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At least 847 records · Page 47Linked to original sources
PubMed1964

CERVICAL DISC INJURY. SYMPTOMS AND CONSERVATIVE TREATMENT.

Primary traumatic cervical disc disease and chronic disc disease associated with spondylitis aggravated by injury causes referred pain to the head, face, neck, arms, shoulders and chest, and even in the low back. Such pain may be reproduced by the injection of contrast medium for cervical discography. Dorsal nerve root pain is rare.Clear-cut disc derangement or annular incompetence may be demonstrated by discography at levels which reproduce symptoms. The pain pattern at each level is not consistent. Conservative treatment, involving primarily the use of a cervical extension collar, results in substantial improvement in 75 per cent of cases.

Arm↗
PubMed1992

Increased c-fos expression in spinal neurons after irritation of the lower urinary tract in the rat.

This study utilized neuronal c-fos expression to examine the spinal pathways involved in processing nociceptive and non-nociceptive afferent input from the lower urinary tract (LUT) of the urethane-anesthetized rat. C-fos protein was detected immunocytochemically in only a small number of cells (< 2 cells/L6 section) in control animals. However, chemical irritation with 1% acetic acid or mechanical stimulation of the LUT markedly increased the number of c-fos-positive neurons (56-180 cells/L6 section) in four regions of the caudal lumbosacral (L6-S1) spinal cord: medial dorsal horn (MDH), lateral dorsal horn, dorsal commissure (DCM), and sacral parasympathetic nucleus (SPN). Only small numbers of c-fos-positive cells were detected in rostral lumbar segments, a region that is thought to receive nociceptive input from the LUT via afferent pathways in sympathetic nerves. The distribution of c-fos-positive cells in the L6 spinal cord varied according to the stimulus (i.e., urethral catheter, bladder distension, or chemical irritation). Distension of the urinary bladder increased the number of c-fos-positive cells mainly in DCM and SPN regions of the cord. In contrast, irritation of the LUT increased c-fos expression largely in DCM and MDH areas. Spinal cord transection (T8 level) did not alter the c-fos expression induced by a catheter or chemical irritation, indicating that gene expression was mediated by spinal pathways. Denervation experiments showed that c-fos expression was induced by activation of afferent pathways in the pelvic and pudendal nerves. These results suggest that neurons in several regions of the spinal cord are involved in processing afferent input from different parts of the LUT. Neurons in the DCM appear to have an important role since they respond to both nociceptive and non-nociceptive inputs and to visceral (pelvic nerve) and somatic (pudendal nerve) afferent pathways. Thus, these neurons may be involved in the mechanisms of visceral-somatic referred pain.

Afferent Pathways↗
PubMedDate not supplied

[Survey on quality of life of patients undergoing dialytic treatment].

The Nottingham Health Profile (NHP) was administered to 85 dialysis patients treated at Mestre Hospital, to assess their quality of life and compare any differences between haemodialysis (HD) and peritoneal dialysis (PD) patients. The two groups were similar for the main characteristics. Overall dialysis patients do not enjoy a good quality of life. Comparing baseline demographic and clinical scores, 72.9% patients have problems with energy and 69.4 with mobility, 47.1% refer pain and 54.1% sleep disorders. The main differences between HD and PD patients concern psychological reactions, where 42.9% of HD patients report "at risk/compromised" scores compared to 17.2% of PD patients. NHP showed to be an easy to administer and efficient instrument in identifying areas of concern for dialysis patients.

Aged↗
PubMed2003

Sacral pseudotumor complicating iliac bone harvest: radiographic, CT and MRI appearances.

We present the imaging appearances of a lytic pseudotumor in the right sacral ala presenting with referred pain to the right thigh. Subsequent imaging revealed the presence of a cystic lesion arising at the site of previous bone graft harvest; CT-guided aspiration yielded synovial fluid presumed to arise from the contiguous sacroiliac joint.

Bone Cysts, Aneurysmal↗
PubMed2004

[Acute abdomen due to rupture of mesenteric cysts. Observations on a clinical case and review of the literature].

