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

Oxalate nephrosis resulted in progressive renal failure in 4 patients after jejunoileal bypass for morbid obesity. In general, increased levels of oxalates in the blood and urine of such patients result from enhanced absorption of exogenous oxalates. Urinary calculous formation is determined further by concomitant deficiency of inhibitor substances, whereas oxalate nephrosis probably occurs as a result of oxalate deposition in renal interstitium via the blood stream. Clinical manifestations of oxalate nephrosis include pain, infection, hematuria and renal failure. Routine postoperative renal function studies and early renal biopsy in suspicious cases are urged to establish early diagnosis. Continued deterioration of renal function, despite therapy with oxalate restruction and oxalate binding agents, indicates a reversal of the bypass to preserve unaffected renal substance.
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PMID:Renal failure owing to oxalate nephrosis after jejunoileal bypass. 43 32

Sixty-six patients who had a jejunoileal bypass with ileosigmoidostomy for intractable obesity were reviewed. Thirty-three patients had sudden, severe, upper pain develop in the abdomen with distention from one to four years after the original operation. All 33 patients had a repeat laparotomy from one to six years after the initial bypass procedure. In every instance, a dilated, hypertrophied defunctioned ileum was found proximal to the ileosigmoidostomy. In 11 patients, an ileosigmoid volvulus was present. In every instance, the ileosigmoid anastomosis was dismantled and an end-to-side ileotransversostomy performed. In one patient, an ileal volvulus developed proximal to the ileotransversostomy because of an inadvertent technicality and this was corrected by reoperation. The remaining 32 patients have been asymptomatic since the ileosigmoidostomy was converted to ileotransversostomy. To date, in more than 200 primary operations for morbid obesity, the ileum has been drained into the transverse colon. None of these patients have had obstruction of the defunctioned small bowel develop.
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PMID:Jejunoileal bypass and the defunctioned bowel syndrome. 45 6

The consequences of jejunoileal bypass include not just metabolic derangements, though the frequency and severity of these problems have led to the procedure being abandoned in the treatment of morbid obesity, but a variety of mechanical complications as well. In this report, a new mechanical complication is presented: Intussusception of the defunctionalized ileum into the sigmoid colon, an intussusception caused by malignant lymphoma of the ileum. Because the patient had pain but no evidence of obstruction, the ileal tumor was fortuitously discovered during flexible sigmoidoscopy.
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PMID:A unique late mechanical complication of jejunoileal bypass. 405 80

The influence of diurnal variation and morbid obesity on the morphine requirements of patients using patient-controlled analgesia (PCA) was studied. Forty-six patients undergoing either elective (Group I) or gastric bypass (Group II) surgery composed the study group. Patients were allowed to use the PCA machine for 36 to 72 hours postoperatively to deliver 0.6 mg/sq m doses of morphine sulfate intravenously. Counters on the device indicating the number of doses received were monitored every two hours along with vital signs and a pain and sedation rating. Dosing rates were studied with regard to the time of day. Morbid obesity had no significant effect on dosing rate requirements. Analyses revealed a significant diurnal rhythm in morphine dosing rate requirements despite a 27-fold interpatient variability. Peak analgesic use was at 0900, and the nadir was at 0300. Patient pain rankings did not indicate any changes in pain status, demonstrating PCA's use of analgesia as an endpoint for dosing. Sedation status showed a higher degree of sedation at night when compared with the daytime values, documenting that sedation was not drug-induced. There is a circadian variation in narcotic analgesic need in the postoperative patient that is met appropriately by PCA.
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PMID:Morphine requirements using patient-controlled analgesia: influence of diurnal variation and morbid obesity. 668 12

