Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors present the first Brazilian series of laparoscopic cholecystectomy. Forty-one patients were operated on for gallstone disease between July and December 1990. Thirty-one operations were conducted by laparoscopy with no complications and good recovery of the patients. Two had to be submitted to laparotomy due to acute cholecystitis and a very difficult field for dissection. The authors concluded that the procedure is feasible, safe and has great advantages such as better cosmetic result, shorter hospital stay and home recovery time, lower postoperative pain and lower personal and social cost.
 ...
PMID:Videolaparoscopic cholecystectomy. Report of the first Brazilian series. 184 89

Two hundred and sixty two patients with gallbladder stones were prospectively evaluated at the Biliary Lithiasis Treatment Unit of the Mater Dei Hospital, Belo Horizonte, MG., and 45 (17.5%) were selected for extracorporal shock wave lithotripsy (ECSWL). From these, 32 were submitted to the procedure. One stone was present in 30 patients, 2 stones in another and 1 patient had 3 stones. The mean diameter was 14.7 mm ranging from 8 to 28 mm. ECSWL was preceded by 1 week course of ursodeoxycholic acid (8 to 10 mg/dk/day) and this medication was continued after the procedure. ECSWL was done with the Lithosthar-Plus apparatus (Siemens). Meperidine (up to 100 mg) IM and pirazolene IV was given when necessary. The intensity of the shock waves was gradually increased to a maximum (9 bar) whenever tolerated. The treatment was well succeeded in 22 cases (71%) with pulverization in 12 (38.7%). In 9 patients (29%) remaining fragments were greater than 4 mm. From these, 3 were submitted to a second session of ECSWL. In 1 patient the stone could not be properly positioned for lithotripsy. The mean number of shock waves was 2,591, ranging from 801 to 4,411. The mean duration of the sessions was 80 min, ranging from 45 to 150 min. In 3 patients, a complete disappearance of fragments was observed in intervals of 1 to 6 months after the procedure. One patient had severe pain during ECSWL and developed acute cholecystitis. One patient had sinus bradycardia. One patient with total stone pulverization, become jaundiced 1 month after ECSWL and a gallbladder carcinoma was found at surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Lithotripsy of gallbladder calculi with extracorporeal shockwaves]. 184 44

Prostaglandins GE2 produces on the gallbladder a rise in intraluminal pressure, an increase in in intraluminal secretion, improves gallbladder contraction and decreases its absorption capacity. In this study, patients who received indomethacin twice a day by rectum, showed a significant reduction in volume and area of gallbladder after 24 and 48 hours (P < 0.05). The gallbladder volume after 24 hours had SEM 9.13 cm3, 95% CI 55.28 + 73.49 (P < 0.05). Score pain reduction after 24 hours was also significant (P < 0.001). The patients who underwent the classical Baralcina treatment of one IV vial BID showed a reduction in diameter and area of gallbladder but this was not statistically significant (P < 0.10). Reduction of volume at 24 hours was SEM 5.34 cm3 95% CI - 64.72 + 76.60 P 0.10 NS; and at 48 hours SEM 3.5 cm3, 95% CI 59.52% + 66.52 P 0.40. Score pain reduction was only significant at 48 hours P 0.001. The number of patients without pain at 24 hours was significantly higher in the indomethacin group ESP 0.21; 95% CI 0.46 + 0.88 P 0.001. In conclusion indomethacin is a useful medication in the treatment of acute cholecystitis and biliary colic due to its anti-prostaglandin effect on the gallbladder.
 ...
PMID:[Indomethacin in the treatment of acute cholecystitis and biliary colic]. 184 81

