Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The records of 101 patients with primary small intestinal malignant tumor at NTUH, collected from 1960 to 1989, were reviewed. These patients represented 1.2% of the patients with gastrointestinal cancer at NTUH over the same period. Fourty-two (41.6%) of the cancer patients had lymphomas, 30(29.7%) had adenocarcinomas, 26 (25.7%) had leiomyosarcomas, and 3(3.0%) had carcinoid tumors. The average age at cancer presentation was 47.5 years (range from 3 to 96). The lymphoma patients had an average age of 35.1 years, while adenocarcinoma patients averaged 60.4 years of age. Leiomyosarcoma and carcinoid tumors averaged 51.2 years and 59 years, respectively. There were 65 male patients and 36 female patients, and there was a male predominance in all groups except for the leiomyosarcoma group which had an equal sex ratio. Generally speaking, the incidence rate for the areas involved were similar in the duodenum, jejunum and ileum. However, adenocarcinomas were more common in the duodenum (53%) and 45% of lymphomas were found in the ileum, as were the carcinoid tumors (66%). The most common presenting symptom was abdominal pain (62%), with bleeding second (32%). Obstruction and palpable mass together were present in 29% of the cases. Body weight loss was found in 25% of patients, and 14% of the patients presented with acute abdomen due to intestinal perforation. Laparotomy was the most common diagnostic procedure (60%). Preoperative diagnoses were possible in cases of duodenal and upper intestinal malignancies, but were rarely possible in patients with lower intestinal malignancies. Sixty-eight patients (68%) underwent tumor resection for palliation or cure. The operation mortality was 4%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Primary malignant tumor of the small intestine. 168 72

Twenty patients with histologically verified carcinoid liver metastases underwent a total of 24 liver artery embolizations by means of interventional radiologic techniques. There were no deaths. The postembolization syndrome, consisting of fever, abdominal pain, nausea, and vomiting, occurred in all the patients. Severe complications were rare, the most serious being multiple hepatic abscesses with septicemia in one patient, septicemia in another, and mild acute pancreatitis in a third. All these three patients recovered without any sequels from the embolization, and none required surgical intervention. The hepatic abscesses were drained percutaneously, guided by ultrasound. Hepatic artery embolization seems justified in patients with disabling symptoms from the carcinoid syndrome, as long as alternative therapy with the same benefit but fewer complications is not available.
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PMID:Side effects and complications after hepatic artery embolization in the carcinoid syndrome. 187 48

A male aged 57 is reported with neurofibromatosis presenting with a tumour in the periampullary region. Pathologic examination revealed a neuroendocrine tumour of the carcinoid type. A review of the literature suggests that neurofibromatosis patients are at significant risk for developing a periampullary tumour which is nearly always of neuroectodermal origin. To date, surgical excision is the only curative therapy. Therefore, early diagnosis is of major importance. In all patients with neurofibromatosis presenting with jaundice, gastrointestinal bleeding or abdominal pain, a periampullary tumour should be considered. A review is presented of the latest developments concerning the DNA-based mutation causing this disorder. In family members, DNA linkage studies should be carried out, and they should be periodically screened, e.g. with gastroduodenoscopy.
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PMID:[Neurofibromatosis and a tumor of Vater's papilla]. 192 4

We describe the case of a patient suffering from relapsing abdominal pain and vomiting over 4 years, in whom various radiological and endoscopic examinations remained normal. CT scan and MRI eventually showed a mesenteric mass corresponding to metastasis of an ileal carcinoid; this tumor was diagnosed only at laparotomy as well as his mesenteric and hepatic metastases. The different localization and clinical manifestations of carcinoid tumours as well as the difficulties of radiological diagnosis of tumours of the small bowel are mentioned; the diagnostic value of sonography. CT-scan and MRI in the diagnosis of hepatic metastasis is discussed.
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PMID:[A difficult diagnosis]. 200 76

Coincident with medical antitumor treatment of 138 patients suffering from mid-gut carcinoid tumors, 51 patients were subjected to surgery with the principal aims of removing primary tumors and debulking mesenteric or liver metastases. Sixteen patients had previously been operated with intestinal resection or, when the tumors had been considered inexcisable, with intestinal bypass or laparotomy alone. Apart from exhibiting symptoms related to the carcinoid syndrome, the majority (approximately 60%) of the 51 patients had generally intermittent, subileus-like abdominal pain and weight loss. In 18 patients, these symptoms were pronounced and associated with intestinal obstruction or severe malnutrition. Computed tomography and arteriography efficiently demonstrated mesenteric and liver metastases. At laparotomy, the primary intestinal tumors were small, mainly less than 1 cm in diameter, and they were multiple in 39% of the patients. Mesenteric metastases measuring up to 12 cm in diameter were present in 86% of the patients. These metastases were frequently associated with a pronounced mesenteric and retroperitoneal fibrosis causing fixation, angulation, and obstruction of the bowel as well as incipient intestinal gangrene in 8 patients. In all but 6 patients, the primary tumors could be removed by comparatively limited intestinal resections although bulky mesenteric metastases were often dissected from the mesenteric vessels. Liver metastases, found in 49% of the patients, were generally bilateral and multiple, and major hepatic metastases were resected in 6 patients. The results support a role for surgery also in the more compromised patients with mid-gut carcinoid tumors and that such intervention may be associated with considerable symptomatic relief and substantial periods of survival.
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PMID:Surgical treatment of mid-gut carcinoid tumors. 236 41

