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

Fifteen cases of gunshot wounds of the esophagus seen between the years 1970 and 1978 were reviewed, eight involving the cervical esophagus and seven involving the thoracic portion. Most common symptoms were pain, neck tenderness, dyspnea, and dysphagia. Signs observed were subcutaneous emphysema, crepitations, fever, and leukocytosis. Plain X-rays showed pneumomediastinum, hydrothorax, and pneumothorax. Perforations were confirmed by barium studies in 12 patients. Injuries in the cervical portion were treated by prompt exploration, closure of the defect, and drainage. There were no deaths in this group. Thoracic injuries were treated by prompt thoracotomy except in one patient, for whom the diagnosis was not made until 22 hours after the injury; his was the only death in this series. Because of the extensive tissue involvement in gunshot wounds, primary repairs of thoracic esophageal perforations have a high incidence of failure. Defunctionalization of the esophagus, through ligation of the distal esophagus, gastrostomy, and cervical esophagostomy, has provided a safer method. Use of a double strand of absorbable Dexon to ligate the distal esophagus made a second thoracotomy for removal of the ligature unnecessary. We have adopted routine use of hyperalimentation, avoiding the need for feeding jejunostomy.
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PMID:Perforations of the esophagus from gunshot wounds. 670 55

Episiotomy is a very common operation but little is known of its short-term or long-term morbidity.A prospective study was designed to record postpartum perineal discomfort and to investigate the presence and persistence of dyspareunia following episiotomy in 140 primigravidae. A comparison was made between those whose perineal skin was sutured with a subcuticular polyglycolic acid (;Dexon') stitch and those sutured with interrupted black silk stitches.Patients sutured with subcuticular ;Dexon' had significantly less perineal discomfort on the third, fourth, and fifth postpartum days. Patients who had epidural analgesia in labour had significantly more pain during the first five postpartum days irrespective of the suture material used.The timing of first coitus after delivery did not influence the presence or persistence of dyspareunia. Dyspareunia was commoner and lasted longer in patients sutured with ;Dexon' and it was also commoner in older primigravidae irrespective of the suture technique.
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PMID:Pain after episiotomy--a comparison of two methods of repair. 700 31

The use of an episiotomy for vaginal delivery is a controversial topic in modern obstetrics. If one is done, however, correct technique of perineal trauma repair is important. The usual episiotomy has traditionally been closed with interrupted suture. The use of a less reactive material, e.g. polyglycolic acid (Dexon), seem to be suitable for subcutaneous skin closure and beneficial in terms of acute postpartum discomfort and healing. The comparison of healing and patient comfort parameters between interrupted and subcutis polyglycolic acid suture used for episiotomy repair after delivery was done. Patients had follow-up during hospital stay, and two months after delivery a self administered questionnaire was sent to all women who participated, enquiring about perineal pain, resumption of sexual intercourse and cosmetics of suture line. Of 52 patients who had repair with interrupted suture, 21 were lost to follow-up. Of 65 gravidas who had repair with subcutis suture, 23 were lost to follow-up. At the 3rd day postpartum examination, patients with subcutis sutures had significantly better healing. An inflammatory process was present in 2 of 52 patients with interrupted sutures comparable with 1 of 65 in the subcutis group, and a gaping wound in 0 of 52 and 1 of 65, respectively. Recovery of function, measured by resumption of sexual activity by 8 weeks, was demonstrated in 5 of 31 patients with interrupted sutures versus 24 of 42 patients who had subcutis sutures. Episiotomy repair with subcutis polyglycolic acid (Dexon) offers significant advantages over traditional interrupted suture, both in terms of wound healing and resumption of sexual activity.
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PMID:[Suture of the episiotomy wound--comparison of two techniques from clinical and cosmetic aspects]. 955 15

Chronic inguinal pain occurs in 20-30% of patients after hernia surgery. A prospective randomized study of 162 patients was undertaken to determine whether absorbable sutures cause less pain than continuous polypropylene fixation of the mesh in the Lichtenstein operation. All patients were operated on under local anesthesia by the same senior surgeon. One-half of the meshes were fixed with continuous 2-0 Dexon II sutures and one-half with continuous 2-0 Prolene sutures. The incidence of pain and recurrence was investigated after a mean follow-up of 2 years. Patient characteristics and operative outcome were similar in the two groups and statistically nonsignificant in both. The rate of significant wound hematomas (n = 3), infections (n = 1), and recurrences (n = 2) were low and not related to the type of sutures. In both study groups 24-26% of the patients felt some pain in follow-up, but over 90% were very satisfied with the operation. The absorbable suture material does not appear to cause less neuropathic pain after Lichtenstein operation than nonabsorbable sutures.
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PMID:Do absorbable mesh sutures cause less chronic pain than nonabsorbable sutures after Lichtenstein inguinal herniorraphy? 1209 May 77

To determine which method of skin closure was associated with less bleeding, 250 women were randomly allocated to have either a suture closure (3-0 Dexon II) or an adhesive strip closure (Steri-Strip) following subcutaneous insertion of hormone (HRT) implants. Data were collected via a tested questionnaire and analysed. Significantly, more women in the adhesive strip group recorded postprocedure bleeding (RR = 2.26; 95% CI 1.42-3.60) and considered the bleeding excessive (RR = 4.17; 95% CI 1.18-14.76) and unacceptable (RR = 12.52; 95% CI 1.63-96.19). Pain scores and symptoms of local infection were similar in both groups. Routine use of adhesive strips for implant skin incision closure is not recommended.
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PMID:Randomised clinical trial of suture compared with adhesive strip for skin closure after HRT implant. 1284 70

