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

This is the first case report of esophageal injury caused by Percogesic. A 31-year-old healthy white woman presented with dysphagia and retrosternal pain following the ingestion of a Percogesic tablet. The patient felt the tablet lodge in her mid-esophagus even though she ingested it with a cupful of water and in the upright position. Additional fluid was taken to dislodge the tablet with no success. Past medical history was unremarkable for heartburn, regurgitation, or dysphagia. Upper gastrointestinal endoscopy revealed a well-circumscribed deep ulceration in the mid-esophagus. Hospitalization was required due to persistent dysphagia. Treatment consisted of a three-day regimen of liquid antacid, intravenous ranitidine hydrochloride, and metoclopramide. This case emphasizes that pill entrapment can occur in the esophagus in healthy individuals, even when taken in the upright position with plenty of fluid; and mucosal injury can be produced by drugs not generally reported to cause gastrointestinal adverse effects or mucosal injury.
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PMID:Drug-induced esophageal injury: a case report of percogesic. 271 1

The incidence of symptoms in relation to upper digestive tract disorders in the French population is unknown. An epidemiologic survey involving a group of 1,800 apparently healthy subjects, considered to be representative of the French population over age fifteen, was conducted in order to evaluate: a) the incidence of epigastric pain and regurgitation, b) the pattern of symptoms, and c) recourse to medical care. The annual incidence of epigastric pain and/or regurgitation was 35.2 p. 100 (epigastric pain: 19.9 p. 100, regurgitation: 27.1 p. 100). The incidence was not related to age and body weight. There were more women and unemployed subjects in the group with epigastric pain and regurgitation. There were more smokers among symptomatic subjects than among those who were symptom free. In 2/3 of subjects, symptoms evolved by attacks. Usually, the attack lasted less than one day. Compared with subjects with regurgitations alone, subjects with epigastric pain had symptoms of longer duration and had more frequent pain attacks (75 p. 100 of these subjects had at least one monthly pain attack). In this group, epigastric pain occurred after apparently stressful events in 39 p. 100, and chest pain in 26 p. 100 of cases. Subjects with epigastric pain sought medical advice more often (74 p. 100) than subjects with regurgitation alone (24 p. 100). An upper barium swallow was performed in half of the consultants, whereas endoscopy was performed in only 21 p. 100 of subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Epigastric pain and regurgitation: descriptive epidemiology in a representative sample of the adult population of France]. 322 Feb 24

Twenty-eight patients with endoscopically confirmed erosive or ulcerative esophagitis completed an 8-week placebo-controlled trial evaluating the symptomatic and endoscopic improvement obtained with ranitidine, 150 mg twice daily. Twice daily the patients recorded the number of episodes of retrosternal pain, regurgitation, and pyrosis on a diary card during a trial period of 1 week and during the 1st and 5th study week. Video documentation of endoscopy findings was undertaken before and at the end of the trial. The symptomatic relief obtained with ranitidine was significantly better than that obtained with placebo. The videotapes were assessed blindly and independently by three experienced fiberoptic endoscopists. The tapes were also recoded and reassessed by the same endoscopist. No systematic difference between different observers, either before or after treatment, could be detected. The interobserver variation, expressed as Kendall's tau b correlation coefficient, was 0.44 to 0.74. This coefficient was higher in intra-observer variation (0.63 to 0.91). Corresponding kappa-values for inter- and intra-observer variations were 0.12 to 0.30 and 0.27 to 0.85, respectively. The esophagitis, as judged by all observers, improved more in the ranitidine group than in the placebo group, but the difference did not reach statistical significance.
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PMID:Reflux esophagitis: assessment of therapy effects and observer variation by video documentation of endoscopy findings. 330 93

In a prospective clinical trial, 26 consecutive patients underwent endoscopic pneumatic dilatation over a 10-year period. Dilatation was achieved by means of a balloon attached to a normal gastrointestinal fiberscope. With the endoscope in an inverse position, the device was placed in the cardia and the dilatation process was monitored macroscopically. Before dilatation, patients suffered from dysphagia (92%), reduced speed of swallowing (100%), symptom aggravation under stress (73%), weight loss (50%), aspiration, pain, regurgitation, and vomiting. After dilatation and long-term follow-up (mean of 5 years), symptoms could be markedly reduced, especially the speed of eating and symptom aggravation under stress. Excellent and good results (Visick scale) were achieved in 76%. Fair results were achieved in 20%. To date, perforation and other complications have not occurred. Mortality was zero. Our series was an uncontrolled trial, so the results are hardly comparable to other studies. Furthermore, the small number of patients in our study represents a weak point with regard to complications. We conclude that the main advantages of the procedure are its simplicity and practicability. The simple procedure may be the method of choice in elderly patients. Of course, no final decision can be made until a well-designed controlled trial has been carried out.
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PMID:Long-term results of Troidl's technique of endoscopic pneumatic dilatation for achalasia of the esophagus. A prospective clinical trial. 333 76

