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

Eighty out of eighty-six patients (93%) with mammary artery implants were followed postoperatively for an average of three and a half years. The immediate mortality rate was 7% (6 cases), and the late mortality was 6% (5 cases). All had angina preoperatively. Twenty-four had a history of myocardial infarction and thirty-one were on limited physical activity, because of the pain. After surgery, thirty-three (45%) became asymptomatic. The angina improved significantly in thirty-five (47%) and remained unchanged in six (8%). Improvement in ventricular repolarization on ECG was observed in 69% of the patients. Postoperative cineangiography was performed in twenty-three patients; thirteen with single and ten with double implants. Out of the total of thirty-three implants, four (12%) were obstructed and twenty-seven patent (82%); twenty were in two cases of double implant, only one implant could be satisfactorily studied effectively functioning (61%). No obstructions were seen in the single implants. Non functioning implants were found in five (38%) of the thirteen single implants and in two of the twenty double ones (10%). The highest incidence of obstruction or non-functioning implants occurred in the group that did not show improvement (43%). This rate fell to 40% in the group that had some improvement and to 29% in those that were completely asymptomatic. Twelve of the eighteen patent mammary implants (67%) on the anterior wall of the left ventricle and eight of nine (89%) on the lateroinferior wall, established collateral circulation to the coronaries. Indication for surgery was considered satisfactory for nineteen out of the twenty-three patients and poor in four. There were two cases of obstruction of the implant (7%) in the group where surgery was correctly indicated and three of the twenty-three (11%) patent implants were non-functioning. Clinical improvement of the angina occurred in 84% in the first group and 50% in the other. In conclusion, this technique of indirect revascularization of the myocardium is valid for patients with severe diffuse lesions of the coronaries with a collateral network and preserved myocardial contractility.
J Cardiovasc Surg (Torino)
PMID:Long-term results of mammary artery implants. 1 Dec 20

Two patients with isolated innominate artery occlusion presented with symptoms of significant right-sided cerebrovascular insufficiency. One of these also noted progressive pain and weakness of the right upper extremity. Both were treated with dacron bypass grafts from the ascending aorta to the innominate bifurcation with complete relief of all symptoms. Unlike the subclavian steal, innominate artery occlusion induces distinct and much more significant hemodynamic alterations in extracranial arterial flow and is rarely asymptomatic. Three distinct patterns of blood flow have been described secondary to this lesion. Correction is best achieved by either innominate artery endarterectomy or dacron bypass grafting which the authors favor. Extra-anatomic bypasses represent a less satisfactory solution except in the poor risk patients. Long term relief of symptoms and patency of the reconstruction have been generally achieved by either of the recommended techniques.
J Cardiovasc Surg (Torino)
PMID:The innominate steal syndrome. 11 10

Twenty-one patients with postinfarction angina (2 to 15 days after acute myocardial infarction) unresponsive to medical therapy were treated by intra-aortic balloon pumping (IABP). Anginal pain and electrocardiographic (ECG) ST-segment changes were prevented in all patients. Coronary angiograms were obtained during IABP without complication and confirmed severe coronary artery disease. Of the four nonoperated patients, three had reinfarction and two died of cardiogenic shock. Seventeen patients underwent aorta-coronary bypass grafting, associated with aneurysmectomy in two patients and closure of a ventricular septal defect in one. Sixteen patients survived the operation. All survivors are in clinically improved condition and 14 are pain free from 9 to 28 months postoperatively, but three have mild heart failure.
J Thorac Cardiovasc Surg 1977 Aug
PMID:Treatment of post-myocardial infarction angina by intra-aortic ballon pumping and emergency revascularization. 30 68

