Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aim of this work was to establish when, in the investigation of local musculoskeletal symptoms, dynamic isotope bone imaging yields useful information not available from static isotope bone imaging, using 99mTc methylene diphosphonate. One hundred and forty-two dynamic bone scans were reviewed, with particular reference to the site being imaged, the suspected underlying pathology, and the contribution of the dynamic phases to diagnosis, management, and eventual outcome. All were performed as part of the investigation of adult patients complaining of localized musculoskeletal symptoms. The dynamic phases influenced diagnosis, management, and eventual outcome most positively in suspected infection, particularly at a previous fracture site or around a prosthesis. They did not alter management significantly in suspected fracture, avascular necrosis, in most patients with pain of unknown cause, and were rarely helpful in imaging the axial skeleton. We suggest that, in the context of routine bone imaging, dynamic bone scanning should be reserved for cases of suspected infection. In the investigation of most other local bone pathologies, the static phase of the bone scan provides all the diagnostic information which is required for management decisions.
 ...
PMID:Dynamic bone imaging in the investigation of local bone pathology--when is it useful? 200 6

Plantar fasciitis is a common orthopedic syndrome among athletes and nonathletes. The etiology of the pain is multifactorial but usually involves inflammation and degeneration of the plantar fascia origin. The majority of patients will respond to conservative measures. Surgical treatment is reserved for those patients who do not respond. A complete plantar fascia release is performed through a medial longitudinal incision. Prominent heel spurs and degenerated areas in the plantar fascia are resected. Of 27 surgically treated cases followed from one to three years, satisfactory results were obtained in 24 cases. Histologically, localized fibrosis or granulomatous changes or both were noted in several cases.
 ...
PMID:Plantar fasciitis. Etiology, treatment, surgical results, and review of the literature. 201 49

Short term symptomatic treatment concerns, above all, painful, active osteoarthritis. Long term treatment prevents or slows down the destruction of cartilage and is assessed by radiological measurement of the joint space in the hip and knee. This must also be combined with a clinical criterion based on a functional pain index and the quality of the patient's life. Interphalangeal osteoarthritis, excluding root arthrosis of the thumb, is a good model and the preventive effect of treatment can be assessed from the extension of interphalangeal involvement. In the lower limbs, osteoarthritis of the hip in its idiopathic form (with overall superior or supra-external narrowing) and minor dysplasias were selected. Internal femorotibial osteoarthritis is suitable for evaluating a drug's effect in protecting cartilage. Other varieties are reserved for symptomatic treatments.
 ...
PMID:[Objectives to be assigned to the various proposed treatments (NSAID, analgesics, preventive or curative fundamental treatments). Which type of patients for which type of clinical trials]. 208 Apr 12

Recombinant tissue-type plasminogen activator (rt-PA), streptokinase (SK), and anisoylated plasminogen-streptokinase activator complex (APSAC) have salutary effects on mortality when administered to patients with evolving acute myocardial infarction (MI). Studies suggest that intravenous rt-PA is more effective in reperfusing occluded infarct-related arteries than SK, and the results of ongoing studies directly comparing the influence of SK and rt-PA on mortality are awaited. The clinical role of agents such as APSAC, urokinase, and pro-urokinase, used alone or in combination, remains to be determined. It is evident that a variety of thrombolytic agents will be effective, and variables such as ease of administration, pharmacokinetics, fibrin specificity, effects on blood viscosity, and incidence of adverse effects need to be assessed to determine which agents are the most suitable for clinical use. There is an increased risk of bleeding at vascular puncture sites with all thrombolytic agents. Current indications for thrombolytic therapy include ischemic chest pain of at least 30 min duration that is unrelieved by nitroglycerin and is associated with ST-segment elevations of at least 0.1 mV in two contiguous electrocardiographic leads. Such therapy is usually reserved for patients less than 75 years old who are not at increased risk for bleeding and whose chest pain began less than 4-6 prior to treatment. Trials are under way to determine whether patients with shorter pain duration, transient ST-segment changes (ie, unstable angina patients), chest pain associated with ST-segment depressions or T-wave inversions (ie, non-Q-wave infarction patients), or patients whose pain began more than 4 to 6 h earlier will benefit from early thrombolytic therapy. Other factors such as patient age, the likelihood of the diagnosis of MI, and the estimated risk of bleeding should also be considered. The findings of available major randomized trials indicate that early invasive procedures are generally unnecessary and that meticulous care must be exercised in the selection and management of patients subjected to thrombolytic therapy.
 ...
PMID:Thrombolytic therapy in acute myocardial infarction. 210 51

Low back pain is a very frequent complaint. Unfortunately, a specific diagnosis can be made only in a minority of cases. Many pain provocation and alleviation tests have been done, and their results help the clinician in some cases to locate the origin of pain in the lumbar spine. It has been postulated that these tests should be reserved for the realization of controlled clinical trials evaluating different treatment modalities.
 ...
PMID:[Diagnosis of lumbar spine pain: are simple anatomic concepts sufficient for common practice?]. 214 Sep 6

Diverticulitis usually manifests as pain of abrupt onset in the lower left quadrant. Complications may occur with or without an acute attack. Plain abdominal films are crucial for initial workup and follow-up. Endoscopic examination is often indicated, but barium enema study should usually be avoided during an acute attack. Computed tomography offers the best means of determining extracolonic extension of diverticulitis. Therapy is usually medical and consists of "resting" the bowel, administering antibiotics to resolve infection, and preventing or minimizing complications. Surgery is reserved for refractory, recurrent, or complicated disease.
 ...
PMID:Colonic diverticulitis. Recognizing and managing its presentations and complications. 186 49