In order to estimate the incidence and significance of aspiration during anaesthesia, a study of cases in which this complication had occurred was made at the Karolinska Hospital. With the aid of the anaesthetic recordkeeping system of the Department of Anaesthesia and the computer-based register of diagnoses of in-patients at the hospital, all cases in which aspiration was recorded were retrieved. Eighty-three cases of aspiration were retrieved from the file of anaesthetic records and four from the in-patient register. This constitutes an incidence of 4.7 aspirations in 10 000 anaesthetics, or 1 in 2131. The patients most often affected were children and the elderly. In 83% of the cases there were one or more preoperative factors indicating an increased risk for aspiration, such as emergency operation (38 cases, 43%), upper abdominal or emergency abdominal surgery (14 cases, 16%), a history indicating delayed gastric emptying (e.g. peptic ulcer/gastritis, pregnancy, obesity, unusual stress or pain, elevated intracranial pressure, 54 cases, 61%). In 29 cases (33%) there was a history indicating an increased risk of regurgitation, e.g. nasogastric tube, oesophageal disease or pregnancy. In 15 cases of elective surgery, no history of increased risk for aspiration could be found. In 67% of those cases the aspiration was preceded by difficulties involving the airways or intubation. The incidence of aspiration was more than sixfold higher during the night than during regular daytime working hours. In 41 cases (47%) the aspiration led to aspiration pneumonitis confirmed by x-ray. Fifteen patients (17%) needed mechanical ventilation, and four died.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Aspiration during anaesthesia: a computer-aided study of 185,358 anaesthetics. 375 72

A clinical profile and the course and outcome with therapy of 126 infants and children with gastroesophageal reflux (GER), diagnosed at a median age of 2.5 months and followed for 1.5 to 3.5 years is presented. Features included repeated regurgitation or rumination (99%), signs suggesting esophageal pain (49%, excessive crying "colic," sleep disturbance, Sutcliffe-Sandifer syndrome, respiratory symptoms 42%), failure to thrive (18%), and minor hematemesis (18%). Feeding problems and maternal distress were common, associated with child abuse in four cases. Therapy was initially conservative (posture, thickening of feeds, antacids, bethanechol), augmented by cimetidine in those with proven esophagitis (n = 34, 0.27%). Most (81%) were symptom-free by 18 months of age (55% by 10 months of age); 17 percent had fundoplication with good results; 2 percent have persisting symptoms beyond 2 years of age (1% failed surgery). No deaths were recorded. Surgery was performed for recurrent apneas/aspiration (6%), refractory esophagitis or stricture (5%), and failed medical management (7%). Esophagitis was a significant determinant to outcome, and the importance of selective early endoscopy is emphasized. GER is a cause of considerable morbidity in infants but, with active therapy, is self-limiting in the majority. Certain distinctive clinical signs indicate those patients who require detailed investigation and to whom more aggressive therapeutic efforts should be directed.
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PMID:Gastroesophageal reflux in children. Clinical profile, course and outcome with active therapy in 126 cases. 380 92

The liquid antacid Novaluzid (10 ml seven times daily) was compared with ranitidine (150 mg twice daily) and with placebo in 57 patients with symptoms and endoscopic signs of oesophagitis and gastro-oesophageal reflux. A randomized three-period change-over design with the double-dummy technique was used. Each treatment period lasted 6 weeks. Only 37 patients (64.9%) completed the entire trial. In retrospect, five patients receiving placebo were withdrawn because of insufficient effect, six patients because of side effects while taking Novaluzid and two while taking ranitidine. The remaining seven dropouts/withdrawals were for reasons without evident relationship to the treatment given. Statistical analyses based both on the 37 completers and on the 43 patients who had at least two treatment periods showed that ranitidine and Novaluzid were superior to placebo with regard to pain score (p less than 0.005) but not with regard to regurgitation, dysphagia, histology, and appearance on endoscopy (p greater than 0.05). It was impossible to distinguish statistically between ranitidine and Novaluzid. In conclusion, ranitidine and high-dose antacids are of equal effectiveness in the short-term treatment of reflux oesophagitis, and both are superior to placebo with regard to symptomatic relief.
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PMID:Ranitidine and high-dose antacid in reflux oesophagitis. A randomized, placebo-controlled trial. 389 81

