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

An association between increased tolerance to pain and arterial hypertension has been reported in experimental animals and confirmed in humans. The underlying mechanisms remain elusive. We have recently reported that diuretics and beta-blocking treatment do not influence pain sensitivity, despite significant reductions in arterial blood pressure. In the present study, ketanserin was evaluated. As in previous work, pain perception was assessed with a tooth pulp tester. Ten hypertensive subjects were studied basally, after 15 days and after 3 months of ketanserin treatment (20 mg twice daily). Significant reductions in arterial blood pressure and of pain thresholds were observed, but no correlation between these changes occurred. These preliminary data indicate that, contrary to other hypotensive drugs, ketanserin tends to decrease or reverse the abnormality in pain modulation observed in hypertensive patients. The lack of a correlation between effects on blood pressure and pain sensitivity seems, however, to favor the hypothesis of two independent underlying mechanisms.
Cardiovasc Drugs Ther 1990 Jan
PMID:Effect of ketanserin on pain perception in arterial hypertension. 228 44

54 patients who had posterolateral thoracotomy were prospectively studied to compare the efficacy of intrapleural bupivacaine with that of bupivacaine intercostal block and cryofreezing. Patients were randomized into three groups. The intrapleural catheter group included 16 patients who had intermittent intrapleural instillation of 20 ml of 0.25% bupivacaine for forty-eight hours postoperatively. The second group included sixteen patients who were given perioperative bupivacaine intercostal block. The third group included fifteen patients treated by cryofreezing of the intercostal nerves. Visual analogue four-hourly pain score was compared between the three groups during the first forty-eight hours postoperatively. The analgesic requirements during the first postoperative week were also assessed. There was no significant difference between the three groups in the average pain score (3.61 +/- 1.37, 3.54 +/- 1.15, and 3.33 +/- 1.47 respectively). During the first forty-eight hours postoperatively, the percentage of patients who required papaveretum in the intrapleural catheter group (56.3%) was significantly less than that in the other two groups (both 100%). The average papaveretum requirement (mg per patient) in the intrapleural catheter group (27.33 +/- 25.27) was significantly less than that in the second group (52.66 +/- 26.85) but the difference was not statistically significant from that in the third group (37.66 +/- 20.95). No complications related to the use of the intrapleural catheter or to bupivacaine toxicity were encountered. In conclusion, the technique of intermittent intrapleural bupivacaine is safe and comparable in efficacy to bupivacaine intercostal block and cryofreezing. Narcotic requirements may be reduced when this technique is used.
Thorac Cardiovasc Surg 1990 Feb
PMID:Intrapleural bupivacaine for early post-thoracotomy analgesia--comparison with bupivacaine intercostal block and cryofreezing. 230 27

Four hundred sixty-eight consecutive thoracotomies for which the lateral limited thoracotomy incision was used are reviewed (1978 to 1988). The limited incision is a lateral muscle-splitting incision with preservation of the latissimus dorsi, splitting of the serratus anterior, and cutting of only the intercostal muscles without rib resection. Patients were designated unsuitable for operation if (1) biopsy-proved distant metastasis existed, (2) mediastinoscopy revealed extranodal metastasis, or (3) severe respiratory compromise resulted in shortness of breath at rest with a forced expiratory volume in 1 second of less than 0.75 L (four patients). Mean patient age was 60.9 (+/- 15.7) years. Surgical procedures included lobectomy (n = 317), pneumonectomy (n = 41), wedge resection (n = 82), resections of blebs or bullae (n = 17), thoracotomy and biopsy for unresectable lesion (n = 6), and decortication (n = 5). Pathologic analysis revealed 354 malignant tumors, 102 benign lesions, and 12 carcinoids. The perioperative mortality rate was 0.85% (4/468) and major morbidity was present in 2.9% (14/468). Mean operative time was 73.1 (+/- 32.2) minutes with a blood loss resulting in a mean decrease of the hematocrit value of 2.6 (+/- 2.5) gm; three patients were given a total of 7 units of blood. Most patients do not require a stay in the intensive care unit postoperatively (less than 10%). Hospital stay postoperatively was a mean of 6.1 (+/- 2.9 days. The limited incision is a significant factor in decreasing operative time, blood loss, postoperative pain and morbidity, and cost.
J Thorac Cardiovasc Surg 1990 Apr
PMID:The lateral limited thoracotomy incision: standard for pulmonary operations. 231 78

A prospective study of 85 lumbar sympathectomies for inoperable peripheral vascular disease was conducted to analyze the correlation between lumbar sympathectomy, ankle/arm index (AAI), popliteal-brachial index (PBI), and the clinical presentation; and to study if predicted clinical criteria, single or combined, could be defined for selection of patients who might benefit from lumbar sympathectomy. Good results were obtained if at six months after surgery pain at rest was absent, ischemic ulcers had healed, and there were no major amputations. Seventy-seven percent of all limbs with a preoperative AAI greater than or equal to 0.3 had a good outcome in contrast to 94% failure for index less than 0.3 (p = .000000477). Sixty-nine percent of all limbs with PBI greater than or equal to 0.7 had a good outcome vs. 52% if index less than 0.7 (p = 0.199). Patients with rest pain, simple leg ulcers, and toe gangrene had a good outcome if the AAI greater than or equal to 0.3 and if the postoperative AAI increased by greater than or equal to 0.1. The PBI and diabetic status had no prognostic value.
J Cardiovasc Surg (Torino)
PMID:Clinical parameters for predicting response to lumbar sympathectomy in patients with severe lower limb ischemia. 232 70

