The relief of pain is of crucial importance in the management of patients undergoing a total three-stage oesophagectomy. Respiratory problems as a result of inadequate or overzealous analgesic regimes can ruin all pre-operative and per-operative efforts. 90 patients who underwent a total oesophagectomy over a 15-year period (1967-1982) at University Hospital Kuala Lumpur, were reviewed (36 for benign stricture and 54 for carcinoma of the oesophagus). Four post-operative analgesic regimes were used: immediate extubation and parenteral analgesics; 24-48 hour IPPV and timed dose/continuous infusion of parenteral narcotics; 24-48 hour IPPV plus extradural catheter analgesia; intra-operative direct intercostal nerve blocks, extubation and parenteral analgesics. Morbidities and mortalities are analysed.
During the 10-year period 1974-1983, 68 patients with intraperitoneal haemorrhage as a result of the rupture of a corpus luteum were managed at the University Hospital, Kuala Lumpur, Malaysia. Most of the patients were aged between 18 and 35 years. In 63% of the patients the rupture occurred between the 14th and the 35th day of the menstrual cycle, and 10 patients had intraperitoneal bleeding severe enough (450-1500 mL) to require blood transfusion. The condition is often confused with other surgical emergencies such as appendicitis and ectopic pregnancy. An increased awareness of the problem in women of reproductive age and the use of laparoscopy, when indicated, will allow a more conservative approach to be adopted for those patients with minimal bleeding. The performance of an appendicectomy in the presence of blood in the peritoneal cavity did not appear to increase morbidity in those patients with a preoperative diagnosis of "appendicitis".
Anterior sacral meningocele is a rare congenital meningeal cyst herniating through a bony defect in the sacrum. Since its description by Bryant in 1837, only 154 cases have been reported in the world literature. The application of ultrasound and C.T. scan following myelography is discussed.
The aim of this study is to determine the social impact of oral and facial pain in a sample involving an industrial population. Out of a total of 355 subjects interviewed, nearly one-half claimed to have oral and facial pain in the previous one month prior to the survey. The most common type of pain was that related to hot or cold fluids or sweet things followed by toothache. On the average, the pain lasted for 4.2 days (SD = 4.9) per person in the past one-month. About one in five persons with pain reported that it was severe enough to disrupt sleep. About one in ten persons reporting pain had to take sick leave because of the pain. However, only one in four persons with pain consulted a doctor or dentist. More than one-third tried to cope with the pain and did nothing while the rest tried various means of self-cure. It is therefore postulated that in this population, pain per se is a poor predictor of utilisation of dental services. Further research into pain coping behaviour and how this affects of pattern of utilisation of dental services is indicated in order to formulate a strategy to encourage the habit of seeking prompt dental care by the target population.
The objective of the study was to determine whether discriminant analysis of characteristics of dyspepsia can differentiate peptic ulcer from non-ulcer dyspepsia in a Malaysian population. Two hundred and twenty six patients with dyspepsia were interviewed using a standard history questionnaire before undergoing upper gastrointestinal endoscopy. Forty seven patients had peptic ulcer while 149 others were classified as having non-ulcer dyspepsia. Stepwise logistic regression analysis was done on 25 variables. The study showed that only five of these variables could differentiate peptic ulcer from non-ulcer dyspepsia, namely, nocturnal pain, pain before meals or when hungry, absence of nausea, age and sex. A scoring system was devised based on these discriminant symptoms. At a sensitivity of 51%, the specificity for peptic ulcer was 83%, but only prospective studies will determine if this scoring system is of actual clinical value.
The results of the present investigation have shown the usefulness of suprofen in the control of pain following surgical removal of impacted wisdom tooth. The regime of 200 mg. q.d.s. orally, was shown to be satisfactory in the control of postoperative pain. Pain was rapidly controlled by the 1st hour after ingestion and subsequently maintained at a low profile until is was completely abolished by the 8th hour of the postoperative period.
