Cases reported "Pain, Postoperative"

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1/16. Intraspinal haematoma following lumbar epidural anaesthesia in a neonate.

    A neonate with chromosomal 9 abnormality and omphalocele received a lumbar epidural catheter after laparotomy. Several attempts were needed to establish this catheter. Bleeding occurred from the operative wound after surgery. Using an epidural infusion with ropivacaine 0.1% for 48 h postoperative pain relief was sufficient. Four days after epidural catheter removal, dysfunction of the sacral parasympathetic nerves was noted. Motor and sensor function of the lower limbs were unaffected. magnetic resonance imaging showed a localized intraspinal haematoma in the lower lumbar region.
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ranking = 1
keywords = wound
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2/16. An unusual post-operative wound infection with salmonella typhi: case report.

    A 25 year old male student presented with a discharging sinus and swelling over right forearm, which on culture yielded S. typhi, sensitive to ciprofloxacin. Predisposing factors were absent but there was a history of surgery for chronic osteomyelitis of right ulna and injury with cricket ball at same site. Pus obtained during surgery was sterile. Patient responded to oral ciprofloxacin. soft tissue infections are uncommon manifestation of salmonellosis. This case is an unusual presentation of post-operative salmonella typhi wound infection.
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ranking = 85.509059038733
keywords = wound infection, wound
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3/16. Late operative site pain with isola posterior instrumentation requiring implant removal: infection or metal reaction?

    OBJECTIVES: To elucidate the cause of late operative site pain in six cases of scoliosis managed with Isola posterior instrumentation that required removal of the implants. METHOD: Microbiologic examination of wound swabs and enriched culture of operative tissue specimens was undertaken in all cases. Histologic study of the peri-implant membranes also was conducted. RESULTS: The presentation in all cases was similar: back pain appearing between 12-20 months after surgery, followed by a local wound swelling leading to a wound sinus. In only one of these cases was the discharge positive for bacterial growth. Implant removal was curative. Histologic examination of tissue specimens revealed a neutrophil-rich granulation tissue reaction suggestive of an infective etiology despite the failure to isolate organisms. Within the granulation tissue was metallic debris that varied from very sparse to abundant from fretting at the distal cross-connector junctions. A review of recent literature describing similar problems suggests that late onset spinal pain is a real entity and a major cause of implant removal. CONCLUSIONS: On reviewing the evidence for an infective etiology versus a metallurgic reaction etiology for these cases of late onset spinal pain, it was concluded that a subacute low-grade implant infection was the main cause. Histologic findings would seem to confirm low-grade infection. There may be more than one causative factor for late operative site pain, as it is possible that fretting at cross connection junctions may provide the environment for the incubation of dormant or inactive microbes.
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ranking = 3
keywords = wound
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4/16. Concept for postoperative analgesia after pedicled TRAM flaps: continuous wound instillation with 0.2% ropivacaine via multilumen catheters. A report of two cases.

    Pedicled TRAM flap surgery is a complex procedure characterised by an extensive wound site. We present two patients with efficient postoperative pain relief by continuous wound instillation of ropivacaine 0.2% via two multilumen catheters. The catheters were placed subcutaneously before the wound closure through the umbilicus into the abdominal wound, and under the autologous flap into the breast. Each multilumen catheter provides even distribution for local anaesthetics over 12.5 cm. At the end of surgery, patients received a single shot dose of local anaesthetic via the pain catheters. After surgery the continuous infusion of ropivacaine 0.2% was commenced at a rate of 10 ml/h per catheter. Pain scores at rest and on coughing were low on the first postoperative day, and later zero. No medication for breakthrough pain was required throughout the recovery period, and the patients experienced no adverse events linked to the analgesia scene. patient satisfaction was excellent, and quality of recovery score was superior.
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ranking = 8
keywords = wound
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5/16. Two-stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculotic spondylitis.

