, and squalane as adjuvant. 798 53

Twenty eight human cases of orf were studied from clinical and epidemiological points of view. Most of the patients were shepherds who were inoculated from infected animals during all seasons of the year. Typical lesions of different stages of orf were located on the hands, and were accompanied by local symptoms such as pain, pruritus, lymphangitis and adenitis, or less frequently by systemic symptoms such as fever or malaise. Two cases developed erythema multiforme, one developed erysipelas and another a papulovesicular eruption. Tzanck test may contribute to the diagnosis. The course of the disease can not be influenced by antibiotics, and only measures of local hygiene are recommended, except in complicated cases.
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PMID:Orf. Clinical and epidemiological study. 808 Apr 15

The most common form of thyroiditis is undoubtedly chronic lymphocytic thyroiditis (Hashimoto's thyroiditis). It presents in the form of a small insignificant struma without any signs of inflammation, which is easily overlooked in our region (where once goiters due to iodine-deficiency have been common). Therapy is only indicated when the patient is disturbed by the size of the goiter or when he is hypothyroid. The disease can be easily diagnosed by palpation and investigation of autoantibodies. Repeated antibody-tests are not necessary, however, it is useful to measure TSH every two years since some of the patients develop hypothyroidism. In contrast to the relatively mild findings in Hashimoto's thyroiditis the subacute granulomatous thyroiditis (de Quervain) presents with an impressive clinical picture with pain, fever, malaise and elevated blood sedimentation rate, that may alarm the patient as well as the unexperienced physician. Treatment with prednisone is extremely effective and leads to complete remission.
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PMID:[Thyroiditis]. 829 30

Shoulder joint infections are severe pathological conditions. Since the success of therapy is decisively dependent on early treatment, if joint infection is suspected, the patient should be hospitalized immediately. Characteristic suspicious features are extremely severe shoulder pain, adoption of a pain-relieving posture, and severe malaise. The diagnosis and differential diagnosis are discussed. In addition to selective parenteral administration of antibiotics, treatment comprises various methods of draining the shoulder joint in combination with temporary immobilization.
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PMID:[Treatment strategies in infections of the shoulder joint]. 830 40

We describe 22 patients who presented between the ages of 4 and 14 years with gradual onset of malaise and pain at the sites of multiple bone lesions. The symptoms from the bone lesions were sometimes sequential in onset and often relapsing. The radiological findings were typical of osteomyelitis. Radioisotope bone scans identified some clinically silent lesions. Bone biopsies were performed in 20 patients and the changes of osteomyelitis were seen in 17; microbiological culture was positive in only one. Seven patients had polyarthritis, two had palmoplantar pustulosis and one had psoriasis. Some symptomatic relief was obtained with anti-inflammatory agents and, to a less extent, with antibiotics. No patient had primary immunodeficiency. The mean duration of symptoms from the bone lesions was two years (1 to 4). When arthritis was present the joint symptoms lasted considerably longer (mean 7 years; range 4 to 10). The long-term prognosis was generally good. There was no evidence of altered bone growth or abnormal joint development. One patient developed a progressive kyphosis requiring fusion, but no other surgical intervention was necessary.
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PMID:Chronic multifocal osteomyelitis. 833 Nov 13

A patient with chronic idiopathic mediastinal fibrosis (MF) without concomitant retroperitoneal fibrosis is reported. He presented with pleuritis, malaise and pain and stiffness in the thoracic spine. During the 3.5 years of observation no clinical signs of obstruction of adjacent visceral structures in the chest cavity have developed. The diagnosis was made by CT, X-rays of the chest remained normal throughout the observation period, except for thickening of the involved pleura. The administration of high doses of oral corticosteroids did not appear to influence either clinical symptoms or the manifestations of MF as seen by CT.
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PMID:Chronic idiopathic mediastinal fibrosis presenting with malaise, pleuritis and thoracic back pain. 834 83

During a 6-year period, 10 patients were treated for severe necrotizing infections of the perineum (Fournier's gangrene) at the Edward Hines Veterans Administration Hospital (Hines, Ill). All were male, and their average age was 60 years. When known, duration of symptoms was 2 to 5 days. Prodromal signs such as edema, erythema, and pain frequently developed into rapidly spreading, full-thickness cutaneous gangrene in less than 24 hours. All patients had significant concomitant disease; 60% were diabetic. All patients had expedient and aggressive initial debridement, usually within 24 hours of presentation to the surgical service. Each patient had a "second-look" debridement within 1 or 2 days. Debridement was done an average of 2.6 times per patient. The cause of the infection was noted in seven patients--five with perirectal abscess and two with urethral trauma. Suprapubic catheters were placed in both patients with urethral trauma. Diverting colostomy was done on two patients who had perirectal abscess as a nidus; eight patients were treated without colostomy. Polymicrobial bacteriologic flora were found in all patients, with a predominance of Escherichia coli, Bacteroides sp, and staphylococci. Broad spectrum antibiotics and early nutritional supplementation were given. Hospital stay averaged 4 weeks (range, 3 to 12 weeks). One patient died (mortality of 10%). Successful management of these patients requires expedient diagnosis, aggressive nutritional supplementation, and early and repeated debridement as clinically indicated. We have not found diverting colostomy to be a necessary part of the management of these patients even when the nidus is perirectal.
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PMID:Necrotizing infections of the perineum. 835 52


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