An interesting case of bifid blind-ending ureter occurring in a young Indian girl is reported. She presented with severe recurrent right iliac fossa pain for which she underwent appendicectomy which did not resolve her symptoms. Subsequent urological investigation--IVU and retrograde pyeleogram--revealed the genuine diagnosis. Surgical excision of the blind-ending branch was successful in relieving the intractable pain. A review of the literature on this uncommon congenital urological problem is outlined stating its clinical significance and treatment options.
We reviewed 31 cases (19 males and 12 females) of spinal tuberculosis seen at the National Tuberculosis Centre from 1985 to 1989. The mean age was 35.4 years. The predominant clinical feature was backache (90.3%), while neurological features were found in 30.9%. An elevated erythrocyte sedimentation rate (in 80.0%) and a positive Mantoux test (in 70.9%) served as useful investigations. Spinal x-ray was abnormal in all cases, the lumbar spine being most commonly involved. Bacteriological or histopathological confirmation was obtained in only 29.0% of cases. The mainstay of treatment was anti-tuberculous chemotherapy with surgery being performed in 41.9% of patients.
In a study to test the association between soil transmitted intestinal helminthiasis and abdominal symptoms in a non-paediatric age group, 242 randomly selected patients (137 males, 105 females, median age 45 years) were asked specific questions pertaining to abdominal symptoms at the time of admission to the adult medical wards. Stool examination on all patients revealed a round worm prevalence rate of 21%. A larger proportion of stool positive female patients were symptomatic than stool negative females (68% vs 30%, p = 0.04). There was no significant difference in symptoms between stool positive and stool negative male patients (34.6% vs 31%, p = 0.91). The results suggested an association between intestinal nematode infection and abdominal symptoms in females but not in males.
This study was undertaken to determine whether an infusion of local anesthetic (LA) delivered through an extrapleural tunnel could provide satisfactory control of pain in the postthoracotomy period. Twelve patients undergoing thoracotomy were studied. A T-shaped tunnel was created by elevating the parietal pleura at the posteromedial end of the thoracotomy wound. An irrigation catheter was then inserted and an infusion of bupivacaine commenced, initially at 5 mg/kg/24 h and subsequently at 3 mg/kg/24 h. Pain was well controlled in eight patients and satisfactory in four patients. The latter required one dose of opiate analgesia each in the 48-h postoperative period. We conclude that an infusion of bupivacaine into the extrapleural space is an effective means of control of pain after thoracotomy.
A retrospective study of 100 patients with acute right upper quadrant pain was performed in order to indicate the diagnostic role of ultrasound including the diagnostic role of ultrasound including guided percutaneous procedures in the evaluation of such cases at the General Hospital Kota Bharu (GH, KB). In the majority of these patients the leading clinical consideration was acute cholecystitis. In all the patients the initial sonographic diagnoses were compared with the final diagnoses. In 35 patients (35%) biliary pathology was diagnosed. In this group the conographic correlation was good. In 65 patients (65%) the symptoms were due to non-biliary pathology. In this group ultrasound detected the actual site of pathology in 28%. Ultrasonography which can image multiple organs rapidly is a useful initial screening procedure in patients presenting with acute right upper quadrant pain because it can detect the actual size of pathology in about two-thirds of the cases.
1. Bradykinin and related kinins may act on four types of receptors designated as B1, B2, B3 and B4. It seems that the B2 receptors are most commonly found in various vascular and non-vascular smooth muscles, whereas B1 receptors are formed in vitro during trauma, and injury, and are found in bone tissues. 2. These BK receptors are involved in the regulations of various physiological and pathological processes. 3. The mode of kinin actions are based upon the interactions between the kinin and their specific receptors, which can lead to activation of several second-messenger systems. 4. Recently, numerous BK receptors antagonists have been synthesized with prime aim to treat diseases caused by excessive kinin production. 5. These diseases are RA, inflammatory diseases of the bowel, asthma, rhinitis and sore throat, allergic reactions, pain, inflammatory skin disorders, endotoxin and anaphylactic shock and coronary heart diseases. 6. On the other hand, BK receptor antagonists could be contraindicated in hypertension, since these drugs may antagonize the antihypertensive therapy and/or may trigger the hypertensive crisis. 7. It is worth suggesting that the BK receptor agonists might be useful antihypertensive drugs.
