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

Between 1950 and 1980, a total of 145 patients with pain-free gallstones in the gallbladder and open cystic duct were followed for a mean observation period of 13.5 years. Pigment stones made up 25.5% of the total, cholesterol the rest. Growth of stones was noted in 70% of cases, new stones in 14%, and calcification in 25%. Colics occurred in 29%, severe ulcerative cholecystitis in 4% and passage of stones with pancreatitis in 5.5%. Constant cystic duct occlusion occurred in 18%, causing mild gallbladder inflammation in 40% of them. Cholecystectomy should be limited to large, old stones, to prevent gallstone ileus. Recently formed cholesterol stones should be removed as soon as possible by litholysis. Otherwise expectant waiting with regular follow-up is indicated.
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PMID:[Changes in silent gallbladder stones. Roentgen-diagnostic and symptomatologic observations over 30 years]. 373 71

The patient with acquired immune deficiency syndrome (AIDS) and abdominal pain presents the surgeon with a difficult challenge. The pain may be due to an opportunistic infection, ileus, organomegaly, or a true surgical emergency. The hospital records of 235 patients with AIDS were reviewed. Of the 29 patients with abdominal pain, 12 had infectious diarrhea, eight were diagnosed as having ileus or organomegaly, and nine had miscellaneous causes for their pain. Only five patients underwent laparotomy. Two patients were operated on for pain associated with bleeding (Meckel's diverticulum and intestinal Kaposi's sarcoma); one had a perforated duodenal ulcer and one had severe ileitis. One patient was electively operated on for Burkitt's lymphoma. Laparotomy for abdominal pain is not usually necessary in patients with AIDS. Specific recommendations for evaluation and management of these patients are offered.
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PMID:Abdominal pain in patients with acquired immune deficiency syndrome. 378 34

The results of this prospective clinical study have demonstrated a low rate of false-positive abdominal sonographic findings in patients undergoing routine studies the seventh day after abdominal surgical procedures. It is concluded that any intraperitoneal fluid collection detected by ultrasound examination in a patient postoperatively demonstrating signs and symptoms of abdominal sepsis (fever, leukocytosis, pain, tenderness, persistent ileus, excessive drainage, wound changes and so on), should be considered as the source, as abdominal fluid collections do not persist as a "normal" part of the healing process one week after extensive biliary tract or colonic operations. Sonography is a highly specific procedure for the detection of abdominal abscesses after the seventh postoperative day. The type of procedure, type of incision, type of closure, presence of drains, history of prior intraperitoneal surgical procedures and operative blood loss did not affect the accuracy of the test. Postoperative ultrasonography is a specific, sensitive and accurate test and is widely applicable to almost all groups of patients.
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PMID:The reliability of the results of ultrasound detection of fluid collections in the early postceliotomy period. 392 80

During a 14-month period we used a left-flank, retroperitoneal, retrorenal approach in 23 high-risk patients with abdominal aortic aneurysm (AAA). Fourteen patients underwent suprarenal/celiac cross clamp for juxtarenal/suprarenal AAA and/or associated occlusive disease. Other indications for this approach included diminished cardiac and/or pulmonary reserve, previous extensive abdominal surgery, obesity, and inflammatory AAA. There was only one death (4%) in this high-risk group and minimal operative morbidity. The flexibility afforded by this approach for high aortic exposure allowed expeditious proximal anastomoses with minimal postoperative renal dysfunction. Pulmonary complications, ileus, and pain were reduced and patient mobilization was rapid despite the complex nature of the operative procedures. We believe that this approach offers significant advantages for all cases of AAA but particularly for anatomically complex lesions and medically high-risk patients.
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PMID:Retroperitoneal approach to high-risk abdominal aortic aneurysms. 395 89

Acute pancreatitis cannnot be diagnosed only by a single sign, symptom or laboratory determination, but on the basis of several clinical and biochemical findings. X-ray examinations and sonography are of limited diagnostic value in the initial phase. --Prognostic signs are helpful in the early evaluation of the course of the disease. --Intensive care in the initial stage is a decisive principle for adequate therapy. --The effect of hormonal and non-hormonal inhibition of pancreatic secretion or enzyme inhibition has not been proven sufficiently until now or has already been shown to be uneffective in controlled studies. --In contrast, albumin-, fluid- and electrolyte-replacement as well as pain relief and nasogastric suction in case of ileus are safe therapeutical procedures. --Besides shock renal and respiratory insufficiency are the most feared complications in acute pancreatitis and require early peritoneal dialysis and artificial ventilation including positive end expiratory pressure.
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PMID:[Current concept of diagnosis and therapy of acute pancreatitis (author's transl)]. 610 47