A 28 yr-old male presented with chest pain and acute ST elevation following ingestion of pseudoephedrine. The pain and electrocardiographic changes disappeared after the administration of sublingual Nitroglycerin. Myocardial enzymes did show some evidence for myocardial necrosis. A subsequent coronary arteriogram showed no occlusive lesions. Pseudoephedrine, a sympathomimetic agent, may be implicated in the initiation of coronary spasm and myocardial infarction in some patients.
Cathet Cardiovasc Diagn 1990 May
PMID:Coronary artery spasm and myocardial infarction in a patient with normal coronary arteries: temporal relationship to pseudoephedrine ingestion. 234 9

A 57 yr-old man suffered an in-hospital inferior myocardial infarction 9 yr following coronary artery bypass surgery. Emergency cardiac catheterization demonstrated a large, occlusive thrombus in the saphenous vein graft to the right coronary artery. Multiple balloon dilitations failed to lyse the thrombus. A guiding catheter was used to aspirate the thrombus from the graft and there was immediate pain relief.
Cathet Cardiovasc Diagn 1990 May
PMID:Thrombus aspiration in acute myocardial infarction. 234 10

Leiomyoma of the esophagus was surgically treated in 15 patients in 1962-1987. Six patients were asymptomatic and nine presented with dysphagia alone or combined with retrosternal pain, vague thoracic discomfort, dyspnea and cough, or palpitations. Barium swallow and esophagoscopy provided the correct diagnosis preoperatively in most cases. Transthoracic enucleation of the tumor was performed via right thoracotomy in nine patients and left thoracotomy in six. The location of tumor was the upper third of the thoracic esophagus in three cases, middle third in six and lower third in six cases. There was no surgical mortality or morbidity. Surgical removal of esophageal leiomyoma thus gave relief of symptoms, with minimal risk and excellent functional outcome.
Scand J Thorac Cardiovasc Surg 1990
PMID:Leiomyoma of the esophagus. 235 88

Traumatic aneurysms of the descending thoracic aorta are a rare but lethal event, having a mortality of 85-90%. Mortality of this population remains high due to the occurrence of aortic rupture. The isthmus of the aorta, just distal to the left subclavian artery is the most frequent site of injury. Acute traumatic injury to the aorta is characterized by hemorrhagic shock symptoms due to the tear in the layers of the aortic wall. Chronic traumatic injury with aneurysmal formation may not surface with symptoms for months or years after initial trauma. Patients who have formed a chronic aneurysm after a trauma incident can experience dysphagia, chest pain, dyspnea, or cough. Surgical repair involves placing a dacron graft in the area of aneurysmal formation. Protection of the lower extremities during the surgical procedure may prevent paraplegia. In a review of ten cases of chronic traumatic aneurysms at Loyola University Medical Center during the past twenty (20) years, all patients underwent surgical repair. There was no incidence of paraplegia. Post-operative nursing care focuses on monitoring hemodynamic stability, preventing respiratory complications and controlling pain.
Prog Cardiovasc Nurs
PMID:Traumatic descending thoracic aneurysms: discussion and nursing care. 236 14

Beta-blocking drugs were specifically introduced for the treatment of exercise-induced angina pectoris. Their therapeutic utility in this specific presentation of coronary insufficiency is undoubted. However, since they were introduced, evolution of the pathological, haemodynamic, and electrophysiological understanding of the disease syndrome has undergone considerable reappraisal, in no small measure owing to the physiological tool that these drugs have furnished. Their influence on the various aspects of the syndrome of exercise-induced ischaemic myocardial pain is widely known. The physiological conflict posed by unopposed blockade of one sympathetic outflow pathway remains the source of many of their clinical disadvantages. Many important questions directly related to their therapeutic use remain unanswered. The potential benefits and hazards of their long-term administration in patients with advanced coronary heart disease remains to be established.
J Cardiovasc Pharmacol 1985
PMID:Coronary insufficiency and beta-blockade. 240 76

One hundred malignant pleural mesotheliomas have been treated in our hospital since 1955. Clinical and autopsy findings are analyzed and compared to X-ray changes. The most common symptoms were dyspnea (49%), pain (40%) and cough (36%). The main initial X-ray signs were pleural effusion (62%), pleural thickening (29%) and solitary nodules (6%). Prior to death a combination of effusion and pleural thickening was the usual finding. Histologically there were 49 biphasic, 32 mesenchymal and 18 epithelial malignant pleural mesotheliomas. At autopsy 82% of the cases had distant metastases, most of which had not been expected clinically. The median survival time was 7.3 months following the first clinical symptoms, and only 4 months after the first radiological signs.
Thorac Cardiovasc Surg 1985 Oct
PMID:Follow-up study of 100 malignant pleural mesotheliomas. 241 79


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