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Query: UMLS:C0184567 (acute pain)
 3,962 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Massive kidney infarct, due to total occlusion of the main artery, is not a frequent process in clinical urology. The most frequent causes are endocarditis, arteritis, atheromatosis and traumatisms. The complete blockage of the renal artery means that the tissue irrigated by the same is bloodless and prone to necrosis and it must be taken into account that although the renal parenchyma cannot withstand for more than 1 to 2 hours the lack of a blood supply, the obstructions or ischemias of shorter duration cause tissue disorders of greater or lesser importance, affecting more quickly and more intensely the cells of the tubules, than those of the glomerules and later the connecting tissue. Clinically, kidney infarcts may sometimes go unobserved and on many other occasions their symptoms are by no means typical although the most characteristic feature is a more intense, sharp, acute pain with macroscopic hematuria, proteinuria and cylindruria and, in the radiological exploration, kidney "silence" but with the excretory duct intact shown by means of retrograde uretero-pyelography. The kidney angiography will reveal the existence of the arterial obstruction, with the resulting avascular image. Extrapremature surgical treatment would be ideal in the cases of massive infarct but this would also require an extrapremature diagnosis, which would enable the embolectomy (where necessary to be carried out, thereby saving the kidney. However, under normal working conditions, taking into account the period of time which inevitably elapses between the patient feeling pain in the kidney and his reaching the Emergency Department and the necessary examinations being carried out which enable the correct diagnosis to be made, the number of hours which have passed make attempts at conservative surgery completely useless. The authors present the case of a 37-year old patient who, 15 days after presenting a picture of right kidney colic, went to the Emergency Department in our Centre where the doctor on duty merely performed a symptomatic treatment and the patient was not admitted to our Department until several days later. In the different radiourographic examinations carried out, right kidney mutism was observed, as well as the permeability of the excretory duct. The aortography revealed the total occlusion of the right renal artery. As more than 20 days had elapsed since the patient first presented the colic pain and before we examined him, there was no other therapeutic solution but the performing of a nephrectomy. The examination of the organ removed confirmed the diagnosis but the origin of the arterial obstruction could not be clarified for sure.
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PMID:[Massive kidney infarct by occlusion of the main artery]. 46 66

An emergency. When treating a patient, relief of any acute pain is a priority. Such pain should be treated as an emergency, rapidly and effectively. Assessment is the first step Pain is a subjective phenomenon. Assessment of its intensity is the first step to its management. Regarding treatment The molecules that can be used for the treatment of acute pain in ambulatory patients can be classified into two categories, co-analgesics (antispasmodics and non-steroidal antiinflammatories) and pure analgesics classified by the WHO into three grades, although this classification presents certain limits. Nefopam is a central analgesic, with non-opiate action and, because of this inscribed by the WHO in the first grade, but with an analgesic capacity that corresponds to the substances of grade II analgesics. Its efficacy relies on medullar and/or supramedullar mechanisms. Via intramuscular injection The delay before action is of around 10 to 20 minutes and lasts for around 6 hours. The advantages of intramuscular nefopam are its analgesic capacity, its simplicity of use and its tolerance. The indications In ambulatory patients, Acupan is administered during acute arthritic pain, post-trauma and dental pain, renal colic, extremely severe migraine and headaches, dysmenorrhoea, and intense spasmodic colic.
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PMID:[The management of acute pain in ambulatory patients. The place of nefopam]. 1502 21

Abdominal pain is an important and the most frequent symptom of acute gastrointestinal diseases; crucial hints on the diagnosis can be gleaned from its location and from associated symptoms and signs. As symptomatic therapy the treatment of pain plays a major role in acute gastrointestinal diseases, e.g. the acute abdomen, acute pancreatitis, biliary colic, peptic ulcer disease and diverticulitis. Acute pain arising from peptic ulcer disease is effectively treated with the H(+)-, K(+)-ATPase inhibitor omeprazole or one of the H(2)-receptor antagonists. While moderate to severe pain caused by these conditions can be effectively treated by intravenous administration of nonopioid analgesic drugs, supplemented by butylscopolamine in a biliary colic, more severe pain or inadequate responsiveness to nonopioid analgesic drugs requires the intravenous administration of a highly potent opioid. Acute severe pain arising from biliary colic and acute pancreatitis should be treated with an opioid that does not influence the sphincter of Oddi or the pressure in the common bile duct, e.g. buprenorphine, nalbuphine or tramadol. An effective but not widely known therapy for colic pain is parenteral administration of a nonsteroidal anti-inflammatory drug, e.g. indomethacin or diclofenac.
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PMID:[Treatment of acute gastrointestinal pain.]. 1841

