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

A variety of operations have been proposed for the treatment of radiation injuries of the rectum. In this study, the procedure advocated by the late Sir Alan Parks--resection of the diseased segment down to its points of fixation to the vagina, bladder or prostate; with perianal mucosal stripping of the anorectal segment and primary coloanal (pull-through) anastomosis--was performed in 11 patients. In two others, an attempt at colorectal anastomosis was abandoned because of extreme scarring in the pelvis. The procedures were done following definitive treatment of carcinoma of the rectum (seven patients), carcinoma of the cervix (two patients), carcinoma of the uterus (one patient), carcinoma of the ovary (one patient), seminoma (one patient), and carcinoma of the bladder (one patient). One patient died from a pulmonary embolus on the seventh postoperative day. Of the survivors with a coloanal anastomosis, all had successful closure of their temporary colostomies with follow-up from one to six years. In eight, continence was assessed as being good or excellent. Four patients required anastomotic dilation and another required a surgical procedure for anastomotic stricture. There was one instance each of reoperation for small bowel obstruction and ileocolic fistula. There were no instances of recurrence of hemorrhage, fistulas, perineal pain or tenesmus. The Parks procedure obviates the need for a difficult dissection of the lower rectum and separation of tissues damaged by radiation and avoids the need for eversion techniques. Its selective use is advocated for patients suffering from severe radiation injuries of the rectum.
Dis Colon Rectum 1985 Feb
PMID:Parks' coloanal pull-through anastomosis for severe, complicated radiation proctitis. 397 3

Strictureplasty recently has been advocated in the treatment of obstructive strictures of the small bowel in patients with Crohn's disease. In contrast to conventional methods of treatment, such as conservative therapy with total parenteral nutrition (TPN) or surgical resection of the involved bowel, strictureplasty eliminates the obstruction without loss of small bowel. The possibility of creating a short-bowel syndrome is of special concern in patients with diffuse Crohn's jejunoileitis. These patients usually present for surgery with chronic obstruction, anemia, weight loss, and malnutrition with folate and other vitamin deficiencies. The authors report the results of 12 strictureplasties for extensive Crohn's jejunoileitis in three patients presenting with chronic obstruction secondary to multiple small-bowel strictures. Both Heineke-Mikulicz and Finney strictureplasties were performed. In two patients, resection of an acutely inflamed phlegmonous segment was also performed. Symptoms (pain, abdominal distention, and nausea) were markedly improved postoperatively in all patients. Nutritional parameters, including serum albumin and total lymphocyte count, improved postoperatively. Dramatic rises in weight were noted also. All three patients were symptom-free six months postoperatively.
Dis Colon Rectum 1985 Jul
PMID:Strictureplasty in diffuse Crohn's jejunoileitis. 401 13

The consequences of jejunoileal bypass include not just metabolic derangements, though the frequency and severity of these problems have led to the procedure being abandoned in the treatment of morbid obesity, but a variety of mechanical complications as well. In this report, a new mechanical complication is presented: Intussusception of the defunctionalized ileum into the sigmoid colon, an intussusception caused by malignant lymphoma of the ileum. Because the patient had pain but no evidence of obstruction, the ileal tumor was fortuitously discovered during flexible sigmoidoscopy.
Dis Colon Rectum 1985 Oct
PMID:A unique late mechanical complication of jejunoileal bypass. 405 80

Internal sphincterotomy is thought by most surgeons to have minimal complications. We retrospectively reviewed 306 patients following internal sphincterotomy to determine the incidence of any complications. Major complications (requiring reoperation) caused by fistula, bleeding, abscess, or unhealed wounds occurred in ten patients (3 percent). Minor complications caused by pruritus, persistent wound, pain, bleeding, abscess, discharge, urgency, impaction, or defects of continence occurred in 110 patients (36 percent). Complications were lowest for closed sphincterotomy (20 percent) and highest for open sphincterotomy alone (55 percent). All patients were cured of anal fissure or stenosis. Long-term follow-up (average 4.3 years) revealed a 22 percent incidence of persistent minor complications. Defects in continence caused 15 percent of total long-term morbidity. Minor complications occur frequently after internal sphincterotomy for anal fissure and stenosis. Closed sphincterotomy has the lowest complication rate. Long-term minor defects in continence occur in a significant number of patients.
Dis Colon Rectum 1985 Nov
PMID:Morbidity of internal sphincterotomy for anal fissure and stenosis. 405 94

