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

The prospectively collected data from 530 cholecystectomies performed in a university clinic from October 1989 to March 1991 were analyzed after 1 to 3 years of follow-up. The aim of this study was to compare the results of laparoscopic cholecystectomy (LC) for acute cholecystitis with that for routine symptomatic gallbladders. The preoperative, intraoperative, and postoperative parameters of 424 routine (noninflamed) LCs and 54 LCs for acutely inflamed gallbladders were compared under the "intention to treat" principle. Operating time was longer in the inflamed group (median 97 minutes versus 75 minutes; p < 0.0001). Significantly more adhesions (20% versus 8%), more blood loss (48% versus 19%), a higher incidence of bile spillage (28% versus 12%), and lost stones (19% versus 8%) were encountered in patients with acute cholecystitis. Common bile duct (CBD) injuries were also more frequent in that group (5.5% versus 0.2%; p = 0.005). The rate of conversion to open surgery was higher than with routine LCs (13% versus 4%). There were two deaths in the routine LC group and none in the acutely inflamed group. There was no difference in postoperative pain intensity or postoperative fatigue according to visual analog scale measurements. Patients with acute cholecystitis stayed only 1 day longer (median 4 days versus 3 days) in hospital. The quality of life scores indicate return to almost normal values by the 14th postoperative day. Long-term follow-up (1-3 years) did not reveal any delayed clinical adverse effects. In summary, LC for inflamed gallbladders has a higher conversion rate than LC for routine symptomatic gallbladders. If successfully performed, it has definite benefit for the patient in terms of better postoperative recovery. The trade-off is that the risk of CBD injury is significantly higher.
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PMID:Laparoscopic cholecystectomy for acute cholecystitis: is it really safe? 858 11

Pharmacological intervention with either cholecystokinin-8 (CCK-8) or morphine during 99mTc- hepatoiminodiacetic acid (HIDA) cholescintigraphy is required primarily for the assessment of the diseases affecting the gallbladder, the common bile duct, or the sphincter of Oddi. For imaging, the patient should be prepared by an overnight fast, or with 4 hours of minimum fast. Pre-emptying with CCK-8 is probably undesirable and should either be avoided or one should wait for at least 4 hours after CCK-8 to begin the 99mTc-HIDA study to achieve higher specificity of the test for acute cholecystitis. When he gallbladder is not observed by 60 mins in a clinical setting of acute cholecystitis, a dose of 0.04 mg/kg of morphine is administered intravenously and imaging continued for an additional 30 mins. Nonvisualization of the gallbladder by 90 mins with morphine in an appropriate clinical setting is diagnostic for acute cholecystitis. When the gallbladder is not observed by 60 min but is seen with morphine administered after 60 mins, a positive diagnosis of abnormal gallbladder function can be made. When the gallbladder is observed in a clinical setting of biliary pain or chronic calculous or acalculous cholecystitis, CCK-8 at a dose rate of 3.3 ng/kg/min is infused intravenously for 3 mins (10 ng/kg/3 min) for the measurement of the ejection fraction. An ejection fraction value of less than 35% is indicative of calculous or acalculous chronic cholecystitis. The gallbladder emptying is directly related to the total number of cholecystokinin receptors in the smooth muscle. The ejection fraction can be controlled to any desired level simply by controlling the dose rate or the duration of infusion of CCK-8. Morphine and other opiate metabolites circulate for many hours in blood and act on the sphincter of Oddi and decrease the gallbladder ejection fraction. Careful drug history, especially that of opiates, is very critical in all subjects with a low ejection fraction before assigning an abnormality to the gallbladder motor function.
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PMID:Cholecystokinin and morphine pharmacological intervention during 99mTc-HIDA cholescintigraphy: a rational approach. 862 48

