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

Many arthritic conditions can affect the small joints of the hand and wrist. An understanding of the disease process helps in managing the problem. Conservative care generally consists of rest, splinting, use of anti-inflammatory drugs, intra-articular injection with corticosteroids, and rehabilitation therapy. Surgical procedures for the arthritic hand are reserved for persistent cases of pain or instability that do not respond to conservative treatment.
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PMID:Arthritis of the hand and wrist. Management options for some common arthritic conditions. 232 May 14

Of 37 patients with 44 intracavernous carotid artery aneurysms (ICCAAns) diagnosed between 1976 and 1988, patients with 20 aneurysms were followed without treatment for 5 months to 13 years (median, 2.4 years). Ten of the 20 ICCAAns were asymptomatic at diagnosis, and 10 were symptomatic. Three of the asymptomatic ICCAAns were symptomatic at follow-up. One of these required clipping because of a progressing cavernous sinus syndrome; the other 2 were minimally symptomatic and have not required treatment. Of the 10 initially symptomatic ICCAAns, 2 had not changed, 4 became more symptomatic, and 4 had symptomatically improved by follow-up. One patient with an ICCAAn that had not changed clinically was lost to follow-up 6 months after diagnosis. Of the 4 ICCAAns that became more symptomatic, 2 continue to be monitored, and 2 required intervention: one with detachable balloon occlusion of the aneurysm with preservation of the internal carotid artery lumen, and the other with gradual cervical internal carotid artery occlusion. The clinical course of this selected group of patients with ICCAAns suggests that the natural history of ICCAAns can be quite variable. Although clinical progression does occur, symptomatic ICCAAns also can improve spontaneously. Therapeutic intervention for asymptomatic ICCAAns should be reserved for patients with aneurysms arising at the anterior genu of the carotid siphon and/or extending into the subarachnoid space, where subarachnoid hemorrhage is most likely. Intervention for symptomatic ICCAAns should be reserved for patients with subarachnoid hemorrhage, epistaxis, severe facial or orbital pain, evidence of radiographic enlargement, progressive ophthalmoplegia, or progressive visual loss.
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PMID:Aneurysms of the intracavernous carotid artery: natural history and indications for treatment. 236 71

Thrombolytic therapy has an established niche in the treatment of acute myocardial infarction. One view, often rigidly held, is that this therapy should be attempted only if ischemic pain is present for less than four hours. Additionally, treatment is often reserved for those with an anterior infarction, a subgroup that did well in early reports. This case report demonstrates an impressive reversal of cardiogenic shock after streptokinase therapy in a patient who experienced an inferior infarction. His chest pain and ST elevations were present for more than nine hours at the commencement of treatment.
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PMID:Threatened reinfarction. Effective therapy using streptokinase with reversal of cardiogenic shock. 237 88

In patients with menisco-ligamentous pathology of the knee, the paraclinical examinations available to physicians and surgeons are standard radiography, arthrography, arthroscopy and magnetic resonance imaging (MRI). The use of these methods on whether the lesions are recent or chronic. Standard radiography and arthrography are sufficient to evaluate chronic lesions, arthroscopy and MRI being reserved to cases with complex laxity. For recent lesions standard radiography must systematically be performed. Arthrography is unreliable, being hampered by haemarthrosis and pain. Arthroscopy may be hazardous and can only be used in patients without peripheral lesions of the articular capsule and ligaments. MRI is sometimes useful, notably in cases with unrecognized post-traumatic haemarthrosis and in children as it avoids hospitalization. In this article, the various situations encountered are analyzed and a strategy for the use of paraclinical examinations is offered.
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PMID:[Strategies for the use of complementary tests in menisco-ligamentous pathology of the knee]. 260 75

