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

Epidural analgesia is a very efficient method of postoperative pain management. Nevertheless, problems such as unilateral analgesia, sensory loss and inadequate pain relief are often difficult to handle. Radiologic evaluation of the position of the catheter and the spread of radiopaque dye (epidurography) is an important advance toward a solution of these problems. METHODS. The findings of 110 consecutive epidurographies from the acute pain service of the Department of Anaesthesiology of the University Hospital of Kiel, Germany, were analysed. Radiograms were obtained following the injection of 2 ml and an additional 8 ml of radiopaque dye (iopamidol) in the anterior-posterior and lateral plane. In addition, typical and instructive examples of epidurographies from the past 8 years are presented. RESULTS. In 99 of 110 patients the epidurography revealed a proper position of the catheter. Seven cases of partial displacement (e.g. paravertebral spread of radiopaque dye) and two cases of complete misplacement were documented. Allergic reactions or other side effects were not observed. The radiologic criteria for a proper epidural position of the catheter are discussed (Fig. 2a). Furthermore, examples of the following malpositions of epidural catheters are presented: intravascular misplacement (Fig. 2b), paravertebral misplacement (Fig. 2c), paravertebral escape of radiopaque dye (Fig. 2e) and correct distribution after the catheter had been withdrawn 2 cm (Fig. 2f), intrathecal misplacement (Fig. 2g), and simultaneous spread of dye in the subarachnoid and epidural space in a patient with preceding dural tap (Fig. 2h). In some cases unexpected reasons for problems in postoperative pain management were revealed by epidurography (e.g. disc prolapse, (Fig. 2d). CONCLUSION. In our view epidurography is a valuable way of improving the quality and safety of postoperative epidural analgesia. It is an important tool for decision-making in the event of clinical problems. The benefits for the patients have to be weighed against the radiation exposure.
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PMID:[Radiologic position control of epidural catheters (epidurography). An instrument of quality assurance for regional analgesia]. 836 75

The most common crystal-related arthropathies-gout, calcium pyrophosphate dihydrate disease or "pseudogout," and calcific periarthritis/tendinitis-may be appropriately diagnosed and managed by the primary care physician. Definitive diagnosis via synovial tap is recommended, as the clinical picture may not identify some cases. The acute pain and swelling of attacks, regardless of etiology, generally respond to treatment with nonsteroidal anti-inflammatory drugs and local or occasionally systemic corticosteroids. Once a causative crystal has been identified and a diagnosis established, a plan for long-term management and prevention of recurrences may be devised. Thus, uric-acid-lowering therapy may be indicated in a patient who has experienced recurrent attacks of gout, whereas control of serum phosphate levels might be effective in some individuals with hyperphosphatemia and hydroxyapatite-associated periarthritis or arthritis. Crystal deposits in joints can be destructive as well as painful. Treatment, therefore, has two objectives: To relieve the pain of the acute attack, thus restoring normal function, and to prevent the accumulation of crystals that can lead to degenerative disease. Identification and subsequent treatment of preventable or correctable underlying disorders may be one of the most gratifying aspects of managing crystal-induced arthropathies.
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PMID:Crystal-induced arthritis: an overview. 860 27

We present a case of acute endophthalmitis after intravitreal dexamethasone implant injection and discuss the management of this rare and challenging case in which the implant could not be removed. A 50-year-old woman with a history of branch retinal vein occlusion in the right eye was treated with intravitreal dexamethasone implant injection for macular oedema. Four days after injection, the patient was admitted to the department with acute pain, decreased vision, and redness. A diagnosis of acute post-intravitreal injection endophthalmitis was made. A 23-guage (23G) vitrectomy was performed immediately to remove the implant, and a vitreous tap for culture and polymerase chain reaction was acquired during the procedure. We were unable to remove the dexamethasone implant during the vitrectomy because of dense membrane formation. At the end of the procedure, we injected intravitreal antibiotics (vancomycin and amikacin), and the patient was treated with fortified topical antibiotics and steroids. At the time of writing, 5 years later, the patient retains a best corrected visual acuity of 10/10 (6/6) with dexamethasone implant therapy maintenance. Intravitreal dexamethasone implant-associated endophthalmitis is a rare and challenging condition. Immediate 23G pars plana vitrectomy, even without removal of the implant, can lead to favourable visual results.
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PMID:Acute Onset of Exogenous Endophthalmitis after Dexamethasone Implant Injection Treated without Implant Removal. 3058 40