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

Femoral arterial pseudoaneurysms or arteriovenous fistulae may sometimes complicate percutaneous femoral artery catheterization procedures. Most surgeons recommend prompt operative repair because of the unfavorable natural history of pseudoaneurysms or arteriovenous fistulae secondary to violent or accidental arterial trauma. However, the natural history of catheterization-induced pseudoaneurysms and arteriovenous fistulae has not been well documented. Accordingly, we prospectively studied the natural history of 22 pseudoaneurysms, 8 arteriovenous fistulae, and 3 combined lesions, identified by duplex scan in 32 patients following trans-femoral cardiac, peripheral vascular, or vascular access arterial catheterization procedures. Angiographic procedures were performed with the use of 5-8F introducer sheaths. A femoral artery complication was significantly more likely to result from coronary balloon angioplasty (9/304; 3.0%) than from diagnostic cardiac catheterization (21/2476; 0.8%) (p less than 0.003; chi square). Fourteen patients (13 pseudoaneurysms, 1 combined pseudoaneurysm/fistulae) underwent surgical repair. Pain and/or enlarging hematoma resulted in repair within two days of the diagnosis in 8 patients. The need for chronic anticoagulation prompted elective repair in 2 patients. A pseudoaneurysm was repaired in one patient five days following catheterization when it became painful. In three stable patients, asymptomatic pseudoaneurysms were repaired electively during another surgical procedure. There were no operative deaths. One patients (7%) developed a wound infection postoperatively. Eighteen patients (19 arterial lesions: 9 pseudoaneurysms, 8 arteriovenous fistulae, 2 combined pseudoaneurysms/arteriovenous fistulae) with improving symptoms and stable physical signs were followed by serial clinical evaluation and duplex scans. Seventeen of 19 (89%) of these lesions resolved spontaneously within 5-90 days (mean 30.7 days).(ABSTRACT TRUNCATED AT 250 WORDS)
J Cardiovasc Surg (Torino)
PMID:Selective non-operative management of pseudoaneurysms and arteriovenous fistulae complicating femoral artery catheterization. 152 48

Three cases of erosive gastroduodenitis secondary to chronic splanchnic vascular insufficiency are reported. In all cases, pain failed to respond to conventional therapeutic measures for peptic ulcer disease. A patchy discolouration and erythematous mottling of the gastric mucosa, with scattered shallow aphthous ulcers, was seen on endoscopic examination. Angiography showed coeliac axis involvement in all patients, with insufficient mesenteric collateral pathways. Chronic gastritis resolved clinically and endoscopically after revascularization.
J Cardiovasc Surg (Torino)
PMID:Chronic ischaemic gastritis: an unusual form of splanchnic vascular insufficiency. 152 50

Autopsy or surgical specimens from six patients with primary cardiac angiosarcoma seen at the Mayo Clinic (all in men) between 1939 and 1988 were studied (patients' ages, 31 to 80 years; mean 50 years). The symptoms were nonspecific and included dyspnea and thoracoabdominal pain in six; anorexia in five; fatigue, hemoptysis, or orthopnea in four; nausea and vomiting, fever, or weight loss in three; and night sweats in two. Cardiomegaly was present in five, and a pericardial effusion or density, a mass adjacent to the heart, or nonspecific ST-T wave changes were present in three. All six neoplasms arose from the right atrium and exhibited epicardial or endocardial extension; three produced obstructive intracavitary right atrial masses. Pulmonary metastatic lesions were noted in five patients. The cardiac neoplasm was diagnosed by computed tomography or magnetic resonance imaging in the three most recent patients, and surgical resection was performed in two of them. Mean survival was 6 months after presentation. Causes of death were pulmonary hemorrhage in three, thoracic metastasis in two, and hemopericardium in one. The diagnosis of primary cardiac angiosarcoma was established at operation in two patients and at autopsy in four. Despite diagnosis by noninvasive imaging procedures and aggressive early surgical intervention, survival was less than 6 months. Thus optimal therapy is unclear.
J Thorac Cardiovasc Surg 1992 Apr
PMID:Primary cardiac angiosarcoma: a clinicopathologic study of six cases. 154 8

Coronary pacing using as unipolar negative electrode a guidewire placed in a coronary branch was tested in 349 sites of 300 consecutive patients undergoing coronary angioplasty. It was possible for 339 sites (97%). The threshold currents ranged from 1 to 15 (mean +/- standard deviation 3.4 +/- 2.4) mA. Side effects were seen in 13 patients (4%): 6 (2%) had transient coronary spasm, 4 (1%) had diaphragmatic stimulation, and 3 (1%) had stinging pain at the skin electrode. Of the 10 cases with pacing failure, left ventricular pacing was successfully tested in 5 by introducing the coronary wire or another wire into the left ventricle. It yielded a threshold of 2-8 (3.2 +/- 2.7) mA. Therapeutic pacing for significant bradycardia was required in 7 patients (2%). It was successful in all. Coronary or left ventricular pacing appears to be a simple and reliable temporary measure. When there is no wire in the coronary artery or for diagnostic catheterization, left ventricular pacing can be done using the same setup and any type of guidewire.
Cathet Cardiovasc Diagn 1992 Apr
PMID:Coronary and left ventricular pacing as standby in invasive cardiology. 157 89

