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

A systematic review of the 14 relevant controlled trials was conducted because there is no agreement about the choice of material and technique for repair of perineal trauma sustained during childbirth. Derivatives of polyglycolic acid (marketed as Dexon and Vicryl) appear to be the absorbable material of choice for both deep and skin closure. Compared with catgut their use is associated with about a 40% reduction in short-term pain and need for analgesia. The main drawback is that some material often needs removal during the puerperium. Glycerol-impregnated catgut is ruled out because of its link with long-term dyspareunia. Compared with the non-absorbable materials (silk and nylon) polyglycolic acid skin sutures were associated with less short-term perineal pain, and had no clear disadvantages. Continuous, subcuticular stitching appears preferable to interrupted, transcutaneous suturing, particularly in terms of perineal pain in the early puerperium.
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PMID:The choice of suture materials and techniques for repair of perineal trauma: an overview of the evidence from controlled trials. 255 6

Acute repair of disruptions of the knee extensor mechanism is indicated to reestablish extensor continuity and allow for early motion. This study reviews the results of acute primary repair of patellar tendon ruptures augmented by a nonabsorbable polyester tape (Mersilene; Ethicon, Inc.) followed by immediate mobilization. Twenty-four patients with disruptions of their patellar tendons were treated using the described technique. The ruptured tendon was initially approximated using an end-to-end suture repair with no. 5 Ticron suture in a whipstitch manner. An O Vicryl suture was used to approximate the free tendon edges. A 5-mm Mersilene tape was then used in a cerclage manner to augment and protect the repair. Postsurgery, passive range of motion (ROM) was begun immediately in the knees with isolated injury or in those patients whose concomitant injuries would allow for early motion. Using clinical and radiographic criteria, follow-up evaluations of 19 patients were performed at an average of 22.4 months. In patients with isolated injuries, active ROM was from 0 degrees extension to 132 degrees flexion (contralateral knee 0-135 degrees). Two patients had prominent knots: in one, the knots were painful and were removed surgically. Six patients developed patellofemoral chondrosis. Five patients had the Mersilene tape tied with the knee in full extension, and all developed patellofemoral pain. The other repairs were done with the knee flexed to 90 degrees before tying; one patient in this group developed patellofemoral symptoms. All patients with isolated injuries have returned to employment. There were no reruptures or infections.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Repair of patellar tendon disruptions without hardware. 762 77

A prospective clinical, manometric, electromyographic and radiological study was conducted to judge the degree of success achieved with anterior-posterior rectopexy in 18 female patients suffering from obstructed defecation and varying degrees of incontinence. Prior to being operated on, 6 of the patients showed symptoms of intussusception, 4 an internal prolapse of the anterior rectum wall, and 5 a rectocele at least 2 cm in size; all of them had significant perianal descent. The main aim of this study was more precise definition of the pre- and postoperative bowel evacuation using a defecation index. This study shows that obstructed defecation is significantly associated with a lasting feeling of needing to defecate after evacuation, a sensation of incomplete evacuation, perianal pain and necessity for manual support during defecation. The patients had a mean age of 62 (range, 38-78) years. All underwent anterior-posterior rectopexy (Ivalon or Vicryl) with posterior pelvic repair of the puborectalis muscle. In 2 patients rectopexy was combined with sigmoidectomy, in 11 cases, with left hemicolectomy, and in 2, with subtotal colectomy. The median follow-up was 40.8 months (range, 6-66 months). Postoperatively anorectal manometry showed a significant increase in the resting anal pressure and the maximum voluntary pressure (P = 0.05). Continence was improved in 10 patients (55%), 7 (39%) of whom regained normal continence. No significant change in pelvic descent or anorectal angle was observed. Only 8 patients reported a complete evacuation of the rectum postoperatively.
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PMID:[Value of abdominal rectopexy in obstructive disorders of defecation. A prospective study using a defecation index, manometry and radiology]. 847 1

