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At least 883 records · Page 49Linked to original sources
PubMed1997

[Chronic tuberculous iridocyclitis].

One patient is seventy-one years old, diagnosed four years ago with latero-cervical ganglionic tuberculosis, presents approximately one year and half, progressive loss of the vision in both eyes, predominant in the left-eye; for several months periocular pains referred to the left hemicranial field are presented. Ocular exam: visual acuity was 1/100 in the right eye and perception movements of the hand in the left eye: intraocular pressure was 28 mmHg in the right eye and 8 mmHg in the left eye: perikeratic congestion, chemosis, pigmented precipitates on the posterior face of the corneo, iris in "umbrella", seclusion and occlusion of the pupillary at the left eye, posterior synechiae at the right eye were noted. The eye ground exam is not possible due the pupillary partial seclusion at the right eye and the pupillary seclusion-occlusion at the left eye. The general exam releaves several latero-cervical keloid scars and pronounced dysphonia. Laboratory exam: IDR of the tuberculin was high positive, chest radiography shows hilar bilateral calcifications, ORL exam shows a tumor at the foot of the epiglottis and anatomopathological exam shows low differentiated epidermoid carcinoma. Using the anamnestic dates, clinical and paraclinical exams, we established the diagnosis: chronic tuberculosis iridocyclitis with pupillary seclusion and occlusion at the both eyes; secondary glaucoma at the right eye: latero-cervical ganglionic tuberculosis: epidermoid laryngeal carcinoma.

Aged↗
PubMed1996

[Cervical intervertebral disc calcification in children: report of 10 patients].

Eleven cervical intervertebral space calcifications were studied in ten children (5 boys, 5 girls), with mean age of 9.4 years. The aetiology, symptoms, roentgenographic clinic features were analyzied. All ten patients showed evidence of calcification of the cervical intervertebral disc. One had calcification in two disc spaces of the cervical spine and associated with subluxation of C1,2. Two patients had calcification protruded into the spinal canal without symptoms of spinal cord compression. One had symptom of nerve root irritation. Eight of ten patients had symptoms which disappeared in two weeks after treatment. Eight patients had been followed over one year. The calcification disappeared from 2 to 8 months. The diagnostic criteria for the syndrome of this study are: (1) pediatric age group only; (2) local or referred pain; (3) limited cervical spine motiion; (4) evidence of inflammation; (5) visible calcification of the cervercal intervertebral disc on roentgenogram; (6) self-limited course; (7) good result after conservative treatment and good prognosis.

Adolescent↗
PubMedDate not supplied

[The assessment of functional capacity in workers with the thoracic outlet syndrome. A pilot study].

Occupational specialists are well aware of the lack of objective measurements for the diagnosis and the functional evaluation of workers affected by thoracic outlet syndrome (TOS). Subjects affected by TOS refer pain, sensation of fatigue in the arm frequently aggravated by overhead work. A "stick-up" position tends to close the costoclavicular space and tense the neck and shoulder muscles to bring into play the abnormal compression mechanism that may affect the brachial plexus nerves and the subclavian vessels. In a previous study, we demonstrated the reliability of an isokinetic hand grip endurance test. In this pilot study we asked 7 industrial workers affected by TOS to perform a 30-second isokinetic endurance test for hand gripping with a Lido WorkSET dynamometer. Tests were performed in two positions (resting and "stick-up" position) before and after a 3-week intensive rehabilitation program. In addition, the subjects performed daily aerobic exercise with an arm crank ergometer. Objective indexes of posttreatment improvement were found. Subjects were able to generate higher grip forces during the isokinetic hand grip endurance test and to sustain higher mechanical workload with the arm ergometer at the same intensity level for longer duration after completion of the rehabilitation program.

Adult↗
PubMed1998

[Testicular infarct simulating a neoplasms].

OBJECTIVE: The diagnosis of torsion of the spermatic pedicle is primarily clinical, despite the reports concerning the utility of complementary studies. A case of testicular infarct is described herein. METHODS: A 22-year-old patient consulted for swelling and pain referred to the left testicle. Scrotal ultrasound revealed hypoechoic areas alternating with hyperechoic areas and thickening of adjacent scrotal tissue. These non-specific findings suggested a misleading diagnosis of a tumor. The patient was submitted to radical orchidectomy. CONCLUSIONS: Scrotal ultrasonography can be misleading in cases of chronic testicular torsion. In equivocal cases, early surgical exploration may be required to discard testicular torsion and unnecessary orchidectomy.