Since February 1987, we have been using extracorporeal lithotripsy for certain cases of chronic biliary lithiasis, using an EDAP lithotripter. The technique is reserved for patients with less than four radiotransparent, or partially calcified calculi, less than 25 mm in size, within the context of a functioning gall bladder with no evidence of lithiasis in the C.B.D. Dissolution of the fragments after lithotripsy is ensured by bile salts, this treatment being continued for at least 3 months after the gall bladder has been completely cleared. 160 patients were treated using a total of 181 treatment sessions. Hospitalisation lasted on average 3 days, 1/5th of the patients suffered right hypochondrial pain and nausea for 24 hours. 17% of patients showed a transient elevation in alkaline phosphatase and 12% an elevation in amylase after the procedure. The rate of gall bladder clearance was 24% at 1 month, 40.7% at 3 months ans 50% at 1 year. 11 cholecystectomies were carried out (6.8%), 8 of which were essential. Bile duct migration occurred in 2 cases and produced oedematous pancreatitis in one case. Recurrent lithiasis was noted in 4 cases between 6 and 18 months after gall bladder clearance. 75% of cured patients had a single, radiotransparent stone less than 20 mm in diameter.
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PMID:[Extracorporeal lithotripsy of biliary lithiasis. 160 patients treated with an EDAP apparatus]. 261 78

Thirty one alcoholic patients with pancreatic cysts were studied by ultrasonographic scanning with the purpose to observe the evolution of the cysts. The mean time of the follow-up was 15.6 +/- 9.2 months; the patients were aged 40.2 +/- 9.3 years (male = 93.5%; female = 6.4%) the average pure ethanol intake was 288.3 +/- 185.9 ml for a period of 20.8 +/- 9.3 years. In 21 of the 31 patients (67.7%) the ultrasonographic examination showed total spontaneous resolution of the cysts within a time span of less than 18 months. The majority of the parameters studied (age, time and volume of ethanol intake, pain, diabetes, calcifications and previous cyst drainage) had no relation with the evolution of the cysts. In 11 patients (52.3%) the cysts showed an initial enlargement before decreasing in size. The cysts located in the pancreatic head showed less tendency to spontaneous resolution. Complications were observed in two patients: intra-cystic haemorrhage in one and rupture into the peritoneal cavity in the other. Our observations suggest that patients with pancreatic cysts secondary to chronic alcoholic pancreatitis should be controlled with periodical ultrasonography. Surgical approach should be reserved for patients with complications.
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PMID:[Spontaneous remission of pancreatic cysts in patients with chronic pancreatitis]. 270 Jan 5

The use of pubectomy in the repair of urethral strictures has not been favored because of the supposed excessive blood loss and operative time and long-term pain. However, in our experience with 30 patients with traumatic urethral rupture, we have found that pubectomy provides excellent exposure with a mean blood loss of 800 ml and few postoperative problems. The technique should nonetheless be reserved for selected patients and performed only by experienced surgeons.
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PMID:Pubectomy in repair of membranous urethral stricture. 271 48

Symptoms of severe nausea, vomiting, abdominal pain, and frequent bezoars, as well as objective gastric retention, can occur following Roux-Y biliary diversion for alkaline reflux gastritis. Medical therapy and prokinetic drugs have proven ineffective. This review evaluates 37 patients who underwent further gastric resection from 1979 to 1987 to improve gastric emptying and resolve symptoms. Fifteen patients underwent perioperative radionuclide solid-food gastric emptying studies. Seventy-three per cent (27 of 37 patients) of the patients who underwent further gastric resection (70% to 95%) had a satisfactory postoperative response. Twenty patients were graded Visick 1 or 2 and 7 Visick-3 patients, although much improved, still had some symptoms of gastroparesis. Twenty-seven per cent (10 of 37 patients) failed to improve and underwent completion total gastrectomy. Overall, 70% of this group had almost complete resolution of their symptoms. Three of 10 patients were considered "failures" due to postprandial pain in 1 and early vasomotor dumping in 2. Of the 10 patients who failed initial revisional surgery, 7 underwent a 70% to 80% subtotal gastric resection (STG) and 3 patients underwent 85% to 95% extensive resection (EXT.G.). Of the 15 patients who underwent perioperative radionuclide evaluation, a mean two-hour gastric retention of 61.4% +/- 4% (SEM) decreased to 25% +/- 4% following further gastric resection. Eight patients were in the STG group and seven patients were in the EXT.G group. Following STG, mean two-hour gastric retention of 58.2% +/- 3.5% decreased to 38% +/- 3% (p less than 0.05). In seven patients who underwent EXT.G, mean two-hour retention of 65% +/- 4% decreased to 10% +/- 2.5% (p less than 0.005). EXT.G resulted in normal gastric emptying and few late failures. In post-Roux-Y patients with symptoms of gastroparesis and documented gastric retention, EXT.G normalizes gastric emptying and restores a better quality of life. Total gastrectomy should be reserved for those patients who are failed by more extensive resection.
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PMID:The surgical treatment of chronic gastric atony following Roux-Y diversion for alkaline reflux gastritis. 273 Jan 85

