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

Chronic spontaneous dislocation of the sternoclavicular joint occurs more frequently in athletes than nonathletes, causing weakness and sometimes pain during prolonged stress upon the arm. Five such joints were successfully treated in 4 patients by means of a dynamic method of repair--tenodesis of the sternal head of the sternomastoid muscle. The sternal origin of the sternomastoid muscle in continuity with its muscle belly and strip of sternal periosteum is looped under the first rib, back through a drill hole in the clavicle and sutured to itself to replace the damaged costoclavicular ligament. Dislocations of the joint should not be repaired for purely cosmetic reasons as the risk of keloid scar formation in this region is notoriously high. All the patients who were young and athletically inclined, recovered fully within 4 months of the operation and returned to their sporting activities. Follow-up has ranged from 12 to 38 months. There have been no late complications or failures of the technique.
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PMID:Chronic dislocation of the sternoclavicular joint: an operative repair. 47 70

The authors describe a truly uncommon case of internal abdominal hernia attributable to malformation of the falciform ligament. The patient, a man aged 26, had complained in the past of cramping pain in the epigastric region, usually occurring after meals and sometimes ending with vomiting of ingested food; but all diagnostic methods and procedures had consistently ruled out any extant pathology of the stomach, duodenum, biliary tract, or pancreas. Present hospitalization was justified by a clinical picture suggesting peritonitis from perforated gastric or duodenal ulcer. At operation the authors found a strangulated loop of small intestine following left-to-right migration through a hole in the falciform ligament of the liver. In the authors' interpretation the background cause of the trouble was incomplete development of the falciform ligament, and the immediate cause of the acute episode was abnormal motility and exaggerated peristalsis of the ileum, possibly due to the presence of a diverticulum; the latter two conditions are invoked as a possible explanation for the repeated episodes of abdominal pain in the patient's history.
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PMID:[Internal abdominal hernia caused by anomaly of the falciform ligament (a case report)]. 55 70

The most common injury to the dorsal distal finger is a subungual hematoma. Relief of pain is promptly achieved by draining the hematoma. If a heated paper clip is used, however, the underlying fluid may be seared and the hole plugged. Local anesthetic block followed by puncture with an 18-guage needle is advocated. When nail avulsion occurs, the free-floating proximal portion should be removed so that it will not serve as an irritant or hide any underlying pathology.
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PMID:Common injuries of the fingernail and nail bed. 91 Jun 71

Percutaneously introduced absorbable purified bovine collagen was used to plug the hole at the site of femoral arterial puncture in 50 patients (42 men, 8 women; median age 58 [22-75] after percutaneous coronary angiography (n = 32; heparin dosage 100 IU/kg) or transluminal coronary balloon dilatation (n = 18; heparin dosage 200 U/kg). Local bleeding ceased after compression of 4 min in 48 of the 50 patients. A pressure bandage was needed additionally in the other two. Bed-rest lasted for 1-24 (median 19) hours. A haematoma of more than 6 cm diameter developed in five patients, but required neither transfusion nor surgical intervention. 39 of the 50 patients were re-examined after a median of 39 days: all of them had had a small pain-free swelling for 2-6 weeks over the puncture site. One patient developed a deep-vein thrombosis one week after the procedure, in another fever occurred after the same period, lasting for two days. These early findings are encouraging. The method may significantly shorten the time of arterial compression and bed-rest, as well as reduce the risk of a large haematoma after arterial punctures.
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PMID:[Use of collagen in sealing of arterial puncture holes after heart catheterization]. 160 Aug 76

Laparoscopic cholecystectomy using Nd-YAG laser was performed in 70 consecutive patients with preoperatively symptomatic gallstones. Sixty-eight patients had successful completion of the laparoscopic cholecystectomy. Mean hospital stay was 7.8 days (range: 4-12), and a diet as well as physical walking was tolerated in all 68 patients by the next day following the procedure. Mean operating time was 216 minutes in the initial 10 cases, which improved significantly to 87 minutes in the latest 28 cases. The difference of operative time did not influence any difference on the postoperative course. Nineteen of 68 patients (27.9%) required postoperative pain medication (pentazocine 15 mg, i.m.). Two patients required conversion to open cholecystectomy because of a pin hole injury on the portal vein by laser quartz in the first case, and difficult dissection due to severe adhesion in the 46th case. There is a definite learning curve in this new modality. Laparoscopic cholecystectomy is a safe and effective procedure, significantly improving the quality of life of the patients with gallstones.
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PMID:[Laparoscopic laser cholecystectomy: a prospective analysis of 70 initial cases]. 183 72