A study was carried out to assess the effectiveness of ranitidine in the short-term treatment of reflux oesophagitis. In a double-blind randomized trial of 37 outpatients with symptomatic, endoscopically proven, moderate or severe reflux oesophagitis, 18 patients received ranitidine (150 mg twice a day) and 19 patients received identical-looking placebo tablets for a period of six weeks. Clinical, laboratory, and endoscopic assessments were made initially, and at the end of six weeks. Two patients withdrew during the trial. Endoscopic evidence of improvement was found in 15 of 17 ranitidine-treated and in five of 18 placebo-treated patients. This difference was significant (P less than 0.01). Antacid consumption was significantly lower in the ranitidine-treated group (P less than 0.01). Improvement in histological findings, and the relief of retrosternal pain, regurgitation, dysphagia, and epigastric pain did not achieve levels of statistical significance. No adverse clinical or laboratory changes occurred in patients in either group. It is concluded that, as judged by endoscopic evidence, ranitidine is an effective drug for the short-term treatment of reflux oesophagitis.
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PMID:Ranitidine and placebo in the treatment of reflux oesophagitis. A double-blind randomized trial. 631 7

We undertook a multicenter double-blind study comparing ranitidine to placebo in 73 patients with symptomatic gastroesophageal reflux ranging in age from 22 to 80 years (mean 49). Initially, all patients had moderate to severe symptoms associated with abnormal endoscopic and/or microscopic appearance of the mucosa. After six weeks, 46% of ranitidine-treated patients had a one-grade improvement in their symptom of regurgitation, as compared with 19% treated with placebo (p less than 0.01); ranitidine was no better than placebo in the improvement of pain or dysphagia. Endoscopic improvement occurred in 61% of ranitidine- and 48% of placebo-treated patients (p less than 0.05). Histological improvement occurred in a similar and small portion of patients treated with ranitidine and placebo; there was no correlation between clinical, endoscopic, and histological improvement. Antacid consumption was only half as great in the ranitidine as in the placebo group. Therapy with ranitidine was maintained for up to 12 months. The patients remained free of regurgitation or pain and there was a trend towards further improvement in the endoscopic or histopathologic appearance of the esophagus. Ranitidine 150 mg b.i.d. is recommended for the relief of symptoms and improvement in the endoscopic appearance of the esophagus. Treatment should be for a minimum of 6 weeks, but may be continued for up to a year if the patient's symptoms persist or return.
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PMID:Ranitidine in the treatment of symptomatic gastroesophageal reflux disease. 632 88

The various pathological types of aneurysm are reviewed and their natural history discussed in relation to morphology, etiology and site of the aneurysm. For diagnostic purposes, computed tomography is a reliable method in the detection of aortic aneurysm; for evaluation of the ascending segment, ultrasonography may also be considered a useful procedure. The two non-invasive methods are particularly valuable in monitoring patients with thoracic aneurysms not (yet) suitable for surgery. In the light of the literature and our own experience, practical guidelines for adequate treatment of non-dissecting aneurysms of the thoracic aorta are elaborated with respect to aneurysm site. In patients with anulo-aortic ectasia, surgical treatment is clearly indicated in the presence of typical Marfan syndrome and in cases showing a demonstrable increase of aneurysm dilatation and/or of aortic regurgitation (hospital mortality 5% in our experience); irrespective of these criteria, surgery should be considered if the echocardiographic root diameter is greater than 6 cm. Replacement of the aortic arch carries a high surgical risk and is suggested for patients suffering from symptoms such as pain or compression of adjacent tissues; in asymptomatic patients, arch resection is scarcely advisable unless the aneurysm is of luetic origin. For aneurysms of the descending aorta, the operative indication will also be related to clinical symptoms as well as to aneurysm expansion and growth; in asymptomatic subjects, surgery is recommended in the presence of a circumscribed posttraumatic false aneurysm, the operative risk being very low in this patient group. In cases with suspected aortic dissection, computed tomography is considered to be the primary diagnostic procedure. Angiography may be mandatory only for those few presurgical candidates who require accurate assessment of aortic valvular regurgitation and determination of peripheral organ perfusion. The extremely unfavourable natural history of acute aortic dissection (50% survival after 48 hours following onset of symptoms) clearly calls for immediate operative treatment in high-risk patients, that is in subjects with acute ascending aortic dissection (hospital mortality 28% in our series). The better prognosis of descending aortic dissection suggests that in these cases conservative hypotensive therapy is the treatment of choice; surgical intervention in type B acute dissection is indicated only if occlusion of a major aortic branch occurs or if impending rupture of the dissecting hematoma becomes evident.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Thoracic aortic aneurysms]. 639 25


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