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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We analyzed our surgical experience in 20 patients who underwent revascularization procedures for symptomatic chronic intestinal ischemia caused by atherosclerosis. The group comprised 17 women and 3 men, with an age range of 25 to 71 years (mean 58.6 years). Sixteen patients had postprandial abdominal pain, and 4 had pain not related to eating. The average weight loss was 23.8 lb. Malabsorption and diarrhea were present in 8 patients. The duration of the symptoms was from 4 to 46 months (mean 13.4 months). One patient presented with acute intestinal ischemia following balloon angioplasty reocclusion of a stenotic celiac artery, and 3 underwent surgery for stenosis of a previously placed graft. Five patients had single mesenteric artery involvement, 10 had double-artery involvement, and 5 had significant occlusion in all 3 mesenteric arteries. The major arteries were revascularized whenever technically possible; therefore, 36 arteries were revascularized in 20 patients. Bypass grafts were done in 27 vessels, reimplantation in 7, and endarterectomy with patch angioplasty in 2. The saphenous vein was used in 12 vessels, polytetrafluoroethylene grafts in 8, dacron in 6, and inferior mesenteric vein in 1. The type of revascularization or graft utilized did not affect long-term patency. Two patients had early graft thrombosis and required intestinal resection. All patients survived the operation. At a mean follow-up of 36 months, all 20 patients were alive and asymptomatic with regard to their abdominal complaint. Ten patients (50%) underwent postoperative abdominal angiography; all the grafts were patent.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term results of the surgical management of symptomatic chronic intestinal ischemia. 128 11

The profunda femoris artery is the primary source of collateral flow to the lower extremity in the presence of superficial femoral and/or popliteal occlusion. The arteriosclerotic disease involvement of this segment is relatively less frequent and in the majority of the cases localized on the ostium and reaches to the first branch. Profundaplasty to relieve limb-threatening ischemia is infrequently employed as an isolated procedure. However many Authors reported their experience on this treatment, in case of critical limb ischemia in patients without significative lesions of the aortofemoral district. Our late four year experience concerns of 22 patients (18 male, 3 female). All the patients had severe ischemia of the lower limbs, with serious symptoms, such as invalidating claudicatio (13), rest pain (7) and gangrene (2). Twenty-two profundaplasty were performed as the only reconstructive procedure. There was no postoperative mortality. Two patients had above knee amputations (15 days and 14 months after the revascularization). All of the other patients improved and follow-up extended to 48 months shows a limb salvage rate of 90%. In conclusion, on the basis of our experience, we think that the operation is recommended, whenever possible, in patients with critical ischemia when the possibilities of more extensive revascularization procedures are considered to be poor.
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PMID:[Profundaplasty as the only revascularization procedure in ischemia of the leg. Clinical contribution]. 129 22

To elucidate the pathological aspects of silent myocardial ischemia, we studied 24 patients with ischemic heart disease who had culprit lesions in the left anterior descending artery (LAD). We determined the presence of myocardial ischemia and measured coronary wedge pressures (CWP; mmHg) and collateral circulation and ST deviation on the ECG (intracoronary ECG: ic-ECG, and surface ECG; mm) after balloon inflation during PTCA intervention. The study subjects included 9 with exertional angina, 10 with post-infarction angina, and 5 with Cohn type II angina. During 78 balloon inflations, the group of ischemic symptoms (Group S) occurred in 40% of all cases, the group without ischemic symptoms (Group A) constituted 45%, and the Cohn type II specific for ischemic symptoms accounted for 15%. The relationship between CWP (X-axis) and ST deviation (Y-axis) of ic-ECG was: Y = -0.46X + 20.19 (r = -0.59; p < 0.01), and the relationship between CWP and ST deviation of the surface ECG was: Y = -0.12X + 6.58 (r = -0.42; p < 0.01). Thus, a negative correlation was confirmed between them. Furthermore, similar results were obtained for Groups S and A. Based on this relationship, the pain threshold was estimated. In Group S, CWP exceeded 34 mmHg, i.e., ischemia was expected to be mild because of good collateral circulation, but an average ST deviation accompanying ischemic symptoms was observed. However, in Group A, CWP was less than 24 mmHg, i.e., ischemia was expected to be severe due to poor collateral circulation, but an average ST deviation lacking ischemic symptoms was observed. Comparison of these results showed that the pain threshold observed from the ST deviation of ic-ECG was 6.0-6.5 mm and that of the surface ECG was 2.6-2.8 mm. From these threshold values, the ST deviations during 12 balloon inflations in the Cohn type II were evaluated. Because 100% of ic-ECG and 75% of surface ECG exhibited values exceeding the threshold values, it was concluded that the cause of the Cohn type II was an increase of the pain threshold. ST deviations of the ic-ECG for Group S and the Cohn type II were 12.0 +/- 6.7 and 9.8 +/- 2.7 mm, respectively, and ST deviations of the surface ECG were 4.7 +/- 2.4 and 3.5 +/- 1.7 mm, respectively. Since there were no significant differences between Group S and the Cohn type II, it was concluded that the ischemic degree of the Cohn type II was approximately the same as that of Group S.
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PMID:[Trial assessment of pain threshold]. 130 72

