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

Out of a total of 120 patients operated on for recurrent ovarian cancer, two at the very best, but possibly not even one, will have a definitive chance of cure. Despite the poor long-term prognosis, as well as the lengthy operation and postoperative treatment involved, it does not seem justified to withhold surgery for recurrent disease totally. In some cases, symptoms can be treated with surgery, such as tumour pain or an impending ileus. In other cases, patients live for 10 years and longer, after multiple operations for relapse, without suffering severe physical symptoms. These are mainly patients with circumscribed, solitary, and very slowly growing tumours, in which cases, it is possible to remove the tumour again and again by surgery. The most relevant prognostic factors include the size of the residual tumour left at the primary operation, the time between the primary operation and the recurrence of the tumour, the type of growth of the recurrent tumour, as well as the extent of the tumour size reduction achieved at the first recurrence operation.
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PMID:[Surgical therapy of progressive or recurrent malignant ovarian tumors]. 171 89

The effect of a fractional epidural blockade on acute pancreatitis was investigated in a prospective study. PATIENTS AND METHODS. Thoracic (20 patients) or lumbar (six patients) epidural blockade was carried out in 26 patients with severe abdominal conditions comprising sub-ileus in 100%, pancreatic edema indicated by sonography/computer tomography in 57.8%, and necrosis of the pancreas in 34.6%. RESULTS. On average, 3.4 (1-6) injections with single doses of 6-20 ml 0.25% bupivacaine were injected per day. In four patients, morphine (up to 4 mg per 24 h) was added to the local anesthetic. The duration of treatment was between 1 and 15 days. After 10.5% of the injections, the systolic pressure decreased by more than 20%, and after 12.8% of the injections the blood pressure decreased by more than 30%. Hypotension of more than 30% was treated with 0.3 to 0.5 ml theodrenaline (Akrinor) and/or 0.1 to 0.2 mg dihydro-ergotamine (Dihydergot). General analgesics had to be administered in addition on 21.8% of the treatment days and intensive care treatment (artificial ventilation) on 32% of the treatment days. The duration of epidural analgesia varied between 1 and 15 days depending on the intensity of symptoms (pain, ileus). Within 4 days, the enzyme activity of the lipase fell from 8120 to 427 IU, and that of alpha amylase fell from 1401 to 143 IU. In 3 patients laparotomy (for drainage) was performed. An ERCP was carried out in 16 patients. Cardiopulmonary failure necessitated artificial ventilation over a period of 1-15 days in 6 patients; the epidural blockade was continued during the artificial ventilation. Cholecystectomy was carried out as an interval operation in 6 patients. No neurological complications were observed. All patients survived and were discharged from hospital.
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PMID:[Epidural blockade for analgesia and treatment of acute pancreatitis]. 178 Apr 89

A report is made about 153 women patients who underwent laparoscopic adhesiolysis, and who underwent laparoscopy primarily because of unclear chronic pelvic pain (57.5%), suspected adhesion (13.1%) or sterility (11.7%). For 86.9% of the patients a complete and only for 13.1% an incomplete adhesiolysis was possible. Out of the 123 patients (80.4%) suffering from pain before adhesiolysis 99 (80.5%) patients could be reexamined by questionnaire one to eight years later. 38.0% suffered from no pain any longer, 20.2% stated a clear improvement, 25.5% being temporarily free from pain only, and 16.2% stated unchanged pain. Because of the results laparoscopic adhesiolysis is recommended for women patients with mere adhesions and chronic pelvic pain and for patients without pain with adhesions who are exposed to a danger of ileus.
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PMID:[Results of laparoscopic lysis of adhesions in patients with chronic pelvic pain]. 182 7

Involvement of the cervical spine is seen in 40%-60% of all patients with rheumatoid arthritis. Consequences are instability of the upper cervical column with pain and neurological deficits, in some cases tetraplegia, and sudden death. From this reason special care has to be taken in the management of those patients, even when they are comatose or anesthetized, to avoid sudden spinal cord compression with irreversible neurological deficits. We report a 49-year-old female with a history of rheumatoid arthritis for more than 10 years. Because of an adhesive ileus complicated by septicemia, she underwent abdominal surgery twice followed by prolonged mechanical ventilation under high doses of sedative drugs. After reduction of the tranquilizer doses tetraplegia with respiratory insufficiency was found. Neurophysiological and X-ray examinations showed spinal cord compression due to dislocation of the odontoid process, a rare but typical complication in patients with rheumatoid arthritis. It was not possible to determine the date of the dislocation, but it might have been caused by intubation or respositioning. Although the patient underwent immobilization and surgical fusion of the upper cervical spine, there was no improvement in the neurological status and she died 5 months later. In patients with advanced rheumatoid arthritis a detailed medical history, clinical examination, and radiography are necessary before general anesthesia or intensive care with intubation is considered. If an unstable cervical spine is suspected, intubation should be performed by fiberoptic technique under light sedation. Regional anesthesia should be preferred over general anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[An unnoticed dislocation of the dens axis in a patient with primary chronic polyarthritis undergoing intensive therapy]. 186 71