Destructive thyroiditis commonly occurs during the postpartum period, with a prevalence rate of 5% to 16%, and is mainly due to postpartum autoimmune thyroiditis (PPT) and, very rarely, to subacute thyroiditis. The thyroiditis is similar to Hashimoto's thyroiditis and is generally painless in nature, although cases with painful thyroiditis have been described. We report a case of painful destructive thyroiditis occurring during the postpartum period, which was clinically and biochemically indistinguishable from the variant of painful PPT or subacute thyroiditis. Fine needle aspiration cytology showed multi-nucleated giant cells diagnostic of subacute thyroiditis.
The efficacy of epidurally administered tramadol hydrochloride, a weak centrally acting analgesic, was studied for the relief of postoperative pain. Sixty patients undergoing abdominal surgery were randomly allocated to three treatment groups to be given the following agents by the epidural route: group 1 tramadol 50 mg; group 2 tramadol 100 mg; group 3 10 ml of bupivacaine 0.25%. The drugs were administered at the patients' request with each patient being allowed four doses in the first 24 h following surgery. Blood pressure, pulse rate, respiratory rate, arterial blood gas analyses, pain scores, the interval between doses and the occurrence of any side effects were recorded. Pain scores (assessed using a visual analogue scale) were significantly less (p < 0.05) at 3, 12, and 24 h in patients receiving tramadol 100 mg than in those receiving tramadol 50 mg or bupivacaine. The mean interval between doses for groups 1, 2 and 3 was 7.40 h, 9.36 h and 5.98 h respectively. The mean interval in group 2 was significantly longer than in group 3 (p < 0.05). The incidence of nausea and vomiting in group 2 was significantly higher than in group 3 (p < 0.05).
Twenty-nine patients (16 males, 13 females) with spontaneous pneumothorax admitted into Hospital Universiti Sains Malaysia, Kubang Kerian, from September 1984 to September 1990 were reviewed. Their ages ranged from newborn to 75 years. The commonest chief presenting symptom was dyspnoea (69%), followed by chest pain (35%). Four patients had chronic obstructive airway disease, 7 had pneumonia, 2 had pulmonary tuberculosis, one patient had emphysema while 4 patients had multiple underlying lung disorders. The left and right lungs were involved with equal frequency. Bilateral pneumothorax occurred in one patient. Most patients had a single episode of pneumothorax but recurrent pneumothoraces occurred in 3 patients (10%). Six patients were observed conservatively, 20 patients required chest tube insertion alone and 3 patients also required pleurodesis. Death occurred in 8 patients (28%) mainly due to coexisting infection and respiratory failure.
A prospective study of blocking T10-L1 with local anaesthetic, bilaterally in 30 patients undergoing caesarean section under general anaesthesia has been shown to provide effective postoperative analgesia thus requiring significantly less narcotics (mean 66.6 mg of pethidine) compared to the 30 patients in the control group (mean 163 mg of pethidine). A cocktail of 0.5% of bupivacaine with adrenaline and xylocaine 1% produced analgesia for the duration ranging from 8 to 12 hours (mean 8.4 hours). Patients with abdominal field block were awake, alert and comfortable during the immediate postoperative period. They were pain-free sufficiently to put the babies to the breast early and frequently.
Intravenous regional guanethedine (IVRG), using the Bier's block technique, was given to relieve pain in a 62 year old Indian woman suffering from reflex sympathetic dystrophy. The patient obtained complete pain relief with 2 injections and has remained pain-free for 18 months.