Developer site: The content shown here is test data.

MyEClinic
MyEClinic
Health Dictionary AI Health Chat Find an Online Doctor
A serene Zen garden with raked sand and smooth stones, symbolising clarity and calm

Health Dictionary

Reliable, easy-to-read patient information on common medical conditions β€” written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

Back to skin conditions

Back pain and fever

Introduction

Abbreviations: ABG = Arterial blood gases, ANA = Antinuclear antibodies, BUN = Blood urea nitrogen, CRP = C-reactive protein, CT = Computed tomography, DRA = Dual energy radiographic absorptiometry, DRE = Digital rectal exam, ERCP = Endoscopic retrograde cholangiopancreatography, ESR = Erythrocyte sedimentation rate, HSV = Herpes simplex virus, IVP = Intravenous pyelography, KUB = Kidney, bladder, ureter, LDH = Lactate dehydrogenase, LFT = Liver function test, MRA = Magnetic resonance angiography, MRC = Magnetic resonance cholangiopancreatography, MRI = Magnetic resonance imaging, MRU = Magnetic resonance urography, NSAIDs = Non-steroidal anti-inflammatory drugs, PCR = Polymerase chain reaction, PET – FDG = Positive emission tomography – fluorodeoxyglucose, PET = Positive emission tomography, PID = Pelvic inflammatory disease, PSA = Prostatic specific antigen, PTC = Percutaneous transhepatic cholangiography, RUQ = Right upper quadrant, SPECT = Single-photon emission computed tomography, TFT = Thyroid function test, VZV = Varicella zoster virus

Classification of pain in the back based on etiology Diease Clinical Manifestation Diagnosis Comments
Symptoms Signs Lab findings Imaging
Onset Duration Quality of pain Radiation Stiffness Fever Rigors and chills Headache Nausea and vomiting Syncopy Weight loss Motor weakness Sensory deficit Pulse Deficit Heart Murmur Bowel or bladder dysfunction Horner’s syndrome
Neurological Arachnoiditis[1] Acute Hours Dull aching pain Head, neck and back +/- + +/- +/- +/- +/- +/- +/- +/- – – +/- +/- CSF
  • Elevated protein with normal or low glucose

Culture and sensitivity

Nucleic acid tests

Radiography
  • Thickened nerve roots

CT

  • Narrowing of subarachnoid space
  • Irregular collections of contrast material
  • Thickened nerve roots

MRI

  • Study of choice shows indistinct cord outline
Epidural abscess[2][3] Acute Variable Dull, throbbing pain Locally – +/- +/- +/- +/- +/- +/- +/- +/- – – +/- +/- CBC

ESR

  • Elevated

Culture and sensitivity

  • To identify causative organism

Immunohistochemical staining

MRI
  • Of choice and demonstrates fluid collection

CT

  • Demonstrates fluid collection

Radiography

  • LP carries risk of spread of infection
Classification of pain in the back based on etiology Diease Clinical Manifestation Diagnosis Comments
Symptoms Signs Lab findings Imaging
Onset Duration Quality of pain Radiation Stiffness Fever Rigors and chills Headache Nausea and vomiting Syncopy Weight loss Motor weakness Sensory deficit Pulse Deficit Heart Murmur Bowel or bladder dysfunction Horner’s syndrome
Bone
Chronic recurrent focal osteomyelitis[4][5][6] Chronic Years Dull aching pain Local +/- + + – – – +/- – – – – – – CBC

ESR

  • Elevated

CRP

  • Elevated

Procalcitonin

  • Elevated

Culture and sensitivity

  • To identify causative agent
 Radiography
  • Demonstrates endosteal or medullary lesion
  • Sequestration and cavity formation

MRI

CT

  • Articular and periarticular involvement

Ultrasound

  • Soft tissue abnormalities

Nuclear imaging

  • Acute presentation is often seen in children and is associated with gait abnormalities
Discitis[7][8] Chronic Years Dull aching or throbbing Local – + +/- – +/- – +/- +/- +/- – – +/- – CBC

ESR

  • May be elevated

CRP

  • May be elevated

Procalcitonin

  • May be elevated

Culture and sensitivity

  • To identify causative agent
 MRI
  • Narrowing of disk space and low signalling indicates edema

CT

  • Detects lesions earlier than radiography, demonstrates hypodensity of disk and destruction of endplates and calcification of annulus

Radiography

  • Disk space narrowing with destruction of endplates and calcification of annulus

Nuclear imaging

  • Focal uptake of gallium-67 and technetium-99m in area of destruction
  • Most likely due to hematogenous spread of organism
Sacroilitis[9][10] Acute or chronic Variable Dull aching or throbbing Hips and legs +/- + +/- – – – +/- +/- +/- – – +/- – CBC

ESR

  • May be elevated

CRP

  • May be elevated

Procalcitonin

  • May be elevated

Culture and sensitivity

  • To identify causative agent
 MRI
  • Narrowing of joint space and low signalling indicates edema

CT

  • Detects lesions earlier than radiography, demonstrates hypodensity of joint space and destruction of articular surface

Radiography

  • Joint space narrowing with destruction of joint space

Nuclear imaging

  • Focal uptake of gallium-67 and technetium-99m in area of destruction
  • Most likely due to hematogenous spread of organism
Vertebral compression fracture[11][12][13] Acute Minutes to hours Sudden, severe, sharp Shoulders, arms, hips and legs +/- – – +/- +/- +/- – +/- +/- – – +/- – CBC

PSA

Urine analysis

  • To detect Bence – Jones protein

Serum protein electrophoresis

ESR

  • May be elevated
 Radiography
  • Decreased vertebral body height

CT

  • Detects more subtle fractures and calcifications

MRI

  • Useful in those with motor weakness and sensory deficits
  • May demonstrate hemorrhage, tumor, or infection

