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

Soft tissue sarcomas are uncommon malignancies, less than 10% of which arise on the distal upper extremities. Consequently, experience with treatments which preserve both the limb and its function is lacking for tumors in this region. Sixteen patients with sarcomas arising in the hand and wrist and one with an aggressive desmoid tumor were treated by combined modality therapy at the Massachusetts General Hospital. Two patients had wide resections for multiple recurrent lesions, 5 had excisional biopsies, and 9 had incomplete excisions to preserve anatomic structures of the hand. One patient refused an amputation and had no surgery. Sarcoma patients were given postoperative radiation with a dose range of 50.2 to 69 Gy (median 68 Gy). The desmoid tumor received 44 Gy. A shrinking field technique with customized castings and cerrobend blocks was used to assure precision and minimize treatment volumes. Chemotherapy was reserved for metastatic disease. Local control was achieved in 14 patients who received combined modality treatment (87%), with a follow-up 1-12 years (median 33 months). Two of the three patients with local failures subsequently obtained a local control after salvage surgery and radiation. Four patients developed metastases, one with epitrochlear lymph node metastases was salvaged by amputation, the others died with lung disease 17, 37, and 111 months after treatment. Functional integrity of the limb was primarily dependent on the extent of surgical resection required. Among 12 patients with local and distant control, one patient (who had multiple wide resections of an extensive desmoid tumor preceding irradiation) lost over 50% use of her limb, but no patients required amputation for edema or pain control. Ten of the 12 patients with local and distant control had less than a 25% decrement in limb function and had no pain or edema associated with normal use of their hand. We conclude that for selected patients with sarcomas of the distal upper extremity, combined modality therapy consisting of conservative resection and careful radiation therapy is a viable alternative to amputation.
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PMID:Extremity preservation by combined modality treatment of sarcomas of the hand and wrist. 377 12

We evaluated the outcome of seven severe hemophilic patients who underwent four total hip and four total knee arthroplasties since 1976. These patients have been followed at regular intervals over a period of 2.5-9.5 years (mean 5.8). Of the four total hip replacements, one had to be removed because of loosening and secondary infection 3 years after the initial surgery but was salvaged by pseudoarthrosis; the other three are pain-free and radiologically stable and have an excellent range of motion 2.5, 5, and 7 years postoperatively. Of the four total knee replacements, one had to be removed because of infection but was successfully salvaged by arthrodesis; one patient has loose components, but the prosthesis is still functional; and the final patient with bilateral knee prostheses is pain-free with limited but functional range of motion. Clotting-factor replacement therapy was effective in controlling intraoperative bleeding, even in a patient with an inhibitor, and only one procedure was complicated by hematoma formation. We conclude that prosthetic joint replacement may be safely performed in hemophilic patients but should be reserved for those who have limited function because of severe pain, joint destruction, and deformity. Total hip arthroplasty is as successful in these patients as in nonhemophiliacs. Total knee arthroplasty provides relief of pain, reduces the frequency of hemarthroses, and corrects most of the deformity, but it is usually associated with a limited range of motion.
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PMID:Long-term follow-up of prosthetic joint replacement in hemophilia. 378 61

The treatment of intraarticular fractures of the distal radius has been dramatically altered over the past decade. Investigations into the pathomechanics of these injuries highlight the problems of arthritis, pain, swelling, weakness, limited range of motion and instability associated with nonanatomic reduction of both intraarticular fragments and their associated ligaments. Factors affecting the prognosis for these injuries include degree and location of articular involvement and the energy of the precipitating force as well as the anatomy of reduction. Operative treatment is reserved for displaced intraarticular fractures. Those extremely comminuted fractures are best fixed with distraction and external fixation. The operative approach to these fractures is dependent on the anatomy. Ligamentous instability, in particular with radial styloid fractures, must be sought and treated. Kirschner wires can be used as "joy sticks" to control unstable carpal bones or fracture fragments prior to fixation. Plates and screws are useful in the stabilization of volar and dorsal rim fractures. The use of intraoperative radiographs is emphasized. Postoperative early range of motion, when possible, greatly improves the long-term results.
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PMID:Displaced intraarticular fractures of the distal radius. 379 36

221 patients have been operated for chronic pancreatitis, secondary to alcoholic intoxication in 92% of cases. Surgery was performed for a complication of the disease (69%), for intractable pain (30%), or for a false diagnostic of cancer; 265 operations were done, among which 41% of resections, 18.5% of internal derivations, and 14.3% of external derivations. Post-operative morbidity was 23.4% and hospital mortality was 6.4%. Late mortality was 35.5%, pancreatitis being responsible for more than half of those deaths during the first three post-operative years. Iterative surgery was necessary in 37 cases. The risk of diabetes was multiplied by 3.2 after resection. Results were good in 50% of cases after 5 years. An important factor was the arrest of alcoholic intoxication. There was no significant difference between resection and derivation. Internal drainage should be preferred when possible. Surgery must be reserved to grave or invalidating complications of chronic pancreatitis.
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PMID:[Surgical treatment of chronic pancreatitis. Retrospective study of 221 cases]. 380 70

