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

In this study, 21 patients who had undergone double innominate osteotomy for congenital hip dysplasia (CDH) were studied to determine if significant improvements in clinical and radiographic indexes were present at follow-up. Quantitative data reflecting functional status, pain level, and range of motion were obtained and analyzed statistically, as were standardized measurements from preoperative and postoperative radiographs. Statistically significant improvements at follow-up were observed in pain level, functional status, acetabular index, center-edge angle, and relative lateral displacement. Significant correlations were found between the postoperative functional score and several clinical indexes, but none were found between radiographic indexes and the final functional score.
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PMID:Clinical and radiographic outcome of patients treated with double innominate osteotomy for congenital hip dysplasia. 201 May 10

Twenty-nine total hip arthroplasties in 16 patients with juvenile chronic arthritis were performed by one surgeon and followed prospectively. The 9 female and 7 male patients averaged 21 years of age (range, 14-35). Height and weight averaged 160 cm (63 inches) and 53 kg (118 lb.), respectively. Preoperative planning used small or miniature components to accommodate the small anatomic proportions of the hip. The femoral component was cementless in the majority (20/29), but required cementing in 10 of 29 hips because of poor bone stock. The acetabula were reconstructed with a porous-coated cup with or without screws (27/29) or with a cemented cup (2/29). Follow-up periods averaged 53 months (range, 24-100 months). The average Harris hip score improved from 37 to 78 after surgery (P = .0001). Pain relief was excellent; 15 of 16 patients (27/29 hips) expressed a significant improvement in daily function and lifestyle, despite systemic involvement of their arthritis. The range of motion of the hip improved significantly in all planes (P = .001). Two of the 4 uncemented Muller CDH components (Protek, Bern, Switzerland) with a large offset have migrated into varus; both are pain-free. One cemented femoral component has been revised because of aseptic loosening. The use of a small or miniature, cemented or cementless femoral component and a porous-coated cup appears to provide an excellent method of hip reconstruction for patients with juvenile chronic arthritis and small anatomic proportions; however, a femoral component with too great an offset should be avoided, because this may result in varus migration of the stem.
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PMID:Total hip arthroplasty in juvenile chronic arthritis: a consecutive series. 959 Jun 36

In a prospective, consecutive series, 41 total hip arthroplasties were performed in 27 small-proportioned patients with small femoral dimensions. The 17 female and 10 male patients averaged 23.6 years (range, 14-47 years), and the mean height and weight were 157 cm (range, 132-183 cm) and 53.5 kg (range, 36-84 kg). The most common preoperative diagnosis was juvenile rheumatoid arthritis in 18 patients (28 hips). Most patients were severely disabled in their daily activity, and 68% of the patients were classified as Charnley functional class C. The femoral implants consisted primarily of the proximally porous-coated miniature Anatomic Medullary Locking femoral component (AML/CDH, Depuy, Warsaw, IN) in 33 hips in 22 patients (average stem diameter, 9.5 mm; range, 8-12.0 mm). A porous ingrowth acetabular cup fixed with screws was used in all procedures. At an average follow-up of 51 months, Harris Hip Scores improved significantly from 34 points (range, 0-65 points) preoperatively to 85 points (range, 33-100 points) after arthroplasty. There were no intraoperative complications. There was 1 revision because of femoral implant loosening. Three cementless femoral components showed evidence of nonprogressive subsidence. One patient had significant bilateral acetabular component polyethylene wear and underwent revision. All other femoral and acetabular components were radiographically stable. The relief of pain and improvement of function were dramatic. The miniature AML/CDH femoral component, combined with an uncemented acetabular cup, provides a promising, off-the-shelf alternative in small-proportioned patients.
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PMID:Outcome of total hip arthroplasty in small-proportioned patients. 1065 59

We compared traditional local excision of hemorrhoids in 40 patients (group A) with excision using the CDH-33 surgical stapler designed for bowel anastomosis, in 41 (group B). In this technique a purse-string suture is prepared 3 cm above the dentate line, and the stapler is inserted and used to form a mucosa-mucosal anastomosis. This technique is less time-consuming than the traditional technique. Data were collected from patients' medical files and from detailed questionnaires in which symptoms prior to and after operation were reported. Mean ages were 53.0 and 51.5 years and male/female ratios were 1.0:1.2 and 1.0:1.1 respectively, neither significant. The most common complaints in both groups were pain and rectal bleeding. All patients had a lower-GI investigation prior to operation to exclude other causes of rectal bleeding. Recovery averaged 2 months in both groups. Patient satisfaction was assessed by decrease or absence of symptoms on return to normal daily activities. Satisfaction tended to be greater in group B. More patients in group A complained of tightness and discomfort at the operative site, but this was not significant. We are extending our study to a larger number of patients to determine if there are statistically significant differences between the results of the 2 methods.
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PMID:[Hemorrhoidectomy using a circular stapler]. 1086 69

