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

Renal autotransplantation as an alternative to ileal interposition has been done successfully in patients with repetitive episodes of renal colic. Urinary tract continuity has been re-established by anastomosis of a Boari tube directly to the renal pelvis. This has resulted in easy egress of recurrent calculi without pain. Furthermore, the musculature of the Boari tube seems to be adequate for prevention of vesicorenal reflux. The procedure has been devoid of electrolyte and mucous urinary retention problems associated with ileal interposition and it is advocated as an alternative in the management of such patients when medical therapy fails.
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PMID:Renal autotransplantation for recurrent renal colic. 39 52

Renal calculi are an infrequent but significant management problem during pregnancy. We reviewed all cases of renal colic occurring during pregnancy between 1979 and 1990 at Grace Hospital, a tertiary care obstetrical hospital in Vancouver, British Columbia. Of the patients 80 had a discharge diagnosis of renal colic and pregnancy during this 11-year period. Calculi were confirmed in 57 patients. Of the patients 66% were multiparous and 99% of the calculi occurred during either the second or third trimester. The most common symptom was flank pain seen in 89% of the patients, while greater than 95% displayed either microscopic or gross hematuria. Methods of radiographic diagnosis included ultrasonography and limited stage excretory urography. A total of 84% of patients passed stones spontaneously. Indications for urological or obstetrical intervention included persistent pain, sepsis, progressive hydronephrosis, solitary kidney or high grade obstruction. There were 37 procedures done in 23 patients. The most common procedure was placement of a ureteral stent. The complication rate associated with intrapartum intervention and stent passage in the 23 patients was 16%. All patients with a ureteral stent subsequently had spontaneous vaginal delivery without complication. A scheme for managing renal calculi in pregnancy is presented.
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PMID:Renal colic in pregnancy. 143 34

In situ (no instrumentation) extracorporeal shock wave lithotripsy (ESWL*) was used to treat 49 patients with obstructing ureteral stones causing acute renal colic. Ureteral obstruction was diagnosed on the delayed films of an excretory urogram and was classified as severe (dilatation above and no contrast medium seen below the stone) in 17 patients and partial (dilatation above and contrast medium seen below the stone) in 32. Upper third ureteral stones were present in 41 patients (obstruction severe in 15 and partial in 26) and lower third ureteral stones were present in 8 (obstruction severe in 2 and partial in 6). ESWL was performed within 14 days of the onset of the acute renal colic because of persistent pain with an unmodified Dornier HM3 lithotriptor in 17 patients and a Medstone STS device in 32. With single stones the stone-free rate at 3 months, the repeat ESWL rate and the secondary procedure (stone basketing) rate were 92%, 6% and 8%, respectively, with severe obstruction, and 78%, 6% and 6%, respectively, with partial obstruction. No urinary drainage procedures for sepsis were required after ESWL. Obstructing ureteral stones, which presented mainly in the upper third of the ureter, were successfully treated with in situ ESWL without the need for either bypassing the stone with a ureteral stent or for pushing the stone back into the kidney before treatment with ESWL.
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PMID:In situ extracorporeal shock wave lithotripsy for obstructing ureteral stones with acute renal colic. 143 8

In a 6-year period, 9 patients were referred by their General Practitioners to the urology unit with a clinical diagnosis of renal colic but were subsequently found to have leaking abdominal aortic aneurysms (AAA). In all cases of loin pain, especially in the elderly patient, the possibility of a leaking abdominal aneurysm must be considered. If no intrinsic urological cause for the pain is found or patterns suggestive of ureteric obstruction are seen on urography, ultrasound examination of the aorta-iliac vessels should be performed. Magnetic resonance imaging (MRI) and computed tomography (CT) scans may be useful adjuncts to this investigation.
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PMID:Abdominal aortic aneurysms presenting as renal colic. 146 52

Emergency physicians often encounter patients in pain and may also have to cope with other problems (eg, alcohol intoxication, a patient's stubborn will to drive after the emergency department visit, narcotic "allergy"). Novel approaches can be used to treat these patients. Dr Heller discusses such approaches, including measures for treating patients with drug-seeking behavior (eg, use of nonnarcotic parenteral agents), and describes treatment options for patients with such specific conditions as hypotension, chest pain, and renal colic.
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PMID:Emergency management of acute pain. New options and strategies. 150 81

US is the imaging modality of choice in many situations encountered in the Emergency Department. It is particularly useful in evaluating renal colic, pain or vaginal bleeding in the pregnant patient, and pelvic pain in the nonpregnant woman; and in diagnosing gallbladder disease, appendicitis, proximal lower extremity DVT, and pericardial effusion. The information presented in each section, including sonographic findings and the role of US, should be helpful in choosing the most appropriate test in the evaluation process.
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PMID:Ultrasonography in the emergency setting. 173 90