Contrary to earlier opinions, the laparoscopic cholecystectomy (LC) is not a contraindication in the acute cholecystitis. The most important parameter in determining the feasibility of attempting laparoscopic cholecystectomy in the setting of acute inflammation appears to be the experience of the surgeon. 59 cases with LC are analyzed: 50 LC and 9 conversion. The operations were more difficult and lasted longer. The patients appeared to be at a greater intraoperative risk and the conversion rate was also higher. Neither lesions of the common bile duct nor deaths were recorded. The advantages of the method (the hospital stay was reduced, less postoperative pain, and early return to normal activities) should not make the surgeon disregard the risks and stubbornly employ LC in acute cholecystitis.
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PMID:[Laparoscopic cholecystectomy in acute cholecystitis]. 864 25

The analysis of treatment of non-calculous cholecystitis in 18 children has been done. Their age was between 5 and 14 years. The diagnosis has been done after several examinations because of recurring pain. The X-ray investigation was most important for the diagnosis and indications for surgery. The indications were: severe recurrent pain, short term remission after acute cholecystitis and gallbladder organic disorders (strangulation, long cystic duct and poor evacuation). Organic disorders of gallbladder and cystic duct were found in all cases intraoperatively. In all patients cholecystectomy has been performed. Long-term results were followed up in 15 patients. Total relieve of chronic pain in all cases shows that timely operation provides good results.
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PMID:[Non-calculous cholecystitis in children]. 892 58

The clinical picture of acute cholecystitis complicated by jaundice has four main types: with the prevailing syndrome of inflammation of the gallbladder, of the pancreatic syndrome, of the cholangitis syndrome and of the profound pain syndrome by the type of renal colic. Echography is thought to be an informative preoperative method of diagnostics of the cause of jaundice, its significance being increased when combined with the percutaneous transhepatic cholangiography (94.4%). The patients must be operated upon within 24-28 hours. The intervention volume must be adequate to the type of the injury independent of the patient's age and of the degree of concomitant diseases.
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PMID:[The characteristics of the clinical course and diagnosis of acute cholecystitis complicated by jaundice]. 896 96

Acute abdominal pain is a frequent diagnostic and therapeutic challenge in hematologic patients. We report on the very rare case of organ endometriosis with acute abdominal symptoms in a 43-year-old female patient with AML-M5, starting 4 days after induction chemotherapy with idarubicin, ara-C, and etoposide. The patient presented with an acute abdomen with clinical findings of acute cholecystitis, subileus, and local pain in the right upper abdomen accompanied by severe diarrhea. Probably due to impaired intestinal resorption, menstrual bleeding occurred despite regular administration of lynestrenol. Ultrasound examination of the abdomen disclosed a tumor with poor echoes in the pouch of Douglas, a subcapsular splenic hemorrhage, and a thickened gallbladder wall with surrounding edema. A cystic adnex tumor was confirmed by endovaginal ultrasound. Based on history and the findings on ultrasound, an endometriosis was diagnosed, and the LHRH agonist (nafarelin) was administered nasally in combination with lynestrenol. Following this medication the abdominal pain ceased, supporting the diagnosis of endometriosis. Nasal administration of an LHRH agonist in the following cycles of chemotherapy was effective in preventing further abdominal discomfort and vaginal bleeding. LHRH agonists should be given to patients with known endometriosis before starting myeloablative chemotherapy to prevent painful hemorrhage from endometriosis.
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PMID:Acute abdomen due to endometriosis as a diagnostic and therapeutic challenge in the treatment of acute myelocytic leukemia. 903 12

The authors discuss the possibility of changing out laparoscopic cholecystectomy during the first clinical manifestation of acute cholecystitis. The international published series report similar results to those found with the laparotomic operation. There is no common operating conduct either or regards surgical technique or the diagnosis of possible pathologies of biliary ducts. It is shown the effective improvement of the pain, the lowest complications and the duration of the postoperative course which, especially in old patients, results considerably diminished with consequent advantage for them.
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PMID:[Laparoscopic management in acute cholecystitis]. 906 82