DRA scanning

  • Detects low bone density

PET scanning

  • To distinguish benign from malignant causes of compression
  • Presents as a midline back pain
Vertebral osteomyelitis[14][15][16] Acute Minutes to hours Sudden, severe, sharp Shoulders, arms, hips and legs +/- + +/- – +/- – – +/- +/- – – +/- – CBC

ESR

  • Elevated

CRP

  • Elevated

Procalcitonin

  • Elevated

Culture and sensitivity

  • To identify causative agent
 Radiography
  • Demonstrates endosteal or medullary lesion
  • Sequestration and cavity formation

MRI

CT

  • Articular and periarticular involvement

Ultrasound

  • Soft tissue abnormalities

Nuclear imaging

  • Loss of bone density
  • Often caused by hematogenous spread of organism
Classification of pain in the back based on etiology Diease Clinical Manifestation Diagnosis Comments
Symptoms Signs Lab findings Imaging
Onset Duration Quality of pain Radiation Stiffness Fever Rigors and chills Headache Nausea and vomiting Syncopy Weight loss Motor weakness Sensory deficit Pulse Deficit Heart Murmur Bowel or bladder dysfunction Horner’s syndrome
Referred pain
Appendicitis[17][18][19] Acute Minutes to hours Burning Umbilicus and lower right quadrant – + +/- – + – – – – – – – – CBC

CRP

  • May be elevated

Urine analysis

Urine 5-HIAA

Ultrasound
  • Demonstrates a non-compressible tubular structure

CT

  • Demonstrates an enlarged appendix with thickened walls and can detect abnormally located appendices

MRI

  • Useful in pregnant ladies

KUB Radiography

  • May detect an appendicolith

Barium enema

  • Demonstrates absent or incomplete filling
  • Cecal spasm may be present

Radionuclide scanning

  • Appendiceal inflammation may be present
Cholelithiasis[20][21] Acute or subacute Minutes or hours Sharp Tip of right shoulder – +/- +/- – + – +/- – – – – – – CBC

LFT

Amylase and lipase

  • Elevated
 Radiography
  • Radio-opaque stones may be present

CT

MRI

Ultrasound

  • May demonstrate gallbladder wall thickening (>5 mm) and gallbladder fluid and distention
  • Gallstones may appear as echogenic foci that cast an acoustic shadow

Scintigraphy

  • May detect cystic duct obstruction

ERCP

  • Stones are seen as a filling defect and can be removed simultaneously

PTC

  • Similar to ERCP
  • Used when ERCP is not feasible
  • May be completely asymptomatic
Cystitis[22][23][24] Acute Hours Burning Suprapubic – +/- +/- – – – – – – – – +/- – Urine analysis

Urine culture

  • Detection of > 1000 colony-forming units/ml

CBC

  • Typically no routine imaging done
  • Cystitis may be infectious, hemorrhagic, radiational, or sterile
Endocarditis[25][26][27] Acute or subacute Variable Discomfort in the chest Jaw and arms – +/- +/- – +/- +/- – – – +/- + – – CBC

Serology

ESR

  • May be elevated

Urine analysis

Blood culture

  • To identify causative agent
  • Streptococci and HACEK organisms are culture negative
  • Organisms that grow on prosthetic valves tend to be coagulase-negative staphylococci
 Echocardiography
  • Vegetations and myocardial abscesses may be present

Radiography

  • Pyogenic emboli may be seen across the lung field

Ultrasound

  • Myocardial abscesses may be seen
  • Valvular dysfunction may also be noted
Myalgia[28][29][30] Chronic Years Dull aching Variable +/- +/- +/- +/- – – – – – – – – – *Typically no specific lab findings
  • A full workup should be done to exclude other etiologies, such as;

Rheumatoid factor and/or anti-cyclic citrullinated peptide antibodies

CRP and ESR

  • May be elevated

CBC

Bone profile

  • May be caused by a vitamin D or calcium deficiency
  • Typically no routine imaging done
Nephrolithiasis[31][32][33] Acute Hours Severe, sharp Abdomen, hips, groin, legs – +/- +/- – +/- – – – – – – – – CBC

Electrolytes

Creatinine

  • To identify potential renal injury with contrast

Uric acid

ABG

CT

IVP

  • Visualizes stones and entire urinary system

KUB radiography

  • Radio-opaque stones may be present

Ultrasound

  • For visualization of stones

Plain renal tomography

  • Can distinguish between intrarenal and extrarenal calcifications

Retrograde pyelography

  • Particularly useful for ureteric calculi visualization

Nuclear renal imaging

  • May determine a decreased renal function
Pancreatitis[34][35][36] Acute or chronic Variable Severe, sharp or dull aching Abdomen – +/- +/- – + +/- +/- – – – – – – Amylase and lipase
  • Elevated

LFT

CBC

Serum electrolytes

BUN and creatinine

  • May be elevated

Triglycerides

  • Usually elevated, however, falsely lowered during acute attack
 KUB radiography
  • May demonstrate free air within abdomen, indicating a perforated viscus

Ultrasound

  • Used to visualize the pancreas and biliary tree
  • May detect microlithiasis and periampullary lesions

CT

MRC

  • May demonstrate a blockage within the biliary ducts

ERCP

  • May remove a blockage, however, can in fact cause pancreatitis
  • Usually caused by binge drinking or long standing gallstones that block the ampulla of Vater
  • Vomiting is a common manifestation
Pelvic inflammatory disease[37][38][39] Acute or chronic Variable Dullaching or throbbing Hips, groin, legs – +/- +/- – +/- – – – – – – – – CBC

Pregnancy test

STD panel

Urine analysis

Transvaginal ultrasound
  • May demonstrate anechoic structures in adnexa indicating hydrosalpinx and/or pyosalpinx