The records of 58 patients treated by radiotherapy for presacral recurrent rectal cancers between 1975 and 1982 were evaluated. Pain was one of the most distressing symptoms, occurring in 38 of 58 patients (66 percent) which, in 90 percent (34 of 38) of patients could be controlled by radiotherapy. Side effects were mild, and could be treated conservatively. The crude survival of the patients was 19.8 months (range, 3 to 71 months). Only 3 percent of those treated survived five years. The dose-survival study showed increased survival of patients treated with more than 44 Gy. Because of negative selection of patients irradiated with lower doses, certain conclusions cannot be made. Surgery, if performed radically, is the treatment of choice. But patients with inoperable disease treated with radiotherapy benefit symptomatically, and might have increased survivals with a small chance of cure.
Dis Colon Rectum 1985 Dec
PMID:Radiotherapy of presacral recurrence following radical surgery for rectal carcinoma. 406 50

Sixty-six patients were operated upon for third- or fourth-degree hemorrhoids during the period of January 1982 through November 1983. A single injection of epidural morphine was given for relief of postoperative pain. Eighty-three point three per cent of the patients needed no other analgesics and 16.7 per cent required only mild analgesics. There were no complications observed after surgery.
Dis Colon Rectum 1984 Aug
PMID:Epidural morphine for post-hemorrhoidectomy analgesia. 646 89

The case records of 12 patients with cecal volvulus over a 20-year period were reviewed. The patients averaged 46.7 years old; 75 per cent were white and 67 per cent were male. Patients presented with signs and symptoms of intestinal obstruction. Pain and distention were present in more than half of the patients. X-rays assisted in making the diagnosis of cecal volvulus in only five of the patients. Diagnosis was made in the remainder at the time of surgical exploration. At operation, one cecum was necrotic and required resection. Five patients underwent cecostomy, two cecopexy, and four simple detorsion. Post-operatively, one patient developed a wound infection. There were no deaths. Follow-up for seven patients averaged 75 months each. One patient who had undergone simple detorsion developed another cecal volvulus. All who were contacted were alive and well. At St. Luke's Hospital, cecal volvulus generally occurs in middle-aged white males. Cecostomy or cecopexy adequately treats cecal volvulus when the cecum remains viable. This study demonstrates that prompt surgical intervention, before strangulation of the colon occurs, results in low mortality even in city hospital patients.
Dis Colon Rectum 1984 Nov
PMID:Cecal volvulus. Low mortality at a city hospital. 649 9

Proctitis cystica profunda is an uncommon benign rectal condition with a range of appearances that has led to confusion in nomenclature. In a personal series of 28 patients with histologically proven proctitis cystica profunda, over 50 per cent had associated rectal prolapse. Cure of the prolapse cured the proctitis cystica profunda in 80 per cent of the patients only. Direct surgical excision (local or segmental) has not been successful and two patients have required a stoma for relief of pain.
Dis Colon Rectum 1984 Mar
PMID:Proctitis cystica profunda. Incidence, etiology, and treatment. 669 41

The treatment of a patient for multiple recurrent pilonidal disease failed all forms of conventional therapy. After re-excision, a gluteus maximus myocutaneous flap, measuring 15 X 15 cm and based on the superior gluteal artery, was swung to cover the defect. Complete relief from severe pain was obtained immediately. No recurrence is noted after two and one-half years of follow-up.
Dis Colon Rectum 1984 Apr
PMID:Gluteus maximus myocutaneous flap for the treatment of recalcitrant pilonidal disease. 671 36

Posterior transmucosal myotomy of the small bowel distal to the pelvic pouch was carried out in two patients who underwent restorative proctocolectomy for ulcerative colitis. Painful spasms of the efferent limb and outlet obstruction of the reservoir were the main indications for surgery. Laparotomy was unnecessary, as the operation could be performed either through a transanal route or by means of a rigid sigmoidoscope. Both patients showed marked clinical improvement after myotomy; therefore, it may be considered an effective and safe procedure in the treatment of functional and mechanical disorders of the small intestine above an ileoanal anastomosis.
Dis Colon Rectum 1984 May
PMID:Transmucosal myotomy of the small bowel after ileoanal anastomosis. 671 49


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