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

The authors studied a series of 104 rheumatoid wrists, stages II, III or IV according modified Larsen's grading, treated between 1980-1988 by synovectomy realignment stabilization. The mean follow-up period was 5 years. The operation presents different steps which have an additive effect and must be associated in order long term clinical and radiological stability. They associated: extensor tendons and articular synovectomy stabilization of the distal radio ulnar complex by Sauve-Kapandji's operation, tendon transfert: the extensor carpis radialis longus is transferred on the extensor carpi radialis brevis the extensor carpi ulnaris is relocated with posterior annular dorsal ligament plasty. Results concerning relief of pain were very clear because the patients presented either complete relief of pain (73%) or only intermittent occasional pain. The overall active range of motion is nearly the same, when compared pre- and post-operative ratings. In general the patients who presented good pre-operative mobility usually improved them and the others preserved them. Larsen's radiological grading was modified by the authors to include instability's criteria in frontal and sagittal plane. Carpal height remained stable (75% less than or equal to 1 mm), ulnar deviation has never overreached 3 mm, radial deviation was not modified in 50% of cases. They found only 4 wrists presenting a stage II radiological grading with an evolution to the stage III and 12 of the stage III grading became stage IV. The instable type of the stage IV was stabilized by a surgical radiolunate arthrodesis. The stabilized type was nearly not modified. The different steps of operation (articular and tenosynovectomy, carpus stabilization and realignment with stabilization by stabilization of the radio ulnar complex joint using Sauve-Kapandji operation, tendons transfers and dorsal retinacular plasty) have an additive effect in achieving relief of pain with preservation of the pre-existing mobility. The stabilization of the radio ulnar complex by the Sauve-Kapandji operation constitutes a new approach in rheumatoid arthritis published by the author in 1985 and in our opinion appears to be simple and is very efficient in stabilizing wrist immediately, thus allowing early rehabilitation of these patients. Long term stability is affirmed by clinical and roentgenologic follow-up and globally a painless wrist, a preservation of the pre-operative motion and a stabilization in frontal and sagittal plane is obtained.
Rev Rhum Mal Osteoartic 1992 Mar
PMID:[Synovectomy in the realignment-stabilization of the rheumatoid wrist. Apropos of a series of 104 cases with average follow-up of 5 years]. 160 38

Despite 25 years of clinical practice, concerning chronic epidural spinal cord stimulation (SCS) for pain control, the mechanisms underlying the beneficial effects are still poorly understood. The main indications for SCS are intractable chronic pain secondary to neurogenic origin (essentially neuropathies by lesion of peripheral nerve or roots) or to ischemic origin. Several observations suggest that mechanisms by which SCS alleviate these two types of pain are different. In peripheral vascular disease, the analgesic effect appears as the consequence of the vasodilatory effect of SCS. The actual experimental data indicate that SCS produce its influence on peripheral microcirculation via a transitory suppression of the sympathetic vasoconstrictor control.
J Mal Vasc 1992
PMID:[Mechanisms of action of medullary neurostimulation in the treatment of limb arteriopathy]. 161 2

The clinical diagnosis must be enriched by quantifiable parameters when a new therapeutic method must be tested. We analyse the role of vascular explorations for epidural stimulation and limb arteriopathies. Four different fields of investigations can be defined. Accuracy of the diagnosis: The tests are useful to rule out some differential diagnoses of arterial involvement, and to establish the functional severity (stage III). 1--Treadmill test: nonischemic pain is ruled out: the evolution can be followed up. 2--Doppler velocimetry demonstrates the extent of the dominant arterial involvement in cases of associated lesions. 3--Arterial pressure gradients: their presence demonstrates significant lesions and allows detecting the affected levels. Quantification of severity: After detecting the lesions, their impact must be appreciated. From a macrocirculatory point of view, the measurement of pressures and flow rates is more sensitive than the Doppler study. From a microcirculatory point of view, the tcpO2 is very useful. 1--Arterial pressure: measured in the ankle and the first toe. There are three degrees: non-threatening ischemia (pulsatile Doppler, distal pressure exceeding 30 mm Hg), threatening ischemia (non pulsatile Doppler, distal pressure exceeding 30 mm Hg), irreversible ischemia (no more pulse, no more capillary flow). If there are arterial calcifications, the pressure in the toe must be measured. 2--Arterial flow rate: the average flow rate may be preserved in an arteriopathy, while the pulsatile rate is already degraded. Non invasive electromagnetic or nuclear magnetic resonance flowmeters measure the total muscular flow. Laser Doppler shows the cutaneous flow rate. 3--The tcpO2: normally greater than 60 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)
J Mal Vasc 1992
PMID:[Vascular exploration tests. Importance for the indications and monitoring of epidural medullary neuro-stimulation]. 161 3

