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

We present a case of cancer of a choledochal cyst in a patient with antecedents of cholecystectomy, who complained of pain in the right hypochondrium. Echography and CAT disclosed a cystic mass of biliary location, and the diagnosis was confirmed by intraoperative cholangiography and biopsy of the cyst margin. Cysto-jejunostomy on a Roux-en-Y loop was performed. The patient survived 11 months and died of tumoral dissemination. We reviewed 130 cases of cancer of a choledochal cyst published up until 1986 and possible etiopathogenic causes, and we discuss the diagnostic problems and related treatment.
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PMID:[Adenocarcinoma in a choledochal cyst. Report of a case and review of the literature]. 268 79

A series of 6 mediastinal tumors of mesenchymal origin is presented. This type of tumors is very heterogeneous in its histology, depending on the differentiation of the primary mesenchymal cell. Presenting symptoms are not diagnostic: nevertheless malignant neoplasms are often revealed by vague thoracic pain, while benign masses usually show the tendency to a slow non infiltrating growth accompanied by faint symptoms of mediastinal compression syndrome. Mesotheliomas and liposarcomas are the most frequent malignant neoplasms, while lipomas are the most represented among the benign ones. Preoperative diagnosis is often casual, based on plain X-ray examination of the chest: subsequent thoracic CAT is of utmost advantage, providing the exact definition of the limits of the mass and of its ability to invade visceral and vascular structures of the mediastinum. Lipomas are well identified by CAT because of their characteristic attenuation value. Surgical operation is mandatory, because benign neoplasms can be effectively cured and infiltrating masses correctly staged and identified by histological examination.
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PMID:[Mediastinal neoplasms of mesenchymal origin]. 274 63

A 4-year-old well boy was seen because of an asymptomatic left testicle undescended since birth; the testis was not palpable and the right side was normal. After an episode of left lower quadrant and left hip area pain, with some bladder symptoms and left leg limping, a work-up including a CAT scan showed a calcified retroperitoneal pelvic tumor on the left side. At laparotomy, an infarcted mass was found in the pelvis just above the internal ring. It was a torsion of an undescended intraabdominal testis with a benign testicular teratoma. The tumor was removed and his recovery was uneventful.
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PMID:Torsion of an undescended intraabdominal benign testicular teratoma. 288 20

Unilateral arch hypertrophy secondary to congenital absence of lumbar articular facets is a rare condition of still undetermined etiology. Most symptomatic cases had a history of mild trauma. Radiologic criteria using plain films and CAT scan are available to make the diagnosis of unilateral arch hypertrophy and the specific defects that cause this condition. Awareness of these signs by the orthopedic community may prove helpful in recognizing this anomaly as a cause of lower-back pain in the future. It would seem logical to conclude that the source of pain in patients with this congenital anomalies may be due to microfracture of the hypertrophic side caused by the concentration of stresses. Treatment of this condition varies, and too few cases are reported to draw any conclusions. A conservative approach of bedrest and immobilization should be attempted first. However, if this regime proves unsuccessful after a long well-documented trial, fusion seems to offer a good prognosis in the cases thus far treated by this method.
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PMID:Congenital absence of lumbar facets as a cause of lower-back pain. 293 70

An approach that allows a consistent, thorough evaluation can be recommended by a mnemonic using the words ankle/foot. The maxim about foot and ankle pain is that "the good exam begins at the back and ends at the toe." During this exam, the cutaneous, vascular, and neural systems need careful evaluation. The exam is directed to the region of maximal discomfort where careful palpation should pinpoint the spot of greatest tenderness. Once this region has been localized and signs and symptoms collected, consider the differential diagnosis specific for that area. This will narrow the focus, make the number of potential pain sources manageable, and often provide the answer. When the diagnosis is still unclear, obtain standard x-rays of the area. A directed evaluation to probe the region is appropriate. This can mean a bone scan to detect early avascular necrosis, stress fractures or osteomyelitis; an EMG-NCS to assess the neural circuitry; and special x-ray views, CAT scan, NMR, or arthrogram to uncover the difficult fracture. At this point, fortunately, the primary physician is not alone. The diagnostic dilemma or the difficult management case can be referred for a second opinion or therapeutic assistance to a podiatrist, rheumatologist, or the orthopedist with a special interest in feet.
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PMID:Ankle and foot pain. 306 97

