Cases reported "Acute Disease"

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11/36. Complete relief of pain in acute painful diabetic neuropathy of rapid glycaemic control (insulin neuritis) with venlafaxine HCL.

    This article reports a case of a diabetic patient who suffered from acute painful diabetic neuropathy, following an intensive insulin treatment after a poor glycaemic control period of 8 yr. On the 15th day of the insulin treatment, which enabled rapid successful glycaemic control, the patient began complaining of pain and a burning sensation in the lower extremities, especially during the night. Venlafaxine HCL was initiated and the patient was completely free of pain on the third day of the treatment. As insulin neuritis is infrequent among diabetic patients we consider it is worth reporting the dramatic effect of the venlafaxine HCL treatment.
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keywords = acute pain
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12/36. Acute zonal occult outer retinopathy in a patient with graft-versus-host disease.

    PURPOSE: To investigate the mechanism of bilateral central vision loss in a patient with graft-versus-host disease. DESIGN: Observational case report. methods: A 43-year-old man with graft-versus-host disease developed acute painless progressive central vision loss, first in the left eye and then in the right. The patient underwent slit-lamp biomicroscopy, indirect ophthalmoscopy, fluorescein angiography, visual field testing, full-field electroretinography, multifocal electroretinography, and testing for paraneoplastic antibodies. RESULTS: Fundus examination and fluorescein angiography were unremarkable. Goldmann perimetry revealed enlarged blind spots with central scotomas bilaterally. An electroretinogram testing showed asymmetric retinal dysfunction, consistent with acute zonal occult outer retinopathy. No paraneoplastic autoantibodies were detected. The patient continued to have asymmetric progressive vision loss that stabilized over the next 6 months. CONCLUSIONS: Graft-versus-host disease should be included in the autoimmune conditions associated with AZOOR.
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keywords = acute pain
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13/36. acute pain and opioid seeking behaviour.

    BACKGROUND: acute pain is a common presentation associated with opioid seeking behaviour. OBJECTIVE: This case study provides a practical approach for general practitioners seeing patients with acute pain whom they suspect of seeking opioids because of dependence. DISCUSSION: acute pain commonly presents as an emergency appointment 'squeezed in' between booked appointments. general practitioners have to make a rapid assessment of the possible underlying causes, relieve pain, and establish a plan for further investigation and management. Furthermore, some opioid dependent people can and do effectively feign acute pain in order to obtain opioid medication.
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ranking = 0.4
keywords = acute pain
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14/36. Acute pain management for patients receiving maintenance methadone or buprenorphine therapy.

    More patients with opioid addiction are receiving opioid agonist therapy (OAT) with methadone and buprenorphine. As a result, physicians will more frequently encounter patients receiving OAT who develop acutely painful conditions, requiring effective treatment strategies. Undertreatment of acute pain is suboptimal medical treatment, and patients receiving long-term OAT are at particular risk. This paper acknowledges the complex interplay among addictive disease, OAT, and acute pain management and describes 4 common misconceptions resulting in suboptimal treatment of acute pain. Clinical recommendations for providing analgesia for patients with acute pain who are receiving OAT are presented. Although challenging, acute pain in patients receiving this type of therapy can effectively be managed.
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ranking = 1
keywords = acute pain
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15/36. Relief of acute pain in chronic idiopathic gastroparesis with intravenous phentolamine.

