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Article
Post Stroke Shoulder Pain Problem

Author: Zeki Nooh Hassan
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2006 Volume: 5 Issue: 2 Pages: 172-176
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Shoulder pain is one of the complications that happened in patient suffered of hemiplagia our aim is tostudy this problem in hemiplegics patients due to strokeMETHODS:56 patients affected by different types of stroke were enrolled in this study , each patient wasexamined by neurologist , CT scan then done and referred to a consultant rheumatologist at alkindihospital for assessment of his shoulder area , the patient then investigated thoroughly for his or hershoulder painRESULTS AND CONCLUSION :The study showed high correlation between shoulder pain and older age patients, aphasia, corticalsensory defectsThe study showed that the frozen shoulder is the commonest cause of post stroke shoulder pain

Keywords

shoulder pain --- stroke


Article
INTRAPERITONEAL INSTILLATION OF NORMAL SALINE TO DECREASE SHOULDER PAIN FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY
تاثير تنقيع المحلول الملحي (نورمال سلاين) داخل الغشاء البريتوني للبطن في تقليل الم الكتف بعد عملية رفع كيس المرارة بالناظور

Authors: ZAINAB M. SALIH زينب محمدصالح --- SARDAR H. ARIF --- FARHAD K. SULAYVANI فرهاد خورشيد سليفاني
Journal: Duhok Medical Journal مجلة دهوك الطبية ISSN: ISSN: 20717334 (online)/ ISSN: 20717326 (Print) Year: 2014 Volume: 8 Issue: 1 Pages: 42-50
Publisher: University of Dohuk جامعة دهوك

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Abstract

ABSTRACTBackground and Objectives Although laparoscopic cholecystectomy (LC) significantly reduces postoperative pain and provides satisfaction for both the patient and the surgeon, still there is some discomfort which is experienced by some patients either as shoulder pain or abdominal pain. The aim was to measure the efficacy of intraperitoneal instillation of thenormal saline in reducing shoulder pain.Methods This is a prospective study, 120 patients who underwent laparoscopiccholecystectomy were randomly divided to four groups. In the group A: no intraperitoneal instillation of normal saline was used and no drain was left in a subhepatic region. In the second group B: no intraperitoneal instillation of normal saline was used but a sub hepatic drain was left for 24 hours. In the group C :intraperitoneal instillation of normal saline underthe right hemidiaphragm and beneath the liver intraoperatively with aspiration at the end of operation. In the group D: the same steps of group C were used but a sub hepatic drain left for 24 hours. Postoperatively shoulder pain score was recorded on a visual analogue scaleduring 2,6,12,24,48,72 hours postoperatively and any additional analgesic requirements were recorded.Results Shoulder pain score revealed a significant decrease in group C and D versus controls A and B at 2,6,12,24,48,72 hours postoperatively .(p value = 0.01) also Analgesicrequirements for shoulder pain were less in groups C and D after surgery compared to that in group A and B.Conclusion: Intraperitoneal instillation of normal saline can reduce postoperative shoulder pain after laparoscopic cholecystectomy.

