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

Fatigue is prominent in cancer patients and probably multifactorial in origin. Factors contributing to fatigue include anemia, weight loss, fever, pain, medication, and infection. In cancer patients, many of these factors are influenced by a frequently disrupted balance between endogenous cytokine levels and their natural antagonists. Indeed, cancer cells and the immune system appear to overexpress a range of cytokines in patients with malignancies. Some of these cytokines act as autocrine or paracrine growth factors for the neoplastic tissue while simultaneously causing secondary symptoms related to fatigue. For instance, cancer-associated anemia may be due to a blunted erythropoietin response and/or cytokines (interleukin-1 [IL-1], IL-6, tumor necrosis factor-alpha [TNF-alpha]), which suppress erythropoiesis. Cancerous cachexia, a wasting syndrome and a hallmark of cancer, can be attributed to loss of appetite or enhanced energy expenditure. Several different interleukins, as well as TNF, interferon-gamma, and leukemia inhibitory factor, act as cachectins in animal models. Similarly, fever and night sweats are influenced by pyrogenic cytokines. Recently, molecules that function as cytokine antagonists have been identified. These molecules may be exploitable in combating the components of cancer-related fatigue, and may inhibit tumor growth as well.
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PMID:The role of cytokines in cancer-related fatigue. 1159 87

We studied 94 cases of multiple hydatid cysts in the liver, over a period of ten years. These cases accounted for 31.3% of all cases of hydatid cysts treated surgically in the Visceral Surgery Department of Avicenne Military Hospital in Marrakech. In these patients, who were often young and male, the principal symptoms were pain in the right hypochondrium (71.3%) and hepatomegaly (24.5%). In about 10% of cases, the cysts were discovered by chance. Ultrasound and CT scans facilitated diagnosis and determination of the position of the cysts, with reliability reaching 100% for CT scans. The cysts had burst in the bile ducts in 26.6% of cases and were infected in 8 cases. They were multivesicular in 77.5% of cases. Association with hydatidosis at another site was observed in 28 cases: in the peritoneum in 15, the thorax in 7, the diaphragm in 4, the spleen in 2 and the kidney in 1 case. Surgically, the route most frequently used was double incision below the rib cage (49.5%). It is not possible to recommend one particular way to treat cysts and the most appropriate approach to treatment depends on the site, type and number of cysts. Resection of the prominent dome is the technique most frequently used (57.25%). However, in recent years, the use of cystectomy has been increasing (20.2%) due to the considerable decreases in post-operative morbidity and duration of hospital stay that it affords. The principal post-operative complications observed were abscesses under the diaphragm (6 cases), biliary leakage (5 cases), pleurisy (6 cases) and the formation of abscesses in the vestigial cavity (4 cases). The rate of morbidity in the RDS appeared high, accounting for 75% of total morbidity. Only one patient died. This patient died from severe hepatic insufficiency due to the near destruction of the liver by the hydatosis. We observed two recurrences during follow up. Both underwent further surgery and neither suffered complications.
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PMID:[Moroccan experience in the surgical treatment of multiple hydatid cysts in the liver]. 1164 Oct 82

Seventeen patients (9 women and 8 men) were prospectively evaluated to determine the results of open scapulothoracic bursectomy in the treatment of unremitting, painful scapular crepitus (snapping scapula syndrome). The mean duration of symptoms was 2 years (range, 4 months-6 years). Twelve related an injury history, and 5 had insidious onset of symptoms. Three had previous superomedial angle resections without relief. The mean age at surgery was 35 years (19-53 years), and follow-up averaged 2.5 years (2-6 years). The surgical approach reflected the rhomboid major from the medial scapula, giving access to the scapulothoracic bursa between the serratus anterior muscle and the rib cage. Only 4 cases required primary superomedial angle bone resection and one a revision resection. Mean outcome scores significantly improved preoperatively to postoperatively: American Shoulder and Elbow Surgeons score: from 48 to 91; Simple Shoulder Test: from 6.2 to 10.1; and Visual Analog Score for Pain: from 6.1 to 1.0 (P <.05). Return to work and sports averaged 3.5 months. Open scapulothoracic bursectomy allowed evaluation and treatment of all areas of potential pathology. Symptomatic crepitus was relieved, and pain relief and functional improvement were consistently achieved.
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PMID:Scapulothoracic bursectomy for snapping scapula syndrome. 1184 54