The case is described of a 33-year-old woman with an 8-year history of oral contraceptive (OC) use who was treated at a hospital in Buenos Aires for a hepatic adenoma. The woman was admitted with an acute abdomen. Apart from OC use she had a history of hypertension for which she was treated with clonidine and diuretics. The physical findings included pain in the right abdomen, involuntary guarding, vomiting, and fever. Ultrasonography showed a normal bladder and pancreas and a nodular image in the right hepatic lobe. A CAT scan revealed a mass in the right hepatic lobe, and a needle biopsy later showed normal hepatic cells. Laparoscopy revealed a solid formation from which blood was obtained on puncturing. Angiography showed tortuous hepatic arteries. Laboratory tests were normal. An exploratory laparotomy was performed when the different studies failed to establish a clear diagnosis. A tumor was found in the right hepatic lobe but was not respected because the frozen section biopsy did not show malignant cells. The definite diagnosis of hepatic adenoma was based on the definitive biopsy. OC treatment was terminated and the tumor was in almost complete remission 1 year later. Hepatic adenomas are benign tumors, usually single, which occur rarely and primarily in women aged 30-40 who use OCs. A review of the literature indicated that the forms of presentation of hepatic adenoma are very varied. Pain was the initial symptom in 12-52% of cases. The pain was of sudden onset in 1/3. Hepatic adenoma is however infrequently considered as a cause of acute abdomen. Treatment in 73% of cases is surgical because of the danger of hemorrhage and shock and because of the potential for malignant transformation.
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PMID:[Acute abdomen as form of presentation of hepatic adenoma]. 307 13

A case of postoperative paraplegia after pneumonectomy of the left lung is presented. The patient received thoracic epidural anaesthesia for postoperative pain relief. The etiological role of epidural blockade in paraplegia is discussed. After consideration of differential diagnosis, postpneumonectomy paraplegia was diagnosed. The neurological sequelae were caused when the arterial blood supply to the spinal cord was compromised during surgery. However, to rule out epidural hematoma in such patients, a CAT scan of the spine must be performed immediately.
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PMID:[Paraplegia following pneumonectomy. An anesthesiological or a surgical complication?]. 317 80

Within seven years 506 patients with blunt abdominal trauma were included into a prospective trial. The aim of the study was checking of the validity of clinical parameters, routinely performed laboratory examinations and of the initial circulatory situation in relation to an abdominal organ lesion. Three groups were separated out of the total collective: Group 1: Patients without abdominal lesion (N = 274). Group 2: Patients with abdominal lesion, verified by operation, sonography or CAT scan (N = 232). Group 3: Patients with rupture of the spleen (N = 107) (subgroup of 2). Among the clinical parameters: spontaneous abdominal pain, contusions marks, abdominal tenderness, shoulder pain, and abdominal palpation, the latter does have a high validity (92%). However, in group 1, more than half of the cases also had palpation pain. Shoulder pain has a high sensitivity. Of the laboratory parameters: hemoglobin, hematocrit and leucocytes, only the leucocyte count provided a certain importance: 83% of group 2 had values above 10,000. The circulatory parameters blood pressure and pulse as initial spot picture are of minor validity. Continuous registration of these values at clinical observation has much higher relevance indicating trends towards improvement or deterioration.
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PMID:[The value of clinical aspects, laboratory and circulatory parameters in blunt abdominal trauma]. 321

NMR is becoming an established diagnostic modality in many of the medical specialties. Seventy-four patients who underwent lumbar spine scans in this series were positive for herniated disk. Of that group, 35 underwent either traditional laminectomy with disk excision (19) or chemonucleolysis (16). All of the positive studies were confirmed at the time of the therapeutic procedure. Among the negative studies (78), three patients persisted in their complaints of pain and underwent subsequent myelogram enhanced CAT scans of the lumbar spine. All of these were negative. There are no known ill-effects of magnetic resonance imaging.
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PMID:Magnetic imaging in the assessment of the lumbar disk. 322 26

Two cases are presented. Case #1, a 27-year-old Caucasian male presented with chronic right leg pain. Case 2 was a 23-year-old Caucasian female with right fifth finger pain. The clinical examination was benign except for mild tenderness of many years duration. No deformities were present in the male patient, the female patient did exhibit mild clinodactyly. The pain was described as constant, low grade, and dull. Plain roentgenograms of both patients demonstrated a hyperostotic process typical of melorheostosis and the bone scans demonstrated increased bone activity. A CAT scan demonstrated both endosteal and periosteal hyperostosis in our male patient. The biopsies of both patients were consistent with the clinical diagnosis of melorheostosis. A discussion and review of the literature covering this process is presented.
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PMID:Melorheostosis: two case presentations and review of the literature. 333 Nov 96


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