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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors report a survey of the French Group of Visceral Pediatric Surgery, concerning 985 congenital anomalies of the pyeloureteric junction in 883 children. 67.3% of them are boys. This article stresses the recent improvements in prenatal ultrasonography and diagnosis which is now able to individualize a homogeneous group of asymptomatic children ready to be repaired in the early post-natal period. Early reconstruction is associated with the greatest degree of recovery of renal function. In children, the average age is 4 years 9 months at diagnosis. In 43.6% clinical symptoms suggest an infectious problem. Pain is noted in 35.5% and an abdominal mass is discovered in 13.3%. Excretory urography (IVP), ultrasonography and cystography are still the main investigations to be done in all cases. But it is now necessary to use modern isotopic technics such as DMSA and diuretic DTPA to quantify obstruction with accuracy and follow long-term evolution after treatment. Treatment is surgical and conservative in 81.4%. Almost all of the uretero-pyeloplasties are performed according to the dismembered technic usually with temporary nephrostomy drainage. Renal reduction is reserved only for the redundant and decompensated renal pelvis. Morbidity is low (2.5%) and good results can be expected in about 95% of cases.
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PMID:[Congenital anomalies of the pyeloureteral junction in children. Multicenter study of 985 anomalies in 883 children]. 331 79

PSC is an unusual disease of unknown etiology. In fact, sclerosis of the bile ducts may be the result of multiple factors, including autoimmune, bacterial, congenital, drug, or viral agents. The most commonly associated diseases are ulcerative colitis and chronic pancreatitis. Except for the earliest stages of the disease, liver histology is 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 diagnosed. Cholangiography is the key to the diagnosis and is usually pathognomonic except in the unusual case where PSC is confused with cholangiocarcinoma. Multiple forms of medical therapy have been tried, including steroids, azothiaprine, D-penicillamine, colchicine, cholestyramine, and antibiotics. To date, however, none of these medications has altered the course of this disease. In recent years, balloon dilation of biliary strictures has been accomplished via endoscopic and percutaneous transhepatic approaches. However, in patients with PSC these nonoperative manipulations must be done repeatedly, may require multiple general anesthetics, and are difficult to perform. A direct surgical approach to the biliary tree with prolonged transhepatic stenting is indicated in patients with severe hilar or extrahepatic stricturing, persistent jaundice and/or recurrent cholangitis, and no evidence of cirrhosis. Hepatic transplantation should be reserved for patients with PSC who have well-established cirrhosis and in whom other therapeutic options have failed.
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PMID:Sclerosing cholangitis. 331 16

The epidemiology, pathophysiology, clinical features, diagnosis, and clinical course of rheumatoid arthritis (RA) and the role of disease-modifying antirheumatic drugs (DMARDs) in its treatment are reviewed. RA, a widespread disease affecting people of all races and sexes around the world, has an unknown and perhaps multifactorial etiology. Conflicting evidence supports an immune-complex, infectious, metabolic, or genetic basis for RA. The disease affects diarthrodial joints and begins as an immune response to unknown antigenic stimuli. A proliferative process ensues, leading to formation of a vascular lesion called a pannus, which then infiltrates into cartilage, subchrondral bone, and tendon. This destructive phase leads to classic RA symptoms of pain, limitation of motion, swelling, heat, and redness of the affected joint. Symptoms and laboratory tests form the basis for diagnosis. For most RA patients, conservative therapy provides substantial benefit. In those patients who suffer from unrelenting and progressively destructive disease, more aggressive intervention is necessary to prevent permanent disability. The DMARDs are reserved for treatment of this group of patients. DMARDs include such diverse agents as the gold compounds aurothioglucose, auranofin, and gold sodium thiomalate; the antimalarials hydroxychloroquine sulfate and chloroquine phosphate; penicillamine; and the cytotoxic agents azathioprine, methotrexate, and cyclophosphamide. DMARDs are effective but toxic therapeutic agents. Because of the toxicities of these agents, careful monitoring at regular intervals is necessary throughout the duration of therapy. For patients in whom these drugs demonstrate efficacy and are tolerated, the DMARDs may attenuate the disabling effects of long-term erosive disease.
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PMID:Current concepts in clinical therapeutics: disease-modifying drugs for rheumatoid arthritis. 331 62

Constrained replacement, like all prosthetic replacements, is constantly undergoing change and will improve as the current state of the art changes. It is not a standard, usual operation like unconstrained arthroplasty, and it should be reserved for the patient who requires arthroplasty and does not have a functional rotator cuff mechanism. If, in addition, the acromial fulcrum and loss of deltoid is present, then there is a greater reason for constrained replacement; it is a salvage procedure that is not as durable as the unconstrained device. Constrained arthroplasty has much merit if the risks and possible complications are well understood; however, pain relief and improved function will be lost if the device fails. The dislocation feature of the MRTS is desirable in order to minimize the risk of scapular fracture. Its disadvantage is that, with this complication, open operation is needed to reduce the assembly and insert new polyethylene components. The method of surface mounting of the metal glenoid component without removing the glenoid subchondral plate or cancellous bone of the vault is believed to lessen the risk of glenoid component loosening or pull-out. Finally, active function always depends upon residual deltoid muscle power. Thus, a poor or absent deltoid will only permit passive motion.
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PMID:Constrained arthroplasty of the shoulder. 332 32