Laparoscopy

MRI and CT

  • May indicate hydro and/ or pyosalpinx
  • Inflammation may spread to perihepatic structures (Fitz-Hughβˆ’Curtis syndrome)
Pyelonephritis[40] Acute or chronic Variable Severe, sharp or dull aching Groin, hips and legs – + +/- – +/- – – – – – – +/- – CRP
  • Elevated

ESR

  • Elevated

Urinalysis

  • Pyuria
  • Bacteriuria
  • May be nitrite positive (gram negative organisms)
  • Culture positibe (Uncomplicated: E. coli, Proteus mirabialis, Klebsiella, S. saprophyticus- Complicated: E. coli, enterococci, S.epidermidis
 Ultrasound

Non-contrast CT

  • Pelvicalceal dilation
  • Cortical involvement

MRI

  • T1: affected region(s) appear hypointense compared with the normal kidney parenchyma
  • T2: hyperintense compared to normal kidney parenchyma
  • T1 C+: reduced enhancement
  • Renal stones
  • Obstruction
  • Pregnancy
  • Prolonged urinary catheterization
Pneumonia[41][42][43] Acute or chronic Variable Variable Chest, back and abdomen – + + +/- +/- +/- +/- – – – – – – CBC

Blood culture

  • To identify causative organism or rule out other organisms such as MRSA
 Radiography
  • Plain x-ray shows multiple patches in the lung fields

CT

  • Used to distinguish pneumonia from non-pneumonias
  • Hospital-acquired pneumonia is common
Pyomyositis[44][45][46][47] Acute or chronic Days to weeks Dull aching or throbbing Variable – + +/- – – – – – – – – – – CBC

ESR

  • Elevated

Serum creatine kinase and aldolase

  • Normal

Blood culture

  • Typically negative

Culture and sensitivity

  • May include a positive gram stain
 MRI
  • Can differentiate between osteomyelitis and pyomyositis by demonstrating early muscle inflammation or abscess formation

CT

  • May demonstrate pphypertrophy]] of muscles and/or effacement of fatty plane
  • An enhancement in contrast may indicate abscess formation

Ultrasound

  • Useful in determining specific muscle involvement

Gallium scan

  • Useful in detecting early muscle pathology
  • Infectious myositis was once considered a tropical disease, however with the emergence of HIV is now prevalent in western societies too
Waterhouse-Friderichsen syndrome[48][49] Acute Minutes to hours Sudden, severe, sharp Back and/or flanks – + +/- +/- +/- +/- +/- – – – – – – CBC

Serum electrolytes

Blood urea nitrogen

  • Elevated

Creatinine

  • Elevated

Plasma glucoseΒ 

Serum cortisol

  • Decreased

Plasma ACTH

  • Elevated
 CT
  • Shows adrenal enlargement or adrenal aymmetry
  • Short cosyntropin (Cortrosyn) stimulation test confirms the diagnosis
Classification of pain in the back based on etiology Diease Clinical Manifestation Diagnosis Comments
Symptoms Signs Lab findings Imaging
Onset Duration Quality of pain Radiation Stiffness Fever Rigors and chills Headache Nausea and vomiting Syncopy Weight loss Motor weakness Sensory deficit Pulse Deficit Heart Murmur Bowel or bladder dysfunction Horner’s syndrome
Tumors Ewing’s sarcoma[50][51][52] Chronic Months to years Dull aching Variable +/- +/- +/- – – – + – – – – – –

Tests are used to rule out other pathologies; CBC

Blood cultures

  • May be positive for various organisms

ESR and CRP

  • May be elevated

LDH

  • May be elevated

Cytogenetic studies

  • May be positive for t(11;22) translocation

Immunohistochemical markers

  • May be positive for MIC2 antigen (CD99)
 Radiography
  • Periosteal reaction “onion skin”
  • Cortical thinning
  • Mottling

MRI

  • Skip lesions
  • Edema
  • Metastasis

PET – FDG

  • To identify metastatic disease
Langerhans cell histiocytosis[53][54][55][55](eosinophilic granulomas) Chronic Months to years Dull aching Variable – +/- +/- – – – – – – – – – – Tests used to rule out other pathologies;

CBC

ESR

  • May be elevated

LFT

Urine analysis

Radiography
  • Single or multiple osteolytic lesions may be noted

CT

  • To identify abnormalities of the hypothalamic and/or pituitary region

MRI

  • To identify abnormalities of the hypothalamic and/or pituitary region

PET – FDG

  • More sensitive than CT or MRI to active disease
Leukemia[56][57][58][59] Acute or chronic Weeks to years Aching Variable – +/- +/- – – – + – – – – – – CBC

Coagulation study

Peripheral blood smear

  • May demonstrate blasts, ppschistocyte]]s, auer rods, and mature lymphocytosis

Blood chemistry profile

Blood culture

  • To rule out infection
  • Typically no routine imaging studies, cytogenetic and flow cytometries aid diagnosis
  • Acute and chronic, lymphocytic and myeloid diagnoses are based on the presence and type of blast or mature cell
Lymphoma[60][61][62][63] Chronic Months to years Aching Variable – +/- +/- – – – + – – – – – – Typically no specific lab findings, however, the following routine tests are performed;
  • CBC
  • Serum chemistry studies, including LDH
  • Serum beta2-microglobulin level
  • HIV serology
 Radiography
  • May demonstrate hilar or mediastinal adenopathy
  • Pleural or pericardial effusion
  • Parenchymal involvement
  • Bulky mediastinal mass

CT

  • May demonstrate enlarged lymph nodes
  • Hepatosplenomegaly
  • Filling defects in visceral organs

Bone scan

Gallium scan

  • May show increased uptake

MRI

  • Signal intensity changes are noted in those with bone marrow or muscular involvement

PET – FDG

  • To distinguish between viable, active tumors and necrosis
  • To detect early recurrence