Coronary artery spasm was induced by intravascular administration of ergonovine maleate (Ergotrate) during cardiac catheterization. In 78 patients suspected to have Prinzmetal's angina, no morbidity or death has resulted despite complete occlusive spasm in two and three coronary arteries. Typical EKG changes and akinesia of the myocardium in the distribution of the occluded vessels documented functional myocardial ischemia during spasm. The occlusive spasm is readily reversed by sublingual or intravascular nitroglycerin, and ventricular contractility returns to normal following relief of spasm. Occlusive spasm has been demonstrated in 15 patients with clinical evidence of Prinzmetal's angina. Symptoms have been effectively relieved by coronary vasodilators in 10 patients. Of the 5 patients in whom medical therapy failed, 4 were treated surgically. These 4 patients were in the intensive care unit with protracted, prolonged pain, subendocardial infarctions, and persistent failure of coronary vasodilators. Aorta-coronary bypass grafts have been combined with total cardiac denervation by autotransplantation (one patient) and total cardiac denervation by stripping of the great vessels (3 patients). Two of the patients treated by cardiac denervation died in the early postoperative period. The patient treated by autotransplantation has total relief of symptoms but persistent spasm on angiography. The angiographic demonstration of occlusive coronary spasm remains a valuable diagnostic tool to document definitively the presence of spasm. The surgical results question the value of surgical intervention in this disease.
J Thorac Cardiovasc Surg 1977 Mar
PMID:Coronary artery spasm. medical management, surgical denervation, and autotransplantation. 40 7

O2 and CO2 tensions were measured in the gastrocnemius muscles of patients submitted for reconstructive arterial surgery due to obstructive arteriosclerosis (37) or abdominal aortic aneurysm (5). Four patients without signs of arterial ischaemia served as controls. Measurements were carried out by means of implanted silastic tonometers during breathing of air and 100% O2 and immediately after walking on a treadmill. Peripheral blood pressures in the ankles were recorded with a Doppler apparatus. Baseline tissue gas tensions showed no essential differences between the various groups of patients: intermittent claudication, pain at rest, praegangrene, abdominal aortic aneurysm and controls. In contrast, baseline ankle pressures correlated well with the severity of the disease. During breathing of oxygen, the smallest increases of muscle PO2 were observed in extremities with pain at rest or praegangrene and the highest responses were recorded in controls and aneurysm patients. Muscle PCO2 values showed no alterations during oxygen breathing. In physical exercise, muscle PO2 and PCO2 levels as well as ankle blood pressures remained unchanged in controls and patients with aneurysm but no claudication. However, in all groups with arterial ischaemia, the exercise test resulted in a profound fall of muscle PO2 and ankle blood pressure and an increase of muscle PCO2.
Scand J Thorac Cardiovasc Surg 1979
PMID:Tissue gas tensions in the calf muscles of patients with lower limb arterial ischaemia. 43 76

A 62-year-old man presented with a grand mal seizure, progressive abdominal distention, and refractory hypotension 18 years after colonic bypass of a benign stricture of the low middle third of the esophagus. He died 3 hours after admission to the hospital. The patient had a history of liniment ingestion in childhood plus a long history of dysphagia and substernal pain. Autopsy disclosed a large ulcer of the anterior wall of the distal esophagus, which had eroded through the posterior wall of the left atrium. Histologic examination revealed chronic esophagitis with fibrous obliteration of the esophageal wall, pericardium, and left atrial myocardium near the site of perforation. Foreign material was present within small arteries of multiple viscera, and in several of these fragments transverse striations were demonstrated. Esophageal-atrial perforation is a rare but fatal complication of chronic esophageal ulceration. The clinical and pathological features of this and previously reported cases of nontraumatic esophageal-atrial perforation are reviewed.
J Thorac Cardiovasc Surg 1979 Aug
PMID:Esophageal-atrial perforation due to recurrent esophagitis 18 years after esophageal bypass surgery. 45 25

Angiographic examination in a patient with sciatic-like pain on the right side and a firm, pulsatile, non-tender mass in the right buttock revealed a large sciatic artery aneurysm. The aneurysm was successfully resected at surgery. The primitive sciatic artery is the main arterial supply to the lower extremities in the 9-mm embryo. Its persistence, while very rare, is of clinical significance because of the tendency for aneurysms to develop in the artery. Surgical resection is indicated in sciatic artery aneurysms because of the danger of rupture or embolic occlusion of arteries distal to the aneurysm.
Cardiovasc Radiol 1979 Nov
PMID:Aneurysm of a persistent sciatic artery. 51 73

