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

The first 50 patients to receive a sacral anterior root stimulator for bladder control were reviewed by questionnaire in mid-1989. At that time, the follow-up period varied from 5 to 11 years, and 48 of the group were alive; 2 had died from unrelated causes. Forty-one used their implants regularly for micturition and of these, 37 were always or usually continent. Twenty-nine reported no symptomatic urinary infections in the previous year, and only 4 had 3 infections or more. Twenty-seven used their implant to assist defaecation, and 13 of 32 male users reported full implant-driven erections. Side effects are minor, except for stimulus evoked pain sensation, which prevents use of the implant in 3 of the 7 non-users. Two of the other non-users were awaiting repair of their implant faults.
Paraplegia 1990 Oct
PMID:Long-term follow-up of patients with sacral anterior root stimulator implants. 226 3

From July 1985 to July 1989, Loma Linda University Medical Center evaluated 46 thoracoabdominal aortic aneurysms (TAAAs). Forty patients were taken to surgery--18 (45%) were operated on an emergency basis for reasons including rupture (12 patients, 30%), dissection (5 patients, 12.5%), and severe pain (1 patient). The overall mortality for all operated patients was five (12.5%-17% for emergency surgery versus 9% for elective surgery). Nonfatal complications occurred in 40 per cent of patients (16). The overall incidence of paraplegia was 10 per cent (4/40), emergency patients 17 per cent (3/18) versus elective patients 4.5 per cent (1/22). Careful preoperative evaluation, standardization of operative technique, and good postoperative management have improved the outlook for these patients who otherwise would progress to eventual rupture and death. Because mortality and morbidity are substantially reduced in elective patients, we recommend that all patients with TAAAs be evaluated for surgery as soon as diagnosis is made.
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PMID:Surgery for thoracoabdominal aortic aneurysms. 226

Two cases of spinal subarachnoid haematoma occurring after spinal anaesthesia are reported. In the first case, lumbar puncture was attempted three times in a 81-year-old man; spinal anaesthesia trial was than abandoned, and the patient given a general anaesthetic. He was given prophylactic calcium heparinate soon after surgery. On the fourth day, the patient became paraparetic. Radioculography revealed a blockage between T10 and L3. Laminectomy was performed to remove the haematoma, but the patient recovered motor activity only very partially. The second case was a 67-year-old man, in whom spinal anaesthesia was easily carried out. He was also given prophylactic calcium heparinate soon after surgery. On the fourth postoperative day, pulmonary embolism was suspected. Heparin treatment was then started. Twelve hours later, lumbar and bilateral buttock pain occurred, which later spread to the neck. On the eighth day, the patient had neck stiffness and two seizures. Emergency laminectomy was carried out, which revealed a subarachnoid haematoma spreading to a level higher than T6 and below L1, with no flow of cerebrospinal fluid, and a non pulsatile spinal cord. Surgery was stopped. The patient died on the following day. Both these cases are similar to those previously reported and point out the role played by anticoagulants. Because early diagnosis of spinal cord compression is difficult, the prognosis is poor, especially in case of paraplegia.
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PMID:[Subarachnoid hematoma and spinal anesthesia]. 227 24

The infiltration of intravenous fluids is common in pediatric practice, but complications are unusual. This is a report of a four-year-old boy with a spinal cord injury resulting in paraplegia who developed a compartment syndrome of the foot due to intravenous fluid extravasation. The patient required surgical decompression and subsequent skin grafting. This case report demonstrates that the normal warning signs indicative of intravenous fluid infiltration such as pain or perception of pressure are not applicable in patients with spinal cord injuries and that equipment warning systems may not be a reliable means for monitoring infiltrations. Intravenous lines placed in the affected limb of these patients must be frequently visualized and evaluated.
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PMID:Superficial compartment syndrome of the foot after infiltration of intravenous fluid. 229 11

Traumatic aneurysms of the descending thoracic aorta are a rare but lethal event, having a mortality of 85-90%. Mortality of this population remains high due to the occurrence of aortic rupture. The isthmus of the aorta, just distal to the left subclavian artery is the most frequent site of injury. Acute traumatic injury to the aorta is characterized by hemorrhagic shock symptoms due to the tear in the layers of the aortic wall. Chronic traumatic injury with aneurysmal formation may not surface with symptoms for months or years after initial trauma. Patients who have formed a chronic aneurysm after a trauma incident can experience dysphagia, chest pain, dyspnea, or cough. Surgical repair involves placing a dacron graft in the area of aneurysmal formation. Protection of the lower extremities during the surgical procedure may prevent paraplegia. In a review of ten cases of chronic traumatic aneurysms at Loyola University Medical Center during the past twenty (20) years, all patients underwent surgical repair. There was no incidence of paraplegia. Post-operative nursing care focuses on monitoring hemodynamic stability, preventing respiratory complications and controlling pain.
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PMID:Traumatic descending thoracic aneurysms: discussion and nursing care. 236 14

