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

The Hoffmann external fixator was used to stabilize unstable pelvic fractures in 56 patients with multiple injuries. It was applied under general anaesthesia and the dislocated pelvis reduced and secured with a single tie bar. In 16 cases residual dislocation of less than 1.5 cm was noted after the reduction and the reduced position was maintained in 48 out of 51 cases, a minor redislocation occurred in the remaining 3 patients. Few complications could be attributed to the method, infection was noted in one patient, the iliac crest was fractured in one case and an exostosis of the iliac crest occurred in one youth. Forty-three patients were symptom free with regard to the pelvis at the time of review whereas 5 patients had residual pain and 3 diffuse symptoms. The technique of application is simple but requires two surgeons at the time of reduction and fixation of the pelvis.
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PMID:External fixation of unstable pelvic fractures. 52 84

Between May 1989 and October 1989, 24 women underwent a prospective, randomized study comparing polypropylene (Prolene) and polytetrafluoroethylene (Gore-Tex) sutures for endoscopic bladder neck suspension. Polypropylene was associated with significantly more suture pain than polytetrafluoroethylene. Polytetrafluoroethylene was more difficult to tie at a predetermined tension.
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PMID:Polytetrafluoroethylene vs. polypropylene suture for endoscopic bladder neck suspension. 187 25

Vasectomy technique by a single incision as used by a urologist is described. The patient is first examined for varicocele or hydrocele or drug allergy to lidocaine, and informed consent obtained. An incision in the median raphe is made after local anesthetic. The vas is grasped with a towel clip percutaneously, which is never removed without applying a second clip. The suggested technique is to cauterize each vas lumen, place a free-tie suture on the proximal vas and a suture ligature, all 3-0 chromic sutures, between the free-tie and the clamp. The end of the vas is tied back on itself and buried on a different fascial level from the other cut end of the vas. The other vas is ligated in the same way and the skin is closed with a 4-0 suture, after palpating both vasa to be sure both have been ligated. A turban dressing is used on the scrotum for 24 hours, and the patient is discharged with oral pain medication. Most can return to work the same day. It is recommended that be bring a semen sample after 6-10 ejaculations, and that 2 consecutive analyses be made with an informed consent, to ensure sterility. Complications and their management are reviewed, hemorrhage, hematoma, epididymitis, pain, infection, sperm granuloma and failure to confer sterility. There are no know long-term health risks of vasectomy.
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PMID:Vasectomy. 305 16

The Research Committee of the World Organization of Gastroenterology has gather information regarding the etiology of acute abdominal pain. Seven diseases cover 96% of the causes of this syndrome in many countries of the world, but some geographical variations have been observed. One example of these variations is amoebic liver abscess, present in 5 to 10% of Mexico City patients. Right upper quadrant pain is often present in amoebic liver abscess and acute cholecystitis. Thus, differential diagnosis of these two entities is difficult. Using discriminant analysis and "stepwise" procedures in 100 cases with cholecystitis and a similar number of patients with amoebic liver abscess, we found six variables (symptoms and signs with a significant chi square to distinguish between these two diseases. The symptoms and signs chosen were hepatomegaly, Murphy's sign, duration of pain greater than or equal to 48 hours, previous history of abdominal pain, dysentery, and facial pallor. These variables proved to be better than laboratory test results. With five of these variables it was possible to obtain an accuracy of 92%. Using six variables, if cases of tie (three variables present and three absent) were excluded, accuracy rose to 96%.
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PMID:Differential diagnosis between amoebic liver abscess and acute cholecystitis. 635 41

In order to cover the defect of the oral mucosa temporarily, we used lyophilized porcine skin (LPS) in 10 cases. The use of LPS seemed to be effective from the following points of view; alleviation of postoperative pain and as a protection against exogenous irritants. A fixation method, that is, a continuous locked suture, was devised technically to prevent the LPS from tearing by suturing. With this simple method, the patient maintained good oral hygiene and had only a slight discomfort. Histological examination using Japanese white rabbits showed no apparent difference in wound healing between this method and interrupted suture with tie-over compression. Re-epithelialization of the wound in the non-dressed (control) group was recognized earlier than that in the LPS-covered group.
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PMID:Use of lyophilized porcine skin to the oral wound. Clinical application and experimental evaluation as a temporary dressing material. 647 73