We performed posterior lumbar interbody fusion (PLIF) on 7 patients with rheumatoid spondylitis (RA) of the lumbar spine with severe low-back pain and/or cauda equina symptoms, and evaluated the effectiveness of PLIF for the lumbar spinal instability in RA secondary to destruction of the anterior elements, including vertebral endplates and the apophyseal joint. The subjects were 7 patients with classic RA, 2 men and 5 women, mean age 65 years old, and the mean duration of RA was 21 years. All had severe low-back pain and difficulty with walking. According to the ARA classification, the patients were at stage 3 or worse and in class 3. Diagnostic imaging including magnetic resonance imaging (MRI), tomography, myelography, and computed tomographic myelography (CTM) of the lumbar spine clearly delineated pathology, destruction of the vertebral endplate, subluxation, and cauda compression which can be well treated with PLIF. We performed L4/5PLIF (5 cases), L3/4 and L4/5 PLIF (2 cases), and posterior fixation with instruments for anterior column repair and stabilization and posterior decompression. Autografts (all cases) and Brantigan IF cage (2 cases) were used. Stable fixation of the lumbar spine was achieved after surgery, and improvement in gait and activities of daily living were achieved through the relief of low-back pain and radicular pain; the mean duration of follow-up was 22 months. Postoperative, plain radiography, CT, and MRI revealed the enlargement of the lumbar canal and fusion and incorporation of grafted bone, but in some cases, collapse of graft, migration of pedicle screw, instability of adjacent level, and collapse of adjacent vertebra were noted. PLIF with spinal instruments is a preferred treatment for rheumatoid spondylitis of the lumbar spine, but in the mutilating type of RA with severe osteoporosis, PLIF in combination with a long fixation system and/or augmentation of the vertebral bodies might be needed.
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PMID:Problems of posterior lumbar interbody fusion (PLIF) for the rheumatoid spondylitis of the lumbar spine. 1188 Sep 6

We report a case of a surgical treatment with anterior instrumentation in tuberculous spondylitis (Pott's disease), in a 71 years old woman, that was in treatment for pulmonary tuberculosis, with lumbar pain, progressive disability to walk, kyphotic deformity and vesical dysfunction. Magnetic resonance image presents a lesion in the bodies of T12 and L1, with paravertebral abscess. The patient was treated surgically by transthoracic-abdominal approach. The vertebral bodies were cut off and the spine were instrumented anteriorly with a mesh cage and a Z plate. This procedure permits a good arthrodesis and a immediately stabilization of the spine, without any complication of the infection. The patient was seen a year after the surgery and is free of infection, without motor deficit, pain or reminiscent kyphosis.
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PMID:[Anterior instrumentation of spine in tuberculous spondylitis: Pott's disease: case report]. 1196 25

When the degree of genetic determination of a trait (i.e. its heritability) is high, one tends to presume that environmental factors will not modify its expression by much. Contrary to this expectation, we show here in rats that a psychosocial-behavioral variable, the identity of cagemates, can largely over-ride genetic predisposition to pain behavior. We used selection-line rats that consistently show high (HA) or low (LA) pain phenotype (autotomy) in the neuroma model of neuropathic pain. Normally, HA animals show autotomy after nerve injury while LA animals do not. However, when caged together with HA rats, LA rats showed high levels of autotomy. This occurred even when the individual HA cagemates were familiar preoperatively, and it did not depend on the actual performance of autotomy by the HA rats. Indeed, cage bedding soiled by HA rats was sufficient to induce a modest level of autotomy in LA animals. Chemical cues associated with HA rats, perhaps in combination with behavioral characteristics, are apparently able to induce pain phenotype despite the powerful protection otherwise rendered by the LA genotype. Social factors must be considered in behavior-related research on rodents that have undergone genetic modification. More generally, the overwhelming influence that psychosocial-behavioral variables have on pain perception, and on pain behavior, in humans may have evolutionary roots deeper than has previously been appreciated.
Pain 2002 May
PMID:Social variables affect phenotype in the neuroma model of neuropathic pain. 1203 87

