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Query: UMLS:C0001511 (Adhesion)
 5,955 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intractable, unexplained deep-ear pain presents a rare, albeit significant problem in otolaryngological and neurosurgical practice. The authors review their experience with 18 cases of primary otalgia during the past 15 years. A total of 31 surgical procedures were performed. Seventeen patients had sequential rhizotomies and one patient had microvascular decompression alone. Based on the clinical diagnosis, the nerves sectioned were singly or in combination: the nervus intermedius (14 patients), geniculate ganglion (10 patients), ninth nerve (14 patients), 10th nerve (11 patients), tympanic nerve (four patients), and chorda tympani nerve (one patient). Microvascular decompression of the involved nerves was undertaken in nine patients, in whom vascular loops were discovered. Adhesions (six patients), thickened arachnoid (three patients), and benign osteoma (one patient) were other intraoperative abnormalities noted. The overall success of these procedures in providing pain relief was 72.2%, and the mean follow-up period was 3.3 years (range 1 month to 14.5 years). There was no surgical mortality. Expected side effects were: decreased lacrimation, salivation, and taste related to nervus intermedius nerve section, and transient hoarseness and diminished gag related to ninth and 10th nerve section. Four patients developed sequelae consisting of sensorineural hearing loss, vertigo, and transient facial nerve paresis. One patient had a cerebrospinal fluid leak and another developed aseptic meningitis as postoperative complications. Except when primary glossopharyngeal neuralgia is the working diagnosis, a combined posterior cranial fossa-middle cranial fossa approach is recommended for adequate exploration and/or section of the fifth, ninth, and 10th cranial nerves as well as the geniculate ganglion and nervus intermedius.
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PMID:Geniculate neuralgia: the surgical management of primary otalgia. 152 Mar 57

Tension of the median nerve produced by simultaneous extension of the supinated wrist and distal interphalangeal joint of the index finger was noted to result in proximal volar forearm pain radiation in patients with chronic carpal tunnel syndrome. This sign was less frequent in patients with a more acute syndrome. Adhesions between the median nerve and the overlying transverse carpal ligament and the development of a pseudoneuroma can individually or together occur in the chronic carpal tunnel syndrome limiting distal nerve excursion of the tethered nerve during simultaneous wrist and index finger extension.
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PMID:"Tethered" median nerve stress test in chronic carpal tunnel syndrome. 377 74

Obscure, chronically recurring pains in the lower abdomen and back are common symptoms in the office of the gynecologist or practitioner. Often the cause has never been found. Many are functional or psychosomatic disturbances. There is no objective measurement of the quality or amount of pain. Common diagnoses have been chronic adnexitis, chronic appendicitis, retroflexion of the uterus, or adhesions. Too often surgical operations have been of little benefit. When consultations with other specialists have not helped, laparoscopy is indicated. Endometriosis is a common finding. Cauteriziation of this lesion at laparoscopy is better than hormone therapy. Adhesions may be severed with relief of symptoms. Varicose enlargement of ovarian veins is sometimes seen. Laparotomy may be indicated for conditions not readily treated by laparoscopy. However, indications for surgery should be carefully considered to avoid iatrogenic damage in an already apprehensive patient. Tranquilizers and small doses of cortisone may be adequate. In about 80% of patients complaining of chronic lower abdominal pain, organic disorders may be found by laparoscopy. The procedure should be recommended more frequently.
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PMID:Chronic pelvic disease of unknown origin. 427 10

In past years, lumbar nerve lateral entrapment seldom has been diagnosed. A presumptive preoperative diagnosis has been made based on clinical findings and radiographs demonstrating disc resorption. The Computed Tomography scan has made it possible to diagnose the lesion with certainty and accuracy. Treatment for patients who do not respond to conservative measures is a bilateral minimal partial laminectomy. The lateral canal is enlarged by removing the medial and anterior parts of the superior articular process. Adhesion formation is prevented by placing a free fat graft posterior to the dura. Instability is diagnosed by examining stress radiographs and, when present, is treated by a one level posterolateral fusion. After operation, marked improvement was obtained in 62% of patients and slight improvement in another 21%; 17% were unimproved. Sixty-two per cent of patients reported no pain or mild pain. Sixty-six per cent resumed their previous occupation.
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PMID:Lumbar spinal nerve lateral entrapment. 710 75

