Cases reported "Chronic Disease"

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1/10. Positron emission tomography study of a chronic pain patient successfully treated with somatosensory thalamic stimulation.

    Previous neuroimaging studies suggested that the neuronal network underlying the perception of chronic pain may differ from that underlying acute pain. To further map the neural network associated with chronic pain, we used positron emission tomography (PET) to determine significant regional cerebral blood flow (rCBF) changes in a patient with chronic facial pain. The patient is implanted with a chronic stimulation electrode in the left ventroposterior medial thalamic nucleus with which he can completely suppress his chronic pain. The patient was scanned in the following conditions: before thalamic stimulation (pain, no stimulation), during thalamic stimulation (no pain, stimulation) and after successful thalamic stimulation (no pain, no stimulation). Comparing baseline scans during pain with scans taken after stimulation, when the patient had become pain-free, revealed significant rCBF increases in the prefrontal (Brodmann areas (BA) 9, 10, 11 and 47) and anterior insular cortices, hypothalamus and periaqueductal gray associated with the presence of chronic pain. No significant rCBF changes occurred in thalamus, primary and secondary somatosensory cortex and anterior cingulate cortex, BA 24'. Significant rCBF decreases were observed in the substantia nigra/nucleus ruber and in the anterior pulvinar nucleus. During thalamic stimulation, blood flow significantly increased in the amygdala and anterior insular cortex. These data further support that there are important differences in the cerebral processing of acute and chronic pain.
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2/10. Non specific jejunoileitis--a report of 8 cases.

    Nonspecific jejuno-ileitis is a nonocclusive, necrotizing inflammation of the small intestine. We treated 8 patients of jejuno-ileitis in a short span of 8 months. Their mean age was 8.6 years. All had acute pain in abdomen and most had hematochezia. radiology was helpful only in diagnosis of complications of the disease. Four patients responded to conservative management; the other 4 required surgery--laparotomy and lavage in 2, and multiple laparotomies with resections in 2. One patient died due to chronic malnutrition and metabolic complications. Bowel histology was suggestive of resolving vasculitis in one patient and chronic inflammation in another patient.
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3/10. Managing cancer and noncancer chronic pain in critical care settings. knowledge and skills every nurse needs to know.

    nurses and physicians caring for people with all types of pain are responsible for providing effective pain management in all clinical settings. Although the principles for managing all types of pain are similar, people with chronic pain have special needs to sustain optimal analgesia in critical care settings. nursing practice must be guided by national standards, guidelines, and recommendations for managing chronic and acute pain. Pain assessment, reassessment, and follow-up; titration of medications to individual responses; aggressive management of side effects; prevention of pain; and routine evaluation of the effectiveness of the plan are basic skills for all health professionals. Every person's baseline level of pain must be determined, and preexisting interventions for pain relief must be maintained to assure continuity of care. chronic pain complicates clinical problems and could have a profound effect on patient outcome. Managing chronic pain improves function, outcome, and quality of life. The knowledge, skills, medications, nondrug interventions, and technology are available to manage nearly all types of pain. Pain relief is a responsibility of all health care professionals. Our patients deserve our best efforts to optimize their comfort, and we must be accountable.
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4/10. From acute pain to chronic pain: a personal journal.

    In 1985 I had back surgery, and I began to keep a journal. I thought it would help me track my progress. I wrote in it often, sometimes two or three times a day. It became a lifeline for me. Four years and ten volumes later it tells my story, the story of my struggle with pain.
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keywords = acute pain
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5/10. Effectiveness of intraarterial plasminogen application in combination with percutaneous transluminal angioplasty (PTA) or catheter assisted lysis (CL) in patients with chronic peripheral occlusive disease of the lower limbs (POL).

    The accepted correct procedure for treating occlusive arterial diseases includes surgical disobstruction, CL as well as PTA. Combined non-surgical strategies are effective in about 60% of these patients. However, a high risk of rethrombosis despite from the prophylaxis with anticoagulants like heparin or antiplatelet drugs like ASA is proven, especially in patients with multi-segmental stenosis as well as in patients with extensive narrowing of the arteries. In these cases primary lesions (endangitis obliterans) or secondary lesions of the endothelium cause local depletion of plasminogen in the endothelium. Independent of the method used for reopening the vessel in these patients, a significant progression of the vessel disease and a high rethrombosis rate during longterm follow-up is observed. These results lead us to apply plasminogen locally to decrease the rate of rethrombosis. In patients suffering from stage III-IV (La Fontaine) including patients with multi-segmental stenosis as well as extended narrowing of the artery, PTA in combination with CL was performed. The catheter was placed as near as possible to the thrombus. In some cases the 'fibrinolyticum' could be injected directly into the thrombus. In these cases a bolus of 4,000 U/ml was locally infused, otherwise 1.0-1.5 million U urokinase per 24 hrs. were locally infused with heparin. In 28% (22 patients) no sufficient clinical response occurred using this combined therapy and plasminogen was applied locally. The following criteria supported our decision to include the patients in this study: 1. Insufficient response occurring after 12-24 hrs. of local infusion. 2. Following 6 bolus injections no reopening of the vessel occured within 60 minutes or the clinical response was insufficient due to rethrombosis. 3. Insufficient effects of lysis therapy after 2 hours and contraindication for a systemic fibrinolytic therapy (e.g. hypertension, age, etc.). 1,000 U plasminogen per ml were infused locally or 2,000 U up to 5,000 U plasminogen (in 5 to 10 ml 0.9% saline) were infused slowly (2-4 minutes infusion time) into the catheter in these patients 10 minutes after unsuccessful treatment with local urokinase therapy. Five minutes after administering plasminogen local intraarterial fibrinolytic therapy with urokinase was continued. No severe side effects due to this therapy were observed, although some patients suffered from acute pains in the peripheral segments of the arteries occurring immediately after infusion of plasminogen. In 16 of 22 patients a complete recanalization occurred and in 3 patients a satisfying clinical improvement was observed.(ABSTRACT TRUNCATED AT 400 WORDS)
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6/10. The management of localized abdominal aortic dissections.