Personal experience based on a clinical case of a young woman with acute abdominal pain referable to acute appendicitis is presented. The surgical procedure was performed through a Mc Burney incision and revealed the rupture of mesenteric cysts; removal of the cysts was carried out without intestinal resection. Post-operative course was uneventful and 2 years follow-up showed no recurrence. Mesenteric cysts are an uncommon pathology, mainly in adult ages. After an analysis of the incidence and etiology, the pathological features and types of clinical presentation are discussed. Diagnosis in asymptomatic cases is usually made in search of other diseases. Complications are rare: rupture, infection and intestinal obstruction. In such cases, the clinical presentation is usually attributable to the main causes of acute abdomen, unless ultrasonography or CT scan are performed. When mesenteric cyst is diagnosed, a laparoscopic approach should be performed, even if in emergency traditional surgery is justified. Total excision of the cyst is necessary to avoid recurrence and obtain a correct pathologic evaluation.

Abdomen, Acute↗
PubMed2005

[Acute appendicitis or diverticulitis of the right colon? Diagnostic dilemma in emergency surgery].

Diverticulitis of the right colon is a rare disease in the Western countries, so that the diagnosis still remains very difficult and frequently indistinguishable from acute appendicitis preoperatively. In presence of acute abdominal discomfort with pain referred to the right lower quadrant region, fever and hyperleukocytosis, nausea and vomiting, surgeons operate with a margin of uncertainty, because of the increased morbidity and mortality associated with delay in diagnosis and consequent perforation of acute appendicitis. Moreover the unexpected inflammatory colonic mass of uncertain etiology is sometimes mistaken for carcinoma at laparotomy and consequently a right hemicolectomy is performed. In these cases it should be better that right-sided colonic diverticulitis should be taken into account allowing a more correct surgical approach and even conservative treatment alone. Therefore, in case of suspected appendicitis, since our experience and literature data indicate that the mean age for right diverticulitis is over 40 years, also in presence of a significative Alvarado's score, computed tomography is strongly recommended, if the age is over 40 years.

Adult↗
PubMed1992

Isolated hypertensive lower esophageal sphincter. Clinical and manometric aspects of an uncommon esophageal motor abnormality.

The hypertensive lower esophageal sphincter is an infrequent primary esophageal motor disorder characterized by elevated mean lower esophageal sphincter pressure (greater than or equal to 3 SD from that of controls), sphincter relaxations greater than 75%, and normal peristaltic activity in the esophageal body. This disorder is frequently associated with the nutcracker esophagus. We report our clinical and manometric experience with the isolated hypertensive lower esophageal sphincter (i.e., unassociated with other motor disorders), which constituted 2.7% of all patients who complained of dysphagia or chest pain referred for manometry during the period from October 1982 to February 1991.

Adult↗
PubMed2005

[Clinical characteristics of nontraumatic rhabdomyolysis in patients with liver cirrhosis].

BACKGROUND/AIMS: Rhabdomyolysis is a serious and lethal condition that can be induced not only by traumatic causes but also by a variety of nontraumatic causes. However, there are few reports about rhabdomyolysis developed in patients with liver cirrhosis. We carried out this study to elucidate the clinical characteristics and courses of rhabdomyolysis in patients with liver cirrhosis. METHODS: We analyzed 19 cases of nontraumatic rhabdomyolysis in patients with liver cirrhosis who had admitted at Korea University Ansan Hospital between October 2001 and September 2004. RESULTS: Alcohol (50%) was the main etiology of rhabdomyolysis in alcoholic liver cirrhosis patients, and the precipitating factors were not apparent (69.2%) in majority of nonalcoholic liver cirrhosis patients with rhabdomyolysis. Nonalcoholic liver cirrhosis patients had complaints of pain referable to the musculoskeletal system, but alcoholic liver cirrhosis patients had no typical complaints. Mortality of rhabdomyolysis in liver cirrhosis patients was high (42.1%), especially in decompensated liver cirrhosis patients (p=0.04). In nonalcoholic liver cirrhosis patients, the development of oliguria (p=0.007) and acute renal failure (p=0.049) in the course of rhabdomyolysis increased the mortality significantly. CONCLUSIONS: In cirrhosis patients, rhabdomyolysis showed a poor prognosis, especially in nonalcoholic liver cirrhosis with oliguria, acute renal failure, or decompensated liver cirrhosis. It is believed that a high clinical suspicion for the occurrence of rhabdomyolysis in liver cirrhosis patients can lead to quicker recognition and better patient care.