The interdisciplinary University of North Carolina Pain Clinic, in existence since 1973, is a coordination center for research, pre and postdoctoral and resident training, and clinical services. It functions primarily as a tertiary care center for outpatients as a component of the North Carolina Memorial Hospital. Inpatient consultations and therapy direction are carried out on request. Approximately 400 new patient visits and 1,200 consults and return visits are made yearly. The clinic is administered by codirectors from the Departments of Oral and Maxillofacial Surgery and Anesthesiology. Consultants to the clinic include the disciplines of psychiatry, neurosurgery, family medicine, pathology-oral pathology, dentistry, physical therapy, social work and nursing. Support staff includes a head nurse, half-time transcription and half-time general secretary and a financial technician. Facilities consist of an 8-room clinic dual equipped for patient care and clinical research. An adjacent conference room is used for research and patient presentation conferences. In addition to routine examining and interview rooms, a minor procedure operating room is equipped with resuscitation equipment, suction, oxygen, anesthesia machine, a physiologic monitoring system with polygraph, a cryosurgical unit and a radiofrequency lesion generator. A second room is equipped for neurosensory studies of peripheral nerve functions including a battery of tactile-mechanical and thermal threshold stimuli tests, as well as nerve conduction and EMG. A system for psychophysical testing is available through tie-in with a computer, which is located in an adjacent laboratory used for data analysis and also subhuman primate experiments. Another room is equipped with psychophysiologic training equipment, particularly EMG biofeedback. A computer terminal on line to the University IBM 360 is located in the Pain Clinic for use in entering patient-research data. A library with dictating space is available for use by consultants, postdoctoral trainees, and residents.
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PMID:Comparative aspects of chronic pain in the head and neck versus trunk and appendages: experiences of the Multidisciplinary University of North Carolina Pain Clinic. 679 Oct 19

The transplantation of cells that secrete neuroactive substances with analgesic properties into the CNS is a novel method that challenges current approaches in treating chronic pain. This review covers pre-clinical and clinical studies from both allogeneic and xenogeneic sources. One cell source that has been utilized successfully is the adrenal chromaffin cell, since such cells constitutively release catecholamines, opioid peptides, and neurotrophic factors; release can be augmented with nicotine. Other graft sources include AtT-20 and B-16 cell lines which release enkephalins and catecholamines, respectively. For grafting in rodents, adrenal medullary tissue pieces are transplanted to the subarachnoid space. Chromaffin cell transplants can decrease pain sensitivity in normal rats using standard acute pain tests (paw-pinch, hot-plate, and tail-flick). In addition, transplants can restore normal pain thresholds in rodent models of chronic pain (formalin, adjuvant-induced arthritis, and sciatic-nerve tie) which closely similate the pathologies of human chronic pain conditions. Xenografts have been studied due to concerns that future application for human pain may be limited by donor availability. Despite immune privileges of the CNS, xenografts require at least short-term immunosuppression to obtain a viable graft. Cell encapsulation is one method of sustaining a xenograft (in rat and human hosts) while circumventing the need for immunosuppression. Clinical studies have been initiated for terminal cancer patients with promising results as assessed by markedly reduced narcotic intake, visual analog scale ratings, and increased CSF levels of catecholamines and met-enkephalin.
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PMID:Update on cellular transplantation into the CNS as a novel therapy for chronic pain. 853 50