Intestinal pseudo-obstruction (IP) is an uncommon disorder of gut motility which must be differentiated from mechanical intestinal obstruction. We have seen 11 such patients over the last 5 years. Characteristic symptoms, shared by mechanical obstruction, include abdominal distention and pain, nausea, and vomiting. Radiologic studies reveal dilated loops of bowel with air fluid levels. In most patients a major differentiating feature from obstruction may be the presence of diarrhea rather than obstipation. Steatorrhea is secondary to an overgrowth of anaerobic bacteria in the motionless dilated loops of bowel. IP has been associated with various disorders: in our series two patients had scleroderma, one multiple small bowel diverticula, one systemic amyloidosis, one celiac disease, and one spinal cord injury; in only two patients was the disorder considered "idiopathic." Three patients had previously undergone a jejuno--ileal bypass for morbid obesity. During the acute episode, the patients were treated symptomatically with decompression by nasogastric or rectal tube with fluid and electrolyte replacement. Malabsorption treated with broad spectrum antibiotics reversing the steatorrhea but not episodes of pseudo-obstruction. Magnesium deficiency was present in seven patients and its correction resulted in amelioration of the symptom complex. In two patients episodes of pseudo-obstruction were markedly reduced by metoclopramide which was not effective in two others.
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PMID:Chronic intestinal pseudo-obstruction. 679 59

Morbid obesity is an aesthetic, social and psychological problem, with characteristic morbidity and mortality. Surgical treatment has been developed due to the high failure rate of medical treatment. In our previous experience with 40 patients, open transverse gastroplasty reinforced with mesh, has been found to be a good procedure to deal with this problem, with very few postoperative complications. In March 1995 we started a prospective study to evaluate the feasibility and results of the same technique done laparoscopically. We operated on 10 morbid obesity patients with several failed medical treatments. Laparoscopic surgery was felt to be easier and faster than the open technique. Weight loss was similar to that in our previous patients with open surgery, but postoperative pain and complications were less frequent, and the aesthetic results were better. More patients and a longer follow-up will be needed to provide definitive conclusions.
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PMID:Laparoscopic gastroplasty. Technique and preliminary results in patients with morbid obesity. 997 52

Morbid obesity is a serious disease that is responsible for several comorbid conditions. Body mass indices > 40 require surgical procedures if diet programs fail. Laparoscopic adjustable gastric banding (LAGB), a more recently introduced gastric restrictive procedure, was designed to be a minimally invasive and reversible operation. 184 patients (164 women, 20 men) with a mean body mass index of 47.8 kg/m2 (range 36-79) were operated on. All patients had been excessively overweight for > 5 years. Each patient was given general anesthesia, and an adjustable LAP-BAND was implanted laparoscopically. The pouch size was 15 ml in all cases; and 3-4 sutures were placed to prevent dislocation. The conversion rate was 0%. The median operating time was 65 min (range 45-190). The mortality was 0%. The mean hospital stay was 5 days (range 4-6). The mean excess weight loss was 16% in 4 weeks, 23% in 3 months, 31% in 6 months, 58% in 1 year, and 87% in 2 years. The patient satisfaction index was 97.6%. Once a surgeon has acquired the necessary laparoscopic surgical experience, LAGB is a feasible, safe, and simple procedure with excellent postoperative results. LAGB does not permanently modify the anatomy of the stomach and maintains the natural continuity of the alimentary tract, while at the same time ensuring a steady weight reduction in morbidly obese patients. The fact that the gastric band can be applied laparoscopically is a significant advantage in this group of high-risk patients, who have less pain, faster postoperative recovery, more rapid return to normal activities, fewer wound infections, fewer hernia problems, and better cosmetic results. The rate of postoperative complications is approximately 9%. In 1.1% of patients, erosion occurred, and in 2.2%, slippage of the band. The rate of port-related complications was 3.2%. Reoperations were necessary in 6.4% of the patients.
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PMID:Laparoscopic gastric banding for morbid obesity. 1019 89

Gastric banding is an exceptionally safe operation for the surgical control of morbid obesity. Most failures are due to a stoma that is too large or too small. To obviate the 20% failure rate (removal of band or readjustment with major surgery), a band which is adjustable from the subcutaneous tissues is described. This revisional surgery can be done on an out-patient basis under local anesthesia. Major intraperitoneal surgery is avoided with the great expense, risk, pain, and disability.
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PMID:Adjustable Gastric Banding. 1071 71