The management of 23 patients treated for choledochal cysts at the Oregon Health Sciences University between 1969 and 1990 is reviewed. The median age was 27 years, with a range from 1 month to 90 years. Seventy-eight percent of patients presented with abdominal pain, and 35% were jaundiced. Three patients presented with cholangitis, two with cyst rupture, and one with recurrent pancreatitis. Nine patients had had previous biliary surgery. The diagnosis was made in all patients with ultrasound and/or cholangiography. Fifteen patients (65%) had type I cysts, 2 had a type II cyst, 5 (22%) had type III cysts, and 1 had a type IV cyst. Stones were present in four (17%) cysts, and all excised cysts were benign. Seventeen patients with type I and II choledochal cysts had complete cyst excision and choledochoenterostomy. Four of five patients with type III cysts had endoscopic cyst incision and drainage, while the fifth patient had transduodenal cyst excision and sphincteroplasty. The patient with a type IV cyst had extrahepatic cyst excision and choledochojejunostomy. There were no operative deaths. Two postoperative complications occurred: cholangitis and a prolonged ileus. All patients had resolution of their pain and jaundice. Two patients had late cholangitis. Cyst excision and choledochojejunostomy are the treatment of choice for types I and II choledochal cysts. Extrahepatic cyst excision and choledochojejunostomy may be adequate treatment for type IV cysts. Endoscopic incision and drainage is appropriate for selected patients with type III cysts.
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PMID:Variation in management based on type of choledochal cyst. 203 47

Colonic surgery patients were studied to measure: the influence of continuous thoracic epidural analgesia (TEA) on a postoperative pain score, the time till onset of defaecation, blood loss, postoperative temperature elevations, rate of bacterial contamination of wounds and urine, and general surgical complications. Group I patients (n = 57) received general anaesthesia and TEA for the operation, followed by continuous TEA (0.25 per cent bupivacaine) for 72 h. Group II patients (n = 59) received general anaesthesia for the operation, followed by systemic analgesia on request. Significant beneficial effects of TEA in group I were demonstrated by lower pain scores in the first 24 h after surgery and earlier defaecation. However, there were fewer temperature elevations in group II. There was no significant difference between the groups in terms of positive bacteriological cultures, blood loss, need for postoperative mechanical ventilation and complications. However, there was a trend toward a higher rate of rectal anastomotic breakdown, increased blood replacement and intensive care therapy, and longer hospitalization in group I. These results do not suggest any significant beneficial therapeutic effect of continuous TEA in colonic surgery compared with a conventional systemic analgesic regimen. In selected patients (i.e. those with severe pain or those prone to develop postoperative ileus) continuous TEA may be beneficial.
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PMID:Epidural analgesia in colonic surgery: results of a randomized prospective study. 222 75

Reported is the case of a 66-year-old woman who complained of a pain in the upper abdomen. A barium enema revealed a stenosis in the transverse and sigmoid colon and since her ileus worsened, an emergency operation was performed, which revealed an unresectable transverse colon cancer with a diffuse peritoneal metastases. After closing the wound, the patient was treated with local thermotherapy of the abdomen using an RF wave in combination with chemotherapy and immunotherapy. Later, since the tumor could not be palpated and the tumor markers dissipated, a reoperation was performed, and it was found that diffuse metastases had completely disappeared from the peritoneum. Further, a histopathological study did not disclose any tumor cells. Therefore, as the cancer was remarkably reduced, a partial transverse and descending colon colectomy was performed.
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PMID:[An unresectable colon cancer with a diffuse metastases that turned resectable following thermotherapy with chemoimmunotherapy]. 212 46

Treating ectopic pregnancy with laparoscopy requires special training, but it results in decreased morbidity, discomfort, and pain; reduced recuperative time; and lower cost to the patient and hospital. Many conditions mimic ectopic pregnancy. Therefore, to make the diagnosis, a complete history must be taken, a careful physical examination must be performed, and certain diagnostic tests must be made. Contraindications include bowel obstruction, ileus, abdominal hernia, peritonitis, brisk intraperitoneal bleeding, diaphragmatic hernia, severe cardiac disease, extremes of body weight, previous surgery, or presence of a large abdominal mass.
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PMID:Pelviscopy for ectopic pregnancy: a safer and quicker alternative. 214 37

The results of using immediate trocar insertion were compared to prior peritoneal insufflation with a Verres needle for laparoscopic tubal sterilization, with respect to total operative time, number of instrumental insertions, volume of CO2 required and complications. 102 women had a direct trocar procedure; 110 the prior needle insertion, selected randomly. Laparoscopy was done with a single-puncture instrument, triple cautery, and upper abdominal inspection under video control. Times were noted from the incision for the Verres needle to trocar insertion, from trocar incision to confirmation of correct placement of the laparoscope, and from then until cutting of the last suture. Total operating time was less in the direct trocar group, 7 minutes 30 seconds, vs. 9 minutes 40 second, p0.0001. 8 women in the direct trocar group had multiple trocar insertions, compared to 24 women in the needle group. The direct trocar group received less CO2, 2.32 L compared to 2.67 for the needle group, p0.001. There were minor injuries to the omentum not requiring intervention in 7 women in the needle group, but 4 in the trocar group. There were 2 complications: a woman in the direct trocar group had to have laparotomy because of insertion of the trocar into the large bowel, which was adherent to the abdominal wall. Another woman in the needle group returned 3 days later with pain, fever and ileus, and recovered after treatment. These observations suggest that direct trocar insertion is safer for patients in terms of operative time, need for additional CO2, and especially risk of multiple instrument insertions, always a blind procedures with potential for injury.
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PMID:Direct trocar insertion vs. Verres needle use for laparoscopic sterilization. 214 89

Traditional gall bladder surgery results in an abdominal incision requiring management of pain, possible ileus, a hospital stay of 5 to 7 days, and a six week recovery period. This type of surgery carries with it the risks of both surgery and anaesthesia and can have a high monetary cost for both the patient and the hospital. Laparoscopic cholecystectomy results in four, 1 to 3 cm incisions, that appear to produce less pain and no ileus. Hospitalization is 24 to 48 hours and complete recovery and return to work can occur within two weeks. This surgery is a safe and economical alternative to traditional surgical methods.
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PMID:Laparoscopic cholecystectomy. 214 26


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