The best prevention of recurrent spontaneous pneumothorax is obtained with a parietal pleurectomy, the recurrence rate being below 0.5%. The sequelae on the muscles and the aesthetic result of a thoracotomy favour a pleurodesis using a closed chest technique. Video-endoscopy enables us to perform 16 percutaneous parietal pleurectomies (PPP) without thoracotomy in 14 patients. 11 cases were idiopathic spontaneous recurrent pneumothoraces and in 3 cases the recurrent pneumothorax occurred in patients suffering from AIDS with progressive pulmonary lesions. PPP was performed under general anaesthetic with selective intubation. The posterior incision of 2-3 cm did not involve any muscular section and the dissection was performed throughout using video-endoscopy which enabled perfect control of haemostasis. PPP achieves a sub-total pleurectomy. The hospital stay was on average for five days. Those operated on did not suffer from immediate post operative pain and shoulder mobility was excellent from the moment at which the patient awoke. The advantages of PPP are: perfect haemostasis and the absence of muscular sequelae or unpleasant aesthetic sequelae. These benefits now make us consider that percutaneous parietal pleurectomy may be the treatment of choice in spontaneous recurrent pneumothoraces.
Rev Mal Respir 1991
PMID:[Percutaneous parietal pleurectomy using video-endoscopy. Modern treatment of spontaneous recurrent pneumothorax]. 176 17

This conflict leads to a chronic irritation of the psoas by the antero-medial part of the cup, but it has been poorly described in the past. A study of six patients suffering from this trauma, and who were re-operated revealed that the muscle was worn thin in front of the prominent cup. In the case of 4 of the 6 patients pain had started to occur shortly after total hip replacement. The following symptoms were noted among all 6 patients: pain was suffered during flexion--extension movements--walking up stairs--arising from a chair. Pressure on the medial part of the groin was painful, especially during active elevation of the lower limb. Passive mobility was normal and painless. Psoas bursitis was observed in three cases. The main cause of this conflict is the protrusion of the cup beyond the antero-medial edge of the acetabulum; this protrusion may be either due to a bone graft or a bit of cement, but most often an acetabular insufficiency (congenital dysplasia) favors the formation of this anterior overhang. The spiral cup screwed into the bone can be especially aggressive when it protrudes. Treatment includes the resection of the overhang, but post-operative results will be uncertain unless the resection is really complete. In the case of 4 patients the results of such an intervention were only mild to poor. This problem can be avoided by proper care and preventive measures in the original replacement avoiding all projections beyond the anterior edge of the acetabulum--cup, bone graft, cement, especially if dysplasic.(ABSTRACT TRUNCATED AT 250 WORDS)
Rev Rhum Mal Osteoartic 1991 Oct
PMID:[Conflict between psoas and total hip prosthesis]. 177 1

The progress made in recent years in the field of bone densitometry, particularly concerning dual-energy x-ray absorptiometry, has resulted in the development of reliable techniques of bone mineral density measurement, especially for measurements in the lumbar spine on anteroposterior views and in the forearm. However, technical improvements are still necessary and concern the standardisation of equipment, measurements in the femur, on lateral views of the lumbar spine and on the whole body, and the definition of normal curves. The value of these measurements must be examined in the light of the epidemiological context of osteoporosis and its current and future cost to the community. They must be evaluated in relation to two pathological situations: osteoporosis and osteopenia. Osteoporosis is a disease characterised by the development of fractures due to bone fragility. It is accompanied by a reduction in bone density and other abnormalities of bone architecture and metabolism, without any disturbance of mineralisation. It is responsible for pain, a functional handicap which alters the patient's quality of life. Osteopenia corresponds to an abnormally low bone density. It is accompanied by an increased risk of fractures. Although it remains asymptomatic, therapeutic intervention may nevertheless be justified. The threshold of therapeutic intervention depends on the degree of bone loss, the patient's age, other associated risk factors and the benefit-risk ratio of the drug used. In all forms of vertebral osteoporosis, the essential conditions for the diagnosis are a decreased vertebral bone density and deformation of a vertebral body.(ABSTRACT TRUNCATED AT 250 WORDS)
Rev Rhum Mal Osteoartic 1991 Dec
PMID:[Evaluation of osteodensitometry]. 178 Jun 82