Cognitive-behavioral analysis and the multiaxial assessment of relevant behavioral domains (headache frequency and severity, analgesic and abortive use and misuse, behavioral and stress-related risk factors, comorbid psychiatric disorders, and degree of overall functional impairment) help set the stage for CBT of headache disorders. Controlled studies of CBTs for migraine, such as biofeedback and relaxation therapy, have a prophylactic efficacy of about 50%, roughly equivalent to propranolol. Cluster headache responds poorly to behavioral treatment. The persistent overuse of symptomatic medication impedes the effectiveness of behavioral and prophylactic medical therapies. Behavioral treatment can help sustain improvement after analgesic withdrawal, however, and prevent relapse in cases of analgesic overuse. Cognitive factors (e.g., an enhanced sense of self-efficacy and internal locus of control) appear to be important mediators of successful behavioral treatment. Patients with CDH are more likely to overuse symptomatic medication (and in some cases abuse analgesics), have more psychiatric comorbidity; have more functional impairment and disability, and are at least as likely to experience stress-related intensification of headache as patients whose episodic headaches occur less than 15 days per month. Despite the significance of these behavioral factors, patients with CDH (particularly those with migrainous features) are less likely to benefit from behavioral treatment without concomitant prophylactic medication than is the case for episodic TTH and migraine sufferers. Continuous daily pain may be more refractory to behavioral treatment as a solo modality than CDH marked by at least some pain-free days or periods of time. The combination of behavioral therapies with prophylactic medication creates a synergistic effect, increasing efficacy beyond either type of treatment alone. Compliance-enhancement techniques, including behavioral contracts for patients with severe personality disorders, can increase adherence to behavioral recommendations. CBT has earned an important place in the comprehensive treatment of patients with episodic migraine/TTH and severe, treatment-resistant chronic daily headache.
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PMID:Behavioral and nonpharmacologic treatments of headache. 1148 Feb 58

The paper presents the early results of surgical treatment of osteoarthritis secondary to hip dysplasia with CDH hip prosthesis. Between 2001 and 2002 fourteen cases of hip arthritis secondary to dysplasia were treated with CDH prosthesis. Surgery was performed in women, age ranging from 22 to 52 years (average age: 40 years). In 8 cases a cementless CDH femoral component was used. In all cases cementless Taperloc (Biomet) acetabulum components were used. Weight-bearing was allowed 7-14 days post-op. Final patient assessment was done 6-26 months post-op, using the Merle d'Aubigne classification. Patient satisfaction was also taken into account. Functional assessment using this classification yielded 7 points (range: 5-9 points) pre-op, and 11 points post-op (range: 10-12 points). In the post-op assessment, patients reported less pain and an increased range of motion of the hip. No infections were noted. In 1 case deep rein irritation was noted on the second day post-op. In 10 cases there was no limb length discrepancy post-op, while in 4 cases it ranged from 1.5 cm to 3.0 cm. CDH prosthesis allows secure hip replacement procedure, especially in cases with narrow femoral canals.
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PMID:[Early results of surgical treatment of dysplastic hip arthrosis with CDH prosthesis]. 1291 Jun 21

We analysed one surgeon's attempt to reconstruct the hip in 66 patients (84 hips) with chronic dislocation and to restore the height of the centre of rotation above the transverse teardrop line, the body-weight lever arm, the abductor lever arm, and the abductor angle to normal. The outcome was assessed using a patient profile at 0, 10 and 20 years, a clinical assessment of pain, mobility and the range of active movement. We measured the work done by active movement against gravity, radiological signs of loosening, migration and subsidence, and the need for revision. We used survival at ten years and revision as the endpoint. The incidence of complications was higher than in arthroplasty for primary osteoarthritis of the hip, but the outcome was considered satisfactory. The advantages of a flanged cemented socket were demonstrated. A custom-made, laterally reduced, Charnley extra small CDH femoral prosthesis was used in certain cases.
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PMID:Reconstruction for chronic dislocation of the hip. 1293 95