Trigeminal neuralgia nearly always can be relieved initially with drug therapy. Long-term relief, however, is achieved in only 25 percent of patients. When medical therapy fails, surgery may be necessary. Percutaneous rhizotomy is an effective technique for pain relief, with few medical contraindications. Posterior fossa exploration and neurovascular decompression or sensory root sectioning is reserved for those patients who do not improve after rhizotomy and for selected younger patients.
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PMID:Surgical treatment of trigeminal neuralgia. 388 75

CT and ultrasound have become invaluable diagnostic tools in the radiologic evaluation of the traumatized and acutely ill patient. CT is the imaging modality of choice in blunt abdominal trauma, retroperitoneal injury and some types of pelvic injury. Ultrasound plays an important role in the evaluation of patients presenting with right upper quadrant pain, renal failure, scrotal pain and enlargement, or pain and bleeding during pregnancy. CT should be reserved for patients with complicated pancreatitis or some forms of renal infection. Thus, CT and ultrasound are important imaging modalities in the work-up of many patients treated by the emergency room physician.
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PMID:Computed tomography and ultrasound of the traumatized and acutely ill patient. 389 83

After reviewing 98 cases with an average follow-up period of one to nine years, the authors describe the surgical indications for simple reinsertion of the supraspinatus muscle, reinsertion with muscle belly transfer, acromioplasty, and simple removal of intratendinous calcifications. The painful shoulder without tendinous tears confirmed by arthrography and with anterior involvement is easily improved by resecting the acromiocoracoid ligament, the anterior border and the inferior portion of the acromion. This anterior release can be associated with a curettage of calcifications if present. Tears of the supraspinatus can be reinserted on the greater trochanter without muscles transfer in 90% of cases. Satisfactory pain relief and function return while only very extensive tears with significant muscle retraction may require transfer of the muscle belly. Surgical repair of the rheumatologic should however, is performed rarely, and should be reserved for the infrequent cases that do not respond to medical therapy.
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PMID:[Lesions of the rotator cuff of the shoulder. Surgical treatment. Apropos of 100 surgically treated cases]. 398 63

Epidural opiates were administered to 139 patients with pain due to malignant diseases via a chronic indwelling catheter inserted percutaneously. So far, 9,716 days of treatment can be evaluated. In 87% of the patients whose pain previously could not be controlled with conventional analgesic approaches, epidural opiates resulted in remarkable pain relief. With a mean daily dose of 15.6 mg morphine (range 2-290 mg) or 0.86 mg buprenorphine (range 0.15-7.2 mg) half of the patients could be treated as outpatients. The mean duration of therapy was 72 days (range 1-700 days), 26 catheters being in place for more than 100 days and one catheter being in place for 510 days. Two severe side-effects (meningitis) were observed, both patients being free of symptoms after catheter removal and antibiotic therapy. Epidural opiates proved to be a valuable method of pain control in terminal illness. The method should be reserved for those patients, for whom oral opiates fail to produce effective pain relief.
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PMID:Epidural opiates: long-term experiences in cancer pain. 399 Jan 66

There are several complications that can result from shortening of the first metatarsal in the treatment of bunion. Metatarsalgia and recurrent deformity can be quite disabling. The surgical technique described in this brief report provides improved support of the metatarsal heads in walking while decreasing pain and enables the patient to stand for longer periods of time. The procedure is reserved for salvage of those patients with severe pain and deformity and in whom other salvage procedures have failed.
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PMID:Treatment of symptomatic first metatarsal shortened by surgery. 404 90

In a double-blind study 171 children with acute otitis media (239 affected ears) were treated by four different methods: neither antibiotics nor myringotomy; myringotomy only; antibiotics only; or both antibiotics and myringotomy. All received symptomatic treatment. There were no significant differences in clinical course (pain, temperature, duration of discharge, otoscopic appearances, audiography, recurrence rate) between the four groups. In the groups treated without antibiotics, the ears discharge for slightly longer and the eardrums took a little longer to heal; these differences were not significant. No complications were seen. Symptomatic therapy with nosedrops and analgesics seems a reasonable initial approach to acute otitis media in children. Myringotomy and antibiotics can be reserved for cases in which the course of otitis is irregular, there are complications such as mastoiditis, or ear discharge continues beyond 14 days.
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PMID:Therapy of acute otitis media: myringotomy, antibiotics, or neither? A double-blind study in children. 611 81


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