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

Six children (7 to 16 years of age) with pelvic osteomyelitis are described. Sites of involvement included the pubis in three patients, the ilium in two patients, and the ischium in one patient. All were right-sided. Each patient presented with a history of fever and an abnormal gait. In four, the point tenderness indicated the site of bony involvement. All patients had pain on abduction but free passive range of motion of the hip. Soft tissue swelling was present on admission pelvic roentgenograms in five patients. Intravenous pyelogram revealed deviation of the bladder toward the midline in each of four patients studied. Roentgenographic changes typical of osteomyelitis developed in four patients ten days to ten weeks after onset of symptoms. In four patients in whom an organism was identified, Staphylococcus aureus was isolated from blood and/or bone. All isolates were methicillin-sensitive and two were penicillin-sensitive. Purulent material was drained from three of the five patients who underwent surgical exploration of the pelvis. All patients received parenteral antistaphylococcal therapy for 3 to 5 1/2 weeks (mean, 4 weeks). Oral antibiotics were given to five patients for an additional 3 to 14 weeks. All patients recovered completely.
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PMID:Pelvic osteomyelitis in children. 23 28

We report the natural course of the hip in fifty-two patients (ninety-five hips) who had sickle-cell disease and had had avascular necrosis in childhood. There were twenty-one African, twenty-one West Indian, and ten Mediterranean patients. At the most recent follow-up examination (at an average duration of nineteen years after the onset of the disease), 80 per cent of the hips that had been affected by avascular necrosis during childhood were painful and had permanent damage with regard to decreased mobility, limb-length discrepancy, and an abnormal gait. When the patients were evaluated, at an average age of thirty-one years, fifteen hips (16 per cent) had had an operation for progressive disability and sixty (63 per cent) had major problems because of pain. Of the twenty hips (21 per cent) that were not painful, five were in patients who had an abnormal gait, with decreased agility. The mean Iowa hip-rating score at the most recent follow-up examination was 73 points (range, 30 to 100 points). Correlations were found between the hip score and the patient's age at the onset of the disease and at the latest follow-up, between the hip score and degenerative changes in the hip, and between degenerative changes and radiographic evidence of deformity of the hip.
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PMID:Deformities of the hip in adults who have sickle-cell disease and had avascular necrosis in childhood. A natural history of fifty-two patients. 198 98

Dolichoectatic intracranial arteries (DIA) have been given several names, e.g. fusiform aneurysms, dolichomega-arteries. It is not an uncommon condition and it raises interesting points: 1) symptoms and signs result from compression (cranial nerve palsies; hydrocephalus) from ischemic or hemorrhagic episodes; 2) the diagnosis is made easier with CT since the arterial wall is often calcified; 3) the pathophysiology has long been assumed to be atherosclerotic in nature, but controversial assumptions are discussed; 4) associated arterial abnormalities are common: one of our cases and approximately half of the post mortem reported DIA were associated with aneurysm of the abdominal aorta. Two cases are reported here: 1) A 56 y/o male presented with progressive gait disorder, deafness and ischemic episodes. CT showed DIA and hydrocephalus. DIA involved the basilar artery, both intracranial carotid arteries, the abdominal aorta and probably one renal artery. A ventriculo-atrial shunt was performed unsuccessfully. Post mortem findings are reported; 2) A 52 y/o male had suffered from trigeminal neuralgia for about one year and from trigeminal permanent pain for two weeks. He had developed left hemiparesis and dysarthria. DIA involved the basilar artery and the left intracranial internal carotid artery. The right internal carotid artery and the right vertebral artery were hypoplastic. Clinical, radiographical and pathophysiological features are reviewed.
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PMID:[Dolichoectatic intracranial arteries. Association with aneurysms of the abdominal aorta]. 305 65

Although the conventional Bordetella pertussis vaccine, which consists of killed whole organisms, has been shown to be effective in preventing disease, it has been associated with transient local and systemic reactions and may produce encephalopathy, though rarely. A new acellular pertussis vaccine containing partially purified protein antigens, filamentous hemagglutinin, and lymphocytosis-promoting factor hemagglutinin has been developed for use in Japan. We compared the immunogenicity and reactogenicity of conventional and acellular pertussis vaccine. Forty children aged 4 to 6 years and 40 children aged 18 to 24 months, all previously immunized at appropriate times with conventional diphtheria and tetanus toxoids and pertussis vaccine, were enrolled. We randomly assigned children to receive either conventional pertussis vaccine or acellular pertussis vaccine in a double-blind fashion. The diphtheria and tetanus components in both preparations were identical. Equivalent rises in pertussis agglutinin titers and antibodies to filamentous hemagglutinin and lymphocytosis-promoting factor hemagglutinin were measured in both vaccine groups at both ages that we studied. However, reaction rates to the two vaccines in both age groups were strikingly different. Acellular pertussis vaccine was significantly less reactogenic for fever, pain, fretfulness, abnormal gait, and local reactions at the vaccine administration site. If studies in progressively younger children confirm its reduced reactogenicity and equal immunogenicity, and if large-scale trials indicate its efficacy, the acellular pertussis vaccine may be a more appropriate candidate than the current vaccine.
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PMID:Diphtheria, tetanus, and pertussis vaccine. A comparison of the immune response and adverse reactions to conventional and acellular pertussis components. 352 66

