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

Renal artery thrombosis after blunt trauma presented without other injury, without external signs of trauma, and without hematuria in the case reported. Review of 65 cases from the literature showed that flank and epigastric pain and proteinuria are usually present. Renal artery thrombosis following blunt trauma has usually been diagnosed too late to salvage the kidney. Nephrectomy is performed for ileus, fever, and pain caused by the necrotic kidney, or for hypertension. Ideally, rapid diagnosis by intravenous pyelogram and arteriography and early surgical intervention should allow revascularization and renal salvage before permanent parenchymal damage has occurred. The cases reviewed showed that successful revascularization without hypertension could be achieved 12 hours after injury. Patent small collateral vessels as well as incomplete or gradual renal artery occlusion may prolong renal salvage time.
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PMID:Renal artery thrombosis following blunt trauma. 739 14

This is a report about 1465 cases of swallowed foreign bodies. Surgery is not necessarily indicated when foreign bodies are swallowed, because 90% of the objects are discharged spontaneously. Complications (perforation, ileus) occur only in 0.5% of the cases. Endoscopic extraction should be attempted; surgical removal is indicated only in cases of acute abdominal symptomatology or ileus. Foreign bodies can be left in the intestine for years without any noticable problems or pain (eight observed cases).
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PMID:[Swallowed foreign bodies: problems, prognosis, and treatment (author's transl]. 740 4

Laparoscopic surgery is becoming widely accepted as an alternative to conventional procedures. It is becoming more and more evident that laparoscopic techniques can be applied successfully to pediatric patients. Advantages of these techniques include less postoperative pain, decreased ileus, fewer pulmonary complications, and shorter hospital stays. Elective splenectomy for hematologic disease or for staging of Hodgkin's lymphoma also appears to be amenable to laparoscopic techniques. This report details 12 consecutive splenectomies successfully performed laparoscopically since July 1993. No case required conversion to laparotomy. Each case was reviewed with respect to operative time, estimated blood loss, identification of accessory spleens, time until full oral intake, analgesia requirements, and length of stay. Factors contributing to morbidity such as ileus, pulmonary complications, and would infections were evaluated. Documentation was also reviewed for late sequelae such as intestinal obstruction and incisional hernias. These patients were compared with 20 consecutively treated patients who underwent open splenectomy in the period immediately preceding the use of laparoscopic splenectomy. Laparoscopic splenectomy, in the authors' experience, is a safe alternative to open splenectomy, has few complications, is cost effective, and has been well accepted by patients and families.
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PMID:Pediatric laparoscopic splenectomy. 747 83

Morphine inhibits propagating and stimulates nonpropagating colon contractions in monkeys and humans. The use of morphine or other opioids that inhibit propulsive contractions prolongs postoperative ileus. In contrast, ketorolac tromethamine, a nonsteroidal analgesic, has no effect on colon contractions in monkeys. In 14 patients having elective abdominal operations, bipolar electrodes were implanted on the right (n = 13) and left (n = 10) colon. Group A (n = 8) received ketorolac, 30 mg IM q6h, for pain relief. Group B (n = 6) needed supplemental morphine, 2-10 mg IV or IM, plus ketorolac to control their pain. Myoelectric activity was recorded from each subject on postop Days 1-5 and analyzed by computer for electrical control activity (ECA), short and long electrical response activity (ERA), and propagation of long ERA. There was a difference between the two groups in return of propagated long ERA bursts that correlated with clinical recovery from postoperative ileus. Postoperative analgesia with ketorolac resulted in faster resolution of ileus compared to morphine plus ketorolac because opioid-induced motor abnormalities in the colon were avoided.
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PMID:Nonopioid analgesics shorten the duration of postoperative ileus. 748 51

A new case of gallstone in a child, with non apparent predisposing condition, who underwent laparoscopic cholecystectomy is reported. The importance of considering cholelithiasis in children with abdominal pain as well as the value of ultrasonography in diagnosis is stressed. The technique of laparoscopic cholecystectomy modified for pediatric patients and its benefits (decreased pain and ileus after surgery, shortened hospitalization and improved cosmesis) are discussed.
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PMID:[Cholelithiasis in children: observations on a further case and the technique of laparoscopic cholecystectomy in a child]. 749 39

Treatment of postappendectomy intraperitoneal abscesses is classically surgical (drainage). We report a retrospective study (1988 to 1991) of our experience in providing exclusively medical treatment for 11 such isolated abscesses in children. The abscess was detected 7 times within the 10 days following appendectomy. Ultrasonography localized the abscess 7 times in the right iliac fossa and 4 times in Douglas' pouch. In 4 cases it was larger than 5 cm in diameter. Parenteral antibiotic therapy associated ticarcillin and clavulanic acid 6 times and piperacillin, tobramycin and metronidazole 5 times. Drug efficacy was evaluated by clinical signs (fever, pain, ileus) and ultrasonography. In one case, an associated ileus led to reoperation at day 4 of treatment. In the other 10 cases, clinical signs disappeared during the first week of treatment. At day 7, parenteral was replaced by oral antibiotic therapy (metronidazole 7 times, amoxicillin-clavulanic acid 3 times) continued until the abscess was no longer visualized on ultrasonography (5 times at 3 weeks, 5 times at 1 month). Medical treatment of isolated postappendectomy abscesses in children would thus appear to be a logical choice in the absence of an associated ileus.
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PMID:Medical treatment of postappendectomy intraperitoneal abscesses in children. 754

