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Query: UMLS:C0184567 (acute pain)
 3,962 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors have observed ten compartment syndromes of the leg. Nine occurred after tibial fractures, one after a contusive trauma. Early signs those of muscular and neural ischemia, with an acute pain when the toes are passively mobilised. The cast must be promptly removed. In 6 cases the two compartments were involved. In all cases the pulses were palpable. Arteriographs could occasionaly verify the integrity of the main arterial trunks. The treatment is based on early fasciotomies. It was realised in 5 cases, with good results when the fasciotomy was realised more than twelve hours after the trauma, the muscles were more or less necrotic. In one case all the muscles of the leg had to be excised.
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PMID:[Compartment syndrome of the leg (author's transl)]. 16 61

The possible options for the management of acute pain are quite numerous and continue to expand as our understanding of the mechanisms of pain becomes increasing sophisticated. Many of the options discussed have been available for years, and their present underutilization may be a reflection of the lack of emphasis on the importance of management of acute pain. An illustration of this would be our present ritual of prescribing narcotics postoperatively, a longstanding, but unfortunately inadequate practice. Because of poor selection and scheduling of doses, postoperative analgesia is typically a less than satisfactory experience for many patients convalescing in a hospital following surgery. The clinician should of course be guided by the clinical situation itself in order to determine what modality or combination of modalities may be appropriate for pain management. Certain techniques, such as continuous local anesthetic infusions, may warrant an escalated level of monitoring and ancillary care. Other techniques, such as the infiltration of a wound with local anesthetic or the addition of a nonsteroidal anti-inflammatory agent to a regimen of mild oral narcotics are so simple that excluding them from patient care is almost callous and inconsiderate. Attention to the mechanisms of pain that may be present in a given situation, whether it be muscle spasm, ischemia, inflammation, edema, or nerve injury, may guide the clinician toward a more rational approach in managing that pain.
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PMID:Non-narcotic modalities for the management of acute pain. 218 13

It is important that a routine search be done roentgenographically for intramural intestinal gas. Several different patterns may be present, but unfortunately, classification of the findings is not helpful in predicting either the cause, or the presence, of gangrene. Also, the clinical circumstances in which intramural intestinal gas is discovered are important--if seen in a patient with acute pain in the abdomen, panmural gangrene is nearly always present and early operation desirable. However, if first discovered in the early postoperative period, a more selective approach is possible. Although many of the patients with intramural intestinal gas died, approximately one-quarter will survive. Hopefully, more timely recognition of intramural intestinal gas will allow earlier surgical intervention in some patients with ischemia of the intestine.
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PMID:Intramural intestinal gas in adults. 683 65

Recently, the ischemia-test (IT) had been suggested to be part of the diagnostic procedure for reflex sympathetic dystrophy (RSD). The present study investigated, for the first time whether pain suppressing, as typically occurring under the IT, would correlate in RSD to the pain relieving effect following a diagnostic guanethidine blockade. For this purpose, both IT and guanethidine blockade were applied to 40 RSD-patients. A high correlation was found between the results of both procedures: 89% of those cases, who showed a positive IT (38 out of 40 patients) also reported acute pain relieve following the guanethidine blockade. Thus, both procedures have the same diagnostic value for pain in RSD. These results are in agreement with new pathophysiological considerations, assuming an indirectly (via the microvascular system) mediated sympathetic-afferent coupling as a cause of pain in RSD.
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PMID:[Diagnosis of sympathetic reflex dystrophy. Comparison of ischemia test and modified guanethidine blockade]. 807 90

We reviewed a series of 500 transplants and found 21 (4.1%) cases of graft rupture. All the renal grafts had been harvested from cadavers. Hemodialysis was required in 18 (85%), acute rejection developed in 12 and acute tubular necrosis in 12 (3 were related to percutaneous maneuvers for biopsy or PCN). All cases developed acute pain and oligoanuria. No significant difference was observed relative to ischemia time or HLA typing. Concerning immunosuppression and graft rupture, a significant difference was observed for the group that received low dose CsA combined with triple therapy (3 rupture grafts, 14.2%) versus the high dose CsA and steroid treated group (11 ruptured grafts, 52.3%), p < 0.01. Twenty grafts had ruptured within the first 15 days following transplantation and one at 8 months. Graft removal was warranted in 8 (38%) and conservative surgery in 12 (57%). Two grafts (16%) were lost and 1 patient (4.7%) died without undergoing surgery. Graft rupture is a severe complication that warrants immediate surgical management. Conservative surgery is a valid alternative in those cases with a viable graft.
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PMID:[Spontaneous rupture of transplanted kidney. Experience with 500 transplants]. 833 69

