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

Vascular complications following the use of intravenous sedative drugs continue to be a problem in dental anesthesia. Etiological factors associated with pain and thrombophlebitis are reviewed. From reports in the literature and clinical experience, venous complications from intravenous sedation may be reduced by utilizing large veins with the dilution of sedative agents in a fast running intravenous infusion. Intravenous lidocaine may be of use to block reflex venospasm and pain.
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PMID:Prevention of venous complications from intravenous anesthesia. 355 73

Fifty Hong Kong Chinese patients between 20-40 years, of ASA Gd I, undergoing third molar extraction were randomly allocated into two groups. For conscious sedation, to supplement local anaesthesia, one group received intravenous diazepam and the other intravenous midazolam. The majority in the study had never heard of intravenous sedation being available to supplement local anaesthesia during dental surgery and when given the chance to experience this method the majority found it highly acceptable. None preferred general anaesthesia for dental surgery. In this study midazolam had more advantages to the patient than diazepam; quicker onset of sedation, less pain during injection, profound anterograde amnesia and fewer postoperative complications being the main features. However, both drugs produced good operating conditions. Incidence of thrombophlebitis was low with both drugs, and may be so in Chinese compared with non-Chinese.
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PMID:A study of intravenous sedation with diazepam and midazolam for dentistry in Hong Kong Chinese. 356 27

Chronic venous stasis is an extremely complex clinical syndrome of pain and changes in the skin that can involve the superficial, deep, and perforating veins. This syndrome is commonly referred to as "the postphlebitic syndrome," implying that thrombophlebitis is its sole etiology. To test this hypothesis, we performed ascending venography on 51 limbs of patients with the chronic venous stasis syndrome and demonstrated that 32 had no radiological evidence of recent or old thrombophlebitis. Instead, they had normal-appearing veins, suggesting primary incompetence of the deep and/or perforating venous valves rather than thrombophlebitis as the etiology. Since various operations have recently been proposed to correct or bypass malfunctioning valves, precise demonstration of pathological change is required to choose the appropriate procedure and to evaluate results. Descending venograms were combined with the ascending studies in 42 limbs for this purpose. In addition to outlining the abnormalities responsible for chronic venous stasis syndrome in individual cases, interesting conclusions regarding the syndrome itself were reached.
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PMID:Radiological evaluation of the chronic venous stasis syndrome. 361 24

Studies of nifedipine have not shown that it reduces myocardial infarct size in humans. These studies did not consider the pharmacokinetics and dynamics of nifedipine. Oral doses of nifedipine cause high plasma concentrations and possibly harmful hemodynamic changes. Intravenous nifedipine infusion can rapidly achieve and maintain a steady concentration without repeated hemodynamic upsets. We studied 24-h intravenous nifedipine infusion in 12 patients with acute myocardial infarct, starting within 6 (mean 4.0 +/- 0.7) h of onset of pain, to determine its safety, pharmacokinetics, and dynamics. An intravenous nifedipine bolus of 15 micrograms/kg was followed by an infusion of 0.9 mg/h for 24 h. After the bolus, pulse rate rose 12.5 +/- 8.0 p less than 0.01) and blood pressure fell (systolic by 20 +/- 34, p less than 0.05, and diastolic by 7.5 +/- 15.6, p less than 0.05). There were similar but lesser changes during the infusion. Myocardial oxygen requirements, as measured by the rate-pressure product, did not increase. The mean nifedipine concentration at steady state was 17.2 +/- 4.2 ng/ml and mean elimination T 1/2 3.57 +/- 2.70 h. Nifedipine was discontinued in 3 patients because of hypotension (SBP less than 90), rapid atrial fibrillation, and complete heart block in one patient each. Seven patients developed thrombophlebitis. Large studies of this preparation examining infarct size limitation and mortality are feasible, although in view of the problems of thrombophlebitis in peripheral veins, shorter infusion times or infusion via central lines would be more acceptable.
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PMID:Nifedipine infusion in acute myocardial infarction: experience in twelve patients. 369 Sep 6

An exceptional complication of a slight sports injury of the knee with rupture of the semimembranosus bursa in a 29-year-old male football player is reported. The diagnosis was verified by immediate arthrography, consequently the possibility of thrombophlebitis could be ruled out. Anticoagulation is dangerous and contraindicated in rupture of the semimembranosus bursa due to the risk of developing compartment syndrome. Simple bed-rest for a week gave complete relief of pain.
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PMID:Ruptured semimembranosus bursa--an unusual complication following sports injury of the knee. 369 97

A follow-up evaluation of 357 patients injected with chymopapain ten to 20 years earlier included 97 females of mean age 42.2 years and 260 males of mean age 41.6 years. Pain distribution and physical findings were positive for discogenic involvement of long duration prior to chemonucleolysis. Eighteen patients were treated under worker's compensation. Postoperation, significant back pain persisted less than 24 hours in seven patients, less than six days in 133, less than 21 days in 178, from one to three months in nine, and between three and six months in two patients. Leg pain remained less than 24 hours in 32 patients, between one and five days in 212, between six and 21 days in 96, between one and three months in seven, and between six and 12 months in three patients. Similar improvement in extensor hallucis longus weakness and straight leg raising was also noted. Pain relief in the long term showed none persisting in the 158 patients or 44%, mild remaining pain in 107 or 30%, moderate pain in 71 or 20% and some pain in 21 or 6%. Thus the result was graded satisfactory in 74%. Complications included thrombophlebitis in two, pulmonary emboli in two, severe abdominal stress two days postoperation in one, severe anaphylatic reaction in one, and transient chest pain of undetermined etiology in one patient. All made good recovery from these complications.
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PMID:Clinical studies of chemonucleolysis patients with ten- to twenty-year follow-up evaluation. 370 68

