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

This is a case report of the 2nd oldest patient reported in the literature with transverse myelitis after mumps, and the 1st with magnetic resonance imaging (MRI) correlation. He is a 38-year-old Chinese man presenting with bilateral lower limb weakness and numbness, and urinary retention starting 3 weeks after an attack of mumps parotitis. Clinically, there was mild lower limb paresis, absent plantar responses and reduced pain sensation below the umbilicus. MRI revealed cord swelling and increased T2 signal from T7 to T11. Cerebrospinal fluid showed 23 cells/mm3 and 55 mg protein/dl. He received a 5-day course of intravenous methylprednisolone 0.5 g/d. The sensory and motor deficits improved over 2 weeks; urinary symptoms improved over the next year. Transverse myelitis following mumps is recognizable clinically and radiologically, and potentially responsive to methylprednisolone.
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PMID:Transverse myelitis following mumps in an adult -- a case report with MRI correlation. 940 4

General surgeons often provide the exposure for the anterior repair of vertebral body lesions. The standard anterior approach to the thoracolumbar junction (T11-L1) is a transpleural 9th or 10th rib thoracoabdominal incision. From October 1995 through March 1997, 22 patients underwent anterior repair of thoracolumbar junction vertebral lesions through an alternative 11th rib resection while maintaining an extrapleural approach. Exposure was excellent, as judged by the neurosurgical team completing the repairs. Chest tubes were not used routinely, and all patients healed without complications. A major limitation of the 11th rib extrapleural approach to the thoracolumbar junction has been poor exposure. This problem is eliminated with the use of an abdominal self-retaining retractor system. With many potential advantages to this 11th rib exposure (less pain, fewer pulmonary problems, and better wound healing), we consider the 11th rib incision to be the approach of choice to the thoracolumbar junction and recommend renewed interest in this incision.
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PMID:The anterior extrapleural approach to the thoracolumbar junction revisited. 954 54

Thirty subjects undergoing posterolateral thoracotomy were allocated randomly to receive one of two analgesic regimens: group Pre received i.v. morphine, i.m. diclofenac and intercostal nerve blocks from T2 to T11, 20 min before operation and placebo injections after operation. Group Post received placebo injections before operation, and i.v. morphine, i.m. diclofenac and intercostal nerve blocks from T2 to T11 at the end of surgery, before discontinuation of anaesthesia. Visual analogue pain scores, extent and duration of intercostal nerve block, analgesic consumption and complications were assessed during the postoperative period by a single blinded observer. Subjects were followed-up for a minimum of 12 months to determine the incidence of post-thoracotomy pain syndrome. During the first 48 h after operation there were lower pain scores in group Pre when taking a vital capacity breath but there were no significant differences between the groups in any other measure. The effects of pre-emptive analgesia given before surgery appeared to be relatively modest in terms of analgesia, analgesic consumption and long-term outcome and were of limited clinical significance.
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PMID:Pre-emptive effect of multimodal analgesia in thoracic surgery. 960 75

Prolonged nerve conduction blockade has been proposed to result from the summed effects of charged and neutral local anaesthetics. Thirty-seven patients were randomly allocated to receive intravenous patient-controlled analgesia alone or combined with intercostal blockade (T7-T11) with a mixture of 0.45% bupivacaine and 0.6% phenol for post-cholecystectomy analgesia. Adequacy of pain relief was measured by patient scores on a 10-cm visual analogue scale and by dose-demand ratio, amounts of loading dose and total consumption of morphine and also the duration of patient-controlled analgesia in each group. No differences were found between groups in post-operative scores, dose-demand ratios and loading doses of morphine. However, in the combined treatment group, a significantly lower total consumption of morphine (P < 0.05), associated with a shorter duration of patient-controlled analgesia (P < 0.02) and a decreased mean number of unsuccessful demands (P < 0.001) were recorded. Intercostal blockade with bupivacaine-phenol supplements intravenous patient-controlled analgesia for post-cholecystectomy pain relief.
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PMID:Intercostal nerve blockade with a mixture of bupivacaine and phenol enhance the efficacy of intravenous patient-controlled analgesia in the control of post-cholecystectomy pain. 978 66