Ultrasound

  • Useful if primary lesion is in testis
Multiple myeloma[64][65] Chronic Years Dull aching Hips, groin and legs +/- +/- +/- – – – +/- – – – – +/- – Serum protein electrophoresis
  • May demonstrate a M peak

Serum free light chain assay and 24 – hour urine collection

  • May detect Bence-Jones proteins

CRP

  • May be elevated

Serum beta2-microglobulin

  • May be elevated

Albumin

  • May demonstrate elevated albumin in urine

LDH

  • May be elevated

Peripheral blood smear

Radiography, MRI and PET
  • Osteolytic lesions may be demonstrated
  • Biopsy will demonstrate elevated plasma cells in the bone marrow
Prostate cancer[66][67] Chronic Months to years Severe, sharp Lower abdomen, hips, groin and legs – +/- +/- – – – +/- – – – – +/- – PSA
  • Detection is helpful in diagnosis, usually > 10 ng/ml

Acid and alkaline phosphatase

  • Useful in detecting metastasis

Serurm creatinine and LFT

  • Useful in detecting metasstasis

Urine analysis

Ultrasound
  • Transrectal biopsy transrectal ultrasound may demonstrate hypoechoicity

MRI

  • May be used to guide biopsy
  • PSA and DRE are gold standard for screening
Classification of pain in the back based on etiology Diease Clinical Manifestation Diagnosis Comments
Symptoms Signs Lab findings Imaging
Onset Duration Quality of pain Radiation Stiffness Fever Rigors and chills Headache Nausea and vomiting Syncopy Weight loss Motor weakness Sensory deficit Pulse Deficit Heart Murmur Bowel or bladder dysfunction Horner’s syndrome
Miscellaneous
Herpes zoster[68][69][70] Acute or chronic Variable Severe, stabbing, electric-like Dermatomal – +/- +/- +/- +/- +/- +/- – +/- – – – – Tzanck smear
  • May demonstrate multinucleated giant cells

Direct fluorescent antibody test and/or PCR

  • Allows for differentiation between HSV and VZV
  • Typically no routine imaging

MRI

Lumbar puncture and cerebrospinal fluid analysis

Sickle cell anemia[71][72][73] Acute or chronic Variable Severe, sharp Variable +/- + +/- – – – – – – – – – – CBC

ESR

  • Decreased

Reticulocyte count

  • Elevated

Peripheral blood smear

  • May demonstrate target cells, elongated cells, and sickle erythrocytes
  • Howell – Jolly bodies in an asplenic patient

Hemoglobin solubility

Hemoglobin F

LFT, renal function test and pulmonary function test

  • To assess organ distress or failure

ABG

Urine analysis

Sickling test

  • As screening for sickle hemoglobinopathies

Secretory phospholipase A2

Radiography
  • Osteonecrosis
  • Dactylitis indicated by medullary expansion, cortical thinning, trabecular resorption, and bone lucency
  • Osteomyelitis may be present and demonstrate sequestra, cortical destruction, periosteal growth and sinus formation

MRI and CT

  • In addition to findings in radiography, may detect bone marrow hyperplasia
  • May also be useful in ruling out renal medullary carcinoma in those presenting with hematuria

Nuclear imaging

  • Used to detect early osteonecrosis through Technetium-99m bone scanning
  • Used to detect early osteomyelitis through detection of elevation ofwhite blood cells in Indium-11 white blood cell scanning

Transcranial doppler ultrasonography

  • Abnormally high blood flow is detected in those at increased risk of stroke

Abdominal ultrasound

Echocardiography

  • Used to diagnose pulmonary hypertension based on tricuspid regurgitant jet velocity
  • Also used to assess abnormalities of systolic and diastolic function
  • Sickle cell trait confers some protection against malaria
Syringomyelia[74][75][76] Chronic Years Dull aching Variable +/- +/- – +/- +/- – – – – – – – – *Typically no specific lab findings MRI
  • Of choice and demonstrates a syrinx (spinal cord cyst)
  • May also be useful in assessment of CSF flow dynamics

Radiography and CT

  • May also visualize a syrinx

Gadolinium scan

  • Useful in assessment of post-operative patients and can distinguish between a tumor, scar, and disk material

Myelography

  • Used when MRI is unfruitful, and may detect widening of spinal cord and complete subarachnoid block
Ureteropelvic junction obstruction (UPJ)[77][78][79] Acute Hours to days Dull aching Groin, hips, legs – +/- +/- +/- +/- – – – – – – +/- – CBC

Coagulation profile

  • To rule out bleeding

Electrolyte levels

BUN and serum creatinine

  • To assess kidney function

Urine culture

Voiding cystourethrography

Renal ultrasonography

  • May determine kidney malformation and scarring
  • Dilation of collecting system
  • Annular stricturing

IVP

  • May demonstrate a hydronephrotic kidney
  • Used to map out entire urinary system

CT and MRU

  • Provides detail about the urinary system such as;
    • Renal vasculature
    • Renal pelvis anatomy
    • Location of crossing vessels
    • Renal cortical scarring
    • Ureteral fetal folds in the proximal ureter

Doppler

  • Used to detect cross vessels associated with obstruction

MRA

  • May demonstrate aberrant renal vessels
  • Congenital abrnormalities in both children and adults are usually the cause of UPJ obstruction