The characteristics features of right-sided endocarditis are summarized in this case report of a 30-year-old female admitted with a history of high grade, continuous, fever, breathlessness, and dry cough over a 10-day period. The patient had had an incomplete abortion 15 days earlier for which dilatation and curettage was performed. On examination, the patient was toxic, febrile with a pulse of 118/minute and respiration 36/minute. Her blood pressure was 110/70 mm Hg. There was soft, tender hepatomegaly and soft splenomegely. There also were scattered coarse crepitations over both lungs. The vaginal examination revealed posterior fornicial bogginess and tenderness. Urine and cervical pus swab showed growth of klebsiella. The blood culture was negative. A plan chest X-ray revealed multiple, small, basal, pulmonary infiltrates. Posterior colopuncture revealed a small quantity of clear, yellowish fluid. Abdominopelvic ultrasonography revealed an ill-defined haziness in the parauterine region. The patient was treated with ampicillin, gentamycin, and metronidazole, but she continued to deteriorate. An urgent exploratory laparotomy was performed. The patient died on the 2nd postoperative day. The autopsy findings revealed that the heart was normal in size and shape. The tricuspid valve showed a large vegetation projecting into the ventricle. Microscopic examination revealed polymorphonuclear infiltration with clumps of gram-negative bacillifocal areas of myocarditis also were seen. In lungs the right lower lobe showed a small, hemorrhagic infarct. Both the liver and spleen were congested. Kidneys showed multiple petechiae on the external surface and on the cut section. Endocarditis during pregnancy may be because of perinatal infections, urinary tract infection, or septic thrombophlebitis of pelvi veins. Septic abortion of pelvic infection secondary to IUD also can provide portal of entry for bacteria. The common organisms are streptococcus, staphylococci, and occasionally bacteroides and gram negative bacilli. Clinical suspicion of right-sided endocarditis is justified in any patient with prolonged fever, cough, pleuritic pain, tachycardia, and multiple pulmonary infiltrates. Heart murmurs are usually absent and if present are soft and may be heard at atypical sites.
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PMID:Tricuspid valve endocarditis following septic abortion. 371 Oct 12

The late consequences of axillosubclavian vein thrombosis were evaluated through a clinical follow-up of 41 patients (45 limbs) treated from July 1975 to December 1985. The causes of the obstruction were classified into two main groups: Intrinsic damage, consisting of thrombophlebitis due to intravenous drug abuse (11 patients), central venous catheterization (10 patients), and hypercoagulability state (2 patients); and extrinsic obstruction, involving effort-induced or thoracic outlet obstruction (9 patients), underlying neoplastic disease (5 patients), trauma (3 patients), and congenital venous malformation (1 patient). Clinical diagnosis was confirmed by upper arm venography in all 41 patients, and all were initially treated by anticoagulation with heparin for 1 to 2 weeks, usually followed by oral warfarin for a variable period of 1 week to 5 years. Only three patients had an operation (rib resection for thoracic outlet obstruction, thrombectomy and clavicle fixation, and repair of a congenital venous malformation). Major early morbidity consisted of a documented pulmonary embolus in five patients, two in Group I and three in Group II, for an overall incidence of 12 percent. Clinical follow-up of up to 5 years revealed that chronic morbidity was related to our classification. Thrombosis secondary to intrinsic damage rarely caused persistent symptoms and responded well to anticoagulation alone. Conversely, when extrinsic obstruction was the cause, only 50 percent of patients were symptom-free, whereas many had disabling intermittent arm swelling and pain. Repeat venography in severely symptomatic patients revealed persistent obstruction with no recanalization. We conclude that patients with axillosubclavian venous thrombosis due to intrinsic damage do not require treatment other than anticoagulants, whereas patients with extrinsic obstruction often have poor long-term results from conventional therapy and therefore should be considered for adjunctive treatment with thrombolysins or operative intervention.
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PMID:Pathogenesis determines late morbidity of axillosubclavian vein thrombosis. 374 Mar 56

Eight patients with severe lower limb ischaemia, aged 65-80, received defibrotide intravenously for periods from 5 to 21 days (mean 13 days). All patients had intractable rest pain. Five had ischaemic ulcers and 3 had minor gangrene. Five had previous arterial surgery and 6 lumbar sympathetic ganglion injections. Pretreatment ankle pressure indices ranged from 0 to 0.5 (mean 0.19). Rest pain, sleep disturbance and analgesic requirement were assessed on a nominal scale. Rest pain improved in 4 and sleeping pattern in 2 patients. One patient showed a diminution in analgesic requirement. Pressure indices improved in 5 patients. Amputation was performed in 4 patients. Adverse reactions included vomiting and diarrhoea (2), thrombophlebitis at infusion site (3) and generalized skin reaction (1). All patients had 'end-stage' peripheral vascular disease but some showed symptomatic benefit. Further evaluation of defibrotide is indicated.
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PMID:Preliminary experience with defibrotide in severe lower limb ischaemia. 375 38

In three morbidly obese patients (mean weight 169 kg), severe hip pain developed immediately after gastroplasty. The differential diagnosis included thrombophlebitis, osteoarthritis and lumbar disc protrusion. The pattern of pain and associated numbness was characteristic of compression of the lateral cutaneous nerve of the thigh, a condition known as meralgia paresthetica. The likely cause was compression of the thigh by the metal post of the Gomez retractor. Only the most obese patients suffered this syndrome and all symptoms resolved spontaneously within 3 months.
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PMID:Meralgia paresthetica after gastroplasty for morbid obesity. 381 87


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