1/80. Continuous inferior mesenteric ganglion block for the control of abdominal pain.BACKGROUND AND OBJECTIVES: A 71-year-old woman was referred for control of intractable left-sided abdominal pain and constipation caused by stage 2B rectosigmoid colon cancer. She was treated with an intravenous morphine sulfate infusion at 4 mg/h which made her drowsy and lethargic. Because the distal colon is innervated by the inferior mesenteric sympathetic ganglion, it was hypothesized that a continuous block of this ganglion would provide both pain control and increased intestinal motility. methods: The patient was placed in a prone position, and a Tuohy needle was placed at an entry site 7 cm lateral to the L3 spinous process. The needle was advanced 2 cm anterior to the L3 vertebral body with fluoroscopic guidance. An 18-gauge indwelling catheter was placed through the needle and a continuous infusion with 0.1% bupivacaine was maintained for 4 days. RESULTS: The patient obtained immediate pain relief and bowel motility. She remained awake and comfortable throughout the duration of therapy. She was discharged home 3 days after stopping the infusion and required a minimal amount of opioids. CONCLUSION: Continuous inferior mesenteric ganglion block may be an option in providing relief for pain caused by distal colon pathology.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/80. abdominal pain in children.Chronic vague abdominal pain is an extremely common complaint in children over 5 years, with a peak incidence in the 8 to 10 year group. In over 90 per cent of the cases no serious underlying organic disease will be discovered. Most disease states can be ruled out by a careful history, a meticulous physical examination, and a few simple laboratory tests such as urinalysis, sedimentation rate, hemoglobin, white blood count determination, and examination of a blood smear. If organic disease is present there are often clues in the history and the examination. The kidney is often the culprit--an intravenous pyelogram should be done if disease is suspected. barium enema is the next most valuable test. Duodenal ulcers and abdominal epilepsy are rare and are over-diagnosed. If no organic cause is found, the parents must be convinced that the pain is real, and that "functional" does not mean "imaginary." This is best explained by comparing with "headache"--the headache resulting from stress and tension hurts every bit as much as the headache caused by a brain tumor or other intracranial pathology. Having convinced the patient and his parents that no serious disease exists, no further investigation should be carried out unless new signs or symptoms appear. The child must be returned to full activity immediately.- - - - - - - - - - ranking = 0.75keywords = pain (Clic here for more details about this article) |
3/80. Reduction in constipation and laxative requirements following opioid rotation to methadone: a report of four cases.constipation is a common symptom in cancer patients, especially in those who are receiving opioid analgesics for pain. Although several articles have recently examined constipation with respect to causation and treatment, little research has been done to elucidate the effects of different opioids on the bowel. Recent research has found that laxative doses may be lower in patients using methadone as an analgesic, but changes in constipation were not measured. We report here on four cases in which patients had improvement in constipation and decreased laxative requirements following opioid rotation to methadone.- - - - - - - - - - ranking = 0.125keywords = pain (Clic here for more details about this article) |
4/80. Care study: providing effective care in palliative nursing.Currently, nurses are under great pressure to demonstrate effective, evidence-based patient care. In this article a single case study will be used to demonstrate that care can be based on recent research within a palliative care setting to produce effective outcomes. research-based interventions, which were used to provide care for a patient who will be referred to as Maria, will be discussed and evaluated to illustrate the contribution that evidence-based practice made to her nursing care. Although it is a single case study and the findings cannot be generalized, it is suggested that this article can be used to demonstrate the need for accurate interpretation of assessment data, illustrate the use of research to support nursing interventions in pain management, constipation and skin pressure damage, and show that empirical evidence alone may not be a sufficient basis for care and that moral issues must be taken into account.- - - - - - - - - - ranking = 0.125keywords = pain (Clic here for more details about this article) |
5/80. Rectal carcinoma with stercoral ulcer perforation.We report a case of ruptured stercoral ulceration due to chronic constipation which is caused by rectal carcinoma. This case suffered from difficulty of stool passage for 5 months. Periumbilical pain and current-jelly stool were experienced before his admission. physical examination revealed diffuse abdominal rebounding pain and laboratory data showed leukocytosis. Computed tomography demonstrated marked dilatation of the sigmoid colon with stool impaction due to neoplastic growth in the rectosigmoid junction. Thickening and edematous change of the colonic wall were noted. There was amorphous material with gas in the mesocolon, which indicated fecal peritonitis. Emergent operation with Hartman's procedure and left colostomy was performed. Diffuse pressure gangrene of the sigmoid colon wall with a perforating hole was identified. Pathologically, the resected colon specimen showed non-specific-acute and chronic inflammatory change. The perforating hole was surrounded by a necrotic border of ulcerative mucosa. After the operation, pelvic drainage was undertaken for 1 month and then the patient was discharged uneventfully.- - - - - - - - - - ranking = 0.25keywords = pain (Clic here for more details about this article) |