References

  1. ↑ Ozateş M, Kemaloglu S, GΓΌrkan F, Ozkan U, Hoşoglu S, Simşek MM (January 2000). “CT of the brain in tuberculous meningitis. A review of 289 patients”. Acta Radiol. 41 (1): 13–7. PMIDΒ 10665863.
  2. ↑ Nathoo N, Nadvi SS, van Dellen JR (April 1999). “Cranial extradural empyema in the era of computed tomography: a review of 82 cases”. Neurosurgery. 44 (4): 748–53, discussion 753–4. PMIDΒ 10201299.
  3. ↑ Heran NS, Steinbok P, Cochrane DD (October 2003). “Conservative neurosurgical management of intracranial epidural abscesses in children”. Neurosurgery. 53 (4): 893–7, discussion 897–8. PMIDΒ 14519222.
  4. ↑ Lew DP, Waldvogel FA (2004). “Osteomyelitis”. Lancet. 364 (9431): 369–79. doi:10.1016/S0140-6736(04)16727-5. PMIDΒ 15276398.
  5. ↑ Mader JT, Shirtliff M, Calhoun JH (December 1997). “Staging and staging application in osteomyelitis”. Clin. Infect. Dis. 25 (6): 1303–9. PMIDΒ 9431368.
  6. ↑ Lew DP, Waldvogel FA (April 1997). “Osteomyelitis”. N. Engl. J. Med. 336 (14): 999–1007. doi:10.1056/NEJM199704033361406. PMIDΒ 9077380.
  7. ↑ Hamanishi C, Tanaka S (October 1993). “Dorsal root ganglia in the lumbosacral region observed from the axial views of MRI”. Spine. 18 (13): 1753–6. PMIDΒ 8235857.
  8. ↑ Gupta A, Kowalski TJ, Osmon DR, Enzler M, Steckelberg JM, Huddleston PM, Nassr A, Mandrekar JM, Berbari EF (December 2014). “Long-term outcome of pyogenic vertebral osteomyelitis: a cohort study of 260 patients”. Open Forum Infect Dis. 1 (3): ofu107. doi:10.1093/ofid/ofu107. PMCΒ 4324221. PMIDΒ 25734175.
  9. ↑ Foley BS, Buschbacher RM (December 2006). “Sacroiliac joint pain: anatomy, biomechanics, diagnosis, and treatment”. Am J Phys Med Rehabil. 85 (12): 997–1006. doi:10.1097/01.phm.0000247633.68694.c1. PMIDΒ 17117004.
  10. ↑ Carette S, Graham D, Little H, Rubenstein J, Rosen P (February 1983). “The natural disease course of ankylosing spondylitis”. Arthritis Rheum. 26 (2): 186–90. PMIDΒ 6600615.
  11. ↑ Genant HK, Cooper C, Poor G, Reid I, Ehrlich G, Kanis J, Nordin BE, Barrett-Connor E, Black D, Bonjour JP, Dawson-Hughes B, Delmas PD, Dequeker J, Ragi Eis S, Gennari C, Johnell O, Johnston CC, Lau EM, Liberman UA, Lindsay R, Martin TJ, Masri B, Mautalen CA, Meunier PJ, Khaltaev N (1999). “Interim report and recommendations of the World Health Organization Task-Force for Osteoporosis”. Osteoporos Int. 10 (4): 259–64. PMIDΒ 10692972.
  12. ↑ Vogt TM, Ross PD, Palermo L, Musliner T, Genant HK, Black D, Thompson DE (September 2000). “Vertebral fracture prevalence among women screened for the Fracture Intervention Trial and a simple clinical tool to screen for undiagnosed vertebral fractures. Fracture Intervention Trial Research Group”. Mayo Clin. Proc. 75 (9): 888–96. PMIDΒ 10994823.
  13. ↑ Papaioannou A, Watts NB, Kendler DL, Yuen CK, Adachi JD, Ferko N (August 2002). “Diagnosis and management of vertebral fractures in elderly adults”. Am. J. Med. 113 (3): 220–8. PMIDΒ 12208381.
  14. ↑ Beronius M, Bergman B, Andersson R (2001). “Vertebral osteomyelitis in GΓΆteborg, Sweden: a retrospective study of patients during 1990-95”. Scand. J. Infect. Dis. 33 (7): 527–32. PMIDΒ 11515764.
  15. ↑ Digby JM, Kersley JB (February 1979). “Pyogenic non-tuberculous spinal infection: an analysis of thirty cases”. J Bone Joint Surg Br. 61 (1): 47–55. PMIDΒ 370121.
  16. ↑ McHenry MC, Rehm SJ, Krajewski LP, Duchesneau PM, Levin HS, Steinmuller DR (1991). “Vertebral osteomyelitis and aortic lesions: case report and review”. Rev. Infect. Dis. 13 (6): 1184–94. PMIDΒ 1775852.
  17. ↑ KΓΆrner H, SΓΆndenaa K, SΓΆreide JA, Andersen E, Nysted A, Lende TH, Kjellevold KH (1997). “Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis”. World J Surg. 21 (3): 313–7. PMIDΒ 9015177.
  18. ↑ Wilms IM, de Hoog DE, de Visser DC, Janzing HM (November 2011). “Appendectomy versus antibiotic treatment for acute appendicitis”. Cochrane Database Syst Rev (11): CD008359. doi:10.1002/14651858.CD008359.pub2. PMIDΒ 22071846.
  19. ↑ Becker T, Kharbanda A, Bachur R (February 2007). “Atypical clinical features of pediatric appendicitis”. Acad Emerg Med. 14 (2): 124–9. doi:10.1197/j.aem.2006.08.009. PMIDΒ 17192449.
  20. ↑ Diehl AK, Sugarek NJ, Todd KH (July 1990). “Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis”. Am. J. Med. 89 (1): 29–33. PMIDΒ 2368790.
