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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 28-year-old man with a history of rheumatic heart disease, alcoholism and amphetamine abuse presented with severe left upper quadrant abdominal pain and persistent fever. He stayed at home for the previous two months due to intermittent dull lower abdominal pain, chills, fever and tarry stools without seeking medical help. A diagnosis of infective endocarditis with splenic infarcts and a renal infarct was made based on the echocardiographic and abdominal computer tomography scan findings. His clinical course was complicated by an acute inferior wall myocardial infarction and cerebral hemorrhage. Despite aggressive medical treatment, his condition deteriorated. One month later, his condition became more critical with pneumonia and intractable shock, and his family requested his discharge. He died soon after leaving the hospital.
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PMID:Widespread embolism in a patient with infective endocarditis--a case report. 776 62

An aim of this study was to determine the extent to which general practitioners (GPs) are their patients' physicians of first contact (PFCs) for specific health problems. It was also designed to explain the differences between physicians who treat these problems, and those who do not, by the type of problem presented, the characteristics of the physician, and the characteristics of the environment in which the physician works. The study is based on data collected in a nationwide mail survey in 1993 among 677 GPs working in 1 or more of Israel's 4 health insurance funds. They were asked if they were their patients' PFC for 27 health problems. There was great variation in the responses to this question according to the type of health problem presented. Thus for problems such as abdominal pain or chest pain, 85% of the GPs reported being the PFC, compared with only 50% for problems of suicidal thoughts or alcohol dependence. Multivariate analysis revealed that those more likely to report being their patients' PFC for the majority of problems presented were specialists in family medicine (p < 0.001), physicians under the age of 55 (p < 0.01) and rural physicians (p < 0.05). Our findings support the model which proposes that characteristics of the physician, the type of problem presented, and characteristics of the environment influence the likelihood of the GP being the patient's PFC. The findings have implications for GP training programs designed to enable GPs to cope with the wide range of problems encountered in general practice and to provide high quality care at reasonable cost.
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PMID:[The general practitioner as physician of first contact with health problems]. 854 75

A 69-year-old alcoholic man with pneumonia and sepsis due to Aeromonas hydrophila is presented. He died of suffocation by a copious amount of hemoptysis six hours after his first symptoms of abdominal pain, diarrhea and dyspnea. Aeromonas hydrophila was isolated from blood and bronchial secretion. A fulminant form of pneumonia could develop in patients with predisposing underlying conditions such as alcoholism with chronic hepatitis and diabetes mellitus. Aeromonas hydrophila pneumonia may be characterized by hemoptysis and rapid clinical deterioration with a high mortality rate.
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PMID:Fulminant pneumonia and sepsis due to Aeromonas hydrophila in an alcohol abuser. 879 58

Thirty-nine Danish cases of Capnocytophaga canimorsus septicemia were reviewed to determine the clinical course of this infection. The cases of septicemia were related to recent dog bites or other close contact with dogs. The period from the bite to the onset of symptoms ranged from 1 to 8 days. The mean age of the patients was 59.1 years (range, 28-83 years). Underlying conditions included previous splenectomy and alcoholism. Thirteen patients had previously been in good health. Common initial symptoms were fever, malaise, myalgia, vomiting, diarrhea, abdominal pain, dyspnea, confusion, headache and skin manifestations. Disseminated intravascular coagulation developed in 14 patients, meningitis in 5, and endocarditis in 1. Twelve of the patients died. All patients except two were treated with penicillin or ampicillin. Five patients had received antibiotics prior to admission. Attention should be drawn to C. canimorsus septicemia in cases of febrile illness following dog bites or contact with dogs, as well as those involving previously healthy persons. The incidence of this condition in Denmark is estimated to be 0.5 case per 1 million people per year.
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PMID:Capnocytophaga canimorsus septicemia in Denmark, 1982-1995: review of 39 cases. 881 32