Outcome after 252 posterior fossa explorations for the treatment of trigeminal neuralgia was determined by a retrospective review. Patients with distortion of the fifth nerve root caused by extrinsic vascular compression underwent microvascular decompression, those with no compression underwent partial sensory rhizotomy, and those with vascular contact but no distortion of the nerve root underwent decompression and rhizotomy. The mean follow-up period was 5.1 years. An excellent (75%) or good (8%) clinical outcome was achieved in 208 patients; 13 patients (5%) experienced little or no pain relief. Thirty-one patients (12%) suffered recurrent trigeminal neuralgia an average of 1.9 pain-free years after operation; recurrence continued at a rate of approximately 2% per year thereafter. Reoperation for recurrent or persistent pain provided excellent or good results in 85% of reoperated patients, but partial sensory rhizotomy was required in most of these patients. Outcome was affected by previous surgical procedures. A previous percutaneous radiofrequency lesion was associated with a significantly greater incidence of fifth nerve complications and a worse outcome after posterior fossa exploration. Because of this finding, the authors recommend that percutaneous radiofrequency rhizolysis be reserved for patients who have failed posterior fossa exploration or who are not candidates for surgery. Patients with compressive nerve root distortion and a short duration of symptoms before surgery had a significantly better outcome than patients with a longer duration of symptoms. In contrast, there was no relationship between the duration of symptoms and outcome of patients without nerve root distortion. Vascular decompression may cause dysfunction of the trigeminal system in tic douloureux, but in patients who remain untreated for long periods an intrinsic abnormality develops that may perpetuate pain even after microvascular decompression. Posterior fossa exploration is recommended as the procedure of choice for patients with trigeminal neuralgia who are surgical candidates.
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PMID:Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia. 276 87

The purpose of this investigation was to evaluate whether the pain of cervicogenic headache could be due to referred symptoms from myofascial trigger points. The presence or absence of cervical spine dysfunction was also of interest. Eleven patients with cervicogenic headaches were systematically examined for myofascial trigger points and cervical spine dysfunction. All patients had at least three myofascial trigger points on the symptomatic side. In eight of these patients, trigger point palpation clearly reproduced their headache. There were 70 myofascial trigger points (35 "very tender", 35 "tender") and 17 non-myofascial tender points on the symptomatic side, compared to 22 myofascial trigger points (one "very tender", 21 "tender") and 19 non-myofascial tender points on the asymptomatic side. These differences were statistically significant [chi-square (2df) = 22.04, p less than 0.0001]. All patients had some evidence of cervical dysfunction. Ten patients (91%) had specific segmental dysfunction of occiput on atlas and/or atlas on axis. Five patients were entered into a non-invasive, interdisciplinary pain management program designed to treat cervical spine dysfunction and myofascial pain. Treated patients reported a significant decrease in the frequency and intensity of their headaches during a median two-year follow-up. It is concluded that myofascial trigger points may be an important pain producing mechanism in cervicogenic headache and that segmental cervical dysfunction is a common feature in such patients. Conservative, non-surgical treatment appears to be effective in reducing the frequency and intensity of cervicogenic headache. These data suggest that surgical approaches should be reserved only for those patients who fail conservative therapy.
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PMID:Are "cervicogenic" headaches due to myofascial pain and cervical spine dysfunction? 279 Sep 46


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