Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0184567 (acute pain)
 3,962 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cholesterol embolism after left heart catheterisation by the femoral approach was diagnosed in seven men (mean age 59.6 years) out of a total of 4587 catheterisations. Diabetes was present in four patients, systemic hypertension in three, and signs of extensive atherosclerosis in six; five patients were taking anticoagulant drugs. Acute pain in the legs or abdomen occurred in six patients, two of whom had abdominal angina; renal failure was present in six patients, cutaneous manifestations in five, and a cholesterol embolus was seen in the retina in one. Six out of six patients had an appreciable increase in the erythrocyte sedimentation rate and five out of five had eosinophilia within a week of catheterisation. Renal failure was progressive in five patients, one of whom required haemodialysis. Three patients required amputation of the toes because of gangrene. Four patients died within four and a half months of catheterisation from causes not directly related to cholesterol embolism. At necropsy cholesterol emboli were found in all four patients. Cholesterol embolism is a rare but serious complication of left heart catheterisation.
 ...
PMID:Cholesterol embolism as a complication of left heart catheterisation. Report of seven cases. 646 20

The study of pain integration, in vivo, within the human brain has been largely improved by the functional neuro-imaging techniques available for about 10 years. Positron Emission Tomography (PET), complemented by laser evoked potentials (LEP) and functional Magnetic Resonance Imaging (fMRI) can nowadays generate maps of physiological or neuropathic pain-related brain activity. LEP and fMRI complement PET by their better temporal resolution and the possibility of individual subject analyze. Recent advances in our knowledge of pain mechanisms concern physiological acute pain, neuropathic pain and investigation of analgesic mechanisms. The sixteen studies using PET have demonstrated pain-related activations in thalamus, insula/SII, anterior cingulate and posterior parietal cortices Activity in right pre-frontal and posterior parietal cortices, anterior cingulate and thalami can be modulated by attention (hypnosis, chronic pain, diversion, selective attention to pain) and probably subserve attentional processes rather than pain analysis. Responses in insula/SII cortex presumably subserve discriminative aspects of pain perception while SI cortex is particularly involved in particular aspects of pain discrimination (movement, contact.) In patients, neuropathic pain, angina and atypical facial pain result in PET abnormalities whose significance remain obscure but which are localized in thalamus and anterior cingulate cortices suggesting their distribution is not random while discriminative responses remain detectable in insula/SII. Drug or stimulation induced analgesia are associated with normalization of basal thalamic abnormalities associated with many chronic pains. The need to investigate the significance of these responses, their neuro-chemical correlates (PET), their time course, the individual strategies by which they have been generated by correlating PET data with LEP and fMRI results, are the challenges that remain to be addressed in the next few years by physicians and researchers. To advance our knowledge of the mechanisms generating both abnormal pain and analgesia (drugs and surgical techniques) in patients is the main motivation of such anexciting challenge.
 ...
PMID:[Positron emission tomography to study central pain integration]. 1079 10

Angina, the prototypic vasoocclusive pain, is a radiating chest pain that occurs when heart muscle gets insufficient blood because of coronary artery disease. Other examples of vasoocclusive pain include the acute pain of heart attack and the intermittent pains that accompany sickle cell anemia and peripheral artery disease. All these conditions cause ischemia - insufficient oxygen delivery for local metabolic demand - and this releases lactic acid as cells switch to anaerobic metabolism. Recent discoveries demonstrate that sensory neurons innervating the heart are richly endowed with an ion channel that is opened by, and perfectly tuned for, the lactic acid released by muscle ischemia.
 ...
PMID:ASIC3: a lactic acid sensor for cardiac pain. 1280 43

The tako-tsubo syndrome (transient left ventricular apical ballooning with normal coronary arteries), initially described in Japanese patients, is now being increasingly observed worldwide and should be considered in the differential diagnosis of acute coronary syndromes. Angina-like chest pain, electrocardiographic changes and an increase in myocardial markers are often present, as well as history of acute stressful events preceding symptom onset. We report the case of an Asiatic woman in whom typical, reversible abnormalities in left ventricular motion were associated with symptomatic junctional bradycardia. Nevertheless, the patient was completely free from angina and excluded acute pain or emotions in the previous weeks. Coronary angiography showed absence of significant disease and left ventricular function was found to be unremarkable 1 month after the acute event. Although infrequent, atypical presentations of tako-tsubo syndrome have occasionally been reported and, in our opinion, they could provide interesting insights into the ill-defined pathophysiology of the disease.
 ...
PMID:[An atypical case of tako-tsubo syndrome presenting with symptomatic bradycardia]. 1769 5

