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

When should an acute coronary event be suspected in a young woman with chest pain? Coronary artery disease is not common in such patients, but the possibility should not be discounted. Correct characterization of the pain, along with presence of known risk factors for CAD, can lead to an accurate diagnosis, even though the presentation may be atypical.
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PMID:Acute coronary syndrome in a young woman. 1243 79

Patients with chronic musculo-skeletal pain have been profiled as "dysfunctional", "interpersonally distressed" or "adaptive copers". The relevance of these for episodic visceral pain is unknown. Our aim was to replicate conceptually the taxonomy in patients with episodic visceral pain. Patients with chest pain and gastro-esophageal reflux disease (GERD; n=25), coronary artery (CAD; n=20), or with chest pain but without either reflux or coronary artery disease (non-cardiac chest pain--NCCP; n=23) were assessed using several standard affective and cognitive measures relevant to pain. Differences between the diagnostic groups were explored. K-means cluster analysis broadly replicated the three groups found in previous research but the "interpersonally distressed" group had few members. An additional cluster analysis suggested a more parsimonious solution for the sample was a two-cluster one, which approximated to the "adaptive coper" and "dysfunctional" profiles. Membership of both the three- and two-cluster profiles was not associated with membership of specific diagnostic category.
Eur J Pain 2003
PMID:Psychological responses to episodic chest pain. 1457 65

Presented herein are the data on the condition of central and cerebral hemodynamics in 98 patients with chronic stage III-IV lower limb ischemia and coexistent CAD as dependent, on the severity of painful syndrome as well as on the necessity of preparing patients at a high surgical risk for reconstructions under prolonged epidural anesthesia. The prognostically dangerous changes in central and cerebral hemodynamics were revealed in persons with severe painful syndrome. In 87% of patients, circulation was hypokinetic. Twenty-six patients with unremovable pain and severe coexistent diseases underwent, as preoperative preparation, prolonged epidural anesthesia. It has been proven that prolonged epidural anesthesia allows to reach not only a good analgetic effect but also to refine the indicators of central and cerebral hemodynamics whereby preventing intra- and postoperative ischemic events.
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PMID:[Preoperative preparation of patients with critical lower limb ischemia and pronounced painful syndrome]. 1562 40

Atherosclerotic CAD is the most common cause of cardiac chest pain in Western countries. Other cardiac syndromes may also cause anginalike pain and may be difficult to differentiate from atherosclerotic CAD. It is essential to make this distinction, because management and prognosis of these conditions are entirely different. A detailed history and, in some cases, special diagnostic methods can help make the diagnosis. When evaluating patients with anginalike chest pain and normal coronary arteries, physicians need to consider this group of diseases and tailor workup and diagnosis on an individual basis.
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PMID:Anginalike pain and normal coronary arteries. Uncovering cardiac syndromes that mimic CAD. 1594 68

Heart rate recovery following a Bruce exercise protocol provides prognostic information on survival. We investigated the impact of ethnicity on HRR in 271 consecutive patients being assessed for CAD in three main ethnic groups (Caucasian (C); South Asian (SA); Afro-Caribbean (AC)). Our sample contained greater referral of younger, male South Asian subjects than would be expected on the basis of census data. The AC group had a low frequency of typical ischaemic pain. The SA sub-group, despite greater prevalence of diabetes, had marginally better HRR and a more preserved response to exercise. Multiple regression analysis revealed that age and not ethnicity was the main independent predictor of HRR (p=0.007) with all three ethnic sub-groups having a similar range of exercise time. There was no evidence of under referral of ethnic minorities. Ethnic effects in raw HRR data are most likely confounded by age.
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PMID:South Asian or Afro-Caribbean ethnicity is not associated with altered 1 min heart rate recovery estimates in suspected coronary artery disease patients. 1660 Apr 5

This report describes a protocol that uses computerized tomography (CT), computer-aided design/computer-assisted manufacture (CAD/CAM) technology, and the Internet to plan placement of anterior and posterior dental implants and construct a precise surgical template and definitive prosthesis, which is connected at the time of implant placement. This procedure drastically reduces surgical treatment time and the recovery period. Patients with an edentulous arch had a denture with radiopaque markers constructed for CT scans of the appropriate jaw. The CT images, with acquisition slices of 0.5 mm, were transferred into a three-dimensional image-based program for planning and strategic placement of dental implants. After implants were virtually placed on the computer, the surgical treatment plan was sent to a manufacturing facility for construction of a surgical template and the prosthesis, Special surgical guide components were also manufactured for placement of implants in the pterygomaxillary region. The manufactured surgical components, surgical template, and definitive prosthesis were then delivered to the clinical site. Implant placement surgery was performed using the surgical template, without a flap, and the prosthesis was delivered, achieving immediate functional loading. Minor occlusal adjustments were made. The total surgical treatment time required was less than 60 minutes. Postoperative symptoms, such as pain, swelling, and inflammation, were minimal. Identification of the bone in relationship to the tooth position via three-dimensional CT prior to surgery allows precise placement of implants. CAD/CAM technology using the three-dimensional images allows for fabrication of the surgical guide and final prosthesis. This is a significant advancement in implant dentistry and prosthodontics.
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PMID:Surgical planning and prosthesis construction using computer technology and medical imaging for immediate loading of implants in the pterygomaxillary region. 1708 35