The presence and migration of stones in the urinary tract are the consequences of lithiasis, a pathological process whose evolutive potential determines the frequency of recurrence. The stones produce haematuria and above all obstruction which manifests itself by pain and may be complicated by infection. The most suggestive type of pain is renal colic, but other revealing manifestations may occur. Such signs require radiological exploration with plain X-ray of the abdomen, renal ultrasonography and intravenous urography. These three indispensable examinations complete each other, provide the diagnosis and in the vast majority of cases point to the appropriate treatment. The haemodynamic repercussions of urinary tract obstruction have been thoroughly documented and now form the basis of treatment of renal colic with non-steroidal anti-inflammatory drugs. Obstruction and infection are the causes of all complications of urinary stones. Their management has been facilitated by recent advances in urology and should prevent the disease from destroying the kidneys and eventually causing chronic renal insufficiency.
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PMID:[Diagnosis and urologic development of urinary lithiasis. Revealing manifestations, radiologic diagnosis, course complications]. 178 97

Hydronephrosis secondary to ureteropelvic junction syndrome (UPJ), especially when it is accompanied by moderate dilatation of the proximal renal cavities tends to be stable with little risk to the kidney. However, there are certain exceptions to this general rule and the situation may very suddenly and almost always unpredictably progress towards complete obstruction of the UPJ with loss of function of the corresponding kidney. From a series of about 400 cases of hydronephrosis, 230 of which were operated, the authors analysed 13 cases of intermittent hydronephrosis, three of which suddenly progressed towards complete, irreversible obstruction of the UPJ. This dramatic outcome is difficult to predict, but it would appear to be wise to operate on cases of intermittent hydronephrosis, even when only moderate, especially when they are symptomatic, i.e. Painful. The authors believe that an episode of renal colic without stones constitutes an absolute indication for surgery.
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PMID:[Acute and irreversible obstructions due to a known and well tolerated ureteropelvic junction syndrome]. 184 30

A randomized, double-blind, multicentre clinical trial was designed to compared the analgesic efficacy of i.m. dipyrone 1 and 2 g, i.m. diclofenac sodium and i.m. pethidine in acute renal colic. The study was carried out in 451 patients in 13 Spanish hospitals. Ureteric colic was diagnosed by the clinical features, urinalysis, or when the presence of a ureteric calculus was confirmed. The severity of pain was assessed by the physicians and by patients using visual analogue scales. The main parameter of drug efficacy was the need for rescue treatment-pethidine 100 mg i.m. 30 min after the experimental treatment. Rescue treatment was required in 93 patients: they represented 24.1% of the group given dipyrone 1 g; 22.3% of those on dipyrone 2 g; 16.4% of those given diclofenac sodium; and 19.5% of those on pethidine. The differences between the groups were not significant. In the remaining 358 patients, no difference between treatments was observed. The results suggest that in acute renal colic the use of dipyrone 2 g is unjustified as dipyrone 1 g is equally effective. Diclofenac sodium is a valid alternative, which shows similar analgesic efficacy.
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PMID:Comparative study of the efficacy of dipyrone, diclofenac sodium and pethidine in acute renal colic. Collaborative Group of the Spanish Society of Clinical Pharmacology. 188 33

A number of studies have suggested that nonsteroidal antiinflammatory agents can relieve renal colic by a mechanism of action different from that of narcotics, offering the potential advantage of avoiding narcotic side-effects such as alteration of mental status. The authors prospectively administered oral indomethacin, 50 mg, to 25 nonvomiting patients with acute renal colic due to a documented stone. Eleven patients group (I) received the drug in an unblinded, nonrandomized fashion after failure of oral or parenteral narcotics to provide satisfactory pain relief, either at home or in the emergency department. In 14 additional patients group (II) indomethacin was given as the only initial treatment. Pain intensity before and after treatment was reported using a 1-to-10 scale. In group I, pain decreased from 5.8 +/- 2.7 to 3.6 +/- 3.8 (P less than .02). Six of the 11 patients reported a decrease in pain intensity of 50% or more, which occurred within 25 +/- 11 minutes, and in 5 of these 6, pain decreased to a 0 or 1 level. In group II, pain decreased from 7.6 +/- 1.5 to 4.6 +/- 4.0 (P less than .008). Eight of the 14 patients reported a decrease in pain intensity of 50% or more, which occurred within 40 +/- 14 minutes, and in 5 of these 8 pain decreased to a 0 or 1 level. Among all 25 patients who received indomethacin, pain relief was not significantly associated with the duration of pain before treatment or with patient age or sex. There was a trend for pretreatment pain intensity to be higher among nonresponders (P = .07).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Oral indomethacin for acute renal colic. 198 42


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