  21. ↑ Fitzgerald JE, White MJ, Lobo DN (April 2009). “Courvoisier’s gallbladder: law or sign?”. World J Surg. 33 (4): 886–91. doi:10.1007/s00268-008-9908-y. PMIDΒ 19190960.
  22. ↑ Foxman B (March 2014). “Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden”. Infect. Dis. Clin. North Am. 28 (1): 1–13. doi:10.1016/j.idc.2013.09.003. PMIDΒ 24484571.
  23. ↑ Hooton TM (March 2012). “Clinical practice. Uncomplicated urinary tract infection”. N. Engl. J. Med. 366 (11): 1028–37. doi:10.1056/NEJMcp1104429. PMIDΒ 22417256.
  24. ↑ Gupta K, Trautner B (March 2012). “In the clinic. Urinary tract infection”. Ann. Intern. Med. 156 (5): ITC3–1–ITC3–15, quiz ITC3–16. doi:10.7326/0003-4819-156-5-201203060-01003. PMIDΒ 22393148.
  25. ↑ Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL (November 2015). “2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM)”. Eur. Heart J. 36 (44): 3075–3128. doi:10.1093/eurheartj/ehv319. PMIDΒ 26320109.
  26. ↑ Meine TJ, Nettles RE, Anderson DJ, Cabell CH, Corey GR, Sexton DJ, Wang A (August 2001). “Cardiac conduction abnormalities in endocarditis defined by the Duke criteria”. Am. Heart J. 142 (2): 280–5. doi:10.1067/mhj.2001.116964. PMIDΒ 11479467.
  27. ↑ Cahill TJ, Prendergast BD (February 2016). “Infective endocarditis”. Lancet. 387 (10021): 882–93. doi:10.1016/S0140-6736(15)00067-7. PMIDΒ 26341945.
  28. ↑ Gumber SC, Chopra S (October 1995). “Hepatitis C: a multifaceted disease. Review of extrahepatic manifestations”. Ann. Intern. Med. 123 (8): 615–20. PMIDΒ 7677303.
  29. ↑ Archard LC, Bowles NE, Behan PO, Bell EJ, Doyle D (June 1988). “Postviral fatigue syndrome: persistence of enterovirus RNA in muscle and elevated creatine kinase”. J R Soc Med. 81 (6): 326–9. doi:10.1177/014107688808100608. PMCΒ 1291623. PMIDΒ 3404526.
  30. ↑ Bratton RL, Whiteside JW, Hovan MJ, Engle RL, Edwards FD (May 2008). “Diagnosis and treatment of Lyme disease”. Mayo Clin. Proc. 83 (5): 566–71. doi:10.4065/83.5.566. PMIDΒ 18452688.
  31. ↑ Fwu CW, Eggers PW, Kimmel PL, Kusek JW, Kirkali Z (March 2013). “Emergency department visits, use of imaging, and drugs for urolithiasis have increased in the United States”. Kidney Int. 83 (3): 479–86. doi:10.1038/ki.2012.419. PMCΒ 3587650. PMIDΒ 23283137.
  32. ↑ Evan AP, Lingeman JE, Coe FL, Parks JH, Bledsoe SB, Shao Y, Sommer AJ, Paterson RF, Kuo RL, Grynpas M (March 2003). “Randall’s plaque of patients with nephrolithiasis begins in basement membranes of thin loops of Henle”. J. Clin. Invest. 111 (5): 607–16. doi:10.1172/JCI17038. PMCΒ 151900. PMIDΒ 12618515.
  33. ↑ Kim SC, Coe FL, Tinmouth WW, Kuo RL, Paterson RF, Parks JH, Munch LC, Evan AP, Lingeman JE (January 2005). “Stone formation is proportional to papillary surface coverage by Randall’s plaque”. J. Urol. 173 (1): 117–9, discussion 119. doi:10.1097/01.ju.0000147270.68481.ce. PMIDΒ 15592050.
  34. ↑ Swaroop VS, Chari ST, Clain JE (June 2004). “Severe acute pancreatitis”. JAMA. 291 (23): 2865–8. doi:10.1001/jama.291.23.2865. PMIDΒ 15199038.
  35. ↑ Yadav D, Agarwal N, Pitchumoni CS (June 2002). “A critical evaluation of laboratory tests in acute pancreatitis”. Am. J. Gastroenterol. 97 (6): 1309–18. doi:10.1111/j.1572-0241.2002.05766.x. PMIDΒ 12094843.
  36. ↑ Fortson MR, Freedman SN, Webster PD (December 1995). “Clinical assessment of hyperlipidemic pancreatitis”. Am. J. Gastroenterol. 90 (12): 2134–9. PMIDΒ 8540502.
  37. ↑ Brunham RC, Gottlieb SL, Paavonen J (May 2015). “Pelvic inflammatory disease”. N. Engl. J. Med. 372 (21): 2039–48. doi:10.1056/NEJMra1411426. PMIDΒ 25992748.
  38. ↑ Ross J, Judlin P, Jensen J (January 2014). “2012 European guideline for the management of pelvic inflammatory disease”. Int J STD AIDS. 25 (1): 1–7. doi:10.1177/0956462413498714. PMIDΒ 24216035.
  39. ↑ Workowski KA, Bolan GA (June 2015). “Sexually transmitted diseases treatment guidelines, 2015”. MMWR Recomm Rep. 64 (RR-03): 1–137. PMIDΒ 26042815.
  40. ↑ Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE (March 2011). “International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases”. Clin. Infect. Dis. 52 (5): e103–20. doi:10.1093/cid/ciq257. PMIDΒ 21292654.
  41. ↑ File TM (December 2003). “Community-acquired pneumonia”. Lancet. 362 (9400): 1991–2001. doi:10.1016/S0140-6736(03)15021-0. PMIDΒ 14683661.
  42. ↑ Shah SN, Bachur RG, Simel DL, Neuman MI (August 2017). “Does This Child Have Pneumonia?: The Rational Clinical Examination Systematic Review”. JAMA. 318 (5): 462–471. doi:10.1001/jama.2017.9039. PMIDΒ 28763554.
