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

Anal bleeding and pain were the symptoms in half of 53 patients with carcinoma within and around the area of the anus treated from 1950 to 1974. Twenty-seven carcinomas were exclusively located in the anal canal and six, in the perianal skin. Vaginal invasion was present in 13 of the women. There were 39 squamous cell carcinomas and nine basaloid cell carcinomas. More than 37 of the patients had an abdominoperineal resection as part of the treatment. The resection margins were positive for carcinomas in 11 patients. Radiation as the primary treatment was used only once. Palpably enlarged inguinal lymph nodes were treated by subsequent radical groin dissection. The crude over-all survival rate was 42 per cent; the adjusted five year survival rate was 38 per cent. Significant correlates of death were symptoms for longer than six months' duration bleeding, inguinal adenopathy and presence of hemorrhoids. In general, abdominoperineal resection is the operation of choice for carcinoma of the anal verge or anal canal. Inguinal lymphadenectomy at a later time should be reserved for patients with signs of metastases to the inguinal nodes.
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PMID:Appraisal of the treatment of carcinoma of the anus and anal canal. 92 54

Experience with the GUEPAR prosthesis in 292 cases of which 103 have been followed for more than 2 years, suggests that: implanting a hinge prosthesis is major surgery on elderly patients in whom severe complications have occurred and for this reason, the operations should be reserved for extremely damaged and unstable knees; the most important local complications have been deep sepsis for which we have noted a rate of 6.6 per cent; in the treatment of sepsis, everything must be done to preserve the prosthesis because arthrodesis is difficult to obtain; pain relief has been significant as a result of the operation. The prosthetic design allows flexion of more than 90 degrees in 85 per cent of the cases and 120 degrees in 26 per cent; after two years, the results seem relatively stable. We have not observed aseptic loosening after this period but a longer observation period is necessary to be reassured on this point; patellar pain remains a major concern because this arthroplasty has not solved the problem, and other solutions will have to be found.
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PMID:Guepar hinge prosthesis: complications and results with two years' follow-up. 97 66

The results of fibreoptic endoscopy have been assessed retrospectively in 71 patients referred for consideration of the oesophagus as the possible or probable cause of their symptoms. Gross endoscopic abnormality was uncommon but friability of the mucosa was seen in about half of the patients with typical symptoms of "reflux-pain" and a quarter of those without. The combination of radiological reflux and endoscopic abnormality--that is, true reflux oesophagitis--was seen in only a third of the patients with typical symptoms though much less commonly in those with atypical symptoms. Histological abnormality was common but did not relate well to symptom pattern. The results of the acid perfusion test were significantly related to symptom pattern though overlap was observed between the two symptomatic groups. Six of these patients had had or were awaiting surgery to correct reflux and they all had uniformly positive findings. This study confirms the value of the acid perfusion test in clarifying the diagnosis of reflux pain, espcially if the symptoms are difficult to assess. Endoscopy and biopsy added little further information of diagnostic value and could probably be reserved for the small minority of patients who have special problems such as blood loss or dysphagia or where clarification of a radiological lesion is required.
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PMID:Oesophagoscopy, biopsy, and acid perfusion test in diagnosis of "reflux oesophagitis". 110 62

Analysis of questionnaire responses of 70208 persons undergoing multiphasic health checkups showed a greater proportion of cigarette smokers than nonsmokers (excesses averaging 1.6-fold in white men, 1.3-fold in white women) admitting to nine types of chest pain. This excess in smokers was greater in younger individuals, and applied about equally to anginalike and nonanginalike pain. The smoking/chest pain association was not explained by greater alcohol or coffee consumption, diminished pain tolerance, or less reliability among smokers; nor did it appear to be mediated chiefly by excess cough, shortness of breath, coronary disease, or musculoskeletal complaints in smokers. Although smokers averaged more complaints than nonsmokers, chest pain resembled clearly smoking-related symptoms, such as cough, when the number of each subject's complaints was considered. Although more smokers had chest pain no type of pain was unique to smokers, suggesting that the "tobacco angina" concept be discarded or reserved for rare patients with coronary heart disease in whom smoking clearly provokes angina pectoris.
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PMID:Cigarette smoking and chest pain. 114 21