Acute Kidney Injury↗
PubMed2006

Myocardial infarction masked by high level spinal anesthesia in a patient undergoing herniorrhaphy.

Myocardial infarction (MI) is one of the leading causes of perioperative morbidity. Although evidence to prove significant reduction of perioperative MI with regional anesthesia is lacking, anesthesiologists still prefer this technique over general anesthesia for surgery involving the lower abdomen or lower extremities, especially in patients with cardiac risks. However, high level of sensory block during spinal anesthesia may obscure the referred pain from MI, which could contribute to the delay of diagnosis and treatment of an acute perioperative attack. We report a case of MI which occurred either intraoperatively or postoperatively, with symptoms that were masked by high level of sensory block to T4 by spinal anesthesia. This perioperative MI was only diagnosed when the patient recovered from anesthesia in the post-anesthesia care unit (PACU).

Aged↗
PubMedDate not supplied

Recent advances in the understanding of acupuncture.

The controversy about acupuncture is familiar to us since its recent reintroduction into this country. Much of its philosophical concepts were taken at their face values as the bases for condemnation. Since I last reviewed these antiquated concepts in the light of modern medicine, much has developed. It seems that if the effects of acupuncture were transmitted along the peripheral nerves to the central nervous system, it would be more effective if applied segmentally to the site of noxious stimulation. Disruption of extralamniscal pathways would abolish its analgesic effect. The distant and nonsegmentally located acupuncture points exert their influences through the integrative efforts of the reticular formation and the thalamus. The demonstration of transmissibility of acupuncture analgesia through blood and cerebrospinal fluid in animals implicates the involvement of humoral factors. Since such an effect can be suppressed by naloxone or by hypophysectomy, endorphins are thought to be involved. Such laboratory evidences indeed begin to shed some light on a possible neurohumoral mechanism of acupuncture. The differences between acupuncture and hypnosis are discussed. Acupuncture points were compared with referred pain, trigger points and motor points of the skeletal muscles. Its possible uses for other than pain, such as drug addiction, alcoholism, etc. are also reviewed.

Acupuncture Therapy↗
PubMed1985

Separate populations of primary sensory neurons project to the splanchnic nerve and thoracic spinal nerve rami of the rat. A fluorescent double labelling study.

Using fluorescent double labelling technique with one tracer applied to the greater splanchnic nerve and a second to the ventral or dorsal spinal nerve ramus at the T9 level, it was shown that two separate populations of sensory nerve cell bodies in the T9 dorsal root ganglion were projecting to the splanchnic nerve and spinal rami, respectively. Only two double labelled cells were detected. The results support the theory that spinal and/or supraspinal interactions and not dichotomizing sensory axons are responsible for referred pain.

Animals↗
PubMed1989

[Cholelithiasis in childhood].

11 patients with cholelithiasis treated at our department, since 1979, are presented. Although cholelithiasis is a typical disease in adults, its frequency in childhood is very low. The rate of cholelithiasis with hemolitic diseases were of 18% and idiopathic in 55%. The main clinical symptom was recurrent abdominal pain, refer to epigastric or right subcostal side. The diagnosis was done with echography and in all cases a cholecistectomy were performed. The results and complications of these cases are presented.

Adolescent↗
PubMed1989

[Congenital inward curvature of the penis without hypospadias. Report of 3 new cases].

We report on 3 young patients with congenital curvature of the penis without hypospadias (a rare disease entity) who consulted us for erectile deviation causing difficulty or inability to achieve vaginal penetration. No patient referred pain and the deviation was ventral, left lateral and ventral, and left lateral, respectively. These patients underwent surgical correction with the technic described by Nesbit in 1965. Good results were achieved in all patients; correction permitted patients to resume normal sexual activity. The literature is reviewed highlighting the good results afforded by this simple yet effective technic for surgical correction of this condition.

Adolescent↗
PubMed1978

[Pathophysiology of facial neuralgia (authors' transl)].