Dissection of a cervicocerebral artery (CAD) is the second leading cause of stroke at younger ages. The pathogenesis of spontaneous CAD is not fully clarified. Defective connective tissue components may cause an arteriopathy predisposing to CAD in combination with certain trigger and risk factors. The clinical spectrum includes local pain in the neck, headaches, Horner's syndrome, isolated cranial nerve deficits, and hemispheric or brainstem infarction. Noninvasively, CAD is confirmed by Duplex sonography, MRI, and MRA. There is no controlled study for best treatment or management. Rational initial empiric treatment in acute CAD to prevent secondary embolism is partial thromboplastin time-guided anticoagulation by intravenous heparin followed by anticoagulation with warfarin. Carotid surgery for treating CAD is not recommended. The duration of anticoagulation is best guided by Doppler sonography follow-up and should extend until normalization of blood flow or at least 6 months after the vessel was occluded. Caution should be recommended for exercises that involve excessive head movements. The recurrence rate for CAD is low at <1%/year except for patients with known hereditary connective tissue disorders or in cases with familial dissections.
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PMID:[Clinical treatment and therapy for dissected cervicocerebral artery]. 1689 46

The aim of the investigation was to study the significance of the functional condition of endothelium for the evaluation of ischemic episodes in patients with type 2 diabetes mellitus (DM2). Ninety-three patients (52 men; 41 women; mean age 58.3+/-4.8 years) were examined. Group 1 consisted of 47 patients with coronary heart disease (CHD) and CD2; group 2 consisted of 46 CAD patients without carbohydrate exchange disorder. Both groups were comparable by gender, age, and the main risk factors. The patients were examined using Holter monitoring, physical load test, EchoCG, reactive hyperemia test (ultrasound evaluation of the endothelium-dependent brachial artery dilation). The number of painless ischemic episodes (PIE), the total duration of ischemia, the maximum degree of ST depression prevailed in group 1 patients. Correlation analysis demonstrated a significant negative correlation between endothelial dysfunction, one the one part, and the number and duration of PIE and the time between the ischemic ST depression and pain syndrome, on the other, in group 1 patients.
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PMID:[Clinicofunctional evaluation of ischemic episodes and vascular endothelium in patients with type 2 diabetes]. 1729 80

It was the aim of the study to assess differences in patient morbidity between transmucosal implant placement and implant installation after elevation of mucoperiosteal flaps. In five of the patients, implants were placed in the maxilla transmucosally using a CAD/CAM surgical template [test group (TG)]. In the remaining five patients, the implants were installed after the elevation of mucoperiosteal flaps [control group (CG)]. Directly after surgery, at days 1 and 7 after surgery the patients rated pain and discomfort on a visual analogue scale (0=minimal pain and discomfort, 100=maximal pain and discomfort). Optical three-dimensional images were assessed preoperatively and at days 1 and 7 after surgery to determine the visible soft tissue swelling of the upper lip and cheeks. Directly postoperatively, the mean pairwise difference between both groups in view of pain and discomfort ratings (control minus test) was 45.6 (SD, 20.7). At days 1 and 7, the mean differences were 51.6 (SD, 21.8) and 19 (SD, 8), respectively. The overall test of the area under curve (AUC) against the null hypothesis 'AUC of pairwise differences of pain score over study time equals null' yielded a significant difference (P=0.01). The mean pairwise difference between both groups in view of soft tissue volume increase was 6.1 (SD, 2) cm(3) at day 1 after surgery and 4.6 (SD, 1.2) cm(3) at day 7. The overall test of the AUC against the null hypothesis 'AUC of pairwise differences of oedema measurements over study time equals null' yielded a significant difference (P=0.002). Within the limitations of this pilot study, it could be shown that transmucosal implant placement reduces patient morbidity significantly compared with an open approach.
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PMID:Patient-centred outcomes comparing transmucosal implant placement with an open approach in the maxilla: a prospective, non-randomized pilot study. 1734 84

The aim was to measure the level of antibodies to oxidized LDL (oxLDL) and C-reactive protein (CRP) in the serum of patients with acute coronary syndrome (ACS). The results were correlated with data obtained from patients with stable coronary artery disease (stable CAD) and healthy controls. Thirty-three patients with ACS and 62 stable CAD patients were enrolled in the study. Fifty healthy individuals served as controls. The evaluation of anti-oxLDL autoantibodies was performed by ELISA, while CRP levels were measured by turbidimetry. The level of antibodies to oxLDL was significantly higher in both groups of patients with ACS and stable CAD compared to controls. The comparison between the acute and stable groups showed that anti-oxLDL levels were higher in the acute group, but because of high SD, the difference was not significant. By performing group analysis, anti-oxLDL levels were found to be significantly higher in ACS patients with unstable clinical state (circulatory insufficiency, malignant arrhythmias, recurring ischemic pain, need for urgent coronary intervention and death). CRP level in patients with ACS was significantly higher than in those with stable CAD. A positive correlation was found between anti-oxLDL antibodies and CRP levels both in patients with ACS and stable CAD. The association between the two biomarkers was stronger in the ACS group. In conclusion, our findings support the notion that the presence of antibodies to oxLDL, a plaque-specific antigen, plays a major role as a predictor of complicated manifestations of ACS.
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PMID:Evaluation of antibodies to oxidized low-density lipoprotein and assessment of C-reactive protein in acute coronary syndrome and stable coronary artery disease. 1772 25


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