Opioid drugs administered postoperatively for pain relief cause increased frequency of nonpropulsive phasic contractions but decreased to absent propulsive migrating contractions in the colon, thus importantly influencing the duration of postoperative ileus. Ketorolac is thought to permit earlier return of bowel function postoperatively compared to morphine. Four monkeys had sets of three strain gauge force transducers implanted on the right and left colon at laparotomy. After recovery, animals were fasted overnight and had colon contractions recorded. After a 1-hr baseline period, 200 micrograms/kg morphine sulfate or 1 mg/kg ketorolac tromethamine was injected intramuscularly and recording continued. Each animal received four injections of each drug. Records were analyzed visually for frequency of phasic on migrating contractions. There was no difference in the frequency of phasic or migrating contractions after injection of ketorolac. Morphine, as expected, increased the frequency of phasic and decreased the frequency of migrating contractions in the colon. Ketorolac does not affect the frequency of colon contractions.
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PMID:Opioid and nonopioid analgesic drug effects on colon contractions in monkeys. 762 61

Gastrointestinal tract motility may be reduced markedly after surgery with delay in gastric emptying. these alterations are induced partly by surgery, partly by the residual effects of anaesthetic agents, and particularly by opioids administered for post-operative pain relief. These changes may be antagonized to a certain extent by administration of prokinetic agents such as cisapride. Post-operative ileus reduces the rate of mobilization and may also reduce or delay absorption of drugs administered by the gastrointestinal tract. Furthermore, post-operative nausea and vomiting, multi-factorial in aetiology, may ensue and also be responsible for delayed mobilization, subjective discomfort and delay in administration of oral agents post-operatively. A serious problem may be leakage from bowel anastomoses. Although the causes are primarily surgical, an increase in bowel contractility may be deleterious and it has been suggested that neostigmine and morphine may be implicated in anastomotic dehiscence.
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PMID:The gastrointestinal tract after anaesthesia. 764 42

Laparoscopic operative procedures are gaining wider acceptance in pediatric patients. Although laparoscopic splenectomy is being performed more frequently, no studies to date have compared this procedure with the standard open technique with respect to operative outcomes. We performed a case control study of seven laparoscopic splenectomies and 14 open splenectomies. Two-tailed t test was used to compare the two groups for mean operative time, mean hospital stay, mean interval before tolerating a regular diet, and total parenteral narcotic dose in morphine equivalents. Operative time was significantly longer in the laparoscopic group (221 minutes vs 59 minutes, P < 0.001). Hospital stay, interval before tolerating a regular diet, and postoperative narcotic dose did not differ significantly between the two groups. In the laparoscopic group, one operation was converted to an open procedure secondary to bleeding complications. Three patients required mini-laparotomies for removal of extremely large spleens after completion of the dissection. Pediatric laparoscopic splenectomy does not appear to have advantages over the traditional method with regard to operative time, hospital stay, postoperative ileus, or postoperative pain. Larger studies, including cost analysis, are needed before major proposed advantages of laparoscopic splenectomy can be accepted.
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PMID:A comparison of laparoscopic versus open splenectomy in children. 766 66

Gallbladder stones remain asymptomatic over a long period. The biliary colic is the typical pain caused by these stones. Dyspeptic symptoms seem to be unrelated to the presence of gallstones. Acute cholecystitis, a serious complication of gallstone disease, spans a wide spectrum of clinical findings. The typical signs are right upper abdominal pain and tenderness, fever, leucocytosis and Murphy's sign. 35% of patients experience gallbladder empyema or perforation. Localized gallbladder perforation, characterized by high fever, severe right upper abdominal pain and tenderness and a palpable mass is often difficult to distinguish from acute cholecystitis. Free perforation into the abdominal cavity causes diffuse peritonitis. Gallbladder perforation into the lumen of an adjacent organ produces fistulas, mostly with minimal symptoms or a pain relief after decompression of the inflamed gallbladder. Air in the bile ducts and on some occasions bile-acid-induced diarrhea may result. Rarely, the perforation of large stones leads to an occlusion of the GI tract and results in a gallstone ileus. Common bile duct stones may be asymptomatic or cause bile duct obstruction with biliary colics and jaundice. Acute bacterial cholangitis characterized by Charcot's triad (pain, jaundice and fever) and the acute biliary pancreatitis with its typical symptoms are the serious complications of common bile duct stones, associated with a high mortality rate. The clinical manifestations of a gallstone disease and its complications reveal important diagnostic features, but the most important diagnostic features, modalities are the imaging procedures. They are decisive for an accurate therapy.
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PMID:[Clinical manifestations of cholelithiasis and its complications]. 776 32


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