Clinically, thoracic disc herniation occurs much less frequently than herniation in the cervical or lumbar regions, and accounts for only 0.15 to 1.8% of all intervertebral discs treated surgically. Classically, open thoracotomy is the standard procedure for thoracic disc herniation, but this type of surgery can cause prolonged postoperative wound pain that jeopardizes the mechanism of respiration and postoperative rehabilitation. We report the case of a 41-year-old woman with a symptomatic T11-T12 thoracic disc herniation and cord compression. Video-assisted thoracoscopic surgery (VATS) was performed to remove the herniated disc successfully. Intraoperatively, there was no injury to vital organs or the spinal cord. The total operating time was 3.5 hours, and the estimated blood loss was 400 ml. Postoperatively, the incisional pain was minimal, and no intercostal neuralgia was noted. At her 2-year follow-up examination, she was fully ambulatory and free of pain. This type of minimally invasive procedure is a good alternative to the classic thoracotomy and proved to be a safe and effective procedure for this patient.
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PMID:Thoracic disc herniation treated by video-assisted thoracoscopic surgery: case report. 1007 33

Percutaneous vertebroplasty (PVP), whereby polymethylmethacrylate cement is injected into the vertebral body (VB), has been used to successfully treat various spinal lesions. The mechanism responsible for the palliative effect of PVP is unknown, but it may be the result of neural damage caused by heat liberated during polymerization of the polymethylmethacrylate. The purpose of the current study was to measure in vitro temperature histories at three key locations (anterior cortex, center, spinal canal) in VBs injected with one of two different bone cements (Simplex P and Orthocomp) to determine the role temperature plays in PVP. Twelve VBs (T11-L2) from three elderly female spines were instrumented with thermocouples and injected with 10 cc of one of the two cements. Temperatures were measured with the VBs in a bath (37 degrees C) for 15 min after injection. A Student's paired t-test was used to determine differences in peak temperature and time above 50 degrees C between the two cement groups. Peak temperatures and temperatures above 50 degrees C were significantly higher and longer, respectively, at the center of VBs injected with Simplex P (61.8 +/- 12.7 degrees C; 3.6 +/- 2.1 min) than those injected with Orthocomp (51.2 +/- 6.2 degrees C; 1.3 +/- 1.4 min). There was no significant difference in peak temperature between cements at the spinal canal location; temperature there did not rise above 41 degrees C. Although thermal damage to intraosseous neural tissue caused by cement polymerization cannot be ruled out as a potential mechanism for pain relief experienced by patients subsequent to PVP, it seems unlikely based on the worst-case conditions tested in the current study.
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PMID:Temperature elevation caused by bone cement polymerization during vertebroplasty. 1045 68

A 30-year-old healthy woman was involved in a road traffic accident. She sustained a fracture dislocation of T11/12 with a complete Frankel A paraplegia below T11. She had no associated injuries. High Dose Methylprednisolone was administered according to the NASCIS III protocol (48 h) together with low molecular weight Heparin and gastroprotected medication. Complete transection of the spinal cord and an anterior haematoma from T11 to T12 were confirmed on X rays, CT's and MRI scans. Posterior surgical stabilisation was performed using Isola instrumentation, starting 8 h post injury. Her post surgical period was uneventful except for some episodes of low blood pressure (85/60 mmHg) from which she had no symptoms. On the 12th post operative day, while in the physiotherapy department, she complained of right scapular pain. This occurred every time she was sat up and was associated with paraesthesia of both upper limbs. Two days later she deteriorated neurologically and her level ascended initially to T8 and then to T3. MRI of the spine with and without gadolinium showed spinal cord oedema between C3 and T1. There was no evidence of haemorrhage or syringomyelia. The authors discussed this case making different hypotheses. They are mainly the following: (1) Gradually ascending ischaemia due to a vascular disorder; (2) Double spinal trauma; (3) Ischaemia related to repeated hypotensive episodes; (4) Low grade intramedullary tumour; and (5) Thrombus of the Radicularis Magna artery. The case has been recognised as being very rare and interesting. In the conclusions, the presenting author stresses the importance of adopting MRI-compatible instrumentation for the surgical stabilisation of the spine, and careful monitoring of blood pressure during the acute phase of spinal cord injury. Dr Aito agrees with Mr El Masry about the opportunity of forming a group of clinicians in order to discuss protocols to cope with this devastating complication.
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PMID:Ascending myelopathy in the early stage of spinal cord injury. 1049 Aug 52