    Aortic dissections limited to the abdominal aorta occur infrequently. We have identified four cases of abdominal aortic dissection and have reviewed these in combination with 43 previously reported cases to identify factors that influence the prognosis and management of this disease. Abdominal aortic dissections are similar to thoracic dissections in their presentation, with acute shearing pain and systolic hypertension occurring commonly. Although the diagnosis may be made by ultrasonography or CT scanning, angiography is the definitive diagnostic study. Factors found to be associated with high mortality include presentation with acute pain (p less than 0.0003), involvement of visceral vessels (p less than 0.02), and rupture (p less than 0.000002). Chronicity appears to be protective (p less than 0.04), although chronic dissections may present acutely. Although prosthetic replacement of the involved aorta is the treatment of choice in most cases, nonoperative management with regular follow-up can be considered in asymptomatic chronic dissections.
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7/10. hypnosis in the treatment of chronic pain.

    chronic pain can be treated by combining hypnosis with brief psychotherapy. hypnosis alone, though useful for acute pain, is seldom effective in relieving chronic pain because it does not address the significant psychologic components in the patient's illness. Treatment using self-hypnosis in conjunction with brief psychotherapy, however, can enable the patient to recognize these components, to change from a passive to an active role in achieving relief, and to modify his attitude toward the pain. This procedure can both reduce suffering and lead the patient to deemphasize pain in his life.
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keywords = acute pain
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8/10. Understanding chronic pain after spinal cord injury.

    survivors of spinal cord injury (SCI) have a range of sensory experiences following the trauma. acute pain commonly accompanies the injury and recedes as healing occurs. Following the initial event, most spinal cord-injured individuals experience phantom sensations and many suffer chronic pain. In extreme cases, chronic pain can become the most disabling sequela, leading to chemical dependency, severe depression and even suicide. Pain arising from injury to peripheral and central neural structures possesses unique characteristics that distinguish it from persisting acute pain and phantom sensations. Ironically, it is experienced in regions of the body that are anesthetic or possess diminished or altered sensation as a consequence of the injury. The qualitative features of the pain have been linked to structural and functional alterations that have been documented in peripheral and central neural structures following SCI. An understanding of these unique relationships provides direction for future research.
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keywords = acute pain
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9/10. Chronic and recurrent appendicitis are uncommon entities often misdiagnosed.

    Those having chronic and recurrent appendicitis represent a small portion of patients with disorders of the appendix. We present a series of nine patients who underwent appendectomy for chronic or recurrent appendicitis at The Johns Hopkins Hospital, baltimore, maryland, between July 1984 and October 1992. There were seven women and two men (median age of 30 years, range of 15 to 63 years). All patients presented with pain in the right lower quadrant or lower abdomen of three or more weeks duration (mean of 16.0 /- 8.4 months, range of three weeks to seven years), had no alternative diagnosis to account for the symptoms, had pathologic evidence of chronic inflammation or fibrosis of the appendix and had complete relief of the symptoms after appendectomy. Although the patients presented herein had clinical and pathologic evidence for recurrent or chronic appendicitis, careful review of the course of each patient before surgical referral revealed at least one episode of acute pain in the abdomen consistent with acute appendicitis managed by nonoperative means. This suggests that, while recurrent acute appendicitis and chronic appendicitis do occur, they can be avoided by the accurate diagnosis and operative management of acute appendicitis. We conclude that acute appendicitis can resolve spontaneously and recur repeatedly in the same individual; in the evaluation of a patient with abdominal pain, a history of prior similar episodes of pain should never dissuade one from considering the diagnosis of acute appendicitis, and recurrent acute appendicitis and chronic appendicitis should be considered in the differential diagnosis of recurrent pain in the lower abdomen.
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keywords = acute pain
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10/10. High transdermal fentanyl requirements in a patient with chronic cancer pain.

    OBJECTIVE: To report a case of high transdermal fentanyl dosage requirements in a patient with chronic cancer pain. DATA SOURCES: Clinical studies, review articles, and relevant laboratory information. CASE SUMMARY: A 42-year-old woman with cervical cancer was admitted for control of her pain. Her outpatient analgesic regimen was a continuous intravenous infusion of morphine sulfate (MS) via an ambulatory infusion device. Upon admission, supplemental doses of intravenous MS were administered in an effort to eliminate the pain. Transdermal fentanyl therapy was initiated on hospital day 1 at 100 micrograms/h and the MS continuous intravenous infusion dosage was increased. Over the next four days, the patient experienced episodes of inadequate pain control and the transdermal fentanyl dosage was increased in increments of 100 micrograms/h. On hospital day 4 the MS continuous infusion was converted to patient-controlled analgesia (PCA). The patient reported acceptable pain control with a regimen of transdermal fentanyl 500 micrograms/h and MS via PCA and she was discharged home on hospital day 7. CONCLUSIONS: This patient's high transdermal fentanyl dosage requirement was related to disease progression. She experienced an acute pain episode that may have been effectively managed by increasing the dosage of her continuous intravenous MS infusion.
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keywords = acute pain
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