20 cases of pelvic actinomycosis associated with the use of an IUD have been reported. A case of a patient with IUD-associated pelvic actinomycosis, in which the organism was identified by histologic testing and culture, is reported. The 26-year-old woman, gravida 2, para 1, had had a therapeutic abortion in March 1971. She used a Dalkon Shield IUD from 1971 to April 1975. It was removed at that time because of menometrorrhagia. The patient noted pain in the lower left quadrant of her abdomen in June 1975. A mass in the left ovary was palpated on pelvic examination, but the patient refused further evaluation. The patient returned in August 1976 complaining of continued abdominal pain. On physical examination, she had a firm, slightly tender, 7 centimeter mass in the left adnexa, contiguous with the uterus. No other abnormalities were revealed in physical examination. There were 11,200 peripheral blood leukocytes per cubic millimeter with 73% polymorphonuclera cells and 6% band forms. A laparotomy was performed in August 1976, and a 5- by 2.5 centimeter tubo-ovarian abscess on the left side was found. Adhesions and clubbing of the right fallopian tube were observed during the operation. The left ovary and fallopian tube were excised. Inflammatory disease involving the right ovary and fallopian tube was evident, but the right adnexa was left in place in accordance with the patient's preoperative request. In October a 2nd laparotomy was performed, and the ovary and the right fallopian tube were removed.
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PMID:Tubo-ovarian Actinomycosis and the Use of Intrauterine Devices. 740 3

New data on the pathophysiology of pain associated with endometriosis are available. The predominant role of deep endometriosis has been stressed. In multivariate analysis, superficial endometriosis and even adhesions and ovarian cysts do not appear to be related with pain. Deep endometriosis is usually located posterior to the vagina and cervix, involving the pouch of Douglas, the rectovaginal septum and the uterosacral ligaments. In such cases, pelvic examination shows a painful induration or a nodule in this area. The anterior cul-de-sac and the lateral pelvic wall may also be involved. Two histological and clinical aspects may be observed: deep endometriosis arising under the peritoneal surface, or adenomyosis arising from the uterine cervix. Only complete surgical excision may be curative, but recurrences may occur after surgery. Hormonal therapy is only suspensive. However, surgical therapy involves a significant risk of complication. Surgery for deep endometriosis may be one of the most difficult gynecologic operations. It should be performed only by experienced surgeons, with skills in oncological dissections of the pelvis. The guidelines for therapy are thus clear. Superficial endometriosis does not cause pain and should not be treated by itself; symptomatic relief of pain may be obtained by therapeutic amenorrhea or by the placebo effect of surgery. Endometriomas are managed in the same way as all organic ovarian cysts. Adhesions are lysed if infertility is associated with pain, or to gain access to the retroperitoneal area. Etiologic therapy is acceptable only in case of deep endometriosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Pelvic pain and external endometriosis. Physiopathology and treatment]. 788 88

Five hundred and nine Laparoscopic examinations performed between 1987-91, (147 procedures for evaluation of gynaecologic pelvic pain and 313 for infertility) revealed ectopic pregnancy (27%), twisted ovarian cyst (18%) and acute pelvic inflammatory disease (14%) in cases of acute gynaecologic pain, and endometriosis (17%) and chronic pelvic inflammatory disease (16%) in chronic pelvic pain. Adhesions (20%), tubal block (15%), endometriosis (9%) and polycystic ovary (7%) were common findings in cases of infertility. These data support the usefulness of this minimally invasive procedure in accurate diagnosis of gynaecological disorders and provides insight into the spectra of diseases seen in Pakistani women with pelvic pain and infertility.
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PMID:Laparoscopic appraisal of infertility and pelvic pain in Pakistani women: a 5 years audit. 804 Sep 92

From January 1988 to May 1991, 30 patients (mean age: 27 years old; range: 15 to 45) sustained 57 tendon injuries in 49 fingers. They were treated by primary repair with assisted post-operative mobilisation by a dynamic splint. Adhesion of extensor apparatus rate was 12 p. cent but only one had a functional impairment. No other complications were noted. At the thumb level (3 out of 49 fingers) the Kapandji-test was respectively at 8.8 and 9/10 without any extensor lack. At the long fingers level TAM was excellent in 91 p. cent of cases, good in 4 p. cent, fair and poor in 2 p. cent. According to Allieu classification results were good and excellent in 9 p. cent of cases. These results were better when injury was localised to or up to zone 5 according to Verdan's classification, and when there was no associated bone nor articular injuries or cutaneous defects. Subjective results were less good (70 p. cent of satisfactory results) because of pain, grip strength lack or disability. Assisted mobilisation allowed intrinsic healing and avoided adhesion when application date and rehabilitation protocol were respected. It was more beneficial for distal and complex injuries.
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PMID:[Controlled mobilisation after suture of extensor tendons of the hand. Apropos of 30 consecutive cases]. 812 7