The Lichtenstein hernioplasty has become a popular method in inguinal hernia repair. This study compared two methods of mesh fixation and wound closure. Forty-six men with unilateral inguinal hernia were randomized into two groups. In the control group polypropylene mesh was anchored with 3/0 Dexon sutures, fascia and skin were closed with sutures 3/0 Dexon and 3/0 Monosof. In the study group, the mesh was secured with butyl-2-cyanoacrylate adhesive and the fascia and skin were also glued with the adhesive. The costs of materials, duration of the operation, amount of postoperative analgesic doses, pain score after the first and the 7th postoperative day and return to daily activity were recorded. No recurrences during the mean follow-up of 4.7 months were observed and the cosmetic effect was very good. In the study group with tissue adhesive the patients had significantly lower pain score after the first postoperative day and had a tendency to require less analgetic doses and to return earlier to their daily activity. Duration of the operation was similar in both groups. The cost of sutures and tissue adhesive used in both procedures was comparable. The use of tissue adhesive in mesh fixation and wound closure seems to be a promising technique in Lichtenstein hernia repair.
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PMID:Lichtenstein inguinal hernioplasty using butyl-2-cyanoacrylate versus sutures. Preliminary experience of a prospective randomized trial. 1559 46

The aim of this study was to assess if a monofilament suture material (Biosyn) compared with a commonly used multifilament suture (Dexon II) would cause fewer problems and lower levels of discomfort and pain after suturing lacerations and episiotomies following vaginal delivery. Women (1139) who required suturing by a midwife were allocated for repair with either the multifilament polyglycolic acid suture (Dexon II) or with a new monofilament of glycomer 631 (Biosyn). The outcome assessment involved inspection of the sutured area and measuring levels of discomfort and pain with a Visual Analogue Scale (VAS). At follow up after 8-12 weeks, more women in the monofilament group reported problems with the sutured area.
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PMID:Suturing after childbirth--a randomised controlled study testing a new monofilament material. 1639 80

Genital tract trauma is common following vaginal childbirth, and perineal pain is a frequent symptom reported by new mothers. The following techniques and care measures are associated with lower rates of obstetric lacerations and related pain following spontaneous vaginal birth: antenatal perineal massage for nulliparous women, upright or lateral positions for birth, avoidance of Valsalva pushing, delayed pushing with epidural analgesia, avoidance of episiotomy, controlled delivery of the baby's head, use of Dexon (U.S. Surgical; Norwalk, CT) or Vicryl (Ethicon, Inc., Somerville, NJ) suture material, the "Fleming method" for suturing lacerations, and oral or rectal ibuprofen for perineal pain relief after delivery. Further research is warranted to determine the role of prenatal pelvic floor (Kegel) exercises, general exercise, and body mass index in reducing obstetric trauma, and also the role of pelvic floor and general exercise in pelvic floor recovery after childbirth.
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PMID:Minimizing genital tract trauma and related pain following spontaneous vaginal birth. 1746 91

Polyglycolic acid (PGA) sheets and commercial fibrin glue are commonly used to cover open wound surfaces in oral surgery. Compared to commercial fibrin glue composed of pooled allogeneic blood, autologous fibrin glue is less expensive and poses lower risks of viral infection and allergic reaction. Here, we evaluated postoperative pain, scar contracture, ingestion, tongue dyskinesia, and postoperative bleeding in 24 patients who underwent partial glossectomy plus the application of a PGA sheet and an autologous fibrin glue covering (autologous group) versus 11 patients in whom a PGA sheet and commercial fibrin glue were used (allogeneic group). The evaluated clinical measures were nearly identical in both groups. Remarkable wound surface granulation was recognized in two cases in the autologous group. No complications were observed in either group, including viral infection or allergic reaction. Abnormal postoperative bleeding in the wound region was observed in one case in the allogeneic group. Coagulation and adhesion of the autologous fibrin glue were equivalent to those of conventional therapy with a PGA sheet and commercial fibrin glue. Thus, our results show that covering wounds with autologous fibrin glue and PGA sheets may help avoid the risks of viral infection and allergic reaction in partial glossectomy cases.
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PMID:Clinical evaluations of autologous fibrin glue and polyglycolic acid sheets as oral surgical wound coverings after partial glossectomy. 2734 70

Postoperative pain is a remaining issue in tonsillectomy. Polyglycolic acid (PGA) is a biocompatible material used for absorbent suture reinforcement, and its sheet has been applied for covering defects after resection of oral carcinoma. The aim of this study is to examine whether the attachment of a PGA sheet to surgical wounds would reduce posttonsillectomy pain. In this prospective single-blind study, 17 consecutive adult patients were recruited who needed to undergo tonsillectomy, mainly due to habitual tonsillitis. Following bilateral tonsillectomies, a PGA sheet was attached with fibrin glue to only 1 side, without notification to patients of which side. Postoperative pain of each side was separately evaluated with a visual analog scale at 4 time points: before each meal and before sleep. Postoperative pain of both the PGA sheet-attached and nonattached sides was most severe before breakfast among 4 time points. Postoperative pain measured before breakfast was significantly more severe in the PGA sheet-attached side than the nonattached side. As such, this study provided solid data on the negative effects of PGA sheeting on posttonsillectomy pain.
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PMID:Effects of Covering Surgical Wounds with Polyglycolic Acid Sheets for Posttonsillectomy Pain. 2740 5


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