Anterior cervical fusion with interbody bone graft and anterior plating is commonly performed. Unfortunately, the plate has been reported to shield the graft from loading, thus reducing fusion rates. Interbody fusion cages have been effective in the lumbar spine and have gained acceptance in the cervical spine. Twenty-five patients underwent anterior cervical fusion with this modified technique. All patients received anterior diskectomy and corpectomy, placement of an interbody fusion cage packed with corpectomy bone, and application of an anterior cervical plate. Fusion was defined by radiographic evidence of trabecular bone bridging through the cage. No external bracing was used except soft collars as needed. Pre- and postoperative pain scales were completed and statistically analyzed using paired t tests. There were no cases of pseudoarthrosis or major neurological, vascular, or wound complications. There was one case of mild dysphagia that remained unresolved. Mean operative time was comparable to standard instrumented multilevel cervical fusion surgeries. Visual analogue pain scales were significantly improved following surgery. The advantages of using interbody cages with anterior plating include immediate stability and support, elimination of donor site pain from iliac crest bone autograft, and a decrease in pseudoarthrosis by halving the number of fusion surfaces.
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PMID:A modified technique for anterior multilevel cervical fusion. 1207 55

Pleuropulmonary amebiasis is the common and pericardial amebiasis the rare form of thoracic amebiasis. Low socioeconomic conditions, malnutrition, chronic alcoholism, and ASD with left to right shunt are contributing factors to the development of pulmonary amebiasis. Although no age is exempt, it commonly occurs in patients aged 20 to 40 years, with an adult male to female ratio of 10:1. Children rarely develop thoracic amebiasis: when it does occur there is an equal sex distribution. The infection usually spreads to the lungs by extension of an amebic liver abscess. Infection may pass to the thorax directly from the primary intestinal lesion through hematogenous spread, however. Lymphatic spread is one possible route. Inhalation of dust containing cysts and aspiration of cysts or trophozoites of E histolytica in the lungs are some other hypothetical routes. The lung is the second most common extraintestinal site of amebic involvement after the liver. Usually the lower lobe, and sometimes the middle lobe of the right lung, are affected, but it may affect any lobe of the lungs. The patient develops fever and right upper quadrant pain that is referred to the tip of the right shoulder or in between the scapula. Hemophtysis is common. The diagnosis of thoracic amebiasis is suggested by the combination of an elevated hemidiaphragm (usually right), hepatomegaly, pleural effusion, and involvement of the right lung base in the form of haziness and obliteration of costophrenic and costodiaphragmatic angles. Infection is usually extended to the thorax by perforation of a hepatic abscess through the diaphragm and across an obliterated pleural space, producing pulmonary consolidation, abscesses, or broncho-hepatic fistula. Empyema develops when a liver abscess ruptures into the pleural space. Rarely, a posterior amebic liver abscess can burst into the inferior vena cava and develop an embolism of the inferior vena cava and thromboembolic disease of the lungs with congestive cardiac failure or corpulmonale. Diagnosis by finding E histolytica in stool specimens is of limited value. In a limited number of cases amebae might be found in aspirated pus or expectorated sputum. "Anchovy sauce-like" pus or sputum may be found. Presence of bile in sputum indicates that the pus is of liver origin. Serological tests are of immense value in diagnosis. Liver enzymes are usually normal and neutrophilic leucocytosis may or may not be found. ESR is invariably elevated. Anti-amebic antibodies can be detected by ELISA, IFAT, and IHA. Amebic antigen can be detected from serum and pus by ELISA. Detection of Entamoeba DNA in pus or sputum may be a sensitive and specific method. Pleuropulmonary amebiasis is easily confused with other illnesses and is treated as pulmonary TB, bacterial lung abscesses, and carcinoma of the lung. A single drug regimen with metronidazole with supportive therapy usually cures patients without residual anomalies. Aspiration of pus from empyema thoracis may be needed for confirmation and therapeutic purposes. The pericardium is usually involved by direct extension from the amebic abscess of the left lobe of the liver, sometimes from the right lobe of the liver, and rarely from the lungs or pleura. An initial accumulation of serous fluid due to reactive pericarditis followed by intrapericardial rupture may develop either (1) acute onset of severe symptoms with chest pain, dyspnea, and cardiac tamponade, shock, and death, or (2) progressive effusion with thoracic cage pain, progressive dyspnea, and fever. Chest radiograph, ultrasound examination, and CT scan usually confirm the presence of a liver abscess in continuity with the pericardium and fluid within the pericardial sac with or without the fistulous tract. Echocardiography may demonstrate fluid in the pericardial cavity. Patients should be cared for in the ICU and ambecides should be started without delay. Pericardiocentesis usually confirms the diagnosis and improves the general condition of the patient. Aspiration of the accumulated fluid should be performed urgently in cardiac tamponade; repeated aspiration may be needed. Surgical drainage should be done if needed. Acanthamoeba, a free-living ameba, may also infect the lungs in the form of pulmonary nodular infiltration and pulmonary edema in association with amebic meningoencephalitis in immunocompromised patients. It usually spreads to the meninges of the brain by way of the blood from its primary lesion in the lung or skin. Early diagnosis and institution of treatment may be life saving for these patients. A literature review shows that HIV/AIDS patients are not prone to infection with E histolytica. It is now clear that there are an increasing number of HIV-seropositive patients among amebic liver abscess patients, however, which suggests that although the incidence of intestinal infection is not high among HIV-seropositive or AIDS patients they are more susceptible to an invasive form of the disease.
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PMID:Thoracic amebiasis. 1209 41

