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

The present clinical aspects of Paget's osteodystrophy are reviewed. The nosological definition, localiztion, natural course and signs are described and the recent description of "rheumatoid manifestations" in Paget's disease by FRANCK et al. is mentioned. The same authors revealed a positive correlation between the grade of extenstion of Paget's disease in the whole skeleton and the concentration values for alkaline phosphatase and uric acid in the serum. Among the complications of Paget's disease the orthopedic, neurological, haemodynamic, oncologic, hematological and dermatological are reviewed X-ray of the involved skeleton, which in most cases is diagnostic, may be supported by isotope scanning with 18F or 87mSr and bone biopsy for establishment of diagnosis. Current drug therapy is confined to diphosphonate and calcitonin. The antibiotic mithramycin, which is cytotoxic, reduces bone turnover and may improve the course in Paget's disease. However, toxic side effects on kidney, liver and hemopoiesis do not allow its further therapeutic use in this disease. A case is described which demonstrates that a spontaneous or traumatic fracture in the area of osteodystrophy exhibits almost the same potential for conso lidation as normal bone tissue following both conservative and osteosynthetic treatment of the fracture. In a further instance corrective osteotomy with osteosynthesis (plate) because of serious varisation and antecurvature of the femur due to Paget's disease were performed sucessfully without assisting drug therapy. A third patient displayed extensive osteodystrophy of the whole pelvic skeleton, which was discovered by X-ray as rehabilitation following CVA failed to progress due to severe bilateral reduction of hip joint function. In view of the age and general status of the patient and the absence of pain, no medication or surgical therapy was performed in this case.
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PMID:[Paget's deforming osteodysttophy]. 115 90

In this study, we investigated the applicability of thermography as a technique for evaluating the painful postcerebrovascular accident (CVA) shoulder in hemiplegic patients. A thermographic series was taken of the upper extremities and upper trunk of 27 female subjects. The four groups we evaluated were nonhemiplegic subjects (n = 9), post-CVA subjects with recovered function (n = 6), hemiplegic subjects with upper extremity motor impairment (n = 6), and hemiplegic subjects with both motor impairment and ipsilateral shoulder pain (n = 6). The data revealed a normal thermographic series in 8 of the 9 nonhemiplegic subjects, but only in 1 of the 18 post-CVA subjects. The majority of the abnormal thermographic series of post-CVA subjects showed a 1 degree to 5 degree C coolness on the involved side. No consistent thermographic patterns emerged that could be related to the severity or location of pain. Further studies are needed to evaluate the efficacy of thermography as a means of determining the relationship between ipsilateral post-CVA coolness and hemiplegic shoulder pain.
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PMID:Thermographic evaluation of the painful shoulder in the hemiplegic patient. 374 69

The relationship between electrophysiological, clinical and radiological parameters in the shoulder of hemiplegic patients was examined in a group of 24 subjects. Measurements and observations were made about the fourth month after CVA and again some eight months later. Total follow-up period extended to a maximum of 28 months. Electrophysiological tests included concentric needle EMG and conduction tests. In the shoulder X-ray four stages were described: normal, V-shaped space, initial subluxation and advanced subluxation. The presence of pain, reflex sympathetic dystrophy, atrophy and return of movement were registered. The most striking findings, consistent with lower motor neuron lesion, were those of parallel changes in axillary nerve latencies (obtained through stimulation from Erb's point) and shoulder X-ray stage. Age and time lapse between examinations turned out to be significantly related to such changes: younger patients did better and changes were registered even after one year from the first examination. An anatomical explanation linking the axillary nerve with humeral head disposition on the hemiplegic side is offered.
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PMID:Temporal changes in electrophysiological, clinical and radiological parameters in the hemiplegic's shoulder. 386 37

Four males with ectopic ureteral opening are reported herein. Case 1 was a 17 year old who complained of miction pain and macroscopic hematuria. Cystoscopy and radiological examinations showed left ectopic ureteral opening into the seminal vesicle associated with left renal agenesis. The left ureter and seminal vesicle were extirpated. Case 2 was a 21 year old who complained of lower abdominal pain. On physical examination, a child's head sized mass was palpable in the midline of the lower abdomen. Operation was performed under diagnosis of intrapelvic tumor, but the mass was cystic dilatation of left ureter which opened into the seminal vesicle. Case 3 was a 19 year old who complained of right CVA colic pain. On cystoscopy, the right ureteral orifice was absent. During the operation, right ureter was found to open into the posterior urethra. Case 4 was a 57 year old who complained of fever. Plain X-ray on the pelvic cavity showed a 82 X 10 mm calcified shadow. CT revealed a right ectopic ureteral opening into the posterior urethra with a ureteral stone in it. On cystoscopy, the right ureteral orifice was identified and pus discharge was observed to flow out of it. Operative exploration demonstrated that the right ureter was inverted Y duplication; one opened into the posterior urethra and the other into the trigone. Seventy nine males with ectopic ureteral opening and 3 with inverted Y ureteral duplication from the Japanese literature are reviewed briefly.
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PMID:[Ectopic ureteral opening in four males: including a case of inverted Y ureteral duplication]. 409 Nov 41

