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

Vascular calcification in chronic renal failure and dialysis patients is well-documented and generally considered to be a consequence of decreased phosphorus excretion, secondary hyperparathyroidism, and increased calcium-phosphorus product. Following renal transplantation or parathyroidectomy, gradual resolution of metastatic calcification in the affected areas occurs. The case presented documents the consequence of secondary hyperparathyroidism with calcification of mammary vessels leading to severe breast pain with resolution of the pain and vessel calcification after renal transplantation.
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PMID:Resolution of breast pain and calcification with renal transplantation. 32 Sep 52

A 52-year-old woman, on intermittent hemodialysis because of chronic renal failure, underwent total hip replacement for severe osteoarthritic changes. The operation was performed under epidural anesthesia, the postoperative course was uneventful, and the patient was completely relieved of pain and limitation of movement. Although total hip replacement is a major surgical procedure, it is suggested that the operation can, when considered necessary, by successfully carried out in a patient on hemodialysis, provided that careful attention is paid to the pre- and postoperative care.
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PMID:Total hip replacement in a patient on hemodialysis. 68 Nov 69

Patients requiring a major amputation for ischemia are frequently gravely ill. Physiologic amputation obtained by freezing the leg, usually with a tourniquet, will permit delay and intensive preoperative therapy. In an efficient, safe, and convenient method which we have developed and used in 46 patients, a pump circulates antifreeze solution through a specially constructed boot. The last 32 patients so treated have been analyzed as to indications and results. Advantages obtained control of sepsis, correction of diabetic coma, dialysis for chronic renal failure, improvement in congestive heart failure, and improvement in pulmonary function. Four patients had successful below-knee amputations after control of infection that had previously seemed to dictate above-knee amputation. The control of pain and odor, the resultant appreciation of the family, and the lessened demand on nursing staff offer worthwhile benefits in many of the patients, even in some in whom advanced systemic disease prevented survival.
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PMID:Freezing an extremity in preparation for amputation. 68 74

Renal biopsies from 145 patients with asymptomatic microscopic hematuria were studied with light microscopic, electron microscopic and immunofluorescence antibody techniques. The predominant lesions were a diffuse proliferative glomerulonephritis (mesangial hypercellularity) with focal epithelial crescents and focal segment and/or global sclerosis in many of them; and a minimal lesion with increased mesangial matrix and mild mesangial hypercellularity. Focal and segmental glomerulonephritis, diffuse mesangio-capillary and membranous glomerulonephritis were less common lesions. IgA deposition with other immunoglobulins was seen in over 50% of cases, with an IgA IgG-Beta1C-globulin combination being the common lesion. IgA secretory piece and HBs antigen were not found in the glomeruli and early complement components C1q and C4 were absent. Changes in the mesangium, basement membranes of capillary loops and mesangial osmophilic deposits reflect the pathogenesis of this disease. In addition to the above 145 patients, thirty-five cases of persistent microscopic hematuria classified as symptomatic, with a past history of "acute nephritis", lumbar pain and other complaints; and 11 patients with macroscopic hematuria, painless or associated with "acute nephritis" had similar glomerular lesions. Raised ASOT levels suggest the role of an upper respiratory infection in the exacervation or precipitation of this lesion. The IgA depositon may be associated with deposition of other antibodies in a picture of chronic glomerulonephritis, post-streptococcal or otherwise. 6 of the 145 patients with asymptomatic microscopic hematuria have gone into chronic renal failure in 3.5 years.
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PMID:Glomerular lesions in asymptomatic microscopic hematuria discovered on routine medical examination. 78 26

Severe proximal myopathy associated with hypophosphatemia developed in three patients with chronic renal failure who had been treated with aluminum hydroxide gel. The syndrome was characterized by severe pain, muscular stiffness, and weakness. The illness was originally misdiagnosed both as uremic myopathy and as an exacerbation of rheumatoid arthritis. In one patient, the correct diagnosis was made when symptomatic relief corresponded to the rise of serum phosphate levels. Discontinuation of antacid therapy was followed by gradual recovery. Oral sodium phosphate brought prompt alleviation of muscular pain and stiffness.
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PMID:Proximal myopathy caused by latrogenic phosphate depletion. 98 96

The study concerns 105 cases of dominant polycystic kidney disease. Affected relatives were observed in 65% of patients. The clinical features that leads to diagnosis were lumbar pain in 37.5% of cases, renal failure in 24.6% of cases and hypertension in 15.1% of cases. Hypertension was observed in 46.7% of cases and it seems that its onset is independent of chronic renal failure. Its frequency is of 55.1% when only kidneys were affected and of 21.4% when the liver was affected too. The progression of chronic renal failure is influenced by hypertension.
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PMID:[Dominant polycystic renal disease. Study of 105 cases]. 134 29