A fluoroscopically guided anterior approach to celiac plexus block was developed that can be performed on the supine patient during a percutaneous biliary procedure. Unlike posterior blocks, anterior blocks can be performed at any time during the procedure and thus can be reserved for the few patients whose pain does not respond to intravenously administered narcotics. Anterior blocks were performed 18 times in 14 patients; satisfactory visceral anesthesia was achieved in ten of the 18 procedures.
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PMID:Anterior approach to celiac plexus block during interventional biliary procedures. 335 75

Sixty-five non-icteric patients presumed to have the postcholecystectomy syndrome (PCS) were followed up for 4-13 years after their first endoscopic retrograde cholangiopancreatography (ERCP) examination, which gave normal findings. All patients, however, experienced severe pain on injection of only 1-2 ml of contrast medium over 5-10 sec into the common bile duct (CBD). Thirty-four of the 65 patients were found to have true PCS on long-term follow-up studies, whereas 31 of them had other diseases. A second ERCP also showed normal results, and the injection-related pain was preceded by an abnormal pressure rise in the CBD at manometry. The CBD acted like a pain trigger zone, and the pain reaction might be diagnostic in everyday clinical practice. In conclusion, ultrasonography is an adequate diagnostic method in non-obstructive PCS. Medical treatment is often successful. ERCP and interventional treatment should be reserved for patients with obstructive symptoms and for patients in whom all medical treatment has failed.
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PMID:The postcholecystectomy syndrome: bile ducts as pain trigger zone. 338 90

The diagnosis and treatment of thoracic outlet syndrome based on a personal experience with 473 patients resulted in relief of symptoms in over 90 percent of patients treated operatively. The diagnosis centers on a thorough history and the exclusion of other causes of arm and shoulder pain, utilizing a strict flow pattern of differential diagnosis. Angiography and electromyography are of limited value and should only be performed in selected cases. Operation should be reserved for the thoroughly evaluated patient who continues to have pain despite adequate conservative therapy. Transaxillary removal of the first rib, fibromuscular bands, and cervical rib, when present, is the operation of choice.
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PMID:Thoracic outlet syndrome. 339 94

A series of 131 tumours of the parotid was reviewed retrospectively to ascertain the value of clinical features in distinguishing between malignant and benign tumours. The overall proportion of malignancy in this group of tumours was 17% (23 tumours). It was found that sex, age, size, duration of symptoms, and history of rapid enlargement were non-contributory to a diagnosis of malignancy, while the presence of facial nerve paralysis, skin infiltration or ulceration, and metastatic neck nodes were found only in patients with malignant tumours. A history of pain, hardness, and fixity, found in 30-50% of parotid cancers, were significant indicators of malignancy. As the yield of routine frozen section examination on all resected parotid tumours is low, it is recommended that if resources are limited, the examination be reserved for tumours highly suspicious of being malignant.
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PMID:Tumours of the parotid--the value of clinical assessment. 345 42

Tibiofibular synostosis may be an underlying cause of tibial pain with activity or ankle pain of uncertain origin. The diagnosis may be suspected when symptoms begin and progress months after an injury, when symptoms occur with vigorous activity, and when symptoms are most pronounced during midstance and preswing phases of the gait cycle. Confirmation of the diagnosis is easily made through radiographic examination, which should include the entire leg. Bone scan may show increased tracer uptake. Interference with normal dynamic function of the fibula subjects the synostosis to repetitive stress and ultimate fatigue fracture with resultant pain. Conservative treatment is recommended initially. Surgical excision should be reserved for the athletically active patient whose symptoms are gradually progressing and disabling, and whose synostosis has taken on the appearance of mature cortical bone on radiographs. The principles of tumor biopsy should be adhered to, lest the diagnosis be in error. Finally, meticulous hemostasis and use of bone wax may lessen the possibility of recurrence.
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PMID:Tibiofibular synostosis: an unusual cause of shin splint-like pain. 361 80

The general opinion on epidural anesthesia in obstetrics may be adversely affected by recent public controversies about the mother's situation during childbirth in hospital, which nowadays is often considered to be a highly technological, impersonal, or "unnatural" procedure. This assumption led us to conduct an inquiry on maternal assessment of obstetric epidural anesthesia and its relation to the clinical and social history. The study included 113 parturients, who received epidural anesthesia (on-demand epidural injections of bupivacaine 0.25%) for vaginal delivery. Mothers were asked to answer certain questions about this regimen (e.g. analgetic efficacy; difficulties in deciding on this method; recommendations to other parturients; opinion of the role of epidural anesthesia in obstetrics; choice of analgesic regimen for future childbirth) 1 day after delivery and 2 months later. Additional social and historical factors (e.g. education; profession; family status; preceding pregnancy, childbirth or abortion; complications during pregnancy or childbirth; duration of parturition) were used to reveal relevant statistical correlations. Sixty-five percent of the patients considered pain relief by epidural anesthesia as "good" or even "very good" during the first inquiry immediately after childbirth. Women who had undergone prior interruptions of pregnancy were less satisfied, probably because of their rather ambiguous attitude towards motherhood. With regard to the choice of analgesic regimen for future childbirth (50% of the patients had made a definite decision to have epidural anesthesia under this condition), those women were especially reserved who had suffered from complications during pregnancy and disapproved of it in the future.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Opinion of mothers on continuous peridural obstetrical anesthesia]. 365 35


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