  43. ↑ Pereira JC, Escuder MM (February 1998). “The importance of clinical symptoms and signs in the diagnosis of community-acquired pneumonia”. J. Trop. Pediatr. 44 (1): 18–24. PMIDΒ 9538601.
  44. ↑ Crum NF (September 2004). “Bacterial pyomyositis in the United States”. Am. J. Med. 117 (6): 420–8. doi:10.1016/j.amjmed.2004.03.031. PMIDΒ 15380499.
  45. ↑ Christin L, Sarosi GA (October 1992). “Pyomyositis in North America: case reports and review”. Clin. Infect. Dis. 15 (4): 668–77. PMIDΒ 1420680.
  46. ↑ Horn CV, Master S (July 1968). “Pyomyositis tropicans in Uganda”. East Afr Med J. 45 (7): 463–71. PMIDΒ 5722778.
  47. ↑ Rodgers WB, Yodlowski ML, Mintzer CM (April 1993). “Pyomyositis in patients who have the human immunodeficiency virus. Case report and review of the literature”. J Bone Joint Surg Am. 75 (4): 588–92. PMIDΒ 8478386.
  48. ↑ Migeon CJ, Kenny FM, Hung W, Voorhess ML (August 1967). “Study of adrenal function in children with meningitis”. Pediatrics. 40 (2): 163–83. PMIDΒ 5006579.
  49. ↑ MARGARETTEN W, NAKAI H, LANDING BH (April 1963). “Septicemic adrenal hemorrhage”. Am. J. Dis. Child. 105: 346–51. PMIDΒ 13932989.
  50. ↑ Cotterill SJ, Ahrens S, Paulussen M, JΓΌrgens HF, VoΓ»te PA, Gadner H, Craft AW (September 2000). “Prognostic factors in Ewing’s tumor of bone: analysis of 975 patients from the European Intergroup Cooperative Ewing’s Sarcoma Study Group”. J. Clin. Oncol. 18 (17): 3108–14. doi:10.1200/JCO.2000.18.17.3108. PMIDΒ 10963639.
  51. ↑ Nesbit ME, Gehan EA, Burgert EO, Vietti TJ, Cangir A, Tefft M, Evans R, Thomas P, Askin FB, Kissane JM (October 1990). “Multimodal therapy for the management of primary, nonmetastatic Ewing’s sarcoma of bone: a long-term follow-up of the First Intergroup study”. J. Clin. Oncol. 8 (10): 1664–74. doi:10.1200/JCO.1990.8.10.1664. PMIDΒ 2213103.
  52. ↑ Raney RB, Asmar L, Newton WA, Bagwell C, Breneman JC, Crist W, Gehan EA, Webber B, Wharam M, Wiener ES, Anderson JR, Maurer HM (February 1997). “Ewing’s sarcoma of soft tissues in childhood: a report from the Intergroup Rhabdomyosarcoma Study, 1972 to 1991”. J. Clin. Oncol. 15 (2): 574–82. doi:10.1200/JCO.1997.15.2.574. PMIDΒ 9053479.
  53. ↑ Grois N, PΓΆtschger U, Prosch H, Minkov M, Arico M, Braier J, Henter JI, Janka-Schaub G, Ladisch S, Ritter J, Steiner M, Unger E, Gadner H (February 2006). “Risk factors for diabetes insipidus in langerhans cell histiocytosis”. Pediatr Blood Cancer. 46 (2): 228–33. doi:10.1002/pbc.20425. PMIDΒ 16047354.
  54. ↑ Baumgartner I, von Hochstetter A, Baumert B, Luetolf U, Follath F (January 1997). “Langerhans’-cell histiocytosis in adults”. Med. Pediatr. Oncol. 28 (1): 9–14. PMIDΒ 8950330.
  55. ↑ 55.0 55.1 Malpas JS, Norton AJ (December 1996). “Langerhans cell histiocytosis in the adult”. Med. Pediatr. Oncol. 27 (6): 540–6. doi:10.1002/(SICI)1096-911X(199612)27:6<540::AID-MPO6>3.0.CO;2-L. PMIDΒ 8888814.
  56. ↑ Clarke RT, Van den Bruel A, Bankhead C, Mitchell CD, Phillips B, Thompson MJ (October 2016). “Clinical presentation of childhood leukaemia: a systematic review and meta-analysis”. Arch. Dis. Child. 101 (10): 894–901. doi:10.1136/archdischild-2016-311251. PMIDΒ 27647842.
  57. ↑ Konopka JB, Witte ON (November 1985). “Detection of c-abl tyrosine kinase activity in vitro permits direct comparison of normal and altered abl gene products”. Mol. Cell. Biol. 5 (11): 3116–23. PMCΒ 369126. PMIDΒ 3879812.
  58. ↑ Siegel RL, Miller KD, Jemal A (January 2017). “Cancer Statistics, 2017”. CA Cancer J Clin. 67 (1): 7–30. doi:10.3322/caac.21387. PMIDΒ 28055103.
  59. ↑ Faderl S, Talpaz M, Estrov Z, O’Brien S, Kurzrock R, Kantarjian HM (July 1999). “The biology of chronic myeloid leukemia”. N. Engl. J. Med. 341 (3): 164–72. doi:10.1056/NEJM199907153410306. PMIDΒ 10403855.
  60. ↑ Anderson T, Chabner BA, Young RC, Berard CW, Garvin AJ, Simon RM, DeVita VT (December 1982). “Malignant lymphoma. 1. The histology and staging of 473 patients at the National Cancer Institute”. Cancer. 50 (12): 2699–707. PMIDΒ 7139563.
  61. ↑ Mohren M, Markmann I, Jentsch-Ullrich K, Koenigsmann M, Lutze G, Franke A (April 2005). “Increased risk of thromboembolism in patients with malignant lymphoma: a single-centre analysis”. Br. J. Cancer. 92 (8): 1349–51. doi:10.1038/sj.bjc.6602504. PMIDΒ 15798767.