Adult↗
PubMed1998

Mapping acupuncture points using multi channel device.

The practice of acupuncture involves the stimulation of specific points on the skin called 'acupuncture points' which are small regions of local or referred pain that are more sensitive than surrounding tissue. The fact that acupuncture points can be identified subjectively as tender points and are found to have characteristic electrical properties suggest that they are functional entities rather than structural ones. These functional properties are used diagnostically in a clinical setting as pathology in a particular body location has been shown to correlate with increased tenderness and electrical conductivity of the 'corresponding' acupuncture point using electronic 'point locators', which measure the DC resistance of points compared to surrounding skin. Commercially available point locators generally utilize a metal locator probe and an indifferent electrode and are designed to produce an auditory output (usually a high pitched tone) when a point is located. These devices however, are open to criticism. They are unable to control for local variations in skin thickness, surface secretions, or pressure placed on the electrode, and are only able to measure a single point at a time. These make them time consuming to use and subjective to user bias in point selection. Furthermore these devices do not store data and are therefore unsuitable for producing a map of skin resistance, which can be accessed over time. To overcome some of the limitations of currently available single probe devices, we have designed a multi-channel probe capable of measuring and then mapping the skin resistance of multiple points.

Acupuncture Points↗
PubMed1998

A physiological approach to the evaluation of lumbosacral spinal stenosis.

It has been demonstrated that MR imaging of the lumbosacral spine may frequently show stenosis in an asymptomatic individual. This article discusses the value of a physiologic test--dermatomal somatosensory evoked potentials--to assist in the diagnosis of true neurogenic spinal stenosis in patients with back and leg complaints and to aid in the separation of these patients from those whose symptoms are caused by degenerative spine disease with referred pain.

Biomechanical Phenomena↗
PubMedDate not supplied

Personality profiles in patients referred for chest pain. Investigation with emphasis on panic disorder patients.

Patients (N = 199) referred to cardiac outpatient investigation because of chest pain were assessed with the Personality Diagnostic Questionnaire (PDQ-4). Thirty-nine percent scored positive for any personality disorder. Borderline and avoidant personality disorders were found significantly more often in patients with panic disorder (PD) (n = 72) than in patients without PD (12.5% vs. 2.5%, 23.7% vs. 7.7%, respectively). In PD patients, the presence of any personality disorder was significantly associated with higher scores of self-reported anxiety-agoraphobia symptoms, neuroticism, and the presence of suicidal thoughts. These results suggest that personality pathology is important in a subgroup of patients presenting with chest pain and that these patients may require more extensive treatment.

Adolescent↗
PubMed1987

A mechanism of new pain following cordotomy; reference of sensation.

An antero-lateral cordotomy was performed on a 62-year-old man who had been suffering from intractable right chest pain caused by lung cancer. Six hours after the cordotomy a new pain occurred in an analogous part of the body on the opposite side; the intensity increased gradually and it became as severe as the original within 1 week. Reference of sensation from analgesic area of cordotomy to the opposite side of the body was induced by noxious stimuli. Intrathecal phenol block to the nerves conveying the cancer pain abolished the new pain and the reference of sensation from this blocked area, though it remained unchanged in other analgesic areas of cordotomy. This substantiates that the new pain was a reference of the original cancer pain.

Electrocoagulation↗
PubMed2005

Current trends in neuropathic pain treatments with special reference to fibromyalgia.

Neuropathic pain and fibromyalgia are prevalent diseases which have major consequences on healthcare resources and the individual. From the clinical point of view neuropathic pains represent a heterogeneous group of aetiologically different diseases ranging from cancer to diabetes. Patients with fibromyalgia also display clinical features common in neuropathic pain suggesting that there might be some overlap. The mechanisms responsible for symptoms and signs in both diseases are still unknown. Recently, there have been numerous reports of various pharmacological treatments of neuropathic pain and fibromyalgia with often disappointing results. Most of the studies were of short duration, had high attrition rates, and displayed other methodological problems. Some compounds had high rates of adverse effects which makes it often difficult for the patients to tolerate the treatment, especially in the long-term. At present, the best options for medication treatment are tricyclic antidepressants in lower dosage than usual in psychiatric disorders and a wide range of anticonvulsants. Opioids are sometimes recommended but have been found to have minor efficacy. Recently, there have been more controlled trials, which are reported here if they had been published between 2002 and 2004. Various compounds have been tested in different studies. Treatment of fibromyalgia, which has many features in common with depressive symptoms, became the focus of interest. New promising studies with dual serotonin-norepinephrine reuptake inhibitors (duloxetine and milnacipram) and a newer antiepileptic drug (pregabalin) are in progress. Future research will have to apply new approaches (e.g., using a mechanism-based classification of neuropathic pain and carrying out studies in populations with the same symptom but not necessarily the same disease) in order to find effective treatments for these common and often debilitating diseases.