Chronic migraine (CM) is an invalidating condition affecting a significant population of headache sufferers, frequently associated with medication overuse headache (MOH). Controlled trials and guidelines for the treatment of MOH are currently not available. We studied the efficacy of a therapeutic regimen for the withdrawal of the overused drug and detoxification in a sample of patients suffering from probable CM and probable MOH during admission in eight hospitals of Piemonte-Liguria-Valle d'Aosta. Fifty patients, 42 females (84%) and 8 males (16%), mean age at observation 50.66+/-13.08 years, affected by probable CM and daily medication overuse following IHS diagnostic criteria were treated as inpatients or in a day hospital. Headache index (HI) and daily drug intake (DDI) were used for evaluating the severity of headache and medication overuse. The patients were treated by abrupt discontinuation of the overused drug and by a therapeutic protocol including i.v. hydration, dexamethasone, metoclopramide and benzodiazepines for 7-10 days. Prophylactic medication was started immediately after admission. Analgesics or triptans were used under medical control only in cases of severe rebound headache. Diagnostic protocol included routine blood tests (at admission and at discharge), dosage of B12 and folic acid. Patients underwent follow-up controls one, three and six months after discharge. The initial diagnosis was probable CM in almost all patients included in the study (41 patients); in nine patients the diagnosis was not specified (coded only as CDH). The overused medications were simple analgesics in 17 cases (34%), combination analgesics in 19 cases (38%), triptans alone or with analgesics in 13 cases (26%) and ergotamine in 2 cases (4%). We collected data from 39 patients at first follow-up (1 month), 32 after 3 months and 14 after 6 months. Mean HI was 0.91 at admission, 0.22 at discharge, 0.38 after 30 days, 0.46 after 3 months and 0.48 after 6 months. Mean DDI was 2.80 at admission, 0.39 at discharge, 0.41 after 1 month, 0.52 after 3 months and 0.59 after 6 months. These results are on average positive and tend to remain stable with time. Although preliminary and obtained on a limited number of patients at 6-month follow-up, our results seem to be encouraging about the use of the proposed therapeutic protocol.
J Headache Pain 2005 Sep
PMID:Preliminary results of a withdrawal and detoxification therapeutic regimen in patients with probable chronic migraine and probable medication overuse headache. 1636 4

Background. The goal of our study was to assess the efficacy of total hip replacement in the treatment of dysplastic arthrosis of the hip. Material and methods. Between November 2001 and June 2003 we performed total hip replacement in 40 patients (46 hips). Arthritic deformations were classified according to Crowe's classification scheme and operated using a variety of techniques and prostheses. Outpatient examinations were performed every 6 weeks. Rehabilitation began 24 hours after surgery. Results. The average time of hospitalization was 14 days. According to Harris's scale, the average result was 35.4 before operation, 59.8 immediately after surgery, and 79.16 at 18 months post-operatively. The average difference between lower limbs was 3 cm before surgery and 1 cm post-operatively. The average range of flexion in the hip preoperatively was 36 degrees , 85 degrees post-operatively. All the patients suffered pain in the dysplastic hip before surgery; 4.4% patients still felt pain 12 months after surgery. In 2 cases there was loosening of the acetabular component of the prosthesis, which required revision surgery. In 3 cases there was dislocation of prosthesis. In 2 cases the implant was infected. In 1 case there was paresis of the femoral nerve. Thromboembolism occurred in 3 cases. Conclusions. In Crowe's first and second degree dysplastic arthrosis of the hip, a good outcome is obtained with standard stem prosthesis. A CDH stem should be used in stenosis of the intramedullary canal. Patients with dysplastic hips have better quality of life after total hip replacement.
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PMID:Local experience with total hip replacement in dysplastic coxarthrosis. 1761 26

Developmental dysplasia of the hip (DDH) or congenital hip dysplasia (CDH) is the most prevalent developmental childhood hip disorder. It includes a wide spectrum of hip abnormalities ranging from dysplasia to subluxation and complete dislocation of the hip joint. The natural history of neglected DDH in adults is highly variable. The mean age of onset of symptoms is 34.5 years for dysplastic DDH, 32.5 years for low dislocation, 31.2 years for high dislocation with a false acetabulum, and 46.4 years for high dislocation without a false acetabulum. Thorough understanding of the bony and soft tissue deformities induced by dysplasia is crucial for the success of total hip arthroplasty. It is important to evaluate the existing acetabular deformity three-dimensionally, and customize the correction in accordance with the quantity and location of ace tabular deficiencies. Acetabular reconstruction in patients with DDH is challenging. Interpretation of published data is difficult and should be done with caution because most series include patients with different types of hip disease. In general, the complication rate associated with THA is higher in patients with hip dysplasia than it is in patients with osteoarthritis. Overall, clinical and functional outcomes following THA in patients hip dysplasia (DDH) differ from those treated for primary hip osteoarthritis, possibly due to the lower age and level of activity. Although function scores decline with age, the scores for pain and range of motion presented with a statistically significant improvement in the long-term.
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PMID:Reconstruction of the Acetabulum in Developmental Dysplasia of the Hip in total hip replacement. 2538 70


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