Effect of a non-steroidal anti-inflammatory drug, pranoprofen (PPF), on sodium urate crystal-induced inflammation was investigated in comparison with standard drugs for treating acute gout in experimental animals. PPF inhibited sodium urate crystal-induced paw edema in both rats (1-10 mg/kg, p.o.) and mice (5-25 mg/kg, p.o.) in a dose-dependent manner. On rat sodium urate crystal-induced paw edema, PPF was found to be almost equally active as indomethacin (IM) and colchicine. In addition, PPF (2.5-10 mg/kg, p.o.) inhibited the accumulation of exudate and decreased the leucocyte numbers and the amount of prostaglandin E2 (PGE2)-like substance in sodium urate crystal-induced pleurisy in rats dose-dependently, with a potency slightly greater than that of IM. The specific anti-gout agent colchicine (5 mg/kg, p.o.) also suppressed the accumulation of exudate and decreased the leucocyte numbers, without affecting the amount of PGE2-like substance. Moreover, in mouse peritonitis, PPF (1-10 mg/kg, p.o.) suppressed the sodium urate crystal-induced increase in vascular permeability in a dose-dependent manner. Furthermore, in experimental models of articular gout, PPF inhibited the pain response (abnormal gait) of sodium urate crystal-induced arthritis in both rats (0.25 and 1 mg/kg, p.o.) and dogs (3 mg/kg, p.o.), with a potency greater than that of IM and phenylbutazone, respectively. These results indicate that as an anti-gout agent, PPF is at least as effective as other standard drugs, so that it should have good clinical potential.
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PMID:[Effect of pranoprofen on sodium urate crystal-induced inflammation]. 358 35

173 patients suffering from symptoms of cervical disc herniation or spondylosis were surgically treated during 1975 through 1984 by Cloward's method via the anterior route or by total or hemilaminectomy with Epstein's foraminotomy via the posterior route. Of the 41 patients with disc herniation, 37 had radiculopathy as the main disorder and only 4 myelopathy. Of the 132 spondylosis cases radiculopathy was the main disorder in 92 and myelopathy in 40 cases. The operative route was selected according to the site of the osteophytes or disc herniation. The criteria for operative treatment were persistent radicular pain, motor weakness and progressive muscle atrophy, or evidence of cord compression. All patients underwent myelography preoperatively and sometimes also x-ray computed tomography. A clear correlation between the roentgenographic findings, clinical signs and symptoms served as the prerequisite for operative treatment. Follow-up review an average of 55 months after the operation showed excellent or good results in 80% of the disc herniation cases, but in only 35% of those with spondylosis. However, in the latter group pain relief was obtained in 76% of cases. In the spondylosis series there were significant correlations between the parameters of severity of disease and duration of symptoms and the surgical results, whereas in the disc herniation series no clear correlations were observed. Gait disturbances associated with myelopathy were only minimally relieved. There was no clear correlation after surgery between the degree of the disease and working capacity, but the duration of preoperative disability was significant in this respect. Postoperative complications were infrequent and no severe complications occurred.
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PMID:Comparative retrospective study of patients operated for cervical disc herniation and spondylosis. 381 69

The analgesic effect of topically applied pranoprofen-gel (1% and 3%) was investigated in comparison with indomethacin-gel in experimental animals. Applied topically, 1% and 3% pranoprofen-gel inhibited the inflammatory pain induced by Randall and Selitto's method and the pain response (abnormal gait) of concanavalin A-induced arthritis in rats dose-dependently. Furthermore, in antigen (methylated bovine serum albumin)-induced arthritis in rats, pranoprofen-gel had a concentration and application-dependent therapeutic effect on knee joint swelling and the pain response. Pranoprofen-gel had a stronger analgesic effect than indomethacin-gel in these experimental models. Both drugs inhibited the flexor reflexes of the hind limb induced by injecting bradykinin (BK) in combination with arachidonic acid into the common iliac artery of the spinal rat, but failed to do so with BK combined with prostaglandin E2 (PGE2). Moreover, pranoprofen-gel inhibited the BK-induced increase in the firing rate of the saphenous nerve of the spinal cat. These results show that pranoprofen-gel, applied topically, permeates well from the skin to the nociceptor site, relieving the hyperalgesia caused by PGs-induced sensitization of pain receptors by inhibiting their production. As a topical anti-inflammatory and analgesic agent, pranoprofen-gel is at least as effective as indomethacin-gel, so that it should have good clinical potential.
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PMID:[Analgesic effect of topically applied pranoprofen-gel]. 387 32