Twenty-eight patients (with 30 primary and 8 revision total hip arthroplasties) completed a standardized questionnaire containing the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index and Harris hip score questions prior to an office visit a minimum of 1 year after surgery. The range of hip motion measured by an orthopaedic surgeon was compared with the responses to questions on stiffness and function as well as with global scores in the WOMAC osteoarthritis index. Patient responses to the questions asking if they could cut their toenails on the operated side and the Harris hip score question asking if they could put on socks and tie a shoe correlated significantly with postoperative hip motion (P < .005). The WOMAC global pain and stiffness scores did not correlate with range of motion. The WOMAC physical function score correlated significantly only with hip flexion (P < .05). Of the WOMAC physical function questions, difficulty bending to pick an object off the floor (P < .05) and getting on and off the toilet (P < .05) correlated with the sum of the range of motion in all planes and weighted Harris hip score range of motion calculation. These data suggest that the points allocated in the Harris hip score for range of motion can be estimated reasonably accurately from questionnaire or phone response to a series of questions on a standardized questionnaire. The question on ability to cut toenails or the Harris hip score question regarding ability to put on socks and tie a shoe correlated with the most individual planes of motion, but several WOMAC physical function questions also correlated with total and weighted range of motion calculations.
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PMID:Correlation of measured range of hip motion following total hip arthroplasty and responses to a questionnaire. 887 77

We present 53 patients who underwent arthroscopic rotator cuff repair and had a minimum of 2-year follow-up. Most tears were avulsions of the supraspinatus from the greater tuberosity, some with associated longitudinal tears. Longitudinal tears were repaired with a side-to-side suturing technique. Avulsion tears from the tuberosity were repaired using nonretrievable suture anchors. Traditional open-mobilization techniques, such as elevating the cuff off the glenoid neck and scapular fossa, and cutting the coraco-humeral ligament, were performed arthroscopically as needed. All repairs were performed using O-PDS or 1-PDS suture and a 7-mm suture punch for suture delivery. Both simple and mattress suture configurations were used. An anterolateral operative portal was used in most cases. A modified UCLA rating system that included additional points for abduction range of motion and strength was adapted for clinical evaluation in this study (maximum score, 45 points). The average preoperative rating was 17 (range, 9 to 26). The average postoperative rating was 41 (range, 16 to 45). There were 36 excellent (41 to 45 points), 13 good (36 to 40 points), 1 fair (30 to 35 points), and 3 poor (< 30 points) results. We have seen intraoperative but no cases of postoperative anchor pullout. The simple sutures performed as well as, and in some ways better than, mattress configurations. All fair and good results were with O-PDS. To perform an arthroscopic repair, the tear must be well visualized and mobilizable back to the tuberosity with only moderate tension. The anterolateral operative portal has been very useful because it allows better angle of entry for instruments and anchors and improved visualization in the subacromial space. The use of PDS and simple suture configurations has made the repair technically easier to perform with the instruments that are currently available. We do recommend 1-PDS suture because it breaks less easily even though it is slightly more difficult to deliver and tie. Arthroscopic cuff mobilization is relatively simple and has allowed us to repair larger tears. Based on our experience, arthroscopic rotator cuff repair is technically achievable and a superior alternative in selected cases for an experienced shoulder arthroscopist. Patients who underwent arthroscopic repairs had less scarring and shorter hospital stays and, we believe, less postoperative pain and easier rehabilitation compared with open repairs.
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PMID:Arthroscopic rotator cuff repair: analysis of technique and results at 2- and 3-year follow-up. 948 32

This paper compares cost-effectiveness of drug regimens based on omeprazole, ranitidine and sucralfate in the treatment of duodenal ulcers. Measures used were expected total costs and expected healthy days in a six month period after starting treatment. Both measures were calculated by decision tree analysis using healing and relapse probabilities estimated by logit regressions from results of earlier RCTs. Omeprazole and sucralfate regimens tied in the direct C/E comparison and were clearly superior to ranitidine regimens. Yet problems with patient compliance and faster relief from pain/symptoms with omeprazole may contribute to breaking the tie to omeprazole's advantage.
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PMID:Comparing the cost-effectiveness of drug regimens in the treatment of duodenal ulcers. 1011 27


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