    OBJECTIVE: To report a case in which complete relief of pain associated with gastroparesis, with promotion of gastric emptying, was achieved with administration of phentolamine. CASE SUMMARY: A 37-year-old opiate-tolerant female with a history of recurrent abdominal pain, gastroparesis, cyclic vomiting syndrome, and migraine headaches was admitted to the emergency department (ED) with severe acute abdominal pain, nausea, and vomiting. The patient had been previously implanted with a permanent gastric electrical stimulator and she was adherent to her prokinetic, antiemetic, analgesic, and migraine prophylactic medications. Pain relief was achieved rapidly and completely in the ED with sympatholysis by administration of intravenous phentolamine 0.5 mg/kg over 60 minutes, with continuous cardiac monitoring. At a 2 month follow-up visit, the patient reported chronic pain relief, and a decrease in opiate doses was maintained by oral administration of clonidine 0.1 mg twice daily. DISCUSSION: gastroparesis represents a difficult treatment challenge because management of gastric dysmotility and the accompanying severe abdominal pain is often mutually exacerbating and ineffective. Sympatholysis by intravenous phentolamine provided profound and immediate relief of acute gastroparesis-related abdominal pain in our patient. The mechanism of phentolamine is believed to be receptor blockade at alpha-adrenergic receptors and, therefore, inhibition of the peripheral sensitizing effects of circulating norepinephrine. Although action at a peripheral nerve level is presumed, modulation of alpha-adrenoreceptors receptors is also possible at the dorsal root ganglion or at other central nervous system sites. CONCLUSIONS: The dramatic relief of acute pain in gastroparesis by phentolamine observed in this case would warrant investigation of a larger, controlled case series. patients who respond to intravenous sympatholysis may likewise be candidates for longer term sympathetic modulation with oral sympatholytics.
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ranking = 1
keywords = acute pain
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16/36. Two cases of acute pseudogout attack following parathyroidectomy.

    Two cases of acute attack of pseudogout associated with primary hyperparathyroidism are reported. Case 1 suffered from acute pain and swelling of the right ankle and dorsal of the right foot. Case 2 suffered from unknown fever and pain of the bilateral jaw, shoulder, elbow, wrist and knee joints. Postoperative radiological studies revealed the association of chondrocalcinosis in both cases. synovial fluid in case 2 was aspirated and analyzed for calcium pyrophosphate dihydrate crystal by microscopic examination.
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ranking = 0.2
keywords = acute pain
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17/36. Alternating proptosis. A case report of acute orbital myositis defined by the computerized tomographic scan.

    A 27-year-old woman had a two-week course of acute painful right proptosis with ptosis, medial conjunctival injection, and restriction of eye movements--particularly abduction. One month later, a similar remitting painful left proptosis with complete limitation of abduction developed. Computerized tomographic x-ray scanning showed marked contrast enhancement of both medial rectus muscles, documenting the presumptive diagnosis of acute orbital myositis without recourse to invasive diagnostic techniques. Myositis is a common component of idiopathic orbital inflammatory disease (orbital pseudotumor), but awareness of the rare patient with acute inflammation clinically localized to the extraocular muscles will decrease confusion with cranial nerve and cavernous sinus disease.
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ranking = 0.2
keywords = acute pain
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18/36. Acute necrotising myopathy associated with amiodarone therapy.

    We report a patient who developed an acute painful proximal myopathy associated with the use of amiodarone. The temporal course, the presence of amiodarone related hypothyroidism and neuropathy, as well as the patient's improvement on drug withdrawal were consistent with a drug reaction. Muscle biopsy demonstrated an acute necrotising myopathy. The mechanism for this reaction is unclear.
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ranking = 0.2
keywords = acute pain
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19/36. Fulminant streptococcal myositis.

    A previously healthy 70-year-old woman was hospitalized for acute pain and edema of her right leg. Deep vein thrombosis was suspected, and she was put on anticoagulant therapy. Ten hours later, she developed a massive swelling of the leg with a well-demarcated violaceous discoloration of the skin and hemorrhagic bullae. She was in deep shock with signs of disseminated intravascular coagulation and adult respiratory distress syndrome. Gram stain of an aspirate from the bullae revealed short chains of gram-positive cocci, and multiple blood cultures showed abundant growth of streptococcus pyogenes. Despite intensive treatment, the patient died within hours. autopsy findings showed extensive pyomyonecrosis of the leg muscles and changes secondary to septicemia. The misleading initial clinical picture and the rarity of this disease entity in temperate climates delayed the correct diagnosis and resulted in a fatal outcome.
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ranking = 0.2
keywords = acute pain
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20/36. Acute painful diabetic neuropathy precipitated by strict glycaemic control.

    A case of acute painful diabetic neuropathy that followed the establishment of strict glycaemic control using continuous subcutaneous insulin infusion is described. sural nerve biopsy shortly after the onset of the acute painful syndrome showed no evidence of active nerve fibre degeneration; instead, the appearances were those of a chronic neuropathy with prominent regenerative activity. The suggestion is made that adequate diabetic control promoted regeneration and that the pain may have been related to the ectopic generation of impulses in regenerating axon sprouts.
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ranking = 0.4
keywords = acute pain
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