The chronic constriction injury (CCI) is an animal model of an experimental peripheral neuropathy. In this model, a mononeuropathy is produced by loosely ligating the left sciatic nerve of the rat with chromic gut suture (Bennett and Xie 1988). Maves et al. (1993) have proposed that chemical constituents of chromic gut suture influence the behavioral changes of rats with the CCI. Considering their results, we became interested in evaluating whether the type of suture material used to produce the CCI also affected spinal levels of calcitonin-gene-related peptide immunoreactivity (CGRP-ir) and substance P immunoreactivity (SP-ir), peptides that are associated with small primary afferent neurons. Using methods of radioimmunoassay (RIA), we measured levels of CGRP-ir and SP-ir in the dorsal quadrants of approximately the lumbar 4-5 (L4-L5) spinal segments of rats with a CCI induced using polyglactin (Vicryl), plain gut, or chromic gut suture. We observed bilateral decreases in CGRP-ir and SP-ir 60 days after a CCI induced with chromic gut suture, but no changes in peptide levels after a CCI induced with either polyglactin or plain gut suture. These results suggest two possibilities: (1) chromic gut suture, when used to produce the CCI, has more than just a constrictive effect on the sciatic nerve, and/or (2) different suture materials produce changes in CGRP-ir and SP-ir with a differential time-course. Our experiments are unable to distinguish between these two possibilities.
Pain 1996 Mar
PMID:Chromic gut suture reduces calcitonin-gene-related peptide and substance P levels in the spinal cord following chronic constriction injury in the rat. 878 15

From 1987 to 1994, the senior author performed 41 Achilles tendon repairs. We identified 11 patients during this period (age, 35.3 years; range, 26-60 years) who fit the criterion for neglected Achilles tendon rupture (repair > or = 4 weeks and < or = 12 weeks from injury). All patients underwent proximal release of the gastrocsoleus complex, imbrication of the early fibrous scar without excision of any local tissue, and primary repair of the tendinous ends with two No. 5 Ticron sutures (5R, 6L). Several (three to five) No. 0 Vicryl sutures were used to augment the repair. The ankle was placed in a 20 degree plantarflexion nonweightbearing short leg cast for 3 weeks. All skin closures were primary. At 3 weeks, weightbearing as tolerated was initiated in a short leg cast. The cast was discontinued at 6 weeks, and physical therapy was initiated, consisting of range of motion exercises and closed kinetic exercises, progressing to functional exercises as swelling, strength, and pain allowed. Minimal follow-up was 18 months (mean, 3.5 years; range, 1.5-5.8 years). There have been no subsequent ruptures to date. All patients returned to a preinjury level of activity at a mean of 5.8 months (range, 2.5-9 months). Total range of motion was not different (P > 0.05) between the involved (67 degree) and uninvolved (74 degree) ankle. Plantarflexion loss of strength in the involved ankle was the same (98.4%, 88.1%, and 87.6% respectively, involved to uninvolved) as that seen after acute repair at all speeds tested. Visual analog pain scale (0 to 10) revealed a mean score of 0.7 (range 0-2) during activities of daily living and 1.0 (range, 0-3) during sports activity. The subjective and objective outcome was similar (P > 0.05) to that seen after an acute repair by the same surgeon. There were no complications including skin sloughs or nerve damage. We believe this is the first article to report the results after primary repair without augmentation for the neglected Achilles tendon rupture. We conclude that this approach can result in excellent clinical and functional outcome, a low rate of subsequent rupture, and a high rate of return to sports in the recreational athlete whose repair is performed between 4 and 12 weeks after injury.
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PMID:Primary repair without augmentation for early neglected Achilles tendon ruptures in the recreational athlete. 931 Jul 66