Patients suffering from vascular disease are often a challenge for the acute pain service. Ischaemia, impaired wound healing, stump and phantom limb pain often require a complex analgesic regimen. Invasive measures such as spinal or epidural catheters can be very helpful but carry the risk of infection, as shown by this case report. A 53-year-old woman with a ten-year history of diabetes developed arterial vascular disease. Her right lower leg had been amputated two years previously. She was now admitted with necroses of the left forefoot. A bypass operation was performed under general anaesthesia. Because of intractable ischaemic pain, she was provided with an epidural catheter by the acute pain service. The bypass occluded, however, and a few days later her left lower leg also had to be amputated, this operation being performed under epidural anaesthesia with bupivacaine. The catheter was subsequently used for postoperative pain control and as a means to prevent phantom limb pain. When signs of superficial catheter infection were noticed days later, the catheter was immediately removed. Intractable pain then developed in the left leg which could not be sufficiently controlled with opioids and NSAIDs, and so a second epidural catheter was inserted one segment rostrally. Several days later the infected vascular prosthesis had to be removed followed by amputation of the thigh, this operation also being performed in epidural anaesthesia. Eleven days after insertion of the first epidural catheter, the patient complained of low back pain and headache. Examination by a neurologist revealed no signs of intraspinal infection. The second epidural catheter dislocated at this point in time and it was decided to introduce a third one, this being the only means to treat the otherwise intractable stump pain. Ten days later meningism, Kernig's sign and leucocytosis developed. NMR tomography detected intraspinal fluid in the epidural space at the dorsal border of the spinal canal. A hemilaminectomy was performed. The spinal epidural space showed signs of inflammation of the adipose tissue, but no pus. A little necrotic material and residues of an old haematoma were removed and the epidural space was lavaged. Specimens taken from the epidural material revealed colonisation with staphylococcus epidermidis, which was sensitive to the broad spectrum antibiotics formerly given to the patient to treat the infection in the left stump. By the next day, all signs of epiduritis had disappeared and the patient recovered completely.
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PMID:[Epiduritis after long-term pain therapy with an epidural catheter--review of the literature with a current case report]. 932 67

This case report presents a 44-year-old woman with severe arterial ischemia leading to claudicatio and acute pain in rest caused by an ergotism. In the history was an abuse of suppositories containing caffeine and ergotamine induced by chronic headache. The initial angiography showed occlusions of the femoral arteries. After excluding other vascular diseases, intraarterial infusions of prostaglandin E were administered. Additionally, physiotherapeutic treatment followed. An progrediency of the symptoms made a epidural catheter for sympathicolysis and treatment of the acute pain necessary. As the results of this intervention were encouraging, a sympathetic blockade with injection of 96% ethanol at the level of L 2/3 and 3/4 was performed. After treatment, the clinical symptoms and the blood flow measured by Doppler ultrasonography normalised. A final angiography demonstrated a now normal arterial status. Ergotism, indication and methods of sympathetic blockades are discussed.
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PMID:[Normalization of the vascular picture with sympathetic block in severe arterial ischemia from ergotism]. 1054 98

Sickle cell anemia (SCA) is a disease caused by production of abnormal hemoglobin, which binds with other abnormal hemoglobin molecules within the red blood cell to cause rigid deformation of the cell. This deformation impairs the ability of the cell to pass through small vascular channels; sludging and congestion of vascular beds may result, followed by tissue ischemia and infarction. Infarction is common throughout the body in the patient with SCA, and it is responsible for the earliest clinical manifestation, the acute pain crisis, which is thought to result from marrow infarction. Over time, such insults result in medullary bone infarcts and epiphyseal osteonecrosis. In the brain, white matter and gray matter infarcts are seen, causing cognitive impairment and functional neurologic deficits. The lungs are also commonly affected, with infarcts, emboli (from marrow infarcts and fat necrosis), and a markedly increased propensity for pneumonia. The liver, spleen, and kidney may experience infarction as well. An unusual but life-threatening complication of SCA is sequestration syndrome, wherein a considerable amount of the intravascular volume is sequestered in an organ (usually the spleen), causing vascular collapse; its pathogenesis is unknown. Finally, because the red blood cells are abnormal, they are removed from the circulation, resulting in a hemolytic anemia. For the patient with SCA, however, the ischemic complications of the disease far outweigh the anemia in clinical importance.
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PMID:Sickle cell anemia. 1145 73

Unilateral pain in the cervical region and limitation of neck movements are nonspecific symptoms frequently encountered in daily medical practice. Vertebral artery dissection is rarely considered as a diagnostic possibility unless brainstem or cerebellar ischemia follows the acute pain. Three cases of vertebral artery dissection (VAD) having the sole complaint of pain of acute onset in the posterior neck region are presented. None of the patients had ever reported a similar pain, and the neurological examination was unremarkable in all of them. Doppler ultrasonography suggested VAD in 2 cases, and the diagnosis was confirmed with T1 fat-suppressed magnetic resonance imaging technique in all patients. Severe neck pain and/or occipital headache frequently accompanies ischemic symptoms in cases with VAD. The cases in this report emphasize that spontaneous and often unilateral posterior cervical pain of acute onset can be the only manifestation of a VAD. A high degree of suspicion especially in young patients with no past history of a similar pain can help to establish the diagnosis, thereby preventing erroneous and potentially hazardous therapeutic interventions such as physiotherapy or neck manipulation.
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PMID:Vertebral artery dissection presenting with isolated neck pain. 1197 15

Angina, the prototypic vasoocclusive pain, is a radiating chest pain that occurs when heart muscle gets insufficient blood because of coronary artery disease. Other examples of vasoocclusive pain include the acute pain of heart attack and the intermittent pains that accompany sickle cell anemia and peripheral artery disease. All these conditions cause ischemia - insufficient oxygen delivery for local metabolic demand - and this releases lactic acid as cells switch to anaerobic metabolism. Recent discoveries demonstrate that sensory neurons innervating the heart are richly endowed with an ion channel that is opened by, and perfectly tuned for, the lactic acid released by muscle ischemia.
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PMID:ASIC3: a lactic acid sensor for cardiac pain. 1280 43


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