Monosegmental, degenerative, cervical discopathy may become symptomatic because of spinal instability or neurocompression and may present as cervicalgia, radiculopathy and myelopathy. Conservative therapy of these conditions is indicated only in case of minor symptoms. In patients with radiculopathy, this treatment may be used for a longer period of time than in individuals with myelopathy. However, the disorder may progress and lead to irreversible complaints, especially in case of myelopathy. Therefore, the surgical treatment is preferred: if conservative therapy does not improve symptoms within a short period of time and if the patient continues to suffer, surgery is clearly indicated. Only recently, novel surgical methods such as microtechniques and cage surgery were introduced. The results of these types of surgery in this indications are very favourable with respect to recovery from pain, paresis and sensory deficits, rates of fusion of the motion segment, morbidity and mortality.
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PMID:[Monosegmental , degenerative, cervical discopathy treated by surgery with insertion of an intervertebral cage]. 1221 92

This study reports on 92 patients treated with circumferential lumbar fusions for degenerative conditions. The elected procedure was a circumferential fusion using transpedicular stabilization. Two groups were examined depending on whether they were stabilized anteriorly with autogenous bicortical iliac crest graft (n = 38) or with an ALIF carbon fiber cage implant (n = 54). The patients were evaluated for clinical and radiographic outcome. The minimum follow-up interval was at least 12 months. Fusion rates, postoperative loss of correction, and clinical results, including pain at the bone donor site, neurologic function, satisfaction, depression, and consumption of analgesics, were not significantly different between patients with autogenous bone graft and patients with carbon cage. This study failed to prove major advantages of the carbon cages in the clinical and radiologic outcome.
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PMID:Circumferential fusion of the lumbar and lumbosacral spine using a carbon fiber ALIF cage implant versus autogenous bone graft: a comparative study. 1239 60


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