6/80. struma ovarii in a 50 year old Ethiopian woman.struma ovarii represents the dominant growth of thyroid tissue in a teratoma. This exceedingly rare neoplasm is described in a 50 year-old Ethiopian woman who presented with right lower quadrant pain and mass of 10 years duration. The patient had nonspecific symptoms in addition to the above complaints. The diagnosis was disclosed by pathologic examination. This exceedingly rare neoplasm is discussed with clinicopathologic correlation and literature review.- - - - - - - - - - ranking = 0.125keywords = pain (Clic here for more details about this article) |
7/80. Surgical treatment of a sigmoid volvulus associated with megacolon: report of a case.Sigmoid volvulus occurring concomitantly with megacolon is an uncommon cause of bowel obstruction, and various approaches to treatment have been proposed. We report herein a case of sigmoid volvulus with megacolon that was successfully treated by elective surgery following endoscopic reduction during the same hospital stay. A 70-year-old woman was admitted to our hospital with abdominal pain, distension, and severe constipation. physical examination, plain abdominal X-ray, and barium enema confirmed a sigmoid volvulus and further examinations revealed concomitant megacolon. An elective sigmoid colectomy was performed following successful endoscopic decompression. The postoperative course was uneventful and there was no residual colonic dysmotility. Histologically, no aganglionic tissue was observed in the resected specimen.- - - - - - - - - - ranking = 0.125keywords = pain (Clic here for more details about this article) |
8/80. Surgical treatment of severe colonic inertia with restorative proctocolectomy.patients with severe constipation due to colonic inertia who remain symptomatic after extensive medical therapy or partial colonic resection have occasionally been treated with ileostomy as a last resort. The hospital records of five patients with persistent symptomatic idiopathic colonic inertia were reviewed. Each of the patients had undergone extensive medical management, and eventually four underwent one or more colonic resections to relieve the recurrent abdominal distention and pain. Three of the patients eventually received a distal ileostomy, which functioned well. Anorectal manometric studies were within normal range for each of the five patients. Restorative proctocolectomy (J pouch) was therefore performed for each. With a mean follow-up of 42 months after restorative proctocolectomy each of the five patients was relieved of constipation and small bowel distention. The average number of bowel movements per 24 hours at 6 months was 4.8. All patients were able to discriminate flatus from stool, could hold back for up to 1.5 hours after the initial urge to defecate, and had total daytime continence. Each returned to work or school within 3 months, and each reported greater satisfaction with bowel function than with the ileostomy. Restorative proctocolectomy with a J pouch provides a satisfactory option for the management of patients with persistent abdominal distention and pain due to idiopathic colonic inertia.- - - - - - - - - - ranking = 0.25keywords = pain (Clic here for more details about this article) |
9/80. uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis. A case report.BACKGROUND: uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis usually presents after menarche with progressive abdominal pain during menses secondary to hematocolpos. We describe a case with the unique presentation of rectal pain and constipation. CASE: A 13-year-old girl presented to the emergency department complaining of lower abdominal and rectal pain and constipation of two weeks' duration. Pelvic ultrasound, physical examination and laparoscopic findings established a diagnosis of hematometracolpos secondary to uterus didelphys with unilateral imperforate hemivagina. An incision in the vaginal septum allowed drainage of the hematocolpos, providing relief of the patient's symptoms. CONCLUSION: uterus didelphys with unilateral imperforate hemivagina and ipsilateral renal agenesis may present with apparent gastrointestinal symptoms. With increased awareness of this problem, timely diagnosis may be achieved.- - - - - - - - - - ranking = 0.375keywords = pain (Clic here for more details about this article) |
10/80. Gigantic jejunal leiomyosarcoma.Jejunal leiomyosarcoma is a rare neoplasm. We report a case of gigantic leiomyosarcoma of the jejunum in a 30-year old man who presented with abdominal distension, pain and constipation. Computerized tomography scan revealed a giant tumor filling the entire abdominal cavity. Fine needle aspiration cytology was suspicious. At laparotomy, a huge jejunal leiomyosarcoma measuring 30 x 25 x 19 cm and weighing 13 kg was completely excised. To the best of our knowledge, this is the first case of a giant jejunal leiomyosarcoma.- - - - - - - - - - ranking = 0.125keywords = pain (Clic here for more details about this article) |
| | Next -> |