Sciatica must always be first considered as a medical problem. Operation is indicated only for refractory cases. Analysis of more than 4 036 operations shows the best indications for surgery. These consist of typical disc sciatica, sciatica with excessive pain, with paralysis and with cauda equina syndrome. Myeloradiculography was not carried out routinely, being reserved for atypical forms. A negative radiculography is not necessarily a contraindication. The results of foraminotomy are less constant than after removal of a disc prolapse. It benefits 60 p. cent of patients, however. Some reserve applies to its use since it is not possible to predict those patients who will be relieved. There exist finally those cases in which the organic origin of the pain cannot be proved, at which time the surgeon should refuse operation which may be an aggravating factor.
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PMID:[The role of surgery in the treatment of sciatica. An experience of more than 4000 operations]. 121 10

The results of treatment of injuries of the thoracic and thoraco-lumbar spine with neurological involvement have been reviewed in a retrospective study of 115 patients, of whom eighty-nine received conservative and twenty-six surgical treatment. Operation was reserved, in general, for patients with irreducible dislocations and incomplete neurological lesions, open reduction and internal fixation being the commonest procedure. Only three patients required a delayed spinal fusion for suspected instability after a period of conservative treatment. On the other hand, ten patients, eight of whom had been treated surgically, were left with severe chronic spinal pain. Of the patients treated conservatively, 35% showed significant neurological improvement compared to 38% of those treated surgically, but the latter group contained a much higher proportion of incomplete lesions with a far better prognosis. It is concluded that the place for early operation might be still further restricted.
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PMID:The management of thoracic and thoraco-lumbar injuries of the spine with neurological involvement. 127 Apr 98

A retrospective clinical and radiological review of 51 patients (mean age 66 years) was performed to assess the outcome of excision arthroplasty for hallux valgus in an elderly population and to compare the results of the Keller, which is still used frequently in many centers in the United Kingdom, and modified Mayo operations. Although significant correction of the deformity was obtained with both procedures, this was incomplete and the mean residual hallux valgus angle was greater than 20 degrees. Lateral metatarsalgia was present in over 40% of patients. Both procedures provided good pain relief, and considerable narrowing of the forefoot was obtained with the modified Mayo operation. Excision arthroplasty in the elderly should be reserved for the low demand patient with symptomatic degenerative changes in the first MP joint in the absence of lateral metatarsalgia.
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PMID:Excision arthroplasty for hallux valgus in the elderly: a comparison between the Keller and modified Mayo operations. 139 59

Knee pain referable to the patellofemoral articulation is common in the general population. It remains a troubling problem for the orthopedic surgeon. Frequently, initial therapy, involving activity modification, anti-inflammatory medications, and isometric quadriceps strengthening, is successful in relieving symptoms. Surgical intervention is normally reserved for those patients with pain that is resistant to these modalities. Unfortunately, none of the various surgical options has proved to be totally dependable, durable, or reproducible. The results of isolated patellar and patellofemoral resurfacing procedures have been guarded. Patellar resurfacing appears to be most beneficial in younger patients with severe anterior knee pain. These individuals should be clearly warned that there is a relatively high likelihood that they will require additional surgical treatment or patellectomy at a later date. Fortunately, patellar resurfacing does not preclude patellectomy from being easily performed. Patellofemoral resurfacing, however, involves more overall involvement of the knee joint. This makes patellectomy less likely to be a successful salvage procedure. Despite our observations that knees with primary patellofemoral arthritis do not do as well after total knee replacement as those with tibio-femoral arthritis, this procedure remains the best treatment option. The durability and predictability of total knee arthroplasty are well documented. Its results far surpass those reported for isolated resurfacing procedures. With regard to patellar resurfacing as part of total knee arthroplasty, we recommend resurfacing all patellae. The literature, although not conclusive, lends support to this practice. Avoidance of metal-backed patellar components and special attention to technical details should decrease the complications associated with patellar resurfacing in future studies.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Patellar resurfacing for patellofemoral arthritis. 140 49

