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

Intermittent incomplete intestinal obstruction was proven by sonography in 25 male and 48 female patients with an age range of 10 to 88 years. All of them suffered from intermittent colicky pain, nausea and meteorism followed by liquid stools. Only 52 patients had undergone a total of 69 abdominal operations. The pertinent symptoms could be traced back for 6 months to 10 years (4 +/- 3 years). In 47 patients, intake of bulky food during the last 12 to 48 hours triggered the onset of disorders. The preadmission diagnoses were: incomplete intestinal obstruction (only 21), gastroenteritis (15), biliary colic (13), peptic ulcer (10), renal colic (4), food intoxication (4), appendicitis (3), adnexitis (3). Sonographic findings were: inconstant lumen distension, visible bowel wall movements with contractions of 3 to 6 mm, food bolus, enhanced paradoxical peristalsis, proof of distended and collapsed gut segments, bowel wall edema and free peritoneal fluid. Based on these ultrasonic findings and trend observation, conservative treatment was successfully instituted. All patients were discharged symptom-free with no subsequent attacks for 12 months. 20 patients, subsequently suffering from complete intestinal obstruction after 1 to 3 years, were operated on, comprising 8 cases of intestinal resection, 7 cases of adhesiolysis and intestinal tube splinting, 3 cases of band dissection and 2 cases of palliative bypass procedures. The diagnostic accuracy of abdominal ultrasonography is clearly demonstrated by the fact, that 11 of these patients with intermittent incomplete intestinal obstruction and now suffering from complete obstruction had no previous abdominal surgery.
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PMID:[Intermittent incomplete ileus of the small intestine. Sonographic diagnosis and trends]. 217 61

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.
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PMID:Gallbladder surgery following cholecystlithotripsy: suggested guidelines for treatment. 203 21

Cholecystectomy is standard treatment for symptomatic cholelithiasis. Long term relief from symptoms, however, has not been reported. We reviewed 671 elective cholecystectomies performed between 1982 and 1987 for biliary colic (group 1, 91 per cent), dyspepsia associated with gallstones (group 2, 5 per cent) and atypical pain syndromes (group 3, 4 per cent), to define precisely important variables for comparison with alternate methods of gallstone treatment. Cholecystectomy resulted in a mortality rate of zero per cent and an over-all morbidity rate of 4.5 per cent. The procedure-related morbidity rate was 2.2 per cent. Long term follow-up period for 81 per cent of these patients (mean of 45 months) showed that 88 per cent were free of symptoms. Patients in groups 1 and 3 were more likely to obtain relief from symptoms than those in group 2 (p = 0.10). We concluded that cholecystectomy is a definitive treatment for symptomatic cholelithiasis with minimal risk to the patient and a high degree of relief from symptoms. Alternative treatments for gallstones must compare favorably with these results of modern cholecystectomy prior to acceptance and widespread use.
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PMID:Modern standards for comparison of cholecystectomy with alternative treatments for symptomatic cholelithiasis with emphasis on long-term relief of symptoms. 229 28

Sixty patients were treated in the emergency ward for biliary colic. Cholelithiasis was proven by ultrasonography. Twenty patients (group I) were treated by placebo. Twenty patients (group II) were treated by papaverine, and 20 patients were treated by diclofenac sodium (Voltaren) (group III). Twenty more patients (group IV) with low back pain (LBP) were treated with diclofenac sodium (Voltaren) as a control to assess the analgesic effect of Voltaren. Two interesting observations were made: Voltaren was proven more efficient for pain relief (P less than 0.002), and none of the patients treated with Voltaren were in need of hospitalization and immediate surgery. In comparison, nine patients of the other two groups progressed to acute cholecystitis and needed surgical intervention. The possible anticolic and anti-biliary inflammation properties and the indications for use of Voltaren are discussed.
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PMID:Biliary colic treatment and acute cholecystitis prevention by prostaglandin inhibitor. 210 77