This article presents the case of a 41-year-old female physician complaining about frequent chest pain attacks and breathing difficulties. Disorders started six months previously after inexpert manipulation of the thoracic spine performed by a physiotherapist while massaging the patient's back. Numerous diagnostic examinations (CT of the thorax, MRI of the thoracic spine, esophagography, cardiological examination, pulmological examination) did not explain the cause of subjective symptoms. Although the patient, who came to our private practice setting for examination of the spine and possible manual therapy, did not complain about disorders in the region of cervical spine, on the basis of clinical examination, we suspected the cervicogenic angina (CA; the attacks of chest pain caused by cervical radiculopathy; earlier term "cervical angina" is terminologically inappropriate). Namely, by means of clinical examination, we found very restricted active and passive mobility of the cervical spine, hyperalgic skin zones in the dermatomes C6-TH4, spasm of the cervical extensors and upper parts of the trapezius muscle, hypoesthesia in the dermatomes C6-TH1 and decreased left triceps reflex. MRI examination of the cervical spine showed left side disc herniation at the C6-C7 segment. Using manual therapy (traction mobilization of the cervical spine, segmental mobilization, distraction manipulation in full Nelson position), the complete regression of subjective symptoms was achieved which confirmed cervical origin of the pain. By analyzing anamnestic data, we concluded that the inexpert manipulation of the thoracic spine (the patient was lying in prone position), which caused strong local pain, induced sudden extension-flexion reflex movement of the cervical spine which the patient did not notice at that moment because of the acute pain in the region of the thoracic spine, resulting in herniation of already degeneratively altered disc at the C6-C7 segment with consequential CA.
 ...
PMID:[Cervicogenic angina. Chest pain caused by unrecognized disc herniation at the segment c6-c7: a case report]. 1906 59

Pain is one of the major complaints leading to doctor visits. Therefore basic knowledge of frequent pain diagnoses and possible treatment approaches is essential. Numerous medical and interventional therapeutic options are available for causal or symptomatic treatment of pain. The treatment of neuropathic pain is often difficult and demands special knowledge. Antidepressants like amitriptyline and anticonvulsive drugs are the first choice in these cases. Also interventional approaches are useful, such as spinal cord stimulation for angina pectoris. For the treatment of complex regional pain syndrome and phantom pain the use of mirror feed-back is a new effective method for pain relief. The only way to prevent from development of chronic pain is the early and effective treatment of acute pain.
 ...
PMID:[Chronic pain management]. 1968 4

The NICE guidance on recent onset chest pain urges GPs to assess the nature and timing of acute pain rapidly and arrange urgent admission for suspected acute coronary syndrome. A 12-lead ECG should be performed and treatment commenced with 300 mg aspirin and GTN spray. Other pain relief such as opiates should be considered. However, starting management and recording a resting ECG should not delay transfer to hospital. Patients should be monitored while awaiting transfer. GPs can diagnose stable angina either on clinical assessment alone or combined with diagnostic testing (anatomical testing for obstructive coronary disease and/orfunctional testing for myocardial ischaemia). The presence or absence of the following three factors should be noted: a constricting discomfort in the front of the chest, or in the neck, shoulders, jaw, or arms; the discomfort is precipitated by physical exertion; the discomfort is relieved by rest or GTN within about 5 minutes. If all three factors are present the symptoms should be classified as typical angina, two factors atypical angina and one or none of these factors non-anginal chest pain. Once the initial assessment is complete the guidance recommends estimating the likelihood of coronary disease based on risk factors, age, sex and symptom classification. If clinical assessment suggests typical angina and the estimated likelihood of coronary disease is >90%, NICE advises that further diagnostic investigation is unnecessary. These patients should be managed as having angina. If the estimated likelihood of coronary disease is <10% then other non-ischaemic causes of chest pain should be considered.
 ...
PMID:Chest pain of recent onset requires prompt diagnosis. 2066 20