Forequarter or interscapulothoracic amputation is a major surgical procedure indicated primarily in the treatment of malignant lesions involving the bony and soft tissue parieties of the upper part of the arm, shoulder, and scapula. It is also indicated in extensive trauma with irreparable damage to the shoulder area and as a palliative measure in intractable pain caused by incurable tumors of the shoulder girdle. Several operative techniques have been described: the classical Berger approach, an anterior pectoral approach, and posterior retroscapular approaches. A radical transthoracic approach has been described in cases in which the tumor had spread through the chest wall. The two main goals of these approaches have been early ligation of the subclavian vessels and immediate exploration for operability. This report details our experience with a modified technique for radical forequarter amputation and chest wall resection in which a transmediastinal approach is employed. This approach was used in two patients: One had a radiation-induced fibrosarcoma of the left axilla and adjacent chest wall following a radical mastectomy 19 years earlier, and the other patient had a recurrent rhabdomyosarcoma of the right axilla with invasion of the chest wall. This technique avoids time-consuming and individual excision of ribs and minimizes the amount of blood loss by early ligation of the internal mammary vessels. Safe and excellent exposure and division of the subclavian vessels and early exploration for mediastinal and intrathoracic involvement are made possible. Details of the procedure with illustrations are described.
J Thorac Cardiovasc Surg 1978 Sep
PMID:Modified technique for radical transmediastinal forequarter amputation and chest wall resection. 68 68

During the twenty-year period 1954--1973, 208 patients were referred to the Department of Thoracic and Cardiovascular Surgery for treatment of mediastinal tumours. Forty-nine patients had malignant tumours (24%), 86 benign tumours and 73 non-neoplastic lesions. The most common histologic types were neurogenic tumours and malignant lymphomas, followed by thymomas and germinal tumours. Most non-neoplastic lesions were cysts. The mediastinal tumours were often asymptomatic, the malignant tumours in 31%, the benign tumours and tumourlike lesions in 65% of the cases. The most common symptom was pain, which occurred in one-fifth of the patients. The most useful diagnostic method was X-ray examination of the chest. However, a final diagnosis could usually be made only at operation. Thirteen malignant tumours were excised radically, 18 palliatively and 18 were only biopsied. Almost all benign tumours were radically excised. Forty-four patients received postoperative radiation therapy and 6 received chemotherapy. The hospital mortality was 8.2% for the patients with malignant tumours and 1.9% for those with benign tumours. At the end of the follow-up period, which varied from 2 to 21 years (median 10.3 years), 41% of the patients with malignant tumours were alive. Two patients with benign tumours had died of an apparently malignant change in a neurofibroma.
Scand J Thorac Cardiovasc Surg 1978
PMID:Mediastinal tumours. A follow-up study of 208 patients. 72 64

Coronary artery spasm (CAS) has been postulated to be a pathophysiologic mechanism in the production of ischemic-like chest pain and ECG changes in patients with idiopathic mitral valve prolapse syndrome. To evaluate the possible role of symptomatic CAS evoked by ergonovine maleate, this agent was administered (0.05 to 0.4 mg IV) to 24 patients with chest pain and mitral valve prolapse who had no significant (less than 50%) coronary artery obstruction. Symptoms, ECG and blood pressure changes were monitored in all patients following ergonovine administration. No significant changes were observed in heart rate, systolic blood pressure, or double product. Six patients developed their typical chest pain. In two of these six with chest pain, ST segment shift greater than 1 mm were seen. Post-ergonovine left ventricular end-diastolic pressure (LVEDP) and coronary angiographic changes were also studied in subgroup of 12 of these patients, including five of the six chest pain responders. In the five chest pain responders, pain was associated with a significant rise in LVEDP, whereas no significant change occurred in those patients not experiencing chest pain (p less than 0.01). Chest pain was also associated with significant CAS (greater than 50% lumen reduction) in two patients, each with ST segment shifts greater than 1 mm. In summary, ergonovine stimulation failed to evoke symptoms, ECG or blood pressure changes in three quarters of mitral valve prolapse patients studied. Six patients developed chest pain. Chest pain was assoicated with ECG changes characteristic of CAS in two of these patients, each with angiographic CAS. Thus, symptomatic CAS induced by ergonovine was absent in the majority of these 24 patients with idiopathic mitral valve prolapse syndrome.
Cathet Cardiovasc Diagn 1978
PMID:Ergonovine testing for coronary artery spasm in patients with angiographic mitral valve prolapse. 73 30


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