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

In a series of 24 cases of acute dissecting aneurysm of the aorta (not including Marfan's disease) the diagnosis was usually suspected on the basis of the clinical picture and plain chest roentgenograms. The most consistent clinical sign was severe pain. Absent pulses and a neurological deficit were each noted in only five patients. In many cases there was no correlation between the clinical picture and the type or the extent of the dissection. Widening of the aortic arch and obliteration of the aortic knob with displacement of the trachea to the right are the most common signs in plain chest roentgenograms. A barium swallow examination in these cases reveals an elongated compression and displacement of the esophagus by the aortic arch. Calcification in the area of the aortic arch is the exception rather than the rule in dissecting aneurysms. Angiography is essential for the definitive diagnosis of dissecting aneurysms. The diagnosis is based on the demonstration of two channels, either by the presence of a linear radiolucency separating the two lumens, or by differences in flow that present as delayed opacification or delayed washout. If only the true lumen is opacified, widening of the outer extraluminal border of the aorta or narrowing of the lumen indicates the presence of a dissection. Abnormal catheter recoil and position were helpful in only two cases, and are not informative when the false lumen is catheterized. Failure to visualize main aortic branches was not always due to involvement by the dissection. It can also be caused by reduced flow due to severe proximal compression of the main lumen. The exact location of the intimal tears is usually not demonstrated unless additional injections are made in the area assumed to contain the tear. If only the false lumen is opacified in the ascending aorta, this can be recognized by the demonstration of a blind end, by failure to visualize the sinuses of Valsalva, from flattening of the medial border of the opacified channel, and from delayed washout in the blind end.
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PMID:Dissecting aneurysm of thoracic aorta: reappraisal of radiologic diagnosis. 120 71

X-rays of the pancreatic duct can now be obtained by a nonoperative endoscopic approach (endoscopic retrograde cholangiopancreatography-ERCP). After more than 2 years experience we have found that the pancreatic duct can be visualized in 85 to 90% of patients. This test is used to detect pancreatic carcinoma in the symptomatic patient and in searching for an operative pancreatic lesion in a patient with known recurrent or chronic pancreatitis. Many of these patients have pain or a transiently elevated amylase; a few have steatorrhea or abnormalities of the duodenal sweep on barium meal. Stenosis or obstruction of the main pancreatic duct with or without proximal duct dilation are the characteristic abnormalities noted in pancreatic carcinoma. A rare pancreatic tumor which is not in juxtaposition with the duct will have a normal pancreatogram although the common duct may be obstructed by cholangiography as it passes through the head of the pancreas. In patients with chronic pancreatitis it may be difficult to differentiate an inflammatory from a neoplastic stricture by either operative or endoscopic pancreatography. In the future, cytologic and biochemical examination of the pancreatic secretions obtained at ERCP may increase the accuracy of diagnosing carcinoma.
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PMID:Operative and endoscopic pancreatography in the diagnosis of pancreatic cancer. 124 76

The authors present 3 cases which illustrate the wide spectrum of clinical presentations of gastrocolic fistula. These complications include (a) pain, feculent vomiting, and diarrhea; (b) gastrointestinal hemorrhage; and (c) peritonitis. The gastric ulcer is easily detected by a barium meal study although a barium enema may be necessary to show the fistulous communication. The relationship of this condition to steroids and acetylsalicyclic acid is stressed. Two other cases are included to illustrate the development of such a fistula and show the distinguishing features of a gastrocolic fistula due to carcinoma of the colon.
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PMID:Gastrocolic fistula as a complication of benign gastric ulcer. 125 59

Experience with the LEm IUD in an immediate postpartum program is reported. During a 6-month period in 1973, the LEM device was inserted in 1359 patients immediately after term delivery. The LEM is made of polyethylene, impregnated with 20% barium sulfate. When inserted through a plastic tube it is a 2-dimensional device in the shape of a Gothic X. When the uterus involutes, the LEM becomes 3-dimensional. A double string is attached. At the end of 1 year, the gross pregnancy rate was 6.4%. This rate was greatest in the second 6 months of use. In 19 of the 25 cases of pregnancy the device was in place. In 1 case a stillbirth resulted at term. In 3 others spontaneous abortion had occurred and in 1 other abortion followed removal of the device by a physician. In 1 year, the gross expulsion rate was 20.6% of users, mostly during the first 6 months. Expulsions represented 76.2% of terminations of use. Removals for bleeding or pain were only 2.2%. In 1 case perforation of the uterine wall had occurred. After a Pomeroy procedure was done, this LEM was removed through the cervical os. The LEM IUD appears to be less effective than desired in pregnancy prevention. Design modifications are planned.
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PMID:The LEM device in an immediate postpartum contraception program. 127 54

Study objectives were to characterize the clinical syndrome of chronic idiopathic esophageal ulceration in patients with acquired immunodeficiency syndrome (AIDS), to determine the extent of local human immunodeficiency virus (HIV) infection, and to evaluate the effect of corticosteroid therapy upon symptoms and healing. Twelve AIDS patients with chronic esophageal ulcers whose etiology remained unknown after clinical evaluation were the subjects. All patients complained of severe odynophagia, chest pain, and weight loss. Barium radiography and endoscopy demonstrated large, undermined ulcers with severe acute inflammation. No evidence of herpes simplex viruses I or II, cytomegalovirus, fungi, or tumors were found histologically. Evidence of HIV was found in all ulcers using a combination of RNA in situ hybridization, immunohistochemistry, and quantitative antigen capture enzyme-linked immunosorbent assay of tissue homogenates. Steroid therapy by the oral or intravenous routes or by direct intralesional injection resulted in pain relief, weight gain in 10 patients, and ulcer healing in five patients. A characteristic clinical syndrome of chronic idiopathic esophageal ulceration may occur in patients with AIDS, related to local HIV infection in the esophagus. Corticosteroids relieve symptoms and may promote healing of the ulcer.
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PMID:Chronic idiopathic esophageal ulceration in the acquired immunodeficiency syndrome. Characterization and treatment with corticosteroids. 129 32