88 unselected patients with acute pancreatitis entered a randomized clinical trial comparing the therapeutic efficacy of fasting alone, nasogastric suction and fasting plus cimetidine. The disease was mild to moderate in all but 3 cases, and cholelithiasis was the main etiological factor. The number of treatment failures and complications, and the clinical outcome were similar in the three groups. However, when compared to fasting alone, nasogastric suction was shown to delay the resumption of bowel activity a mean of 11 h (p less than 0.05), prolong the duration of pain a mean of 20 h (p less than 0.01), increase analgesic needs (pentazocine lactate) a mean of 64 mg (p less than 0.05), and lengthen hospital stay a mean of 2 days (p = NS). In conclusion, cimetidine has no beneficial effects in acute pancreatitis. It is suggested that fasting alone be initially used as the simpler, safer and more economical therapy. Nasogastric suction should be reserved for patients presenting with intestinal ileus, a situation that occurred in 1 out of every 8 cases in the present series.
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PMID:Comparison of fasting, nasogastric suction and cimetidine in the treatment of acute pancreatitis. 639 81

The epidural instillation of morphine for pain control has been utilized for some time, although primarily intraoperatively or for patients with chronic severe pain, as in terminal cancer. Long term indwelling catheter or subarachnoid administration of epidural morphine are both potentially hazardous. However, in relatively brief applications, up to a few days, the epidural administration of morphine sulfate Is effective, safe, and well tolerated when used according to a carefully controlled plan. We report the use of this method as an improved means for the control of post-lumbar surgery pain in 25 cases. These patients were compared with 25 others receiving standard doses of parenteral and oral narcotics. The two groups were quite similar preoperatively. However, patients receiving epidural morphine were more comfortable, had fewer side effects such as nausea and lassitude, and exhibited no respiratory depression. Further, they ambulated sooner, showed no definitive orthostatic hypotension and less ileus, and remained much more alert and cooperative during the initial 48 hours after operation. Hospitalizations were usually shorter by 1 or 2 days. The administration of very small doses (1.0 to 2.5 mg) of morphine every 12 to 24 hours was usually adequate for good to excellent postoperative pain control. Hydroxyzine was sometimes used to potentiate the analgesia between doses. The epidural catheters were routinely removed within about 72 hours. The technique for the intraoperative placement of the epidural catheter and drug administration are detailed. Precautions for catheter placement were carefully followed to prevent dural penetration or intrathecal injection.
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PMID:Indwelling epidural morphine for control of post-lumbar spinal surgery pain. 663 31

One hundred patients with benign disease of the upper urinary tract were operated on: 50 through the standard flank approach and 50 through the dorsal approach. The analgesic requirement for control of postoperative pain was less for patients operated on through the dorsal incision, and these patients had a shorter postoperative ileus and a hospital stay an average of 4.29 days less than those operated on through the flank approach. The dorsal lumbotomy incision is recommended for certain operations on the kidney and proximal ureter.
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PMID:Dorsal approach to upper urinary tract. 682 97

In prospective, random assignment of 2 groups of 15 patients, relief of postoperative pain with narcotic medications was evaluated and compared with transcutaneous electrical nerve stimulation (TENS) for 2 days immediately following surgery. Presence of ileus and hospital stay were identical in both groups. Patients on TENS demonstrated a marked significant decrease in the amount of narcotics administered. There was favorable nursing, physician and patient acceptance to these devices. Further clinical evaluation is, therefore, in progress.
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PMID:Postoperative pain relief by transcutaneous electrical nerve stimulation (TENS). 699 77

The main difference between intussusception in children and adults is its mostly chronic course in adult age. Whereas the mechanical ileus is characterized by acuteness the prevailing chronic form will often lead to wrong diagnoses, thus causing a delay of adequate therapy. Sonography, radiologic and endoscopic investigations should be applied for diagnosing this disease. In most cases the indication for surgery does not correspond to the real cause. There are 4 typical symptoms: pain, vomiting, tumour and melena which should induce the diagnostician to pay attention to intussusception also in adult age.
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PMID:[Intestinal intussusception in the adult]. 717 Aug 46


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