Topical dissolution of cholesterol gallbladder stones using methyl tert-butyl ether (MTBE) is useful in symptomatic patients judged too ill for surgery. Previous studies showed that ethyl propionate (EP), a C5 ester, dissolves cholesterol gallstones rapidly in vitro, but differs from MTBE in being eliminated so rapidly by the liver that blood levels remain undetectable. Our aim was to test EP as a topical dissolution agent for cholesterol gallbladder stones. Five high-risk patients underwent topical dissolution of gallbladder stones by EP. In three patients, the solvent was instilled via a cholecystostomy tube placed previously to treat acute cholecystitis; in two patients, a percutaneous transhepatic catheter was placed in the gallbladder electively. Gallstone dissolution was assessed by chromatography, by gravimetry, and by catheter cholecystography. Total dissolution of gallstones was obtained in four patients after 6-10 hr of lavage; in the fifth patient, partial gallstone dissolution facilitated basketing of the stones. In two patients, cholesterol dissolution was measured and averaged 30 mg/min. Side effects were limited to one episode of transient hypotension and pain at the infusion site; no patient developed somnolence or nausea. Gallstone elimination was associated with relief of symptoms. EP is an acceptable alternative to MTBE for topical dissolution of cholesterol gallbladder stones in high-risk patients. The lower volatility and rapid hepatic extraction of EP suggest that it may be preferable to MTBE in this investigational procedure.
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PMID:Successful topical dissolution of cholesterol gallbladder stones using ethyl propionate. 920 Oct 95

Analysed were the results of all 48 patients with acute cholecystitis, who underwent laparoscopic cholecystectomy between 1991 and 1995 in the department of general surgery, AKH, University of Vienna. In 18 cases it was necessary to convert to laparotomy. In a second step the results of these two groups of patients were compared with results of patients without acute cholecystitis, who elective underwent laparoscopic cholecystectomy. In about 2/3 of the patients with acute cholecystitis laparoscopic cholecystectomy is possible. In these cases we found a mean postoperative hospital stay of 4.4 days, with a significant difference between those with drain (5.9 days) and those without (2.7 days). In cases of laparotomy the mean postoperative stay was 7.7 days, also significant longer. These patients consumed at the first postoperative day more than 1.5 times of opioid analgetics than those, who underwent laparoscopy with acute cholecystitis, laparoscopied patients without acute cholecystitis half of this. After the second postoperative day patients after laparotomy took 3 times of opioid analgetics than patients after laparoscopy, no matter if there was an acute cholecystitis or not. The rate of conversion to laparotomy sank with the increase of experience of a surgeon. Postoperative benefit of laparoscopic treatment, as less pain and shorter hospitalisation, can be saved even in cases of acute cholecystitis. So the management should primary be laparoscopic.
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PMID:[Postoperative benefit after laparoscopic cholecystectomy in acute cholecystitis]. 922 39

Four (1.2%) out of 321 patients required percutaneous transhepatic gallbladder drainage (PTGBD) following cardiovascular surgery. Cholecystitis was initially suspected based upon the occurrence of postoperative fever and the results of abdominal X-ray films. The main physical finding was tenderness of the right upper quadrant abdomen in all patients. Spontaneous pain and Blumberg's sign were not apparent. Distension of the gallbladder and sludge in the gall-bladder were detected in all four patients by ultrasonography, but calculi were not observed. Thickening and edema of the gallbladder wall, generally suggestive of cholecystitis, were observed in only one patient. PTGBD was performed from 5 to 43 (mean 16) days after surgery. The drained fluid was concentrated bile and not purulent. High fever dropped and serum transaminase and C-reactive protein levels decreased within three days after PTGBD. Bacteriologic examinations of the bile and arterial blood were negative in all cases. No complications as a result of PTGBD introduction occurred. PTGBD is a safe and effective procedure, and therefore should be actively performed even in the early phase of acute cholecystitis.
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PMID:Percutaneous transhepatic gallbladder drainage for acute acalculous cholecystitis following cardiovascular surgery. 935 11


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