Considerable surgical progress of treating aortic dissection has been achieved during the past decade. The emergency indication for acute dissection of the ascending aorta (type A according to the Stanford classification) is unquestioned while surgical treatment for acute dissection of the descending aorta (type B dissection) is mainly reserved for complicated cases. The major complication of acute operations--fatal hemorrhage from the suture line and secondary multi-organ failure--have been successfully reduced by a progress of cardiopulmonary bypass techniques, the introduction of cold cardioplegic myocardial protection, the development of modern suture materials and glues and last not least by a continuous intensive monitoring. Especially the introduction of the so-called french glue safely enabled both the closure of the false lumen as well as the strong reinforcement of the diseased aortic wall and seems to offer a reliable alternative to the application of multi-layered teflon strips. Since the principle of all reconstructive approaches in case of dissection consists of closure of dissected layers and the limited replacement of the segment that is susceptible to a rupture the exact readaptation and reinforcement of the diseased aortic wall represents a fundamental operative step. In type A operations the supracoronary aortic prosthetic replacement or the combined replacement of ascending aorta plus aortic valve followed by the reattachment of coronary arteries has become the standard operative technique. In fact, independently from the location of the primary intimal tear the operation has been traditionally limited to replace the ascending aorta in order to remove an aortic segment that is most likely to rupture. Yet an increasing number of follow-up investigations has demonstrated recurrence of dissection or an aneurysmatical dilatation of the false lumen in about 20% of patients treated with ascending aortic replacement. Consequently, repair of the aortic transverse arch and the radical elimination of the intimal entry is now favoured by an increasing number of surgeons. In addition to these various perioperative and intraoperative adjuncts the introduction of new imaging techniques, especially computerized tomography, magnetic resonance imaging and transesophageal echocardiography allowed to establish adequate therapeutical concepts on a more rational basis. Transesophageal echocardiography as a mobile diagnostic device enables investigators to perform a bed-side dynamic visualization of both the location and extent of a dissection, the evaluation of ventricular performance and aortic competence. Treatment of acute type B dissection is mainly conservative unless complications like intractable pain, aneurysmatic enlargement of the false lumen, ischemia of visceral organs or even rupture occur.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Surgical therapy of thoracic aortic dissection]. 148 25

Born in secret in 1987 and developed in an atmosphere of scepticism throughout 1988, laparoscopic cholecystectomy triumphed in 1989 and 1990, causing a veritable revolution in the world of general surgery. The 777 consecutive cases that are reported in this chapter reflect the spirit of these various periods. From conservatively restrictive, our indications widened to include 90% of gallstone cases. For us the sclero-atrophic gallbladder still constitutes the greatest endoscopic challenge and should be reserved for the most experienced operators. The rates for mortality (0.1%) and complications (3.3%), which include three common bile duct injuries (0.4%), are comparable to, if not better than, those for traditional cholecystectomy. The quality of recovery is markedly better: near absence of pain, short hospitalization, return to normal physical activity within 10 days, rapid return to work and preservation of the abdominal musculature in sportspeople. These advantages are unavailable to the 5.5% of patients for whom an intraoperative conversion to an open procedure is necessary. Their recovery is that of traditional cholecystectomy, which itself is far from being poor. The large multicentre studies, such as those carried out in France and Belgium recently, reporting 3708 cases, have reached identical conclusions. Laparoscopic cholecystectomy is set to become the gold standard for treatment of gallstones and is the first step towards surgical techniques of the 21st century which will be performed within the musculocutaneous envelope of the intact human body.
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PMID:Laparoscopic cholecystectomy: an analysis of 777 cases. 148 12


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