Facial neuralgia appears in a variety of forms which have different fundamental pathophysiological mechanisms. Of decisive importance are neuralgias with sensitive trigeminal, intermediate (sensory root), glossopharyngeal and vagus nerves which are caused by functional disturbances or damage to the nerve. In addition, projected or referred pain occurs in intracranial and cervical affections. A vascular origin may be assumed for Horton's neuralgia. This periodic paroxysmal and unilateral facial neuralgia is related to migraine. Serotonin, histamine and plasma kinin may be important eliciting factors; the concomitant symptoms of lachyrmation and rhinorrhea, reddening of the eyes and the face and a transitory Horner's syndrome suggest participation of the sympathetic and parasympathetic systems. Consideration of the previously known pathophysiological mechanisms permits a differentiated therapy for the various facial neuralgias.

Cluster Headache↗
PubMed1986

[Peripheral and spinal mechanisms of nociception].

Due to the combination of multidisciplinary studies, the last fifteen years have seen a major step forward in our knowledge of nociception. At the peripheral level the role of A delta and C polymodal cutaneous nociceptors is relatively well demonstrated in animal as well as in man. The activation of these nociceptors probably results from both direct effects of the stimulus and indirect effects, mediated by the release of various chemicals. The specific roles of articular, muscular and visceral fine afferent fibers in nociception, is less well understood. Cutaneous A delta and/or C fibers terminate mainly in the superficial zones (laminae I and II outer) of the dorsal horn. The nature of the transmitter (s) released by nociceptive afferents is still unknown. Substance P has long been a candidate but the multiplicity of peptides revealed by immunohistochemical techniques and their coexistence on occasions in the same dorsal root ganglion cells question a unequivocal role of substance P. At the level of the dorsal horn of the spinal cord, nociceptive specific and nociceptive non-specific units have been described in laminae I, II, IV to VI. It is generally held that nociceptive specific neurons are mainly found in the superficial laminae which also contains nociceptive non specific cells. Convergence of cutaneous, muscular and visceral inputs on these neurons is indicative of a role of both cell types in referred pain where consideration must also be given to the possibility of dichotomizing afferent fibers serving cutaneous and visceral territories. The involvement of contralateral ascending pathways (spinothalamic and spinoreticular tracts) in the transmission of nociceptive messages toward supraspinal structures is well established while the role of ipsilateral ascending systems (spino-cervical and dorsal columns post-synaptic fibers) is still questioned. Both segmental and descending modulating controls are exerted at the spinal level. At segmental levels, the inhibitory action of large diameter cutaneous fibers is now well established. The action of fine fibers seems also to be inhibitory. Descending influences are exerted from the periaqueductal gray matter and the ventromedial medulla (mainly the nucleus raphe magnus). They are sustained by serotoninergic and noradrenergic mechanisms and they involve to a lesser extent the endogenous opioids. The physiological function of these descending systems is still sharply discussed.

Afferent Pathways↗
PubMed1974

Meralgia paresthetica as a cause of leg discomfort.

A series of 74 cases of meralgia paresthetica is presented. All patients were satisfactorily treated with nonsurgical modalities. A brief review of the etiological factors involved supports the impression that it is an entrapment syndrome related primarily to external pressure against the lateral femoral cutaneous nerve in the region of the anterior superior iliac spine. Though its peripheral symptomatology is relatively straightforward, often associated pain referred to the gluteal area results in an incorrect diagnosis of sciatic radiculopathy due to "disc disease". The correct diagnosis can be easily made from the relief obtained by injecting the lateral femoral cutaneous nerve with an anesthetic agent.

Chlorprothixene↗
PubMed1982

Changes of electrodermal properties in the "acupuncture points" on men and rats.

The measurements of skin resistance to electrical current performed in rats and men indicated the occurrence of small skin areas, in which the conductivity for DC and AC was sharply increased. In healthy men, the anatomical localization of these areas of increased skin conductivity (AISC) corresponded to the localization of the so-called "acupuncture points" (AP). In patients, the AISC were also found outside the ordinary AP, mainly in areas of referred pain. The measurements of the size of AISC by multiple electrodes indicated the approximate size of AISC cca 350 microM in the rat, ccs 450 microns in man. The recording of skin conductivity were taken from : a) AISC in man and the rat, b) skin in the close neighbourhood of AISC, c) from the sweating human skin.

Acupuncture Therapy↗