Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 65-year-old Japanese male, who was treated for Fournier's gangrene, developed an enlarged erythema over the right thigh and right lower quadrant. The area was surgically debrided, and he was given antibiotics. However, he complained of abdominal swelling with a metallic bowel sound, pain, and vomiting and was then treated for paralytic ileus. Although his symptoms initially improved, he complained again of the same symptoms and underwent surgery for mechanical ileus occurring at the site of a surgical scar from an appendectomy 43 years earlier. This is a very rare case of Fournier's gangrene which caused mechanical ileus of the small intestine and adherence to a peritoneal scare after paralytic ileus due to inflammation of the abdominal fascia following scrotal gangrene.
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PMID:Fournier's gangrene: report of a case associated with paralytic and mechanical ileus throughout the management of the gangrene. 840 25

CT scans were performed 40 times in 28 postcystectomy patients to identify the type and location of tumor recurrence. Sixteen patients showed tumor recurrence. Patients without recurrence showed a complete symmetric pelvis and a thin string that looked like an operation scar. Cutaneous ureterostomy showed small tube-like structures, and ileal conduit looked like herniation of the ileum. Cases with recurrent tumors were divided into 3 patterns, 1) pelvic abscess recurrence, 2) anterior abdominal wall thickening, 3) pelvic lateral wall thickening, and combinations of these types. The abscess-recurrence type often showed air within the mass or a fuzzy contour that could not be differentiated from true inflammatory abscess. Anterior abdominal wall thickening was usually accompanied with abscess-type recurrence and appeared as thickening of the operation scar. Lateral wall thickening was usually seen at the site of the obturator internus muscle or obturator node. Patients without recurrence had no complaints except for two who had ileus. All patients with recurrence except one had complaints of pain, abnormal secretion, or a palpable mass. Because all patients with recurrence already had a relatively large tumor at the time of CT, routine follow-up CT is recommended even if the patient has no complaints.
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PMID:[CT evaluation of the pelvic cavity after total cystectomy]. 847 58

With the current clinical popularity of patient-controlled analgesia pumps (PCAP) in postoperative pain management, it is prudent to be aware of the possible risk of adynamic ileus formation from intravenous narcotic administration. We hypothesized that prolonged PCAP exposure could delay bowel motility and increase post-operative morbidity. After stringent exclusionary parameters were met, we retrospectively analyzed 170 postcesarean patients who received PCAP medication and compared data with 171 postcesarean patients who received traditional intramuscular (IM) administration. The degree of adynamic ileus formation of moderate and severe intensity was higher in PCAP users (21.8%) vs. IM users (13.5%), P = .02. There was no significant difference in the average cumulative amount of analgesic administered during the first 24 postoperative hours for PCAP (442.2 mg) vs. IM (397.7 mg), reflecting that the mode of narcotic delivery is responsible for ileus formation rather than the dosage. Type of postoperative diet and speed of diet advancement were also factored into the analysis and did not statistically influence the results. We conclude that PCAP usage may increase the morbidity risk for adynamic ileus formation, and that usage should be accompanied with close monitoring of bowel motility.
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PMID:The incidence of adynamic ileus in postcesarean patients. Patient-controlled analgesia versus intramuscular analgesia. 850 38

Epidural analgesia has been reported to enhance gastrointestinal motility and shorten postoperative ileus. Postoperative ileus can be influenced by many factors, including the operative procedure. Our aim was to evaluate the effect of supplemental epidural anesthesia and postoperative analgesia on ileus after ileal pouch-anal anastomosis (IPAA). This was a retrospective review of 50 consecutive nonrandomized patients undergoing IPAA over a 10 year period by a single surgeon. 27 patients received general anesthesia and parenteral analgesia. 23 patients received supplemental epidural anesthesia and analgesia. The two groups were comparable with respect to age, sex, diagnosis, and American Society of Anaesthesiology status. Operative time, blood loss, and transfusion requirements were also similar, but massive (>1,000 mL) blood loss was more frequent in the general group (37% vs 13%, P < .05). Twelve (44%) patients in the general group and seven (30%) in the epidural group had complications (NS). Mean duration of nasogastric suction, tube reinsertion, and interval to taking liquid and regular diets was similar in the two groups. Mean pain scores for the first 24 hours were significantly lower in the epidural group (1.9 +/- 1.0 vs 2.5 +/- 0.6, P < 0.05). Supplemental epidural anesthesia and analgesia does not shorten clinical postoperative ileus after a complex colorectal procedure (IPAA).
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PMID:Effect of epidural analgesia on postoperative ileus after ileal pouch-anal anastomosis. 865 37

Improvements in the surgical aspects of combined kidney and pancreas transplants have resulted in better overall graft and patient survival. Pancreas transplants were initially performed through lower transplant flank incisions opposite the kidney. However, because of high wound complication rate, most centers now perform pancreas transplants through lower midline incisions. We retrospectively reviewed our experience in 40 combined kidney and pancreas transplant recipients with an initial group of 6 midline incisions and 34 later lower transverse abdominal incisions. The number of midline incisions was too small to make a direct comparison, but our series of patients with transverse incisions was compared with the reported literature using a midline incision. The overall infectious and hernia rates for the transverse incision were 12% and 6% respectively which are both very acceptable. The average operative time was 5.5 h. The transverse incision may be associated with less pain, shorter ileus, and fewer pulmonary complications. A lower transverse incision has the major advantage of excellent exposure directly over the iliac vessels and is our incision of choice.
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PMID:Combined kidney and pancreas transplants through lower transverse abdominal incisions. 882 73