A carbon dioxide laser, used in a rapidly pulsed mode, was evaluated for intra-articular use in horses. Under arthroscopic guidance, a lensed 5 mm laser probe attached directly to a hand-held carbon dioxide laser was inserted into one intercarpal joint of eight horses. In four horses, a cartilage crater 1 cm in diameter was created to the level of the subchondral bone of the articular surface of the third carpal bone. In four horses, the laser was directed perpendicular to the articular surface of the third carpal bone and activated to penetrate the cartilage and subchondral bone. The intercarpal joint of the opposite carpus in each horse was subjected to arthroscopic examination and insertion of the laser probe for an equivalent time. The laser was not activated and these joints served as sham operated controls. The horses were evaluated clinically for 8 weeks, then euthanatized, and the joints were examined radiographically, grossly, and histologically. Pulsed carbon dioxide laser vaporized cartilage readily but penetrated bone poorly. Cartilage vaporization resulted in no greater swelling, heat, pain on flexion, lameness, or synovial fluid reaction than the sham procedure. Laser drilling resulted in a shallow, charred hole with a tenacious carbon residue, and in combination with the thermal damage to deeper bone, resulted in increased swelling, mild lameness and a low-grade, but persistent synovitis. The carbon dioxide laser is a useful intra-articular instrument for removal of cartilage and has potential application in inaccessible regions of diarthrodial joints. It does not penetrate bone sufficiently to have application in subchondral drilling.
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PMID:Pulsed carbon dioxide laser for cartilage vaporization and subchondral bone perforation in horses. Part I: Technique and clinical results. 185 52

A 44-year old woman had pain in the epigastric region under the thorax aperture on the left side 6 weeks prior to admission. Her doctor had prescribed Rewodina and Myocuran without success. Then she suffered circulatory collapse twice. Upon hospitalization, she experienced colicky upper abdominal pain and vomiting. She had been taking oral contraceptives (OCs) for 13 years. Spontaneous liver rupture attributable to adenoma was suspected, based on computer tumograms, and laparotomy bore out the suspicion. However, the cause was peliosis hepatis: the left half of the liver was more altered than the right, and a 10cm parenchyma defect was located under the left lateral liver lobe to which a large intrahepatic cavity filled with coagulum was attached. There was a copious amount of blood in the upper abdomen and another hole was filled with old blood. Partial liver resection was performed. The patient returned 3 weeks after recuperation because of fluctuating inflamed swelling developed on the right side. An incision was made to remove the abscess, but instead of finding pus, massive bleeding ensued whose source could not be located; it was squelched by tampons. Removal of the tampons 7 days later started another rupture with signs of liver insufficiency, and the patient died. Although the role of OCs in inducing liver changes has not been conclusively proven, the fact that she had taken OCs for years without any medical supervision seems to implicate this contraceptive method.
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PMID:[Liver rupture in peliosis hepatis]. 190 60

Electrical stimulation in the PAG has been shown to elicit profound analgesia in experimental animals that is at least in part due to the release of endogenous opioid substances. Electrical stimulation in the thalamic nuclei VPL and VPM inhibits the activation of spinal dorsal horn neurons by noxious stimuli. Acute electrical stimulation in these two targets relieves chronic pain in about 80% of patients. Chronic electrical stimulation by permanently implanted electrodes relieves pain in about 70% of patients with pain of peripheral or nociceptive origin but in only about 50% of patients with central pain resulting from deafferentation. Stimulating electrodes are implanted stereotactically by a burr hole under local anesthesia. Transient complications occur in 15% to 25% of patients and include infections, malfunctions of the stimulating hardware, pain at the implant sites, and mild temporary neurologic deficits. Permanent complications, including hemiparesis, intracranial hemorrhage, and death, occur in 1% to 2% of patients. Brain stimulation is recommended for the treatment of chronic pain in patients in whom other forms of treatment have failed. The technique is reasonably safe and provides pain relief for a group of patients who have exhausted all other therapeutic modalities. Unfortunately, not all patients receive effective pain relief with brain stimulation. Other stimulation targets such as the K-F nucleus in the parabrachial region of the brain stem are currently being explored in an attempt to provide pain relief to a greater proportion of patients. In addition, improvements in stimulation hardware have made the technique easier and more effective.
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PMID:Brain stimulation. 213 74

This paper presents the long-term results of using a modified version of McBride's procedure for the treatment of hallux valgus. The operation used in this group of patients is that described by McBride where the adductor hallucis tendon is detached from the base of the proximal phalanx. Our modification has been to augment this with a medial capsular reef, the adductor tendon is taken through a hole in the metatarsal neck and attached to the medial capsule. We did not remove the sesamoid bone. Twenty-nine feet have been followed up for up to 12 years and the results graded using Bonney and MacNab's scoring system. In a group of women aged 51-71 years 93% still have a satisfactory result up to 12 years after their operation. This operation would appear to be a reasonable option in the treatment of hallux valgus in patients with significant pain and deformity as long as they do not have major arthritic changes in the first metatarsophalangeal joint.
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PMID:Modified McBride's procedure: long-term results. 228 16

The goal of this study was to assess the efficacy of a simple technique used for producing analgesia during any thoracic operation. Its principle consists in peroperative local anesthesia of the nervous trunk in the intercostal space exposed by the surgeon. Methods 17 patients had peridural anesthesia via a multi-hole catheter, and received a bolus injection of 1.5 mg/kg of lidocaine, with subsequent continuous drip injections by electric needle, at a rate of 50 mg/hr. Results This treatment induced no side effects. Although not complete, analgesia allowed the patient to cough and expectorate without experiencing pain block. This permits to avoid, to the greatest extent, occurrence of postoperative atelectasia and provides for carrying out very prompt, effective chest physical therapy.
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PMID:[Post-thoracotomy antalgic treatment]. 237 48


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