At Baylor University Medical Center in Dallas, we began performing lithotripsy with the Medstone STS lithotripter for gallstones in January 1988 and in the first year treated 81 patients. Fifty-five of these patients were available for 4-month follow-up. We randomized half of the patients to receive ursodeoxycholic acid for 7 days prior to lithotripsy and gave all of the patients ursodeoxycholic acid after lithotripsy. Only 10.4 percent of the patients who contacted us ultimately proved to be candidates for lithotripsy. Gallstone fragmentation occurred in 95 percent of all patients and in 97 percent of those patients with solitary stones under 20 mm in size. The rate of clearance for solitary stones less than 20 mm in size was 50 percent. Unfavorable effects ascribable to lithotripsy were infrequent. All of the patients had pain before treatment, and one-third complained of biliary colic after treatment. Minor skin bruising which resolved in 1 to 5 days was found in 20 percent of the patients. This study lends credence to the findings of previous studies and demonstrates that lithotripsy combined with bile acid therapy is a useful therapy for cholelithiasis.
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PMID:Biliary lithotripsy. 267 41

The purpose of this prospective study, conducted on 88 patients, was to assess the tolerance, efficiency and early complications due to a piezo-electric lithotriptor in the destruction of gallbladder stones. One hundred and sixty one sessions were performed in 82 patients. All patients had symptomatic, uncomplicated lithiasis, the diameter of which was less than, or equal to, 30 mm. All patients had less than 7 stones in a functional gallbladder. In 22 patients, the stones were calcified. Lithotripsies were carried out without anesthesia or premedication, except in an 8-year-old child who had to be anesthetized. In 3 cases it was impossible to visualize the gallstones and in 3 other patients, the procedure was discontinued because of abdominal pain. Following the procedure, biliary pain occurred in 20 per cent of the patients. One patient only had biliary colic with transient anicteric cholestasis. Clinical examination, sonography, biological tests were found to be normal in all other patients. Endoscopic sphincterotomy or emergency surgery was never required. Stones were found to be unaltered in 6 patients following 2 lithotripsy sessions. The 76 other patients had fragmentation of their stones. The free gallbladder rate was 15.8 per cent between 0 and 2 months, 24.6 per cent between 2 and 4 months and 51.3 per cent between 4 and 8 months. These results tend to show that the destruction of biliary stones by piezo-electric lithotriptor is efficient and well tolerated. As repeated routine examinations were always negative, the three-day hospitalisation period no longer seems necessary.
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PMID:[Extracorporeal lithotripsy of gallbladder calculi. Tolerability, complications and early results]. 275 84

The inhibition of prostaglandin synthesis by nonsteroidal anti-inflammatory drugs can alleviate the pain and inflammation associated with a variety of disorders. Nonsteroidal anti-inflammatory drugs have a role, therefore, in the treatment of nonrheumatic conditions as well as in the treatment of rheumatic diseases, an area in which these agents have been used and studied more extensively. In clinical conditions marked by acute or chronic pain and inflammation, such as oral surgery, dysmenorrhea, low back pain, renal colic, and biliary colic, as well as in post-traumatic and postoperative conditions, diclofenac sodium, a nonsteroidal anti-inflammatory drug with potent prostaglandin synthetase inhibition, has been shown to be an effective analgesic agent. In the current studies, diclofenac was given orally or by intramuscular injection in doses ranging from 50 to 75 mg daily, or up to 150 mg per day for longer-term use. When compared with placebo, diclofenac provided consistently superior relief of symptoms. Comparisons with other nonsteroidal anti-inflammatory drugs or with opioids, such as pentazocine or Spasmofen, demonstrate that symptom relief with diclofenac was either comparable to or better than that obtained with these agents.
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PMID:Use of diclofenac in analgesia. 293 15