Internal pancreatic fistulas are rare but debilitating complications of chronic pancreatitis. Fistulous tracts from the pancreatic duct to the peritoneal or pleural cavities have been treated by medical therapy and surgical management, with success rates of 41% and 89%, respectively. Endoscopic stent placement for internal and external pancreatic fistulas has also been shown effective. We report on three patients with histories of chronic alcohol abuse and pancreatitis. Two patients presented with dyspnea and pleuritic chest pain. Imaging studies revealed pleural effusions, and endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a patent fistulous tract from the pancreatic duct to the pleural cavity in each patient. Chemical analysis of the pleural fluid indicated pancreatic origin. The third patient, who had left-upper-quadrant abdominal pain and a small pleural effusion, had a large noncommunicating pseudocyst adjacent to the stomach. Nasopancreatic drains, along with chest tube drainage, were placed in the patients with pancreatic pleural fistulas. The patient with the pseudocyst received nasocystic drainage via the stomach. Drainage was measured until closure of the fistulas or cyst. Additionally, simply by injecting contrast medium, we were able to monitor the closure of fistulas without ERCP. The fistulas closed within 7 days, and the pseudocyst resolved within 14 days. Following discharge, all three patients were pain free, without evidence of recurrent fistulas or pseudocyst. In conclusion, the use of nasopancreatic/cyst drainage is an effective and convenient way to treat internal, communicating collections and pseudocysts of pancreatic origin. Furthermore, this method provides a simple means of assessing closure of fistulas and pseudocysts.
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PMID:Nasopancreatic drainage: a novel approach for treating internal pancreatic fistulas and pseudocysts. 899 90

It's well known that patients was acquired immunodeficiency syndrome (AIDS) can develop various kinds of hepatobiliopancreatic diseases, for causes related to AIDS and for causes not related to HIV infection. The authors describe a case to their attention due to a suspected acute pancreatitis. The patient presented with abdominal pain, increased serum alkaline phosphatase and amylase levels. Serological test and stool concentration didn't show any opportunistic infection (Cytomegalovirus, Cryptosporidium). Abdominal ultrasonography showed enlargement of the head of the pancreas, gallbladder with biliary sludge, and a little dilatation of the biliary tree. The patient didn't feel better despite the medical treatment, so considering the probability of the migration of calculus, the patient underwent cholecystectomy. After the operation the patient felt better quickly. This case confirms the presence in HIV patients of pancreatitis for causes unrelated to AIDS like cholelithiasis as we showed, alcoholism, hypercalcemia, and the importance of an opportune surgical treatment that was resolutive.
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PMID:[Acute pancreatitis and AIDS]. 932 71

The aim of our study was to analyze the influence of alcohol consumption on the early clinical manifestations of alcoholic chronic pancreatitis of the 517 patients in whom chronic pancreatitis was initially suspected, 158 were diagnosed with this disease; of these, alcohol was considered the cause in 136 (86.1%). Alcohol was considered a major etiologic factor when mean consumption was > or = 60 grams per day for at least 4 years. Alcohol consumption, initial clinical manifestations and time of onset were considered up until the moment of diagnosis in all patients. The sex distribution was 133 men (97.8%) and 3 women (2.2%). The average age was 22 +/- 6.5 years at onset of alcoholism, 38 +/- 9.4 years at onset of clinical features, and 44 +/- 9.4 years at diagnosis. The interval between the onset of alcoholism and the initial clinical manifestations was 15.8 +/- 8.8 years, and the interval between the latter and diagnosis was 6.1 +/- 4.9 years. Average alcohol consumption was 162 +/- 8 grams/day and total consumption was 1312 +/- 1017 kg. A statistically significant relationship was found only for mean alcohol consumption and abdominal pain. We found a higher frequency of acute pancreatitis outbreaks, calcifications, steatorrhea and diabetes until the moment of diagnosis in the higher alcohol consumption groups, although the relationship was not statistically significant.
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PMID:Influence of alcohol consumption on the initial development of chronic pancreatitis. 942 5