Fourteen days after renal transplantation, at first gave with good transplant function, a 36-year-old woman developed neurogenic dysfunction of bladder emptying. This was treated with baclofen, 5 mg three times daily by mouth. Between the 7th and 10th treatment day she progressively developed an organic psychotic syndrome and increasing respiratory paralysis after the onset of renal failure, associated with rejection of the transplanted kidney which required dialysis. Plasma concentration of baclofen was 565 ng/ml (therapeutic range 80-400 ng/ml). After discontinuing the drug and renewed haemodialysis the baclofen level rapidly fell and the symptoms receded. In a second case, a 57-year-old man on dialysis developed a thalamic pain syndrome after an intracerebral haemorrhage in the region of the basal ganglia. He was given four times 10 mg baclofen by mouth over 24 hours. 24 hours after the first dose he became deeply unconscious with respiratory failure. Plasma concentration of baclofen after the first haemodialysis period was 480 ng/ml. After 48 hours of artificial ventilation it was possible to extubate; a symptomatic transitory psychotic syndrome disappeared within 4 days. Both patients had pre-existing cerebral damage in addition to the chronic renal failure (in the first patient, meningoencephalitis 30 years previously with persisting focal lesions in the computed tomogram CT]; in the second one, residual lesions in the CT after intracerebral haemorrhage). It is emphasized that in patients who are in renal failure baclofen treatment should be undertaken cautiously: toxic signs can quickly develop especially if there is pre-existing cerebral damage.
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PMID:[Baclofen intoxication in chronic hemodialysis and kidney transplantation]. 157 39

Bilateral and simultaneous rupture of the quadriceps tendon of the knee without significant trauma in five patients, two males and three females, with chronic renal failure and secondary hyperparathyroidism is reported. Ruptures of the extensor mechanism are relatively rare injuries. Unilateral rupture is more common. Bilateral, simultaneous and spontaneous rupture is a very rare condition and only eleven cases have been reported in patients with a number of systemic diseases. Two cases have also been described in healthy subjects. The following points contribute to the diagnosis of quadriceps tendon rupture: 1) sudden pain and inability to extend the knee, 2) a palpable defect above the patella, 3) lateral x-rays with technique for soft tissue, reveal a defect and anterior tilting of the proximal pole of the patella. Operative repair of the ruptured tendon was the treatment in all our cases and gave excellent results.
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PMID:Bilateral, spontaneous and simultaneous rupture of the quadriceps tendon in chronic renal failure and secondary hyperparathyroidism. Report of five cases. 178 48

Reflex sympathetic dystrophy syndrome (RSDS), a complex clinical syndrome characterized by pain and swelling of an affected extremity, is most commonly seen after trauma. We report the case of a woman with diabetes mellitus and chronic renal failure who presented with RSDS 5 months after placement of an arteriovenous (AV) graft for hemodialysis. The temporal relationship between RSDS and the vascular surgery suggests AV graft placement as the precipitating event for the development of RSDS. Treatment with systemic corticosteroids successfully relieved the patient's symptoms. We believe that RSDS should be included in the differential diagnosis of unexplained limb pain and swelling after AV graft placement.
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PMID:Reflex sympathetic dystrophy syndrome of the hand after placement of an arteriovenous graft for hemodialysis. 188 37

Calciphylaxis is a rare, severe complication of secondary hyperparathyroidism. Patients present with painful, violaceous, mottled skin lesions of the upper and lower extremities, which become necrotic and produce nonhealing ulcers. Gangrene of fingers and toes frequently requires amputation, produces nonhealing wounds, and can lead to sepsis and death. We reviewed the clinical course of five patients with calciphylaxis treated in our institution. The three men and two women (aged 47 to 72 years) had secondary hyperparathyroidism from chronic renal failure. All patients had severe pruritus, painful ulcers, and severe hyperphosphatemia with elevated serum calcium-phosphate product (greater than 12 mmol2/L2), but the serum parathyroid hormone levels were only moderately elevated. Most patients had medical calcification of medium and small blood vessels, and some had soft-tissue calcification visible on roentgenography. Treatment consisted of local wound care, antibiotics, phosphate-binding agents, and parathyroidectomy. Two patients died of uncontrollable sepsis. The three survivors had dramatic improvement of pain and ulcers after parathyroidectomy. Calciphylaxis is a limb- and life-threatening complication of secondary hyperparathyroidism. Diagnosis can be made by recognizing the characteristic painful skin lesions, ulcers, and gangrene of the digits, and patients should be treated with subtotal parathyroidectomy.
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PMID:Calciphylaxis in secondary hyperparathyroidism. Diagnosis and parathyroidectomy. 192 21


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