  62. ↑ Cozen W, Katz J, Mack TM (1992). “Risk patterns of Hodgkin’s disease in Los Angeles vary by cell type”. Cancer Epidemiol. Biomarkers Prev. 1 (4): 261–8. PMIDΒ 1303125.
  63. ↑ Bazzeh F, Rihani R, Howard S, Sultan I (December 2010). “Comparing adult and pediatric Hodgkin lymphoma in the Surveillance, Epidemiology and End Results Program, 1988-2005: an analysis of 21 734 cases”. Leuk. Lymphoma. 51 (12): 2198–207. doi:10.3109/10428194.2010.525724. PMIDΒ 21054151.
  64. ↑ Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, Fonseca R, Rajkumar SV, Offord JR, Larson DR, Plevak ME, Therneau TM, Greipp PR (January 2003). “Review of 1027 patients with newly diagnosed multiple myeloma”. Mayo Clin. Proc. 78 (1): 21–33. doi:10.4065/78.1.21. PMIDΒ 12528874.
  65. ↑ Turesson I, Velez R, Kristinsson SY, Landgren O (March 2010). “Patterns of multiple myeloma during the past 5 decades: stable incidence rates for all age groups in the population but rapidly changing age distribution in the clinic”. Mayo Clin. Proc. 85 (3): 225–30. doi:10.4065/mcp.2009.0426. PMCΒ 2843108. PMIDΒ 20194150.
  66. ↑ Porta M, Fabregat X, Malats N, Guarner L, Carrato A, de Miguel A, Ruiz L, Jariod M, Costafreda S, Coll S, Alguacil J, Corominas JM, SolΓ  R, Salas A, Real FX (June 2005). “Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage”. Clin Transl Oncol. 7 (5): 189–97. PMIDΒ 15960930.
  67. ↑ Crawford ED, Schutz MJ, Clejan S, Drago J, Resnick MI, Chodak GW, Gomella LG, Austenfeld M, Stone NN, Miles BJ (1992). “The effect of digital rectal examination on prostate-specific antigen levels”. JAMA. 267 (16): 2227–8. PMIDΒ 1372943.
  68. ↑ Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, Betts RF, Gershon AA, Haanpaa ML, McKendrick MW, Nurmikko TJ, Oaklander AL, Oxman MN, Pavan-Langston D, Petersen KL, Rowbotham MC, Schmader KE, Stacey BR, Tyring SK, van Wijck AJ, Wallace MS, Wassilew SW, Whitley RJ (January 2007). “Recommendations for the management of herpes zoster”. Clin. Infect. Dis. 44 Suppl 1: S1–26. doi:10.1086/510206. PMIDΒ 17143845.
  69. ↑ Jumaan AO, Yu O, Jackson LA, Bohlke K, Galil K, Seward JF (June 2005). “Incidence of herpes zoster, before and after varicella-vaccination-associated decreases in the incidence of varicella, 1992-2002”. J. Infect. Dis. 191 (12): 2002–7. doi:10.1086/430325. PMIDΒ 15897984.
  70. ↑ Kost RG, Straus SE (July 1996). “Postherpetic neuralgia–pathogenesis, treatment, and prevention”. N. Engl. J. Med. 335 (1): 32–42. doi:10.1056/NEJM199607043350107. PMIDΒ 8637540.
  71. ↑ Platt OS, Thorington BD, Brambilla DJ, Milner PF, Rosse WF, Vichinsky E, Kinney TR (July 1991). “Pain in sickle cell disease. Rates and risk factors”. N. Engl. J. Med. 325 (1): 11–6. doi:10.1056/NEJM199107043250103. PMIDΒ 1710777.
  72. ↑ Keeley K, Buchanan GR (August 1982). “Acute infarction of long bones in children with sickle cell anemia”. J. Pediatr. 101 (2): 170–5. PMIDΒ 7097407.
  73. ↑ Resar LM, Oliva MM, Casella JF (November 1996). “Skull infarction and epidural hematomas in a patient with sickle cell anemia”. J. Pediatr. Hematol. Oncol. 18 (4): 413–5. PMIDΒ 8888755.
  74. ↑ Milhorat TH (March 2000). “Classification of syringomyelia”. Neurosurg Focus. 8 (3): E1. doi:10.3171/foc.2000.8.3.1. PMIDΒ 16676921.
  75. ↑ Brickell KL, Anderson NE, Charleston AJ, Hope JK, Bok AP, Barber PA (August 2006). “Ethnic differences in syringomyelia in New Zealand”. J. Neurol. Neurosurg. Psychiatry. 77 (8): 989–91. doi:10.1136/jnnp.2005.081240. PMCΒ 2077633. PMIDΒ 16549414.
  76. ↑ Larner AJ, Muqit MM, Glickman S (January 2002). “Concurrent syrinx and inflammatory central nervous system disease detected by magnetic resonance imaging: an illustrative case and review of the literature”. Medicine (Baltimore). 81 (1): 41–50. PMIDΒ 11807404.
  77. ↑ Klahr S (February 1983). “Pathophysiology of obstructive nephropathy”. Kidney Int. 23 (2): 414–26. PMIDΒ 6842965.
  78. ↑ McAleer IM, Kaplan GW, LoSasso BE (October 2002). “Congenital urinary tract anomalies in pediatric renal trauma patients”. J. Urol. volume=168 (4 Pt 2): 1808–10, discussion 1810. doi:10.1097/01.ju.0000028338.48621.57. PMIDΒ 12352365.
  79. ↑ Tekin A, Tekgul S, Atsu N, Ergen A, Kendi S (March 2001). “Ureteropelvic junction obstruction and coexisting renal calculi in children: role of metabolic abnormalities”. Urology. 57 (3): 542–5, discussion 545–6. PMIDΒ 11248635.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]