A 31-y-old black man with neurofibromatosis, alcoholism and hypertension was admitted because of abdominal pain, hematemesis and cough. In the hospital he had prolonged fever and developed a multiorgan crisis. Despite thorough investigation, no infectious cause for fever was found. Urinary catecholamines and metabolites were markedly elevated. Computerized tomography revealed a mass abutting the left kidney. A diagnosis of pheochromocytoma was made, and as soon as treatment with phenoxybenzamine and propranolol was begun, the fever resolved. Serum interleukin-6 (IL-6) concentration was initially elevated, decreased after the start of adrenergic blockade, and gradually fell to an undetectable level after surgery. These observations suggest that interleukin-6 might have been causally related to the patient's fever and possibly the multiorgan crisis.
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PMID:Interleukin-6 in the fever and multiorgan crisis of pheochromocytoma. 957 53

A 71-year-old male who had previously suffered from chronic alcoholism was admitted to the Internal Medicine Service of Coimbra Hospital Center in January 1996 due to asthenia, loss of weight, icterus and abdominal pain, clinical features that had begun six months before admittance to hospital. A physical examination revealed that, in addition to icterus, the patient presented multiple hemangiomas of 1 to 5 cm in diameter, located in the oral cavity, neck, breast and left axilla. These lesions were bluish, elevated and with a rubber-nipple consistency, and had been developing for about 15 years. Subsequent examination revealed normocytic normochromic anemia, cholestatic icterus and the existence of a gastrointestinal hemangioma located in the esophagus. Excisional biopsy of an element proved that it was cavernous hemangioma. A subsequent angio-scintigraphy indicated other aspects suggestive of deep hemangiomas located in the legs, face and cervical region. The authors had the opportunity of examining other members of the patient's family, who apparently did not exhibit similar lesions. They concluded that it was a case of blue rubber bleb nevus syndrome (BRBNS), probably in its sporadic form. Treatment was essentially conservative and the patient is well.
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PMID:[The blue rubber bleb nevus syndrome or Bean's syndrome. A rare cause of digestive hemorrhage]. 1019 91

Hypertriglyceridaemia is thought to be the aetiology in 3% of patients with acute pancreatitis, often associated with poorly controlled diabetes mellitus or chronic alcohol abuse. However, in patients with non-biliary pancreatitis, chylomicronaemia is an underrated cause of acute pancreatitis. The activity of lipoprotein lipase (LPL) is crucial in removing triglycerides from the plasma; LPL gene mutations combined with secondary alterations in plasma lipoproteins, such as occur in pregnancy, diabetes mellitus, and alcohol abuse can cause severe hypertriglyceridaemia and pancreatitis. Heparin and insulin stimulate LPL activity. During a 12 months' period we consecutively screened all patients with the diagnosis of acute non-biliary pancreatitis for hypertriglyceridaemia, to evaluate the prevalence of hypertriglyceridaemia-induced pancreatitis and to assess the outcome under standardised treatment with intravenous heparin and insulin. Hypertriglyceridaemia-induced pancreatitis was diagnosed in 5 out of 46 patients (11%) with acute pancreatitis. In 2 patients hypertriglyceridaemia was associated with diabetes mellitus, in one patient with pregnancy and in another with chronic alcohol abuse. Four patients had to be referred to the intensive care unit. Plasma concentrations of triglycerides were (median +/- range) 43 mmol/l (14.7 to 80.4); pancreas amylase was 574 U/l (155 to 1606), and lipase was 1003 U/l (330 to 3010). All patients had oedematous pancreatitis demonstrated by CT scan. Treatment with i.v. heparin and i.v. insulin decreased trigylceride levels to less than 10 mmol/l within 2.8 days (1 to 6), the amylase and lipase levels returned to normal after 3 and 4 days respectively, and the abdominal pain was resolved. Hypertriglyceridaemia is a common and under-diagnosed etiology of acute non-biliary pancreatitis. Intravenous heparin and insulin is safe and effective in the treatment of hypertriglyceridaemia-induced pancreatitis. Low fat diet, supplements of (n-3) fatty acids ("fish oil") and fibrates are recommended for long-term maintenance therapy.
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PMID:[Heparin and insulin in the treatment of acute hypertriglyceridemia-induced pancreatitis]. 1049 50


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