This study was performed to compare the standard open Swenson pull-through (OSP) with the laparoscopic Swenson pull-through (LSP) for Hirschsprung's disease. The Swenson pull-through was performed on eight patients with a rectosigmoid transition zone, during a 14-month period, using one camera port and three working ports. The results were compared with those of 10 patients with a similar lesion treated by the open procedure during an overlapping 19-month period. One laparoscopic procedure was converted to the open version because of technical difficulties. Both methods had a hand-sewn anastomosis approximately 1 cm above the pectinate line. The preoperative variables of age, weight, incidence of colostomy, and incidence of Down's syndrome were similar for the two groups. The operating time for LSP was similar to that for OSP (4 hours 42 minutes v 4 hours 37 minutes, respectively: P = NS). Postoperatively, the laparoscopic group had a shorter hospital stay (5.25 v 8.8 days; P < .05) and had a shorter period until the start of oral intake (2.75 v 5 days; P < .05). The requirement for narcotic pain medication was similar (12.6 v 12.8 doses; P = NS). Early postoperative complications were more common in the open group (3 wound infections, 1 prolonged ileus, and 1 anastomotic leak). No complications occurred in the laparoscopic group. Late postoperative follow-up was too short to compare functional results. The authors conclude that the Swenson pull-through can be performed safely with the laparoscope, with reduced morbidity.
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PMID:Laparoscopic Swenson pull-through: a comparison with the open procedure. 886 54

Peritoneal irritation in rats induced by i.p. administration of acetic acid produces abdominal contractions reflecting visceral pain, and gastrointestinal ileus characterized by inhibition of gastric emptying and small intestine transit. In this study, gastric emptying (GE) and intestinal transit, calculated by the geometric center (GC) method, were estimated using a test meal labeled with 51Cr-EDTA. Visceral pain was assessed by counting abdominal contractions. Acetic acid produced abdominal contractions (80.8 +/- 3.3) and inhibition of GE (-54%) and GC (-63%) during the test-period. The kappa-opioid receptor agonists, CI-977 (+/-)-U-50,488H, (+/-)-bremazocine, PD-117,302, (-)-cyclazocine, and U-69,583, reversed abdominal contractions and inhibitions of gastrointestinal transit in a dose-related manner. The mu-opioid receptor agonists and potent analgesics, morphine and fentanyl did not restore normal gastric emptying and intestinal transit. These data suggest that selective kappa-opioid receptor agonists might be used to treat abdominal pain associated with motility and transit impairment during postoperative ileus.
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PMID:Reversal by kappa-agonists of peritoneal irritation-induced ileus and visceral pain in rats. 904 65

The clinical anesthesia, general surgery, and gynecology literature addressing the pathophysiology and management strategies for perioperative pain were reviewed. There are few prospective, randomized studies from which to draw meaningful conclusions. Nevertheless, a theoretical construct has been developed which may help the gynecologic surgeon optimizing pain management. The era of managed care and shorter hospital stays has focused physicians and, in particular, surgeons on elements of patient care that can be addressed and improved. Reducing or eliminating postoperative pain without excessive sedation promotes rapid mobilization and return to self-care. Strategies for pain management can be adopted that reduce postoperative ileus and other adverse reactions to analgesics.
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PMID:Perioperative pain management. 905 May 89

The management of severe small and large bowel adhesions in patients suffering from chronic pelvic pain after undergoing hysterectomy remains highly challenging. A cohort of 48 women (median age 41 yrs, range 26-59 yrs) with chronic pelvic pain had severe bowel adhesions. Forty-two had undergone a total abdominal hysterectomy (27 with bilateral, 7 with unilateral salpingo-oophorectomy), five a vaginal hysterectomy (4 with bilateral salpingo-oophorectomy), and one a laparoscopic hysterectomy. After laparoscopic adhesiolysis, 23 patients were followed for up to 24 months, 23 for 48 to 60 months, and 2 were lost to follow-up. Three intraoperative complications (6.2%) were one ileus, which required a 2-day hospital admission, one pelvic abscess requiring readmission and second-look laparoscopy, and one episode of urinary retention requiring a 1-day readmission. Of the 23 women followed for more than 24 months, 11 (47.8%) required from one to three subsequent surgeries. Complete pain relief was reported by 10 (43.5%) women, 8 of whom did not require further surgery. Twelve (57.1%) of the 21 patients followed for 6 to 12 months reported complete pain relief. Laparoscopic adhesiolysis achieved complete pain relief in approximately half of the women.
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PMID:Long-Term Outcome of Laparoscopic Adhesiolysis in Women with Chronic Pelvic Pain after Hysterectomy 907 93

The authors report their experience of biliary ileus, namely 8 cases out of 533 intestinal occlusions of the small bowel operated from 1982-1994. The patients included 5 women and 3 men with a F/M ratio = 1.7. Mean age was 79 years. Past medical history involving the biliary tract was only recorded in 3 cases. At the time of hospitalization occlusive symptoms had been present for between 2 and 7 days: pain in 7 patients, abdomen closed to gas and feces in 6, and vomiting in 7. Direct abdominal X-ray was only performed in 3 cases. A diagnosis of intestinal occlusion was made in 6 cases and biliary ileus in 2. During surgery it became clear that the occlusion was primarily localized at the level of the terminal ileum. Cholecysto-duodenal fistula was present in 5 cases. Enterolithotomy alone was performed in 5 cases. In 4 patients postoperative progress was normal leading to recovery. Two patients died: one immediately after surgery and the other on day 12. In conclusion, the authors confirm the increasingly frequent presence of cholecysto-duodenal fistula and the increasing age of patients, with a prevalence of females. They also emphasize the importance of an early diagnosis, supported by direct abdominal radiography so that surgery can be performed as rapidly as possible. Lastly, the need to perform cholecystectomy at a subsequent date is underlined.
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PMID:[Mechanical occlusion of the small intestines by gallstones. Our experience]. 910 11


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