The authors report their experience with 60 patients treated for lumbar disc herniation by chemonucleolysis with chymopapain and followed-up 1 to 3 years after treatment. Long-term results were as follows: excellent: 50%; good: 40%; fair: 8.2%; poor: 1.8%. The high percentage of positive results is attributed to the rigid criteria for patient selection used, which resulted in treatment by chemonucleolysis in only 18.6% of the surgical cases of lumbar disc pathology observed. 27.2% of the patients treated complained of disorders which resulted in postoperative complications and/or prolonged convalescence: prolonged low back pain and vertebral stiffness in 20%, persistent contralateral sciatic pain in 5.4%; intense but transitory worsening of the sciatica in 1.8%. The most feared complication of chemonucleolysis is paraplegia occurring after the inadverted injection of the enzyme into the spinal fluid. This risk overshadows the positive attributes of the method. The most important advantage of chemonucleolysis, as compared with surgery, is that it avoids epidural scarring and permanent postoperative anatomical changes. Patients may benefit from these advantages, but they must be willing to accept the negative aspects of the method, as well.
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PMID:Chemonucleolysis: advantages and disadvantages. 236 52

Among all kinds of pain, deafferentation pain is the most physically and mentally debilitative; this affliction is often resistant to medications and to the effects of ablative neurosurgical procedures. Since the introduction of neurostimulation as a method of treatment of pain, stimulation of the sensory thalamic relay nucleus has been proven effective in the majority of cases of patients suffering from deafferentation pain. The method used for thalamic stimulation and the results obtained in a series of 89 patients treated from October 1978 to October 1985 will be presented. Postherpetic trigeminal pain has the best chance of responding to thalamic stimulation with a long-term success rate of 80%. This is also true for anesthesia dolorosa of any origin (after ablative surgery, nerve lesions, paraplegia). In the opposite, only 50% of patients with either brachial plexus avulsion or thalamic pain syndrome will have a significant benefit from thalamic stimulation. It would appear that the success of thalamic stimulation in these disorders may be dependent upon the extent of the central lesion from the periphery up to the thalamic regions (dorsal horn destruction, lesions of the thalamus).
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PMID:Sensory thalamic neurostimulation for chronic pain. 243 80

Pain is the earliest and most prominent feature of symptomatic spinal metastases. In some cases, pain may have been present for months and dismissed as arthritis or back strain. Local back or neck pain occurring in a cancer patient is due to spinal metastasis until proved otherwise. Once weakness occurs, the disease progresses to paraplegia unless treatment is undertaken. Pedicle erosion is the most common abnormality on spinal films. Irradiation is often effective, but surgery is indicated for radiation failure, unknown diagnosis, pathologic fracture-dislocation and rapid disease progression.
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PMID:Symptomatic spinal metastases. 252 57

19 patients diagnosed as non-tuberculous infectious spondylodiscitis (NTIS) have been studied retrospectively over the last 10 years in three general hospitals. The etiology of 13 cases was confirmed (there were nine cases of Staphylococcus aureus, two of Brucella, one of Pseudomonas aeruginosa and another of Salmonella typhi), and the diagnosis of the remaining cases was based on clinical and radiological data as well as on the evolution with antibiotic treatment. The age of the majority of these patients ranged between 40 and 60 years (p less than 0.05), showing a clear predominance of males (p less than 0.05). The most frequently appearing symptom at the beginning of the disease was local pain which was observed in nine patients; the rest presented mixed symptoms which led to misdiagnosis at admission; an exploratory laparotomy was carried out in one patient. The interval from the symptoms' onset to diagnosis ranged between two and sixteen weeks, with an average of 6.8 weeks. The VSG had values between 22 and 148 mm during the first hour, with an average of 83.3 mm. Seven patients underwent surgery, six of them presenting paraparesis-paraplegia, while another presented cervical spondylodiscitis. One patient passed away, two persisted with paraparesis-paraplegia as an irreversible sequela and one with persistent local pain.
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PMID:[Non-tuberculous spondylodiscitis. Multicenter study of 19 cases]. 223 79

Spinal subdural abscess is rare, compared with spinal epidural abscess. The first case was reported by Sittig in 1927. Only 43 cases have been reported throughout the literature. We experienced an atypical fulminant case of spinal subdural abscess, following the operation for intracranial aneurysms. The patient was a 48-year-old male, admitted to our hospital on April 9, 1987 with complaining of sudden headache and vomiting. A lumbar puncture proved subarachnoid hemorrhage (S.A.H.), CT scan revealed saccular aneurysms in left middle cerebral artery and left internal carotid-ophthalmic artery. Radical surgical treatment for those aneurysms was undergone successfully. Neither cerebral ventricular nor cisternal drainage was established. His postoperative course was uneventful until the 9th postoperative day. He suddenly complained of pain in his legs and back, followed by paraplegia, respiratory, and cardiac arrests with clinical course of several hours. Antibiotics had been used for eight days after surgery, and there was no clinical evidence of inflammation sign. For his abrupt aggravation, a spinal infarction was suspected. However, the autopsy demonstrated that the dorsal side of the entire spinal cord was covered with masses of pus, and central necrosis and hemorrhage of the spinal cord mainly occupied the central gray matter; so-called Pencilsharped softening. In this case, the cause of spinal subdural abscess was unclear. But the lumbar puncture performed on the day of admission, was most responsible. Also, the reasons why the clinical course of our case was rapid and fulminant were discussed with preference of spinal abscess to primary spinal circular disorder. 44 cases in the literature, including the presented report, was reviewed. Those symptomatology, predisposing factors, pathogenesis, the extent of spinal subdural abscess, clinical diagnosis, treatment, and prognosis were discussed. Among previous cases, this case was one of the most extensive subdural abscess and fulminant clinical course.
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PMID:[Spinal subdural abscess--report of a case and a review of the literature of 43 cases]. 256 85


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