Seventeen postoperative total knee arthroplasty (TKA) patients were evaluated using two tests of knee joint position sense. Young controls and age-matched controls underwent identical tests. The TKA patients also underwent gait analysis, including foot switch stride analysis, and clinical evaluation using a standard scoring system. Results showed statistically significant decreases in joint position sense from young controls to old controls, and further significant decreases with joint disease; however, no further worsening was noted as a result of TKA. The abnormal gait parameters seen in TKA patients correlated as well with position sense as with clinical score. Strongest correlations were seen when a combined clinical and proprioceptive score was compared with gait parameters. In spite of alleviation of pain and correction of deformity, normal gait and function are not typically achieved after total knee replacement. Irreversible loss of joint proprioceptive function due to the disease process may be a major factor in the discrepancy between clinical and functional outcomes of total joint arthroplasty. Furthermore, loss of proprioception and the resulting abnormal gait patterns may place increased stress on components and contribute to loosening. In addition, an association between degenerative joint disease and decline in proprioception is suggested.
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PMID:Joint position sense in total knee arthroplasty. 648 11

Spondylolysis is a common problem found in 5% of the general population. The etiology is a combination of two factors: (1) hereditary predisposition resulting from a congenital deficiency of the sacrum and posterior structures and (2) developmental factors, such as trauma, posture, or certain repetitive activities, that may precipitate a stress fracture of the pars interarticularis in susceptible individuals. Although the lesion occurs during the growth years, few individuals develop symptoms during childhood and adolescence. For the occasional child who develops symptoms, the onset usually coincides with the adolescent growth spurt, and similarly progression of spondylolisthesis occurs between the ages of 10 and 15. When symptoms develop, the child may complain of low back pain and to a lesser extent pain in the posterior buttock and thighs, usually without a neurologic deficit. A few seek medical attention because of the postural deformity or abnormal gait, secondary to hamstring tightness. Symptoms are usually initiated by strenuous activity and relieved by limitation of activity or rest. Children with spondylolisthesis appear to have more flexibility or looseness at the L5-S1 junction than their adult counterparts (Fig. 7-11). This increased mobility is reflected in the radiologic appearance of the vertebrae. There is gradual erosion of the anterior as well as the posterior aspect of the sacrum, which becomes domed or peaked in the middle. This inhibition of growth is mirrored in the trapezoid shape of the body of L5 and directly related to the degree of slip. The wear pattern suggests a teeter-totter type of instability of the fifth lumbar vertebra on the sacrum (Fig. 7-15). The sclerotic buttress appearance or reactive changes common in adults are uncommon in children (Fig. 7-17). As the slip advances to the higher grades, the sacrum and posterior aspect of the pelvis become more vertical (anterior inclination), again reflecting instability in combination with tight hamstrings and backward pulling of the pelvis (angle of tilt), giving rise to the marked physical changes and localized kyphosis of the lumbosacral spine. There is considerable evidence to suggest that when the spondylolisthesis exceeds 50%, there are many dynamic and anatomic factors at work to potentiate continued deformity and symptoms in the growing adolescent. This is reflected clinically by the frequent failure of conservative measures in controlling symptoms and the need for surgical intervention in a significant percentage of patients once the slip exceeds grade II.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Spondylolysis and spondylolisthesis in children. 654 62

We reviewed the clinical records of all the patients examined at the Mayo Clinic who were operated on and found to have arachnoid diverticula of he cervical and thoracolumbar regions of the spinal column. Only patients whose lesion did not have a traumatic cause were selected for a study. There were 21 patients: 20 had been operated on at the Mayo Clinic and 1 was seen 43 years after surgery done elsewhere. The symptoms associated with the thoracolumbar lesions were, in order of decreasing frequency, pain, weakness, gait disorder, sensory symptoms, and sphincter dysfunction. The conditions associated with thoracic arachnoid diverticula included congenital pigmented nevus, diastematomyelia, multiple sclerosis, Marfan's syndrome, and syringomyelia.
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PMID:Idiopathic ("congenital") spinal arachnoid diverticula. Clinical diagnosis and surgical results. 678 Jul 35


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