Personal experience in the treatment of acute cholecystitis with percutaneous cholecystostomy in high risk patients and in elderly patients is reported. Between January 1989 and November 1990, 28 patients affected by acute cholecystitis were treated with percutaneous cholecystostomy at Emergency Surgery Department, Verona University Hospital. The patients treated included 13 men and 15 women; 8 of them were under 70 years old, 5 between 70th and 75th and the remaining patients over 75 years old. The suspected clinical diagnosis of acute cholecystitis was confirmed in all cases by ultrasonography (accuracy 95.4%). The percutaneous cholecystostomy was successful in 26 over 28 cases. In all these cases patients had a sudden improvement of their clinical conditions. In one case we failed because the guide-wire slipped out of the gallbladder and we couldn't perform a second attempt for the patient's refuse; in an other case there was the dislodgment of the catheter after less than 12 hours from the cholecystostomy and the patient was operated on. Twenty-two of 26 patients whose conditions were improved by percutaneous cholecystostomy, subsequently underwent elective cholecystectomy. In 2 cases of acalculous cholecystitis the patients did not undergo the operation; in 2 cases because of the elderly age of the patients and their bad cardiorespiratory conditions we preferred not to perform the operation. We had not major complications; 6 patients complained pain irradiating to right shoulder which disappeared within 30-60 minutes from the end of the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[The role of echo-guided percutaneous cholecystectomy in acute cholecystitis]. 195

The importance of clinical, laboratory and imaging data in the diagnosis of acute cholecystitis (AC) was studied in 825 patients with right upper quadrant pain hospitalized in the Surgical Clinic of the Fundeni Hospital--Bucharest, between January 1, 1986 and June 30, 1988. A number of 21 parameters were analysed in each case. Of these 825 patients, 259 were considered after surgery as AC. These 259 cases were divided, after the microscopical examination of the surgically-obtained specimens, into two groups: 1) pathologically confirmed AC (137 cases) and 2) pathologically non-confirmed AC (122 cases). The importance of every parameter in establishing a histologically confirmed diagnosis of AC was determined by the diagnostic probability calculated according to Bayes'theorem. The hierarchy of the value of parameters in the diagnosis of AC was based on their capacity to distinguish between the cases histologically confirmed and those detected on surgery, but without microscopically demonstrated changes of AC. The same decision criterion was used in building the decision trees in the exploration of the cases of presumed AC. In the 825 cases with right upper quadrant pain, the main and most frequent cause was chronic calculous cholecystitis (31.8%), followed by AC pathologically confirmed (16.6%), AC non-confirmed (14.7%) and chronic acalculous cholecystitis (12.4%). The most useful parameters in distinguishing between pathologically confirmed AC and pathologically non-confirmed AC were: 1) sudden onset of pain; 2) mild resistance to abdominal palpation; 3) frank peritoneal irritation; 4) stone impacted in the gallbladder neck (ultrasonography); 5) fever; 6) palpable gallbladder; 7) lithiasis (ultrasonography); 8) gallbladder wall with double outline (ultrasonography). Ultrasonography supplied a diagnostic probability of 85% for the correct diagnosis of AC in cases without a clinical picture suggestive for AC. The decision tree analysis supported the same conclusion: only ultrasonography gives a good distinction between pathologically confirmed AC and pathologically non-confirmed AC.
 ...
PMID:Decision analysis in the clinical and imaging diagnosis of acute cholecystitis. 210 Aug 78

We report a retrospective series of 20 cases of peri-hepatitis diagnosed using the laparoscope. They were all young women who were nulliparous or primiparous. In eight cases, the dominant clinical picture was of acute cholecystitis. In the other cases, asymptomatic peri-hepatitis was discovered when the laparoscope had been used to try to diagnose acute salpingitis. Chlamydia trachomatis is the principal aetiological agent (in 18 cases) and it has overtaken the gonococcus which was the common one in early publications but here was responsible for only one case. Treatment with tetracyclines or quinolones always brings about a cure. Whenever a young woman complains of pain in the right hypochondrium, one has to think of this infection as well as diagnosing and treating the associated salpingitis early.
 ...
PMID:[Chlamydia trachomatis perihepatitis (Fitz Hugh-Curtis syndrome). Apropos of 20 cases]. 214 4

The increasing detection of asymptomatic gallstones leads to difficult decisions for the surgeon and patient about whether the stones should be managed expectantly or surgically. This review examines the evidence currently available upon which such decisions must be based. Gallstones may present as biliary pain, acute cholecystitis, biliary obstruction or pancreatitis, but it is not clear who will develop symptoms and what are the commonest initial symptoms. Studies of the natural history of silent gallstones suggest that a large majority of patients with such stones will remain asymptomatic. However, diabetics are at increased risk, as are patients whose stones are detected initially at laparotomy. Incidental cholecystectomy is usually safe, and preoperative detection by ultrasonic screening is an advantage in planning the operation. Prophylactic cholecystectomy is not indicated to prevent gallbladder carcinoma (except in cases of porcelain gallbladder) and there is conflicting evidence about whether cholecystectomy predisposes to colorectal carcinoma.
 ...
PMID:Asymptomatic gallstones. 218 58