This randomised prospective clinical study compared the use of an absorbable suture (subcuticular 4:0 polyglactin 910) and a non-absorbable suture (5:0 monofilament polypropylene) for elective carpal tunnel decompression wound closure. An increased perception of pain was reported by the patients in the polypropylene (Prolene) group. At the 6-week assessment, there was a higher level of residual wound inflammation in the polyglactin 910 (Vicryl) group.
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PMID:Absorbable versus non-absorbable suture in carpal tunnel decompression. 1188 25

Currently, there are two fast-resorbing suturing materials on the Dutch market, viz. Vicryl Rapide and Safil Quick. The aim of this study was to compare the clinical suitability of both suturing materials, which was defined as minimal discomfort or pain for the patient, good knot security and tensile strength, predictable resorption, minimal tissue response, and good wound healing. In a group of 120 patients (60 patients randomized in each group), who were referred for apectomy, the clinical suitability of Vicryl Rapide and Safil Quick as fast-resorbing suturing materials was prospectively studied. The results showed that the tested materials were equivalent with regard to most aspects of their clinical suitability.
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PMID:[Vicryl Rapide versus Safil Quick. A prospective comparison of two fast resorbing suturing materials]. 1476 37

Wandering spleen is a rare clinical condition associated with a high incidence of splenic torsion and infarction. The preferred treatment for this condition is splenopexy to reposition the spleen in the left upper quadrant of the abdomen and to preserve splenic function. We present two cases of wandering spleen managed by laparoscopic splenopexy. Both young women presented with intermittent abdominal pain. A CT scan was diagnostic of wandering spleen in each case. Both patients were successfully treated with the laparoscopic splenopexy. The spleen was inserted in a Vicryl mesh bag and fixed in the left upper quadrant in both cases. Both patients had resolution of their preoperative symptoms. Laparoscopic splenopexy has many advantages over open splenopexy or splenectomy, including preserving splenic function, minimal postoperative pain, early discharge from the hospital, and rapid recovery.
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PMID:Laparoscopic management of the wandering spleen. 1534 61

The aim of the study was the evaluation of results of modified Ferguson hemorrhoidectomy, with use of the Ligasure radiofrequency coagulator, compared to the Milligan-Morgan and Longo techniques. From January 1988 to December 2005, 3011 patients underwent Ferguson hemorrhoidectomy (1849 F, 1162 M; age range: 18 to 84 years). One thousand three hundred patients had previously been treated by medical therapy with poor results and in 225 patients (7.5%) the indication was recurrence after previous surgical treatment. All patients underwent a closed Ferguson hemorrhoidectomy (combined with anoplasty in 28 cases of post-hemorrhoidal stenosis). Eighty percent of patients were operated on with loco-regional assisted anaesthesia, and the remainder with narcosis (cases of recurrence). During the last two years we performed hemorrhoidal excision in 116 patients (4%) with the Ligasure radiofrequency coagulator, followed by continuous suturing with Vicryl 4/0. There was no intraoperative mortality. Mean operation time was 25 minutes. Postoperative complications were hemorrhage in 6 patients (0.2%) and acute urinary retention in 9 patients (0.3%). No important complications were observed in any of the patients treated with Ligasure. The hospital stay was 24 hours for 2852 patients, and 36-86 hours in the other 5%. Seventy-two percent of patients (2160) had moderate postoperative pain, while 14% (420) had severe postoperative pain necessitating repeated administration of analgesics. The 115 patients undergoing Ferguson haemorrhoidectomy plus Ligasure were discharged within 24 hours of surgery. No cases of major domiciliary haemorrhage were observed. There were 13 cases of suture dehiscence (none in the Ferguson plus Ligasure group). Five patients presented suture infection, not requiring surgical drainage, but only medical treatment with local antibiotics. These results, obtained with the modified Ferguson technique, as compared to the classical and even the most innovative hemorrhoidectomy, appear to confirm the feasibility and accuracy of this operation in almost all patients, with both a considerable reduction in costs and enhanced patient comfort and compliance.
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PMID:[Ferguson hemorrhoidectomy, modified by using the Ligasure radiofrequency coagulator]. 1736 37

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


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