Recent investigations of SMI occurring during daily life have advanced our understanding of the pathophysiology of myocardial ischemia. These contributions have directed our attention away from "chest pain" alone and physical exertion as the central provoking factor toward transient myocardial ischemia and its broader triggers and consequences. Transient myocardial ischemic episodes, the majority of which are silent, are found in a subset of patients with any clinical manifestations of CAD (eg, stable angina, unstable angina, myocardial infarction, and sudden death), as well as in those patients with CAD who are and have been totally asymptomatic. These episodes are an independent predictor of increased risk for future cardiac events. Most medical therapy and revascularization therapies have the potential to prevent or relieve these silent episodes; however, we do not yet know which method is superior in reducing SMI episodes or preventing future cardiac events. Furthermore, the benefit of reducing SMI versus the cost and potential morbidity of these chosen therapies is not known. At least three trials are now underway to examine some of these concerns (Table 2). Focus on pain relief alone does not appear to be an adequate approach to alter outcome in patients with CAD and may prove insufficient to control SMI. Until these issues are resolved, we believe a conservative approach to the management of patients with CAD is warranted. Documentation of ischemia (painful or painless) is essential. Three general principles should be kept in mind. First, the presence of detectable ischemia is of central importance. This information should be used in the overall risk assessment of the patient. Second, the level of concern or aggressiveness of treatment should be based on the risk associated with the ischemic abnormalities documented (Table 3). The exercise stress test is the most useful to begin this process. The detection of ischemic-type ST-segment depression, either silent or painful, at a low workload (eg, less than or equal to 120 beats per minute or less than or equal to 6.5 metabolic equivalents [METS]) implies high risk for adverse outcome. Likewise, these ST-segment changes occurring in leads that reflect multiple coronary artery distribution, of greater than 2 mm in magnitude and persisting for greater than 6 minutes, are all markers for high risk. Thallium redistribution defects occurring at low work loads, in multiple areas, associated with increased lung uptake and enlargement of the cardiac pool all imply high risk.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Treatment strategies for daily life silent myocardial ischemia: a correlation with potential pathogenic mechanisms. 135 7

The use of a pneumatic ankle tourniquet applied to the supramalleolar ankle region is a useful method of obtaining a bloodless field in surgery of the foot. The pneumatic ankle tourniquet allows for more accurate and reproducible control of circumferential compression than the standard Esmarch bandage, when used in conjunction with the regional ankle block. Between March 1987 and October 1990, 84 foot surgeries were performed using the pneumatic tourniquet and ankle block technique on 76 patients by one surgeon. Tourniquet ischemia lasted from 30 to 105 min. Tourniquet pressure was set to 100 to 150 mm of mercury above systolic blood pressure without exceeding 325 mm of mercury. Two patients reported mild pain directly beneath the tourniquet after 45 and 70 min, respectively. Neither patient required deflation of the tourniquet to complete the procedure. The clinical and electrophysiologic evidence showed that no neurologic or vascular damage occurs. The use of the pneumatic tourniquet in conjunction with regional ankle block anesthesia provides a reasonable alternative to the standard thigh tourniquet for surgery of the foot.
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PMID:The pneumatic ankle tourniquet with ankle block anesthesia for foot surgery. 139 64