A 48-year-old man developed progressively more severe epigastric pain, pain on pressure in the right upper abdomen and fever up to 38.6 degrees C so that acute cholecystitis was suspected. Ultrasound did not demonstrate a gall-bladder but a sickle shaped, dense echo with a distal adjoining echo-free zone. Computed tomography revealed air in the gall-bladder lumen as well as intramural and pericholecystic air pockets, findings pathognomonic for emphysematous cholecystitis. In addition pneumoperitoneum was diagnosed. Subsequent cholecystectomy intraoperatively revealed a gangrenous, nonperforating gall-bladder in which E. coli was demonstrated. During the first postoperative week, there were no complications under transitory antibiotic treatment with tobramycin and ticarcillin with clavulanic acid. Then, an abscess developed in the residual gall bladder bed; this abscess was cured after drainage, local irrigation and re-initiation of antibiotic treatment. The patient was finally discharged well.
 ...
PMID:[Acute emphysematous cholecystitis as a cause of pneumoperitoneum]. 222 58

Twenty-three of 229 symptomatic patients undergoing cholecystlithotripsy underwent surgical intervention: 22 of the patients had cholecystectomy performed (five also undergoing choledochotomy) and one patient had a cholecystostomy. Of these 23 patients, five were lithotripsy failures, five developed acute pancreatitis, one had acute cholecystitis, and one had cholangitis. One patient had her gallbladder removed incidentally at the time of surgery for a bleeding gastric ulcer. Ten patients underwent surgery for recurrent biliary pain, probably related to fragment passage via the cystic duct. We suggest that up to 16 of these 23 patients did not necessarily require cholecystectomy, i.e. five patients with pancreatitis, one patient with cholangitis and ten patients with recurrent biliary colic. Conservative and/or endoscopic management may be successful in the first instance to allow further treatment with lithotripsy in the majority of patients. If, however, the expertise to perform endoscopic sphincterotomy is not available or the patient declines further lithotripsy, then resort to surgery may be necessary. We propose that it is the responsibility of the management team in charge of the lithotripsy unit to inform both the patient and the referring clinicians of the possible side-effects and outcome of treatment in an attempt to avoid unnecessary surgical procedures.
 ...
PMID:Gallbladder surgery following cholecystlithotripsy: suggested guidelines for treatment. 203 21

At Zurich fragmentation of gallstones is a joint venture between the Visceral Surgery Clinic, the Medical Clinic, Medical Policlinic, Radiodiagnostic Central Institute and Urologic Clinic. Lithotripsy is performed by a team from the Visceral Surgery Clinic with apparatus placed at their disposal by the Urologic Clinic. Indications for lithotripsy include symptomatic cholecystolithiasis, functioning gallbladder, and up to 3 gallstones of at least 10 mm and at most 30 mm diameter. Bile duct stones, acute cholecystitis, coagulopathy, pregnancy, aortic aneurysm and pacemakers are exclusion criteria. Patients spend two days in hospital, lithotripsy is performed without anesthesia, and outpatient follow-up is performed 1, 3, 6 and 12 months afterwards. Our experiences show that lithotripsy is more difficult and more treatments are needed if multiple gallstones are present. We had to perform cholecystectomy in 6 of a total 48 patients, mainly because of therapy resistant biliary pain due to stone fragments. The intraoperative findings did not correspond to the ultrasonic examination before lithotripsy in two of the patients who underwent cholecystectomy. Histologic examination of the six gallbladders in the surgical cases showed no abnormality. After an average treatment duration of 209 days, 9 of 48 patients are stone-free, 15 patients show improvement, in 14 patients no distinct reduction of fragments could yet be shown in recent follow-ups and 4 patients have not yet been reached for follow-up. Of the 230 patients examined lithotripsy was indicated only in 48 (21%) cases.
 ...
PMID:[The organization of gallstone lithotripsy using the MPL-9000 at the Zurich University Hospital, successes and failures. Initial results]. 233 87


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>