Analgesics↗
PubMed1991

Prospective study on prevalence of esophageal chest pain in patients referred on an elective basis to a cardiac unit for suspected myocardial ischemia.

The prevalence of esophageal chest pain was studied prospectively in patients referred on an elective basis to a cardiac unit for suspected myocardial ischemia. A group of 248 consecutive patients without previously documented heart disease was admitted for elective diagnostic coronary angiography. The clinical history classified 185 patients as having anginal pain and the coronary angiogram was normal in 48 of them. In 37 of these 48 patients full esophageal testing was performed including 24-hr intraesophageal pH and pressure recordings with indication of chest pain episodes as well as a number of esophageal provocation tests, ie, acid perfusion, edrophonium stimulation, balloon distension, and ergonovine stimulation, all performed under continuous esophageal manometric and electrocardiographic monitoring. In 19 of these 37 patients, the familiar chest pain could be reproduced by esophageal provocative testing without ischemic ST-T segment alterations; six of these 19 patients had also a positive 24-hr pH and pressure recording. These data strongly suggest an esophageal origin of chest pain in half the patients with typical angina and a normal coronary angiogram.

Angina Pectoris↗
PubMed1993

Painful lumbosacral sensory distribution patterns: embryogenesis to adulthood.

When the dorsal root ganglion is irritated by any of a variety of mechanisms, pain is referred to the various structures innervated by that root. In many circumstances, this pain is specific and may be used as a diagnostic aid. Unfortunately, emphasis is placed on defining a dermatomal distribution; the existence of a myotomal or sclerotomal origin of referred pain is often overlooked. This review presents the embryologic, anatomic, and neurophysiologic etiology of referred pain from the lumbar spine.

Adult↗
PubMed1993

Clinical features in patients with chronic muscle pain--with special reference to fibromyalgia.

Clinical characteristics were studied in patients with chronic muscle pain, divided into three groups according to the characteristics of their pain; "fibromyalgia" (n = 23), "widespread muscle pain" (n = 21), and "regional muscle pain" (n = 28). Typical fibromyalgia features were also seen in the other groups of patients, but not to the same extent. In particular, sleep disturbance, subjective swelling, cold and exercise intolerance and low self-reported physical performance were significantly related to fibromyalgia. The major components of fibromyalgia were not wholly different compared with other European and North American studies, except for sleep disturbance and subjective swelling, which was somewhat more pronounced in this study. The most used medications in fibromyalgia patients at referral were analgesics, anxiolytic drugs and female sex hormones. Medication in fibromyalgia was not excessive and seemed appropriate compared to the other patient groups. Effects of various biases and classification criteria on the results of fibromyalgia studies are discussed. The characteristic features of fibromyalgia, its stability when diagnosed and the promotion of research and patient management justify the current classification of fibromyalgia at this stage.

Adult↗
PubMed1993

Psychosocial aspects of chronic pelvic pain, with special reference to sexual abuse. A study of 164 women.

Patients with chronic pelvic pain attending a tertiary referral centre show certain social, developmental and psychological characteristics. Specifically, they appear to have fewer children and to report more paternal overprotection, and a trend towards low maternal care compared to normals. They also show more depression, free-floating anxiety and somatic anxiety than such populations. The levels are similar to those found in other outpatient populations presenting with migraine or irritable bowel syndrome. Hostility levels are greater than those in normal subjects. Overall the present patient population reports the same degree of childhood sexual abuse as do many other female clinic and community sample populations. Sexual abuse is unlikely to be a specific aetiological factor in the development of chronic pelvic pain though it may yet be found to be important in subsets of the population.

Adolescent↗
PubMed1996

Endoscopic, histologic and microbiologic evaluation of upper abdominal pain with special reference to Helicobacter pylori infection.