Within a two year period, the diagnosis of acute dissection of a segment of the abdominal aorta was made in five cases without aneurysmal dilation or leakage and with virtually no ischaemia. All patients presented with an atypical painful abdominal syndrome and the diagnosis was made by computed tomography. Only one patient, suffering persistent pain was treated by resection and graft interposition of the infrarenal aorta. All the others were treated conservatively and kept under close follow-up. Two of them died from intercurrent disease. The remaining three patients are doing well after 30 and 42 months conservative treatment and 43 months after surgery respectively. A non-complicated dissection of the abdominal aorta must be considered in the differential diagnosis of atypical painful abdominal syndromes. In cases of persistent pain, progression, ischaemia, aneurysmal dilatation or leakage, surgical treatment is mandatory. In uncomplicated cases conservative treatment is recommended, similar to the principles of management for dissections of the descending thoracic aorta.
J Cardiovasc Surg (Torino)
PMID:Limited acute dissections of the abdominal aorta. Report of five cases. 160 11

Continuous intrapleural bupivacaine administration was assessed in a randomized double-blind manner with respect to its analgesic effect and its impact on breathing after thoracotomy. The pleural cavity was infused continuously for 48 hours in 24 patients following thoracotomy for pulmonary resection. 12 patients received 10 ml/h of bupivacaine hydrochloride 0.5% solution, and 12 patients 10 ml/h NaCl 0.9% solution. There were no differences in the patients' characteristics, extent of surgery, mode and duration of general anaesthesia. There were no complications related either to the catheter or to bupivacaine. The amount of postoperative opioid, given on request, was used to assess the effect of bupivacaine administration on pain relief. Post-thoracotomy breathing was assessed by measuring the forced vital capacity (VC) prior to and after physiotherapy. The VC values measured 24 h, 36 h and 48 h after the operation were similar in both groups of patients with or without bupivacaine administration (p greater than 0.05). Patients given bupivacaine required significantly less opioid analgesia than those who received NaCl 0.9% at 24 h (p less than 0.001), 36 h (p less than 0.001) and 48 h (p less than 0.01) after the operation. Continuous intrapleural bupivacaine analgesia through a paravertebral catheter positioned in the paravertebral groove is safe and provides efficient pain relief after thoracotomy.
Thorac Cardiovasc Surg 1992 Apr
PMID:Pain relief and respiratory mechanics during continuous intrapleural bupivacaine administration after thoracotomy. 163 78

Brachial plexus injury is a typical complication after median sternotomy. A prospective study was performed on 1000 consecutive patients to determine whether preventive actions, including lower position and least possible opening of the sternal retractor, help to reduce the complication rate. Twenty-seven patients were observed with postoperative brachial plexus injury. Nerve conduction measurements and electromyography were performed. Patients without preparation of the internal mammary artery had a complication rate of less than 1%, whereas the complication rate of those patients with preparation of the internal mammary artery was as high as 10.6%. The main symptoms were continuous pain and motor and sensory disturbances. Most frequent were lesions corresponding to the roots C8-T1. Six patients had Horner's syndrome; three had ptosis only with no other signs of Horner's syndrome. Symptoms persisted in eight patients more than 3 months after the operation, and one patient still had intractable pain. Increasing use of internal mammary artery grafts in coronary artery bypass demands measures to protect the brachial plexus.
J Thorac Cardiovasc Surg 1991 Nov
PMID:Brachial plexus injury after cardiac surgery. The role of internal mammary artery preparation: a prospective study on 1000 consecutive patients. 168 32

Intravenous (i.v.) bolus administration of adenosine causes increased ventilation and an angina pectoris-like chest pain. Whether adenosine per se or one of its metabolites such as inosine mediates these effects is not clear. Bolus doses of adenosine, inosine, or saline were administered i.v. blindly to six volunteers. Spirometry, ECG recordings, and pain ratings were taken. Adenosine induced both an increase in tidal volume and respiration rate, a dose-dependent chest pain and, at higher doses, various degrees of atrioventricular (AV) block. None of these effects were noted after equimolar injections of inosine or saline. The findings indicate that the angina pectoris-like pain and increased ventilation is induced by adenosine per se and is not produced by adenosine metabolites.
J Cardiovasc Pharmacol 1990 Jul
PMID:Intravenous adenosine but not its first metabolite inosine provokes chest pain in healthy volunteers. 169 61

Bradykinin antagonists effective in a great variety of kinin-responsive tissues have been developed and used to study the roles of kinins in various physiological and pathological phenomena. Structural changes required to yield antagonists and to confer high potency, tissue selectivity, and resistance to enzymatic degradation have been explored in several hundred analogs. Certain of these offer promise for the development of drugs effective against pain, inflammation, and asthma.
J Cardiovasc Pharmacol 1990
PMID:Kinin antagonists: design and activities. 169 64

An attempt was made to study possible interaction between neuromodulation by adenosine and nicotine stimulatory effects. Dose-effect curves were made double blind in 7 nonsmoking, nonsnuffing healthy volunteers (25-49 years) before and during exposition to nicotine roughly corresponding to the nicotine of one cigarette, 2 mg ingested from a chewing gum (800 chews during 20 min). Chest pain was estimated by the Borg CR-10 scale. ECG was followed, and respiration was recorded continuously by spirometry. Maximal tolerable dose of adenosine was 12.7 +/- 3.0 mg. Chest pain increased dose dependently to 5.7 +/- 1.7 units. Nicotine increased the pain response by 20 +/- 15%, (p less than 0.02). The total time with atrioventricular (AV) block provoked by adenosine increased with nicotine (7 +/- 12%, p less than 0.03) while increased ventilation provoked by adenosine was unaffected by nicotine. In conclusion, interaction between adenosine and nicotine was demonstrated. Nicotine enhanced both stimulatory (chest pain) and inhibitory actions (AV-block) of adenosine.
J Cardiovasc Pharmacol 1990 Dec
PMID:Nicotine enhances angina pectoris-like chest pain and atrioventricular blockade provoked by intravenous bolus of adenosine in healthy volunteers. 170 90


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