على الرغم من ان عملية رفع كيس الم ا ررة بالناظور يقلل بدرجة كبيرة من الالم بعد اج ا رء العملية مع اعطاء القناعة لكل من الج ا رح والمريض الا انه يبقى هناك بعض الالم في منطقة الكتف والبطن. في هذه الد ا رسة نحاول ان نعلم مدى تاثير تنقيع المحلول الملحي (نورمال سلاين) داخل الغشاء البريتوني للبطن في تقليل الم الكتف.طريقة البحث:. اجريت هذه الد ا رسة في مدينة دهوك لمدة سنة واحدة للفترة من بين كانون الثاني ٢٠١٠ حتى كانون الثاني ٢٠١١ تم اختيار ١٢٠ مريضا يعانون من حصاة الم ا ررة ممن ستجرى لهم عملية رفع الم ا ررة بالناظور. حيث تم تقسيمهم بطريقة عشوائية إلى أربع مجاميع:تضم المرضى الذين تم إج ا رء العملية لهم بطريقة كلاسيكية. A مجموعة تضم المرضى الذين تم اج ا رء العملية لهم بطريقة كلاسيكية مع وضع انبوب تصريف تحت الكبد لمدة ٢٤ B مجموعة ساعة ثم رفعه.تضم المرضى الذين أجريت لهم العملية بنفس الطريقة السابقة وفي نهاية العملية تم تنقيع الغشاء البريتوني C مجموعةللحجاب الحاجز وتحت الكبد بالمحلول الملحى (نورمال سلاين) بمقدار ١٥٠٠ مللتر ثم سحبه في نهاية العملية.مع وضع انبوب تصريف تحت الكبد بعد C تضم المرضى الذين تم اج ا رء العملية لهم بنفس طريقة مجمموعة D مجموعة العملية لمدة ٢٤ ساعة.٧٢ بعد العملية مع تسجيل ،٤٨ ،٢٤ ،١٢ ،٦ ، تم تقييم الم الكتف حسب الجدول البصري لقياس الالم خلال الساعات ٢ اي ادوية مسكنة اضافية اعطيت للمريض خلال هذه الفترة.النتائج:B و A بالمقارنة مع المجاميع C و D حسب الجدول البصري لقياس الم الكتف هناك تقليل كبير لنسبة الالم للمجاميع٧٢ ساعة بعد العملية.وكذلك كمية الادوية المسكنة المعطاة للمرضى في المجاميع ،٤٨ ،٢٤ ،١٢ ،٦ ، خلال الفت ا رت ٢ .B و A اقل بنسبة كبيرة بالمقارنة مع المجاميع D و Cالاستنتاجات:،٦ ، تنقيع الغشاء البريتوني للبطن بالمحلول الملحي (نورمال سلاين) يقلل بدرجة كبيرة من الم الكتف خلال الفت ا رت ٢٧٢ ساعة بعد عملية رفع الم ا ررة بالناظور. ،٤٨ ،٢٤ ،١٢ ساعة بعد عملية رفع الم ا ررة بالناظور.


Article
DOES POST-LAPAROSCOPIC CHOLECYSTECTOMY INTRA-ABDOMINAL DRAIN REDUCES POSTOPERATIVE SHOULDER PAIN?

Authors: Ahmed H. Ismael احمد حقي اسماعيل --- Anees K. Nile انيس خليل نايل --- Hassan A. Hassan حسن احمد حسن
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2011 Volume: 9 Issue: 1 Pages: 4-10
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background: In the context of the much-heralded advantages of laparoscopic surgery, it can be easy to overlook post-laparoscopy pain as a serious problem, yet as many as 80% of patients will require opioid analgesia. It is generally accepted that pain after laparoscopy is multifactorial, and the surgeon is in a unique position to influence many of the putative causes by relatively minor changes in technique.Objective: To determine whether a drain placed in the peritoneal cavity during laparoscopy is both clinical and cost-effective method of reducing postoperative shoulder pain.Methods: One hundred female patients were having laparoscopic cholecystectomy were divided into two groups, a control group (50 patients) where no intra-peritoneal drain was inserted and second group (50 patients) in which the patients had intra-peritoneal gas drain sited in the subhepatic area. Patients' age, weight, height, operative time, total amount of CO2 and amount of analgesia used were recorded for each patient in both groups. Shoulder pain was assessed using visual analogue score (VAS) from 1-5 scale at 4, 8, 24 & 48 hours postoperatively, where as abdominal pain was assessed at 48 hour post-operatively. pH of the abdominal fluid was assessed in the second group of patients by using pH meter 48 hours postoperatively. ResultsShoulder pain may occur in many of patients of the control group more frequent than those of the second group, where as postoperative abdominal pain was found to be greater in patients with subhepatic drain after laparoscopic cholecystectomy.Conclusion: Low-cost drain decreased the frequency of shoulder pain and reduced the need for analgesia, but increases the abdominal pain; however it is less cost-effective than simple oral analgesia after laparoscopy.Keywords: laparoscopic cholecystectomy, intra-abdominal drain, shoulder pain