We evaluated the outcome of microsurgical (n = 72) and laparoscopic (n = 51) adhesiolysis in women who complained of chronic pelvic pain. Adhesion severity was not significantly different between the two treatment groups. The influences of the following variables on the outcome of all 123 cases of adhesiolysis were examined: (i) surgical modality (microsurgical or laparoscopic), (ii) history of infertility, (iii) associated dyspareunia and (iv) aetiological factors of adhesive disease (endometriosis, pelvic inflammatory disease and previous laparotomy). To adjust for differences in follow-up intervals, overall and subgroup cumulative rates of pain persistence/recurrence were calculated and compared. To adjust for interrelationships between variables and to correct fo differences between the treatment groups, a proportional hazards regression analysis was employed. This analysis showed that the cumulative rate of pain persistance/recurrence at 24 months was not significantly different after microsurgical (44%) and laparoscopic (53%) adhesiolysis. From all the variables which were examined, the only one which appeared to influence the impact of surgical adhesiolysis for chronic pelvic pain was a history of previous laparotomy. A history of previous laparotomy was associated with approximately three times higher rates of pain persistence or recurrence. This effect did not depend on whether previous laparotomy was carried out for pain or for other indications. The most likely explanation for the failure of these patients who had a previous laparotomy to respond to surgery is that they intrinsically have a higher rate of adhesion formation and reformation. This can only be confirmed with a prospective study where all patients will undergo a second-look laparoscopy.
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PMID:An analysis of the outcome of microsurgical and laparoscopic adhesiolysis for chronic pelvic pain. 874 39

Adhesions, which occur after 67% to 93% of abdominal operations, represent a major clinical problem, resulting in intestinal obstruction, infertility, and pain and incurring considerable economic costs. The magnitude and seriousness of the problem of adhesions have been underappreciated. Moreover, efforts to prevent or reduce adhesions largely have been unsuccessful, hindered by their empirical basis, the lack of good predictive animal models, and the biochemical complexities of adhesiogenesis. The two major strategies for adhesion prevention or reduction are adjusting surgical technique and applying adjuvants. Modifications in technique that all surgeons should implement include minimizing the invasiveness of surgery, minimizing surgical trauma, such as ischemia from peritoneal suturing, and avoiding the introduction of foreign material, e.g., starch glove powder, into the body. Given the adhesiogenic nature of peritoneal repair, however, improvements in surgical technique alone will help decrease but not prevent adhesion formation. Adjuvant therapy is necessary. Adjuvants fall into two main categories, drugs and barriers. Nonsteroidal anti-inflammatory drugs have shown questionable clinical efficacy, possibly because of difficulties in drug delivery. Corticosteroids, alone or with antihistamines, also have had equivocal clinical results and may be immunosuppressive and delay wound healing. Experimentally, fibrinolytics such as tissue plasminogen activator (tPA), administered systemically or intraperitoneally (i.p.), have demonstrated conflicting results and hemorrhagic complications. However, recently, tPA, administered topically in a carboxymethylcellulose (CMC) gel, has been effective in reducing and preventing adhesions in rabbits. Phosphatidylcholine, given i.p. or orally, also has shown promise in animal studies. Barriers, by separating traumatized surfaces for the critical first five to seven days of peritoneal re-epithelialization, are useful adjuvants, and include macromolecular solutions and mechanical devices. Dextran, a macromolecular solution, has been studied widely, but has not demonstrated consistent clinical efficacy and has been largely abandoned as an anti-adhesion barrier. A newly developed hyaluronic acid-phosphate-buffered saline solution applied intraoperatively to protect peritoneal surfaces from indirect surgical trauma effectively and safely reduced adhesions in a large multicenter study of women undergoing gynecological laparotomy. Three recently developed mechanical barriers also have demonstrated clinical progress in adhesion prevention. A bioresorbable membrane consisting of hyaluronic acid and CMC has gained regulatory approval for clinical use in both general and gynecological surgery following demonstration of efficacy and safety in reducing adhesions. A barrier made of expanded polytetrafluoroethylene and another developed from oxidized regenerated cellulose are currently available for gynecological surgery. With continued research, new and improved approaches hopefully will become available to prevent adhesion formation.
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PMID:Adhesions: preventive strategies. 907 50


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