ST segment depression in leads V2 to V4 in a clinical and biochemical context of myocardial infarction is usually interpreted as a sign of non-Q wave anterior walls infarction. In order to determine if this clinical electric entity could indicate transmural posterior or posterolateral infarction, as recently suggested, we undertook a prospective study of 328 primary myocardial infarctions. Isolated ST depression in leads V2 to V4 was observed in 28 patients (8.5%). It was maximal in V3 (1.8 +/- 0.7 mm) or V4 (2 +/- 1 mm). The T wave was always positive. All these case had segmental wall motion abnormalities of the left ventricular posterolateral wall on 2D echocardiography. The Q wave confirming the transmural character of the infarct was observed in leads V7, V8 and V9 on average 33 hours after the onset of pain (10-56 hours) as did the increase in the R/S ratio in leads V1 and V2. Coronary angiography performed in 26 patients showed significant disease of the left circumflex artery in all cases. This was isolated (39%) or associated with left anterior descending (15%), right coronary artery disease (19%) or both (27%). In conclusion, isolated ST segment depression in leads V2-V4 in the clinical context of acute myocardial infarction indicates a transmural posterior localisation of the necrosis. It corresponds to reciprocal subepicardial posterior ischaemia. In cases of inferior infarction, it reflects postero-lateral extension rather than associated anterior wall ischemia.
Arch Mal Coeur Vaiss 1991 Dec
PMID:[Isolated ST segment depression from V2 to V4 leads, an early electrocardiographic sign of posterior myocardial infarction]. 179 18

In a prospective study, the influence of a mammary hypertrophy on some clinical and radiological parameters of the lumbar and dorsal spine had been studied in 14 women comparatively to 14 control women, before and after a reduction surgery. Clinically, the frequency of the lumbar pain was identical in the two groups of patients before surgical treatment but a significant decrease of the frequency and the intensity of the lumbar pain was found after the surgery in the mammary hypertrophic group (p less than 0.01). Some radiological parameters of lordosis and the dorsal kyphosis were significantly higher in mammary hypertrophic patients than in control patients. After surgery, an increase of parameters of lordosis was observed associated with a significant decrease of the dorsal kyphosis (p less than 0.05). Nevertheless, by use of a radiological classification of the lumbar lordosis with the Ferguson's indice, two main groups of lordosis had been distinguished. The intensity of the lumbar pain and the dorsal kyphosis were significantly higher in patients with a low indice than in those with an high indice. More, the dorsal kyphosis has decreased only in patients with a low anterior lumbar indice. In conclusion, a mammary hypertrophy must be searched in women with a lumbar pain and an surgical treatment may be proposed.
Rev Rhum Mal Osteoartic 1991 Jun
PMID:[Breast hypertrophy and dorsolumbar spine. Prognostic influences of lumbar lordosis: preliminary results]. 183 85

We have studied post-operative pain in 116 patients who underwent a thoracotomy. The pains were assessed using a visual analogue scale and were significant and identical whatever type of operation was used and irrespective of sex or diagnostic disease category. On the operative day only the surgeon seemed to have any influence. On the first post-operative day the pain was influenced by age and on the eighth day by socio-professional category. The insertion of drains had no influence on the pain. Massage and physiotherapy decreased the pain in a significant fashion. The importance of taking account of post-operative pain is underlined.
Rev Mal Respir 1991
PMID:[Postoperative pain after thoracotomy. A study of 116 patients]. 185 14

A follow-up study is reported on 49 patients with acute deep vein thrombosis (DVT) treated on an ambulatory basis. Venography had shown crural DVT in 27 % and proximal extension in 73 %. The initial treatment consisted of heparin (7,500 U iv, 40,000 U sc), ethylbiscoumacetate (900 mg), phenprocoumon (9 mg), and a ready made compression stocking for the calf. The patients were advised to undertake frequent strolls, the first when leaving the office. Pain, swelling and incapacity for walking vanished within two days. The partial thromboplastintime was prolonged 2.4-times on the first day and the thromboplastintime was in the therapeutic range on the second day already. Until follow-up 4 patients died of other diseases. There was no clinical pulmonary embolism, no secondary hospitalisation and only one new DVT. Of 844 months of patients at risk of recurrence 50 % passed under anticoagulants and 70 % with compression therapy. At an average of 19 months, 82 % of patients were asymptomatic and 45 % showed mild chronic venous insufficiency. In contrast, impaired drainage function (by lightreflectionrheography) was found in 79 % overall and in 100 % after DVT of the proximal veins. The discrepancy is explained by the compliance with compression therapy.
J Mal Vasc 1991
PMID:Ambulatory care for ambulant patients with deep vein thrombosis. 186 Nov 6


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