Article
Postoperative Pain Reduction with Bupivacaine Instillation After Laparoscopic Cholecystectomy

Authors: Sami Hasson --- Firas AL Chalabi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 2 Pages: 186-191
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

BACKGROUND:Pain occurs frequently following laparoscopic cholecystectomy leading to increased patientsdistress, delayed discharge, increase the need for analgesia and delayed oral intake. OBJECTIVE: To evaluate the effect of bupivacaine instillation on pain relief in the early post- operative periodfollowing laparoscopic cholecystectomy. MATERIALS AND METHODS: Eighty patients having symptomatic gall stones were included in this study. The procedure wasexplained to the patients and informed consent was obtained. The patients were divided into twogroups: group (A) received 40 ml of(0.125%) bupivacaine diluted in 60 ml of isotonic saline(0.9%)instilled in the subdiaphragmatic and subhepatic spaces, the remaining 40ml of (0.125%)bupivacaine were used for wounds infiltration. The post operative pain was assessed by visualanalogue scale(VAS) at fixed time intervals, both patients and house officer doctor were blinded tothe group of the patients. Group (B) stood as a control group.RESULTS: The two groups were comparable in age, gender, weight, and duration of operation. The maleto female ratio was (1:4), the mean age in both groups were insignificantly different, theirweights ranged from (58- 96) kg. Post operative abdominal pain was significantly lower in group A(bupivacaine group) than group B ( control group) in the first twelve hours.The mean abdominal pain score ranged from (3.85 to 2.55) for the bupivacaine group, and from(6.62 to 3.16) in the control group, the p value is < 0.001which is highly significant in the first 6hours. Group A had a lower incidence of shoulder pain in comparison with the control groupalthough statistically not significant. CONCLUSION: Intraincisional infiltration with bupivacaine is a simple and feasible procedure which significantly reduces post operative pain


Article
An adult adrenal neuroblastoma presented as a right shoulder pain: A case report
والعصبية الكظرية الكبار كما عرضت ألم الكتف الأيمن: تقرير حالة

Authors: Yasser I. Abbass --- Idreiss J. Khalaf --- Azzawi M. Hadi
Journal: The Medical Journal of Tikrit مجلة تكريت الطبية ISSN: 16831813 Year: 2008 Volume: 2 Issue: 142 Pages: 89-92
Publisher: Tikrit University جامعة تكريت

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Abstract

Neuroblastoma of the adrenal gland is an extremely rare tumor in adulthood although it is one of the most common malignancies in childhood. In this report, a 25-year-old woman who had a left adrenal mass on preoperative imaging. She was operated and the mass was resected in en-block manner along with the left kidney. The histopathological examination of the specimen revealed the diagnosis of neuroblastoma. She had metastasis to the cervical part of the spinal cord operated upon before the time of diagnosis as a suprarenal tumor and received chemotherapy after the operation. Although neuroblastoma of adrenal gland is rare in adulthood, it should be considered in the differential diagnosis for patients with adrenal masses

العصبية من الغدة الكظرية هو ورم نادر جدا في سن البلوغ على الرغم من أنه هو واحد من الأورام الخبيثة الأكثر شيوعا في مرحلة الطفولة. في هذا التقرير، وهي امرأة 25 عاما، الذي كان له كتلة اليسار الكظرية في التصوير قبل الجراحة. اجريت عملية جراحية كانت مقطوعة وكان القداس في EN-كتلة بطريقة جنبا إلى جنب مع الكلية اليسرى. كشف فحص الأنسجة لعينة لتشخيص العصبية. كان لديها ورم خبيث في عنق الرحم جزء من الحبل الشوكي يعمل على قبل وقت التشخيص وجود ورم الكظر، وتلقت العلاج الكيميائي بعد العملية. على الرغم من العصبية من الغدة الكظرية أمر نادر الحدوث في سن البلوغ، ينبغي النظر في ذلك في التشخيص التفريقي للمرضى مع الجماهير الكظرية

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