The results of 20 total hip and knee arthroplasties performed in patients with morbid obesity who were treated with bariatric surgery before arthroplasty are reviewed. Bariatric surgery was successful in reducing the Quetelet ratio (weight in kilogram divided by height in square meters) of patients from a mean of 49 kg/m(2) (range, 38-56 kg/m(2)) to a mean of 29 kg/m(2) (range, 25-32 kg/m(2)). The average time from bariatric surgery to arthroplasty was 23 months (range, 7-65 months). The cumulative Knee Society score had improved significantly from a mean of 103.6 (range, 45-165) before arthroplasty to a mean of 148.9 (range, 66-185) at final follow-up in 12 knees undergoing total knee arthroplasty (P<.01). The Harris hip score also had increased significantly from a prearthroplasty mean of 40 (range, 25-55) to 67.5 (range, 50-95) at final follow-up in 8 hips receiving total hip arthroplasties (P<.05). All but 1 patient with continuing patellofemoral pain were satisfied with the result of the arthroplasty at final follow-up. One hip was revised at 5 years for aseptic loosening of the femoral component; no knee revisions were required. All other prostheses were stable with no evidence of radiographic loosening or wear at final surveillance. Morbidly obese individuals, with severe degenerative joint disease, who are considered unsuitable for arthroplasty because of excess weight should be considered for bariatric surgery. Total joint arthroplasty after surgical treatment of obesity has an excellent outcome with an acceptable complication rate.
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PMID:Total joint arthroplasty in patients surgically treated for morbid obesity. 1111 95

Anesthesia during and after off-pump surgery is critical for the outcome of the procedure. Intubation time has been shown to correlate with ICU time and length of stay. This study is to evaluate the extubation time and predictors of prolonged extubation in this institution. One hundred and sixty consecutive patients during Jan 2001-June 2002, excluding pre-operative tracheostomy (n = 1) were retrospectively reviewed. Anesthetic agents include fentanyl, rocuronium Bromide, midazolam and sevoflurane. Phenylephrine and nitroglycerine were used to maintain adequate arterial pressures. Post-operative pain control was mainly with intravenous fentanyl and oral pain medications. The extubation time was divided into 4 groups; 0-2 h, n = 76, mean = 1.11 +/- 0.5 h; 2-4 h, n = 30, mean = 2.91 +/- 0.5 h; 4-24 h, n = 39, mean = 11.44 +/- 7.3 h; > 24 h, n = 5, mean = 33.3 +/- 21 h. The data were collected and analyzed following the guidelines of National STS cardiac surgery database. All pre-operative risk factors included: Age (> 70 yrs vs < or = 70 yrs), gender (male vs female), diabetes (yes vs no), hypertension (yes vs no), morbid obesity (yes vs no), renal insufficiency (yes vs no), chronic obstructive lung disease (yes vs no), history of cerebrovascular accident (yes vs no), smoking (yes vs no), dyslipidemia (yes vs no), history of myocardial infarction (MI) (yes vs no), history of congestive heart failure (CHF) (yes vs no), unstable angina (yes vs no), left ventricular ejection fraction (LVEF) (> 40% vs < or = 40%), left main (LM) lesion (LM > 50% vs LM < or = 50%), intra-aortic balloon pump (IABP) used (yes vs no) and time between operating and closing (> 4.30 h vs < or = 4.30 h) were used to predict failed early extubation (2 h). More than 50 per cent of the patients were extubated in less than 2 h (1.11 +/- 0.5 h) and only 5 patients were extubated after 24 h. Univariate analysis revealed old age, diabetes, MI, CHF, LVEF < or = 0.4 and the use of IABP are the predictors (p < 0.05) of failed early extubation. Multivariate analysis of these variables revealed old age with adjusted odds ratio of 4.6 (95% CI = 1.5-13.7) p < 0.01, diabetes with adjusted odds ratio of 3.2 (95% CI = 1.3-7.5) p < 0.01 and IABP used with adjusted odds ratio of 4.3 (95% CI = 1.3-14.6) p = 0.02 are the predictors of fail early extubation. The findings suggested early extubation is possible in OPCAB surgery and attention should be made when operate in patients who have old age, diabetes, and IABP used.
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PMID:Off-pump coronary artery bypass surgery: evaluation of extubation time and predictors of failed early extubation. 1286 66


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