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Query: UMLS:C0392326 (discomfort)
 22,423 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This report describes the initial experience of laparoscopic live donor nephrectomy (lap-LDN) in Taiwan and discusses the technical considerations and modifications of our technique. From September to November 2000, three (one right and two left) lap-LDNs were performed at our institute. The right kidney was retrieved in one donor because of an early branching of the left renal artery. The details of our technique are described for both left and right LDN. The perioperative parameters were compared to those of the 10 immediately preceding cases of LDNs using the traditional open approach. All lap-LDNs and open LDNs were successful, and all 13 recipients had smooth recovery of renal function. The donors recuperated better in the lap-LDN group with resumption of oral intake on postoperative day (POD) 1 and discharge on POD 5 (vs POD 3.4 and 8.5, respectively, in the open group). The mean blood loss was lower and narcotic use was less in the lap-LDN group (75 vs 164 mL, 25 vs 47 mg morphine sulfate equivalent, respectively). The extraction wound was much shorter in the lap-LDN group (6.5-8 vs 23 cm). The warm ischemia time was slightly but not significantly shorter in the open group (4 vs 2.75 min), and the average operative time was shorter in the open group. The results of our initial experience suggest that for surgeons with laparoscopic surgery experience, lap-LDN is a feasible procedure that decreases donor discomfort, while improving the quality of graft kidneys and the safety of the donor.
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PMID:Technical considerations in hand-assisted laparoscopic live donor nephrectomy: initial Taiwan experience from National Taiwan University Hospital. 1191 Oct 43

The present study was aimed at determining the frequency and circadian variations in symptomatic or silent myocardial ischemia in ambulatory patients with stable coronary disease. A comparative analysis was then made of the recordings on symptomatic and asymptomatic patients according to their medical history. Three hundred and twenty-one cardiologists recruited a total of 1,088 patients who were monitored for 4 days with a new type of electrocardiographic recorder. The patients were able to voluntarily start up the recorder in the case of cardiac discomfort or pain. The results showed that over a total recording period of 95,725 hours, the following data, which were validated by an experienced cardiologist, were obtained: 3,258 ischemic episodes, 2,963 (or 91%) of which were cases of silent ischemia, and 295 (or 9%) which were symptomatic. All the ischemic episodes involved a limited number of subjects, i.e., 271 patients. Of these, 148 (54.6%) were completely asymptomatic; only 63% of these patients with silent ischemia would have been detected if the recording had just lasted 24 hours. Moreover, the medical history showed a correlation between certain factors (such as poorly managed arterial hypertension, cardiac insufficiency, renal failure, arteritis of the lower limbs, and a waist-hip relation of over one in men) and an increase in the number of cases of silent ischemia. However, no single factor was found to be linked more to silent ischemia than to symptomatic ischemia. This investigation therefore shows the significant numeric incidence of silent ischemia. It raises the question of the need to prescribe treatment in at-risk subjects which includes recordings of long duration, so that silent ischemia, which may increase the risk of mortality, can be more readily detected.
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PMID:[Frequency of silent and painful ischemia in patients with treated stable coronary insufficiency]. 1255 11

The evaluation of women with chest pain for the presence of important coronary artery disease may be challenging. Coronary artery disease is the leading cause of death, but it is much more prevalent in women of older age. However, chest discomfort is a very common symptom among women of all ages. Younger women are much less likely (but not completely immune) from having significant coronary disease, but the existing forms of cardiac testing are more likely to yield false results when applied to low-risk groups. Women should be assessed for their overall level of risk for coronary disease and the severity and nature of symptoms. Noninvasive cardiac testing is best applied to women at intermediate risk. There are strengths and weaknesses for each of the available imaging modalities, but both nuclear scans and echocardiography have reasonable accuracy and reliability for detecting serious coronary disease in women. Importantly, a negative study imparts an excellent prognosis. The application of a systematic and comprehensive evaluation of women will improve detection of important coronary disease and permit reassurance to women who do not have evidence for ischemia producing coronary disease. For women whose symptoms are determined not to be caused by significant coronary disease, additional evaluation for noncardiac causes can then be undertaken.
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PMID:Evaluating women with chest pain for the diagnosis of coronary artery disease. 1256 52

A 64-year-old man was admitted to our hospital with chief complaint of chest discomfort. He received coronary artery bypass grafting utilizing the in situ left internal thoracic artery 10 years ago. Coronary and left subclavian artery angiogram revealed coronary subclavian steal syndrome and 90% stenosis in the proximal left subclavin artery. Ultrasonography of neck vessels demonstrated 75% stenosis in the bifurcation of left carotid artery. We performed axilloaxillary artery bypass grafting to avoid brain ischemia. Myocardial thallium scintigraphy on dipyridamole testing after axilloaxillary artery bypass grafting could not detect myocardial ischemia. Axilloaxillary artery bypass grafting was effective for coronary subclavian steal syndrome.
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PMID:[Coronary subclavian steal syndrome; report of a case]. 1264 17