Of 96 consecutive renal transplants in 2 years, 50 (52%) were living donor grafts. Donor demographics, treatment plans, length of stay (LOS), charges, and complications were reviewed. Donors included 27 women and 23 men aged 22 to 61 (mean 42.2) years; 33 were living related and 17 living unrelated donors. Racial distribution included 1 Hispanic, 2 Asian, 8 black, and 39 white donors. Pretransplant evaluation defined renal anatomy and function (minimal creatinine clearance 75 cc/min). Hospital admission occurred the morning of donation. Nephrectomy under general anesthesia entailed an anterior flank, extra-retroperitoneal approach (no rib resection); and postoperative epidural pain control was standard. Progressive early ambulation and pulmonary self-care optimized recovery. The 50 donors were hospitalized for 2 (n = 7), 3 (n = 18), 4 (n = 15), 5 (n = 6), and 6-8 (n = 4) days (mean LOS: 3.74 +/- 0.17, range 2-8 days). The mean charge for donor hospitalization was $15,415 +/- $397 (range $10,808-$29,579). One major intraoperative hemorrhage required transfusion; 1 patient was readmitted for wound drainage and pneumonia treated medically. While 40 of 50 patients (80%) were hospitalized for 4 days or less, there was no readmission because of short hospital stay. One early graft loss (3 days) occurred from technical problems; all others gained excellent life sustaining function. Three additional kidneys failed from rejection, noncompliance, and systemic coagulopathy. One recipient died at 8 months (CVA) with normal renal function. Current strategies for successful living kidney donation are thorough patient and family education, ambulatory preoperative testing, morning of surgery admission, and discharge planning beginning before hospitalization. Excellent outcomes may be accompanied by a brief LOS, epidural pain management, and liberal use of willing and healthy related and unrelated living donors.
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PMID:Current issues in living donor nephrectomy. 936 51

The disinhibition hypothesis of post-stroke central pain (CPSP) suggests that 'the excessive response (dysesthesia/hyperalgesia/allodynia) is accompanied by a em leader loss of sensation' resulting from a lesion of a 'lateral nucleus' of thalamus or of 'cortico-thalamic paths' [Brain 34 (1911) 102]. One recent elaboration of this hypothesis proposes a submodality specific relationship, such that injury to a cool-signaling lateral thalamic pathway disinhibits a nociceptive medial thalamic pathway, thereby producing both burning, cold, ongoing pain and cold allodynia. The current study quantitatively evaluated the sensory loss and sensory abnormalities to discern submodality relationships between these sensory features of CPSP. The present results were statistically tested within individuals so that sensory loss and sensory abnormality are directly related by occurrence in the same individual. The results demonstrate that individuals with CPSP and normal tactile detection thresholds experience tactile allodynia significantly more often than those with tactile hypoesthesia. Most patients (11/13) exhibited hypoesthesia for the perception of cool stimuli, but few of these (2/11) showed cold allodynia. The most dramatic case of cold allodynia occurred in a patient who had a normal detection threshold for cold. Individuals with cold hypoesthesia, strictly contralateral to the cerebro-vascular accident (CVA or stroke), were often characterized by the presence of burning, cold, ongoing pain, and by the absence, not the presence, of cold allodynia. Overall, these results in CPSP suggest that tactile allodynia occurs in disturbances of thermal/pain pathways that spare the tactile-signaling pathways, and that cold hypoesthesia is neither necessary nor sufficient for cold allodynia.
Pain 2004 Jun
PMID:Allodynia in patients with post-stroke central pain (CPSP) studied by statistical quantitative sensory testing within individuals. 1515 97

The thalamus has been described as a "relay station" for sensory information from most sensory modalities projecting to cortical areas. Therefore injury to the thalamus may result in multimodal sensory and motor deficits. In the present study, a 61-year-old woman suffered a right thalamic cerebral vascular accident (CVA; as evidenced by a computerised tomography [CT] scan). Secondary to this incident, she complained of altered sensations across multiple sensory modalities, including olfactory, visual, auditory, tactile, temperature, and pain sensation. Interestingly, during recovery from the thalamic CVA, the patient reported hallucinations in all the modalities cited above. Multimodal dysaethesias (odd sensations) and hallucinations showed reliable laterality in the affective valence across modalities with positive associations within right hemispace and negative associations within left hemispace. Overall, the results support multimodal role of the thalamus and provide evidence for lateralisation of positive and negative affect within the right and left hemispheres respectively.
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PMID:Asymmetry in the emotional content of lateralised multimodal hallucinations following right thalamic stroke. 1769 Oct

Symptom control for hospice patients frequently involves the use of pharmacologic agents for control of pain, dyspnea, and anxiety. Other troubling symptoms that will often require pharmacologic agents include nausea, vomiting, constipation, and delirium. While the Medicare requirement for hospice is a prognosis of six months or less, accurately predicting prognosis is very difficult. Because of this, medications for symptom control will often have to be prescribed and refilled without knowing exactly how much the hospice patient may require. The objective of the current study was to determine the amount of medication discarded at death. Additionally we wanted to estimate the cost related to discarded medication. We reviewed the records of 296 patients over a three-year period in a community hospice to characterize the medications that were discarded at death. Seventeen patients were not eligible for evaluation because of lack of complete information, leaving 279 study subjects. Cost calculations were used using a website cost calculator (HealthTrans.com). Fifty-six percent of the decedents were female and the majority were Hispanic (62%). The five most common diagnoses were cancer (36%); dementia (22%); and COPD, CVA, and congestive heart failure (CHF) (8%). The median length of stay in hospice was 16 days. The most frequent medication unused at the time of death was morphine solution followed by lorazepam. The cost of discarded morphine including tablets as well as solution totaled over $6,000 for the study period. The next highest medication cost was lorazepam for both solution and tablets, which came to over $1,600. The total estimated cost for all medications for the study period amounted to $14,980. The results of this study indicate that hospice patients have variable amounts of discarded medication at the time of death and that the cost involved of these unused medications can be significant. Hospice organizations should investigate creative ways to reduce the amount of discarded medications.
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PMID:Costs and implications of discarded medication in hospice. 2380 30