Fifteen patients with history of biliary colic, induceable by cholecystokinin, but normal oral cholecystogram and ultrasonogram were studied prior to and after cholecystectomy. Fasting duodenal bile, obtained preoperatively after administration of cholecystokinin, and gallbladder bile obtained at operation were analyzed. The lipid composition as well as the cholesterol saturation were within the range seen in gallstone-free subjects. The total lipid concentration of gallbladder bile was normal, whereas that of duodenal bile was reduced by about 50%, indicating a less efficient gallbladder emptying. In 10 of the 15 patients, the analysis of the excised gallbladder displayed macro- or microscopic abnormalities; two patients had cholesterol gallstones. At re-examination 9-27 months after the operation, 12 of the patients were completely symptom-free and two patients reported a clear improvement while on still had unchanged symptoms. It is concluded that cholecystectomy is the treatment to prefer in patients with "acalculous" biliary pain, induceable by cholecystokinin.
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PMID:Biliary colic without evidence of gallstones: diagnosis, biliary lipid metabolism and treatment. 346 Feb 88

In many countries, the pyrazolone derivatives, which include dipyrone, antipyrine, aminopyrine and propyphenazone, are widely used analgesics. Dipyrone, the most widely used pyrazolone, has been the most studied. The pyrazolidine derivatives, phenylbutazone and oxyphenbutazone, which are not generally used for analgesia since they differ from the pyrazolones in terms of efficacy and tolerance, are not discussed in this article. Dipyrone is an inhibitor of cyclo-oxygenase but, unlike aspirin, its effect is rapidly reversible. The inhibition of prostaglandin biosynthesis contributes to the analgesic activity of the pyrazolone derivatives. Peak plasma concentrations of the pyrazolone derivatives generally occur 1 to 1.5 hours after oral administration. Half-lives vary from 1 to 2 hours with propyphenazone, to about 7 hours with dipyrone (2 hours for the active metabolite of dipyrone, 4-methylaminoantipyrine, MAA). Half-life of antipyrine varies considerably between individuals (5 to 35 hours). Unlike the NSAIDs generally, the pyrazolone derivatives antipyrine, aminopyrine and propyphenazone are minimally bound to plasma proteins. The pyrazolones undergo extensive biotransformation, aminopyrine and dipyrone being converted to active metabolites. Dipyrone is the only drug for which results of recent double-blind trials are available. Oral dipyrone has been shown to be more effective than an equal dose of aspirin or paracetamol in alleviating postoperative pain, and intravenous dipyrone 2.5g was similar in efficacy to pethidine 50 mg. In patients with acute ureteral or biliary colic, dipyrone 2.5g intravenously was similar in efficacy to indomethacin 50 mg or pethidine 50 mg. The most frequently reported side effects of the pyrazolone derivatives are skin rashes. Gastrointestinal side effects are rare. Blood dyscrasias, mostly associated with aminopyrine, have received wide attention in the medical literature, but their true incidence with dipyrone is considerably lower than the often quoted incidence for amidopyrine reported more than 30 years ago.
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PMID:Pyrazolone derivatives. 355 86

Prostaglandins have been postulated to be involved in the formation of gallstones and the pain and inflammation of calculous gallbladder disease. This report evaluated prostaglandin E and F levels in patients with acalculous gallbladder disease. Control gallbladders were obtained from patients undergoing cholecystectomy during insertion of hepatic artery catheters for regional, hepatic chemotherapy. Patients without gallstones and with long-standing post-prandial biliary colic with abnormal cholecystokinin administration underwent cholecystectomy for chronic acalculous cholecystitis. A third group of patients underwent cholecystectomy for acute acalculous cholecystitis. Gallbladder mucosa and muscle were separated, and prostaglandin E and F concentrations in mucosal and muscle or mucosa were identified in gallbladders from patients with chronic acalculous cholecystitis compared to gallbladders from patients without biliary tract symptoms. In gallbladders from patients with acute acalculous cholecystitis a seven-fold increase in PGE production by muscle tissue and mucosal cells was found. The more histologically inflamed gallbladders had higher mucosal and muscle prostaglandin E concentrations than were found in less inflamed gallbladders. Prostaglandin F levels were not significantly changed or were decreased, resulting in a significant increase in the ratio of PGE/PGF in acutely diseased gallbladders when compared to normal gallbladders. Prostaglandin E may be a manipulatable intermediary in the sequence of events that results in the development of acute acalculous cholecystitis.
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PMID:The role of prostaglandins E and F in acalculous gallbladder disease. 359 60


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