Acute suppurative thyroiditis is an uncommon thyroid disorder usually caused by bacterial infection. The most common route of infection is a fistula that originates from the fundus of the pyriform sinus. Pre-existing thyroid disease, most commonly nodular goiter, has been reported to be present in acute suppurative thyroiditis. A 44 year old man presented a subacute thyroiditis, resolved by nonsteroidal antiinflammatory treatment. One year later, the patient abruptly complained of fever and painful swelling in the thyroid region. A relapse subacute thyroiditis was diagnosed and prednisone treatment was started. A few days later owing to a worsening of the pain and of the clinical features the patient was referred to our department. He presented dysphagia and he was feverish, the overlying skin of the neck swelling was erythematous and warm. There was a neutrophilia (83.7%). Plasma FT4, FT3 and TSH were normal. Anterior neck region ultrasonography showed an enlargement of the left thyroid lobe with poorly defined shapes and inhomogeneous parenchyma while the right lobe of the gland was normal. The 131-I thyroid scan showed a large cold area in the upper part of the left thyroid lobe and preserved radionuclide uptake in the residual parenchyma. The RAIU was normal. We diagnosed acute suppurative thyroiditis and started antibiotics treatment. The day after the patient was still feverish and he gave out from the mouth a great quantity of sero-purulent material with a swelling reduction and improvement of the neck pain. Barium swallow examination did not show any fistula in the cervical esophagus. The fistula opening was demonstrated by indirect laryngoscopy in the postero-lateral side of hypopharynx.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Acute suppurative thyroiditis in a patient with prior subacute thyroiditis]. 129 72

The case of a 56 year old female with intermittent pain, weight loss, anaemia, and a palpable tympanic abdominal mass is reported. Barium enema showed a very redundant loop of proximal colon, which was thought to have undergone recurrent volvulus. At colonoscopy, the findings seemed normal, but a much shorter length of colon was intubated to the caecum than expected from the barium findings. The duplicated colon was discovered only intra-operatively. This unusual diagnosis should be considered when a barium enema shows a long redundant colon which is not confirmed on colonoscopy.
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PMID:Duplication of the proximal colon mimicking volvulus: a case report. 145 13

From 1966 to 1990, 226 consecutive patients were operated on electively for diverticular disease of the sigmoid colon. The indications for surgery were colovesical fistula or suspicion of residual abscess, existence of two or more previous attacks of acute inflammation, existence of chronic symptoms and suspicion of colonic carcinoma. Colonic resection with primary anastomosis was performed in 217 patients with a covering colostomy in 1 case only. The Hartmann procedure was performed in 9 patients with extension of the lesions to the rectum and/or high operative risk. One or more abscesses were found by the surgeon or the pathologist in 50 p. cent of the patients. There were no postoperative deaths, no clinical anastomotic leakages. Long-term results were evaluated for the patients operated on before 1987, with a follow-up from 2 to 22 years. 85 p. cent of the patients had no more symptoms, 11 p. cent complained of persistent symptoms and 3% had recurrent attacks of pain and fever. Colonic barium enema is the best examination for diverticulitis and chronic abscesses. Surgical treatment is easier for abscesses located within the colonic wall and mesentery, than for extracolic abscesses with local peritonitis. Correlations between preoperative symptoms and operative findings are often not good. The good results obtained in 82 p. cent of the patients operated on for chronic symptoms suggest that chronic symptoms should be part of the indications for elective surgery. The low incidence (3 p. cent) of recurrent attacks of pain and fever is in favour of a resection limited to the sigmoid colon even when diffuse colonic diverticula are present.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Sigmoid diverticular diseases: surgical treatment]. 151 69

Gastrointestinal lipomas are rare, but commonest in the colon and rectum, characteristically submucosal and seldom subserosal. An 18-year analysis revealed 17 cases of large-bowel lipoma, 13 presenting with colicky pain, abdominal discomfort, blood-stained feces or rectal bleeding and altered bowel habits and four asymptomatic. The 17 patients had totally 21 lipomas, all submucosal. No patients with multiple lipoma had evidence of lipoma at other sites. The ileocecal valve and cecum were most commonly affected, followed by the rectum, sigmoid colon and descending colon. Tumor size (largest diameter) was 0.5-10 cm, averaging 3.1 cm (3.5 cm in symptomatic, and 1.8 cm in asymptomatic patients). The primary diagnosis (with barium enema, colonoscopy and CT) was lipoma in only five cases, but CT gave the correct diagnosis in all three cases in which it was used. Two lipomas were found in surgical specimens from colorectal malignancy, while nine were misinterpreted as polyps and one as angiodysplasia. In symptomatic patients unnecessary colotomy or colonic resection may be avoidable by colonscopic removal of lipoma.
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PMID:Submucous large-bowel lipomas--presentation and management. An 18-year study. 167 82

Two children with gastric outlet obstruction without oesophageal involvement secondary to acid ingestion are described. They presented with frequent vomiting along with pain in the epigastrium. The diagnosis was made by barium swallow and barium meal examination. Treatment consisted of gastrojejunostomy. The literature on this subject is briefly reviewed.
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PMID:Corrosive pyloric obstruction without oesophageal involvement in children--a report of two cases. 169 89


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