Prosthetic shoulder replacement is impeded by two main obstacles: the articular cavity is very shallow, and the small glenoid surface rests on a narrow neck to which prosthetic pieces are difficult to attach. The principal, currently used prostheses are non-retentive models which reproduce the anatomy of the joint. They differ from each other mainly in the glenoid piece pattern which may be sealed only to the glenoid cavity or also fixed onto the acromion. On the whole, the clinical results reported are encouraging, particularly as regards the absence of pain, but the radiological course of the glenoidal sealing is a source of concern. Obvious unsealing is rare, but cracks between bone and cement are very frequent and some of them become wider as time goes by. In addition, there is still no satisfactory solution to the problem of big rotator cuff tears. This type of prosthesis must be envisaged with caution and should be reserved to very painful shoulders, but it would be wise not to wait until the rotator cuff is destroyed. The best indications are glenohumeral osteoarthritis, rheumatoid arthritis and necrosis of the tumoral head.
 ...
PMID:[The total shoulder prosthesis]. 218 40

Primary sclerosing cholangitis is a rare disease of unknown etiology. Sclerosis of the bile ducts may actually be the final result of multiple factors such as autoimmune, bacterial, congenital, drug, or viral injury. The most commonly associated diseases are ulcerative colitis and chronic pancreatitis. Except in the earliest stages of the disease, liver histologic findings are not specific. Most patients present with jaundice, pain, and pruritus, although an increasing number of asymptomatic patients with inflammatory bowel disease and abnormal liver function are being identified. Cholangiography is key to the diagnosis and is usually pathognomonic except in the unusual case where primary sclerosing cholangitis is confused with cholangiocarcinoma. Many forms of medical therapy have been tried, including antibiotics, azathioprine, cholestyramine, colchicine, cyclosporine, D-penicillamine, steroids, and ursodeoxycholic acid. To date, none of these medications has been proved to alter the course of this disease. Recent reports of ursodeoxycholic acid trials have been encouraging, but long-term results of ongoing randomized trials have yet to be published. In recent years, balloon dilatation of biliary strictures has been accomplished via endoscopic and percutaneous transhepatic approaches. However, in patients with primary sclerosing cholangitis, these nonoperative manipulations must be done repeatedly, may entail multiple general anesthetics, and are difficult to perform. We believe that a direct surgical approach to the biliary tree with long-term transhepatic stenting is indicated in selected patients with severe hilar or extrahepatic stricturing, persistent jaundice or recurrent cholangitis, and no evidence of cirrhosis. Hepatic transplantation should be reserved for patients with primary sclerosing cholangitis who have well-established cirrhosis and have not responded to other therapeutic measures.
 ...
PMID:Primary sclerosing cholangitis. 224 21

Clearly, no one surgical procedure is ideal for the treatment of degenerative joint disease. Many factors are involved in planning for the proper approach, such as age and activity of the patient, etiology, and stage of the disease. Arthroplasty, implant arthroplasty, cheilectomy, enclavement, various osteotomies, and joint fusions have been advocated as procedures for choice of degenerative joint disease of the first metatarsophalangeal joint (24-26). Similar procedures have been used to treat arthroses of the lesser metatarsophalangeal joints as well. Some of these procedures are designed to address the etiology of the degenerative process. This is the case with the enclavement and metatarsal osteotomies such as the Watermann procedure (25, 26). Most of these procedures are primarily effective in the early stages of the disease (26). Other procedures attempt to alleviate symptomatology as with the Keller arthroplasty, implant arthroplasties, cheilectomy, and joint fusions (24, 26). With the exception of the cheilectomy, these generally are reserved for late stage arthroses. Subchondral drilling has been used to treat cartilage defects in conjunction with other procedures that address the etiology and symptomatology of the disease process. It has been shown that small drill holes may be effective in producing fibrocartilage to replace full- and partial-thickness cartilage defects (14, 18). Such drilling has been useful in the treatment of osteochondral lesions of the ankle and promises to be equally effective in treatment of osteochondral lesions of the metatarsophalangeal joints. As with any procedure, applications are limited. Subchondral drilling addresses only the cartilage defect and the pain attributed to that defect. It does nothing to address the etiology of a biomechanical problem. (ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Subchondral bone drilling: a treatment for cartilage defects. 229 54

Pain in the temporomandibular joint is primarily responsible for the morbidity often associated with this syndrome. Of the 448 cases in this study, 48% presented as ear pain and 46% complained of either headache, sinus pain, or neck pain. Temporomandibular joint pain and mastication muscle tenderness elicited with palpation were frequent physical findings. In this review, temporomandibular joint syndrome was successfully managed in 75% of 448 cases with conservative treatment consisting of patient education, heat, massage, non-narcotic analgesics, and occlusal splints. Seventeen percent were referred to dentists for restorations or orthodontics. The success rate for the 6% who underwent diagnostic arthroscopy and/or open joint surgery with disc replacement was 67%. Therefore, patients with ear pain or head and neck pain require an objective evaluation of medical history and physical examination to obtain the correct diagnosis and subsequent correct treatment and pain relief. Early diagnosis helps to prevent changes in the joint that can become irreversible with intractable pain. Surgery is reserved for those patients who fail to respond to conservative management.
 ...
PMID:Managing temporomandibular joint syndrome. 229 2


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>