OBJECTIVE: To study children with significant upper abdominal pain of unidentifiable etiology and evaluate: (a) the relationship of pain to inflammatory esophago-gastro-duodenal lesions and Helicobacter pylori (HP) infection, and (b) the response to specific therapy. DESIGN: Prospective study. SETTING: Pediatric section of a tertiary referral gastroenterology center. SUBJECTS: Thirty three consecutive children with significant upper abdominal pain [mean age 9.9 +/- 2.7, range 4-15 years; 20 males] were subjected to upper gastrointestinal tract endoscopy and antral mucosal biopsies obtained for rapid urease test (RUT), Gram's staining of impression/crush smears and culture for HP and histologic examination. Patients with HP gastritis were treated with triple therapy, colloidal bismuth subcitrate, amoxycillin and metronidazole, for two weeks. At 8 weeks from the initiation of therapy, patients were re-evaluated for symptoms and HP eradication by repeat endoscopy and antral biopsies. Patients with esophagitis, gastritis and duodenitis without HP infection were treated with ranitidine for 6 weeks. All the patients were followed up for 6 months. RESULTS: Histology revealed antral gastritis in 28/33 (85%) patients. HP infection was present in 12/28 (43%) patients with antral gastritis. Symptomatic improvement with triple therapy was observed in 10/12 (83%) patients with HP gastritis and eradication of HP in 5/7. Improvement on ranitidine therapy was observed in 12/16 (75%) patients with HP negative gastritis. On follow-up, no patient with initial improvement with therapy had relapse of symptoms. CONCLUSION: Symptomatic children with HP related gastritis should be treated with triple therapy and HP negative gastritis with H2-receptor antagonist.

Abdominal Pain↗
PubMed2004

Clinical profile of rheumatic disease patients referred to a multidisciplinary pain center.

OBJECTIVE: Good pain control is a prerequisite for success in the management of many rheumatological diseases. However, some rheumatology patients may present challenges in terms of pain management and be subsequently referred to a specialized pain clinic. We examined the characteristics and assessed the outcome of patients with rheumatic diseases who were referred to a tertiary care pain center. METHODS: All new patients with a primary rheumatological diagnosis referred over a 9 year period to the McGill University Pain Centre were studied. Patients were identified through a computer search according to both diagnoses and symptoms. Demographic information, clinical and pain characteristics, and subsequent management and final outcome were assessed. RESULTS: Out of a total of 1120 new patients, 60 (5%) had a primary rheumatologic diagnosis to account for pain and referral. The diagnoses were as follows: fibromyalgia in 26 (43%), inflammatory arthritis 17 (28%), degenerative arthritis 9 (15%), and soft tissue rheumatism 8 (13%). The median age at presentation was 52 years and 47 (78%) were female. The median duration of pain was 5 years. The mean pain scores according to the McGill Pain Questionnaire and the visual analog scale were 27 +/- 15 and 7 +/- 2, respectively. Patients were followed a mean duration of 10.6 +/- 15 months. Seventy-two percent were assessed by a psychologist and 52% by a physiotherapist or occupational therapist. New pharmacologic treatments were prescribed for 47 (78%) patients, with 47% receiving opioids, 37% antidepressants, 12% nonsteroidal antiinflammatory drugs, 8% tranquillizers, and 18% other medications. Final outcome was described as follows: improved in 55%, no change in 43%, and worsened in 2%. CONCLUSION: Although patients with a primary rheumatologic process to account for pain constituted a small proportion of patients evaluated, improvement was considerable in over half. Further study should address the selection of patients that are most likely to benefit from referral to multidisciplinary pain centers and the longterm outcome of such interventions.

Aged↗
PubMed1996

Pain and the quality of life in patients referred to a craniofacial pain unit.

Although there are reasons to believe that temporomandibular disorders and other facial pain conditions would have a major impact on the quality of patients' lives, only a small number of studies have attempted to address this in a systematic way. In this study, data on pain and its consequences were assessed for 121 patients making their first visit to a craniofacial pain research unit. The extent to which musculoskeletal and neurologically based facial pain compromised the quality of life was measured using the Oral Health Impact Profile, a recently developed index of the functional and psychosocial outcomes of oral conditions. The data indicated that facial pain had a substantial impact on daily life and that its most common outcomes were psychologic. When compared with a nonpain population, the extent of this impact was striking. There was a four-fold increase in functional problems such as difficulty chewing foods and a nine-fold increase in reports of depression. As anticipated, scores on the Oral Health Impact Profile were associated with the characteristics of the pain and diagnostic subgroups.

Adult↗