Crushing injury of the hand usually causes "explosive" damage. Subsequent swelling of the palmar structures further impairs venous outflow, and hemorrhage into structural spaces increases the pressure. The arterial system and the large dorsal veins, however, are seldom obstructed and provide adequate circulation unless hampered by improper bandaging. A bandage that compresses the dorsal veins causes back-pressure, which increases the swelling further and brings about ischemia. Swelling and pain cause the patient to restrict exercise of the injured hand, which permits contractures to develop. The author has averted this sequence in more than 100 cases by preserving integrity of veins during debridement, arresting hemorrhage, bandaging the hand with compression dressings in functional flexion, and reducing swelling with hyaluronidase. In these cases, on removal of bandages in 24 hours, swelling was reduced and continued to diminish. All patients exercised the hand at this time without discomfort and only a few required aspirin for pain.
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PMID:Crushing injury of the hand; prevention of ischemic contracture. 1363 24

The role of emotional distress (e.g., anger, depression, and anxiety) in anginal chest discomfort (ACD) may have been underestimated. The authors review the empirical studies in this area, which are inconsistent with the standard theory on the ischemia-angina relationship; summarize the substantial evidence indicating a strong and consistent cross-sectional/prospective epidemiological association of emotional distress and ischemia/ACD; review the distress-targeted, interventional evidence confirming a causal relationship (i.e., reduced chest discomfort and health system utilization), thus confirming clinical utility of such interventions; and explore the possible mechanisms that might account for the relationship between emotional distress and chest discomfort. Substantial clinical benefit may be achieved by aggressively detecting and treating emotional distress in ACD patients.
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PMID:What's "unstable" in unstable angina? 1512 42

Visceral pain, which originates from organ tissues of the thorax, abdomen or pelvis, is generally perceived as a deep, dull and vague sensation; in most cases it cannot even be clearly described, being a sense of discomfort, malaise or oppression rather than real pain. Crushing, cutting and burning generally have no algogenic effect in the viscera whereas mechanical stimulation, ischemia and chemical stimulation, separately or in combinations, may cause pain. With these characteristics, visceral pain differs from somatic pain. The characteristics of visceral pain, perception and transmission of painful visceral stimuli are explained, some common visceral pain syndromes are presented and sympathetic neurodestructive approaches as a treatment option are described in this review.
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PMID:Visceral pain. 1515 83

Optimal treatment of patients who present with chest pain is predicated on accurate identification of those patients with a cardiac etiology of their discomfort. Serial troponins and electrocardiograms are very sensitive for the detection of myocardial infarction but they are insensitive for the detection of ischemia. There are many analytes that are being actively evaluated for routine use to facilitate the identification of patients with myocardial ischemia. At present, only one assay is US Food and Drug Administration-approved for the exclusion of ischemia; many other analytes are under clinical evaluation and are briefly reviewed. At present, none of these analytes are yet appropriate for routine clinical use.
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PMID:Markers to define ischemia: are they ready for prime time use in patients with acute coronary syndromes? 1518 99

The radial artery has gained widespread acceptance as a conduit for coronary artery bypass. Advantages include minimal donor site discomfort, ease of handling, excellent early patency rates, and the possibility of freedom from late conduit atherosclerosis. Although most series describe minimal morbidity, a significant incidence of radial sensory neuropathy and isolated instances of hand claudication and ischemia have been reported. We performed an outcome study utilizing the Short Form-36, the Upper Limb-Disabilities of Arm, Shoulder and Hand, and a modified self-administered hand diagram to compare 288 patients undergoing coronary artery bypass utilizing the radial artery with a control group of 174 patients undergoing coronary artery bypass without the radial artery. The data were analyzed by the t test for continuous variables and the chi-square test for categorical variables, and subsequently a multivariate regression model was constructed. No patients developed hand claudication or ischemia. Although there was an incidence of radial sensory neuropathy of 9.9% associated with radial artery harvest, it was not significantly higher than the incidence in the control group (5.2%, p =.16). Intrinsic patient factors such as obesity, age, diabetes, and peripheral vascular disease were the principal determinants of overall health and quality of life issues.
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PMID:Outcome assessment of hand function after radial artery harvesting for coronary artery bypass. 1524 87

We present the case of a patient in whom a previously undetected anomalous origin of the circumflex coronary artery caused myocardial ischemia and led to positive myocardial scintigraphic results. Subsequent coronary angiography showed that the left circumflex coronary artery arose from the right coronary ostium-an anomaly that has been associated with chest discomfort-without atherosclerotic lesions. The peripheral distribution of the left circumflex artery was normal. We describe the clinical and angiographic findings in our patient and discuss the relationship between coronary artery anomalies and ischemia.
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PMID:Myocardial Ischemia caused by a coronary anomaly: left circumflex coronary artery arising from right sinus of valsalva. 1556 49


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