We have compared intrathecal bupivacaine 1.25 mg and fentanyl 25 micrograms (group A) with bupivacaine 2.5 mg and fentanyl 25 micrograms (group B), for combined spinal-epidural analgesia in 49 labouring parturients in a prospective, randomized, double-blind study. Onset and quality of analgesia were similar in both groups, with median visual analogue scale pain scores of 0 achieved in 5-10 min. Median duration of analgesia was longer in group B (median 120 (range 90-120) min) compared with group A (75 (75-105) min) (P = 0.013). Median upper sensory level was higher in group B compared with group A at 15 min (T6-7 vs T11, P = 0.003) and at 30 min (T6 vs T11-12; P = 0.001). Motor block was greater in group B: seven patients had a modified Bromage score > or = 1 compared with none in group A at 15 min (P = 0.017). Group B also had a greater decrease in arterial pressure. Patient-midwife satisfaction scores and other side effects were similar. We conclude that intrathecal bupivacaine 1.25 mg with fentanyl 25 micrograms provided analgesia of similar onset and quality compared with bupivacaine 2.5 mg and fentanyl 25 micrograms. Although the duration of analgesia was shorter, the incidences of motor block and hypotension were less with the smaller dose.
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PMID:Combined spinal-epidural analgesia in labour: comparison of two doses of intrathecal bupivacaine with fentanyl. 1070 Jul 84

The rat neurokinin-1 (NK1) receptor gene contains a cyclic adenosine monophosphate (cAMP) response element, and gene transcription may be activated upon binding of phosphorylated cAMP response element binding protein (pCREB). If pCREB contributes to increased expression of NK1 receptors, pCREB should increase in neurons that express NK1 receptors under conditions that increase NK1 receptor mRNA. Evidence for this relationship was found following injection of formalin into one hindpaw of rats. Immunohistochemistry was employed to visualize NK1 receptors and pCREB in spinal cord sections. Formalin injection produced an increase in pCREB-immunofluorescence within NK1 receptor-immunoreactive neurons from segments L4 and L5. No change occurred in pCREB-immunofluorescence within NK1 receptor-immunoreactive neurons from segment T11. These data support the hypothesis that transcription factor pCREB contributes to increased expression of spinal NK1 receptors during persistent pain.
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PMID:Phosphorylated cAMP response element binding protein increases in neurokinin-1 receptor-immunoreactive neurons in rat spinal cord in response to formalin-induced nociception. 1072 26

One hundred consecutive stiff shoulders in 93 patients resistant to conservative therapy were treated with surgery and intermittent regional anesthesia via indwelling interscalene catheter. Each patient underwent manipulation and one of several operative treatments to release any additional contracture. The indwelling interscalene catheter remained in place and functioned well for an average of 3 days in 87 shoulders. At an average follow-up of 3.0 years, overall clinical results according to Neer's criteria were excellent in 39 shoulders (39%), satisfactory in 28 (28%), and unsatisfactory in 33 (33%). Patients reported no or mild pain in 83 (83%) of the shoulders in the study. At final follow-up, average gains in motion were 44 degrees of elevation (115 degrees to 159 degrees), 31 degrees of external rotation (22 degrees to 53 degrees), and 5 spine segments of internal rotation (L4 to T11). At final follow-up, 95% of the elevation and 79% of the external rotation achieved intraoperatively were maintained. The best results were obtained in those shoulders with idiopathic stiffness (88% excellent or satisfactory results); the worst results were in the postsurgical shoulders (47% excellent or satisfactory results). There were no catheter-related complications. The use of an indwelling interscalene catheter for postoperative pain control is a safe technique that facilitates early physical therapy in a patient population with a high risk of developing recurrent stiffness.
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PMID:Indwelling interscalene catheter anesthesia in the surgical management of stiff shoulder: a report of 100 consecutive cases. 1097 20


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