    STUDY DESIGN: A retrospective analysis was performed of the clinical outcomes of patients with pyogenic or tuberculotic spondylitis who were treated with two-stage surgery (first stage: placement of posterior instrumentation; second stage: anterior debridement and bone grafting). OBJECTIVE: To evaluate the clinical outcomes of the abovementioned two-stage surgical treatment for pyogenic or tuberculotic spondylitis. SUMMARY OF BACKGROUND DATA: Although several methods of surgical treatment for pyogenic and tuberculotic spondylitis have been reported, there have been few reports of two-stage surgical treatment. methods: Eight patients (7 male, 1 female) with pyogenic or tuberculotic spondylitis (pyogenic: 6; tuberculotic: 2) were treated by two-stage surgery (first: placement of posterior instrumentation, second: anterior debridement and bone graft). Age at the time of surgery was 63.5 /- 9.91 years (average /- SD) (range: 47 to 77 years). Most of the patients had systemic problems, such as pneumonia, diabetes mellitus, or chronic renal failure. First, posterior spinal instrumentation was placed. Then, anterior debridement and bone grafting were performed. patients were evaluated before and after surgery in terms of pain level, hematologic parameters, neurologic status, and Barthel index. RESULTS: Average duration of surgery for both procedures was less than 4 hours. Changes in the pain level, blood parameters, and Barthel index demonstrated significant clinical improvement in all patients. Posterior wound infection occurred in two patients who were in poor general condition. CONCLUSIONS: This two-stage surgical treatment for pyogenic or tuberculotic spondylitis provided satisfactory results and can also be used in patients who are in poor general condition.
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ranking = 17.101811807747
keywords = wound infection, wound
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6/16. Delayed and recurring infection in postoperative abdominal wounds.

    Delayed and recurring wound infection in the abdominal wall of twenty-five patients, producing a variety of signs and symptoms months or years after original operations, were most frequently associated with silk sutures and endogenous infection due to escherichia coli. The restorative procedures employed at a small community hospital varied from incision and drainage to en bloc wound excision. Timing of operations, culture data, pre- and postoperative antibiotics, and changes in the type of suture material were important adjuncts to therapy.
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ranking = 22.101811807747
keywords = wound infection, wound
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7/16. Prolonged differential wound hyperalgesia after an interval of unilateral epidural blockade during lower abdominal surgery.

    We assessed postoperative pain at rest and with movement along with wound hyperalgesia in a patient who had undergone lower abdominal surgery under general anesthesia with a unilateral epidural block that persisted throughout surgery and in whom the epidural catheter was replaced immediately afterward. Pain and wound hyperalgesia were consistently greater on the "unblocked" side for the 3-wk period of observation. Thus, even imperfect intraoperative attenuation of noxious stimuli can lead to persistent reductions in postoperative pain.
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ranking = 6
keywords = wound
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8/16. Intrathecal diamorphine during laparotomy in a patient with advanced multiple sclerosis.

    A patient with advanced multiple sclerosis was successfully managed for a sigmoid colectomy using spinal anaesthesia. Effective postoperative analgesia was achieved with intrathecal diamorphine administered through an indwelling intrathecal catheter, and wound infiltration with 0.25% bupivacaine.
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ranking = 1
keywords = wound
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9/16. Controlled environment treatment for limb surgery and trauma (a preliminary report).

    This paper demonstrates a new approach to postsurgical and post-traumatic wound management in the lower limbs. Our own results of 20 below-knee amputations are documented. A less detailed report is then given of experience with an additional 20 amputees: this second group includes experience not only here at Seattle but at five other centers in the united states. The same method for wound management and for control of edema was employed in all cases. The method, Controlled environment Treatment (CET), uses filtered air as a dressing medium, with a control console to maintain the pressure, constant or varying, according to a preset program. temperature and humidity are also controllable, as is gas composition. The limb, together with its controlled environment, is contained with a pliable, transparent, treatment bag, which permits inspection and palpation of the wound site without disturbing the bacteriologically sterile air within the chamber. A special seal reduces air leakage yet avoids constriction of the limb. This CET system was originally developed by the Department of health and social security, Biomechanical research and Development Unit, Roehampton, england. Subsequent developments are also noted of an improved Mark II CET Unit and of simpler, related, management systems for conditions not requiring sterile environments.
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ranking = 3
keywords = wound
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10/16. Beneficial effects of ketamine in a chronic pain state with allodynia, possibly due to central sensitization.

    Allodynia is a well-known component of neuropathic pain resulting from injury to the nervous system. Clinical pain states with allodynia in connection with longstanding superficial wounds have, however, not been reported in the literature. In this case a chronic pain state developed in a previously healthy 17-year-old girl in and around a persistently suppurating appendectomy wound. There was no spontaneous pain but pronounced allodynia in the wound and in the surrounding skin. Quantitative thermal tests showed abnormal thresholds for several sensory modalities confirming abnormal processing of sensory input from the involved area. The pattern of sensory abnormalities evaluated with thermal testing changed transiently and the allodynia diminished during a phentolamine block. Since the pain responded poorly to opioids and ketamine has been reported to reduce allodynia, it was administered in a sub-dissociative bolus dose during wound dressing. The wound was essentially unchanged after treatment for 3 months but the allodynia and sensory aberrations had decreased significantly. We interpret these results as a de-sensitizing effect in the long term of repeated NMDA-receptor blockade by ketamine in a chronic pain state, with indications of central sensitization, partially maintained by sympathetic activity.
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ranking = 5
keywords = wound
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