We report a case of primary colonic lymphoma incidentally diagnosed in a patient presenting a gallbladder attack making particular attention on the diagnostic findings at ultrasound (US) and total body computed tomography (CT) exams that allowed us to make the correct final diagnosis. A 85-year-old Caucasian male patient was referred to our department due to acute pain at the upper right quadrant, spreaded to the right shoulder blade. Patient had nausea and mild fever and Murphy's maneuver was positive. At physical examination a large bulky mass was found in the right flank. Patient underwent to US exam that detected a big stone in the lumen of the gallbladder and in correspondence of the palpable mass, an extended concentric thickening of the colic wall. CT scan was performed and confirmed a widespread and concentric thickening of the wall of the ascending colon and cecum. In addition, revealed signs of microperforation of the colic wall. Numerous large lymphadenopathies were found in the abdominal, pelvic and thoracic cavity and there was a condition of splenomegaly, with some ischemic outcomes in the context of the spleen. No metastasis in the parenchimatous organs were found. These imaging findings suggest us the diagnosis of lymphoma. Patient underwent to surgery, and right hemicolectomy and cholecystectomy was performed. Histological examination confirmed our diagnosis, revealing a diffuse large B-cell lymphoma. The patient underwent to Cyclophosphamide, Hydroxydaunorubicin, Oncovin, Prednisone chemotherapy showing only a partial regression of the lymphadenopathies, being in advanced stage at the time of diagnosis.
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PMID:Primary colonic lymphoma: An incidental finding in a patient with a gallstone attack. 2486 15

It is well known that a number of patients affected by hemodynamic stable pulmonary embolism are admitted to the emergency department presenting chest pain without further symptoms of pulmonary embolism, such as dyspnea, cough, hemoptysis, syncope, and tachycardia, but in a few cases, the presenting symptoms are even more unusual. The gold standard for pulmonary embolism diagnosis is computed tomography pulmonary angiogram resulting in significant exposure to ionizing radiation and contrast, but recently bedside ultrasound has shown to be useful in diagnosing pulmonary embolism in the emergency department. We describe two cases of pulmonary embolism in young men evaluated in the emergency department for acute pain of the upper abdomen, preliminarily diagnosed as abdominal colic, in which bedside ultrasound ruled out abdominal diseases and showed basal pulmonary abnormalities consistent with infarction, suggesting the need of diagnostic completion with computed tomography pulmonary angiogram. Bedside ultrasound was useful as complementary imaging test in diagnosing pulmonary embolism in young patients admitted for abdominal pain of unknown origin.
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PMID:Abdominal pain as pulmonary embolism presentation, usefulness of bedside ultrasound: a report of two cases. 2691 52

Objective pain assessment in donkeys is of vital importance for improving welfare in a species that is considered stoic. This study presents the construction and testing of two pain scales, the Equine Utrecht University Scale for Donkey Composite Pain Assessment (EQUUS-DONKEY-COMPASS) and the Equine Utrecht University Scale for Donkey Facial Assessment of Pain (EQUUS-DONKEY-FAP), in donkeys with acute pain. A cohort follow-up study using 264 adult donkeys (n = 12 acute colic, n = 25 acute orthopaedic pain, n = 18 acute head-related pain, n = 24 postoperative pain, and n = 185 controls) was performed. Both pain scales showed differences between donkeys with different types of pain and their control animals (p < 0.001). The EQUUS-DONKEY-COMPASS and EQUUS-DONKEY-FAP showed high inter-observer reliability (Cronbach's alpha = 0.97 and 0.94, respectively, both p < 0.001). Sensitivity of the EQUUS-DONKEY-COMPASS was good for colic and orthopaedic pain (83% and 88%, respectively), but poor for head-related and postoperative pain (17% and 21%, respectively). Sensitivity of the EQUUS-DONKEY-FAP was good for colic and head-related pain (75% and 78%, respectively), but moderate for orthopaedic and postoperative pain (40% and 50%, respectively). Specificity was good for all types of pain with both scales (91%-99%). Different types of acute pain in donkeys can be validly assessed by either a composite or a facial expression-based pain scale.
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PMID:Monitoring Acute Pain in Donkeys with the Equine Utrecht University Scale for Donkeys Composite Pain Assessment (EQUUS-DONKEY-COMPASS) and the Equine Utrecht University Scale for Donkey Facial Assessment of Pain (EQUUS-DONKEY-FAP). 3209 91