Seventeen arterial bypass procedures distal to the wrist have been performed in 13 men and two women at the Oregon Health Sciences University during the past 9 years. Ten patients had traumatic true or false aneurysms of the ulnar artery with digital embolization. Five patients with end-stage renal disease had severe hand and finger ischemia manifested by rest pain or digital ulceration resulting from widespread forearm and hand arterial occlusions. Patients with aneurysms of the ulnar artery underwent excision and reversed autogenous vein grafting (n = 11) from the distal ulnar artery in the forearm to the superficial palmar arch. All the patients with end-stage renal disease had severe occlusive disease of the forearm and hand arteries and underwent a variety of procedures including radial-radial bypass (n = 2), ulnar-ulnar bypass (n = 2), radial-radial bypass with takedown of a Brescia-Cimino fistula (n = 1), and brachial-radial bypass (n = 1). High-quality upper extremity and magnification hand arteriography was essential for operative planning and was available on all patients. Distal saphenous vein from the ankle or foot was the graft source in 16 procedures and basilic vein the source in one procedure. All operations were performed with headlight illumination, optical loupes, fine sutures, and microvascular instruments. There were no operative deaths or major complications. The mean follow-up period was 14 months. Of the 17 grafts, 16 remained patent by clinical and vascular lab criteria. The single occlusion occurred in an ulnar aneurysm bypass and was accompanied only by mild intolerance to cold.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Upper extremity arterial bypass distal to the wrist. 140 83

The results from recent studies suggest that the endogenous opioid beta-endorphin (beta-E) is related to pain modulation. Therefore, plasma beta-E levels were studied in 23 patients with essential hypertension (EH) and in 7 patients with coronary artery disease (CAD) during asymptomatic ischemic events and in 5 patients with CAD during symptomatic ischemic events. Blood samples for beta-E were taken at the moment of silent ST depression, pointed with alarm by the real time ECG monitor "Q Med Monitor" (USA). Control blood samples were taken under the same conditions without ischemic events. Control plasma beta-E levels were significantly higher (p less than 0.01) in patients with EH as compared to that in both groups of patients with CAD (22.9 +/- 4.0 vs 7.0 +/- 1.9 and 4.5 +/- 1.6 pmol/l). At the time of silent ischemia, beta-E showed a significant increase in patients with EH (+10.1 +/- 2.1 pmol/l, p less than 0.01) and in patients with CAD (+10.7 +/- 1.3 pmol/l, p less than 0.05) as compared to the control levels. However, plasma beta-E showed no increase (+1.0 +/- 0.6 pmol/l, p greater than 0.1) during symptomatic ischemia as compared to the control levels. Thus, differences in the circulating levels of beta-E may be associated with the presence or absence of pain during myocardial ischemia.
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PMID:[Plasma beta-endorphin level in "silent" myocardial ischemia during Holter ECG monitoring]. 140 1

In 1983-1988, the results of conservative and surgical treatment of patients with atherosclerotic ischemia of the lower limbs were assessed with the aid of a questionnaire. A possibility of prognosis was assessed with the use of mathematically processed data obtained with such approach. An effect of clinical symptoms (intermittent claudication distance, resting pain, necrosis) and stage of the disease (duration, K/R index) and risk factors (blood cholesterol, triglycerides, diabetes mellitus, ischemic heart disease, arterial hypertension) on the result of surgical treatment was analysed. The obtained results suggest that clinical symptoms and risk factors may predict the results of surgical treatment in the atherosclerotic ischemia of the lower limbs.
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PMID:[Anticipated results of arterial surgery in chronic atherosclerotic ischemia of the lower limb]. 140 53

From 1985 to March 1991, 83 patients with the diagnosis aortoiliac obliteration and aortic occlusion were operated on at the Department of Surgery, Nordland Central Hospital. The main symptom was claudicatio intermittens. 16 patients had pain while at rest, and two had gangrene. The surgical technique was either Y-prosthesis or thrombendarterectomy. Four patients (4.8%) died postoperatively, three of myocardial infarction and one of intestinal ischemia and peritonitis. In our study 66 patients with aortoiliacal atherosclerosis were compared with 17 patients with aortic occlusion. Patients with aortoiliacal atherosclerosis demonstrated by angiography had much more severe infrainguinal arterial pathology. In the occlusion group the postoperative outcome, as measured by ankle/brachial index, was significantly better (p < 0.01). The study included four female patients less than 50 years of age with total infrarenal aortic occlusion. Their symptoms and signs are discussed.
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PMID:[Surgical treatment of aortic occlusion and obliterating aorto-iliac arteriosclerosis]. 141 87

Exercise test in coronary patients with angina of effort class II and III, painless cardiac ischemia reflected their increased coronary and myocardial reserves due to peloid therapy of cervical and thoracic osteochondrosis. As indicated by bicycle ergometry, angina of effort class III complicated by attacks of retrosternal pain at rest, circulatory insufficiency stage IIA, complex arrhythmia present contraindications for peloid application.
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PMID:[The coronary and myocardial reserves of patients with ischemic heart disease under the influence of the peloid therapy of concomitant spinal osteochondrosis]. 141 15


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