Since carcinoid tumors rarely originate in the colon (excluding those that arise in the appendix and rectum), there are few large clinical series describing these neoplasms. Seventy-two patients with colonic carcinoids treated over a 40 year period have been reviewed. The peak incidence was in the seventh decade and females outnumbered males 2:1. Virtually all patients were symptomatic, usually complaining of abdominal pain. The symptom duration averaged 3.6 months. Thirty-eight percent of patients had masses in the right lower quadrant and 16 percent, hemoccult-positive stools. Three patients had a documented elevation of the urinary 5-HIAA level. Nearly 70 percent of the lesions were situated in the right segment of the colon. Barium enemas usually detected the neoplasms. Most patients had colon resections and five had resection of adjacent organs. Forty-four percent of the lesions had spread to regional sites and 38 percent to distant points. Most lesions were bulky. The operative mortality was 19 percent overall. Chemotherapy and radiotherapy did not appear to provide good palliation. Synchronous or metachronous neoplasms developed in 30 patients, especially in the colon, during the period of follow-up. The crude survival rates were 58, 51, 25 and 10 percent at 1, 2, 5, and 10 years, respectively.
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PMID:Carcinoid tumors of the colon. A study of 72 patients. 240 28

A transcatheter embolisation was carried out for treatment of a patient suffering from hepatic metastases of a malignant carcinoid tumour. Recurrent and very severe carcinoid symptoms could be observed; a bronchial carcinoid supposingly the primary tumour without characteristic symptoms was removed six years before. The carcinoid symptoms became resistant to pharmacological agents and finally ended in life-threatening clinical complications. The transcatheter hepatic artery embolisation was successfully performed and repeated three months later. After embolisation relief of carcinoid symptom and a significant decrease in 5-hydroxyindole acetic acid (5-HIAA) urinary excretion lasting for eight months could be observed. There were no serious complications with adequate pharmacological cover, however, a transient fever, leucocytosis, abdominal pain and an increase in serum transaminase activities occurred after the procedure. The transcatheter hepatic artery embolisation should be a method of choice for treatment of patients with carcinoid metastases producing severe carcinoid symptoms resistant to pharmacological agents.
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PMID:Hepatic artery embolisation--new approach for treatment of malignant carcinoid syndrome. 242 13

Seven patients with progressive ileal or caecal carcinoid tumors and liver metastases were treated with human recombinant alpha-interferon (IFN alfa-2b) at a dosage of 2-4 x 10(6) U daily or every other day subcutaneously. Six patients had symptoms of the carcinoid syndrome. No change of tumor size lasting 4 to 40+ months (median, 18 months) was noted in 6 patients, and 1 patient had hepatic tumor progression. A decrease in urinary excretion of 5-hydroxyindoleacetic acid by more than 50% lasting 2-11 months (median, 4) was observed in 5 patients. Four patients were completely or partially relieved of flushing, diarrhea, obstruction or abdominal pain. The side-effects were negligible with the exception of mild fever, headache and confusion only during the first days of therapy. Treatment with IFN alfa-2b offers good palliation to patients with disseminated ileal or caecal carcinoid tumor and carcinoid syndrome.
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PMID:[Treatment of metastasized carcinoid tumor of the ileum and cecum with recombinant alpha-2b interferon]. 245 Mar 26

We compared the clinical and biochemical profiles of 11 patients with idiopathic flushing (IF) with those of eight patients with carcinoid syndrome (CS). Patients with IF were more often women, had a longer duration of symptoms, and were younger. Palpitations, syncope, and hypotension occurred only in patients with IF, while wheezing and abdominal pain occurred only with CS; diarrhea occurred in both types of patients. Elevated blood serotonin levels were present primarily in CS. Increased levels of urine 5-hydroxyindoleacetic acid was specific for CS but unsufficiently sensitive to detect all cases. Abnormalities of gut and vasoactive peptides failed to distinguish the two conditions. Flushing in carcinoid patients responds uniformly to octreotide (Sandostatin), but only one third of the patients with IF are relieved of the symptom. Patients with IF have features that distinguish them from individuals with flushing from other causes, such as CS, postmenopausal state, chlorpropamide-alcohol flush, panic attacks, medullary thyroid carcinoma, and autonomic epilepsy. Familiarity with the clinical and biochemical features of IF should facilitate evaluation and identification of these patients.
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PMID:Distinguishing features of idiopathic flushing and carcinoid syndrome. 246 88

Carcinoid of the small intestine, usually found in the terminal ileum, presents a diagnostic challenge when the classic clinical and laboratory findings are absent. The commonest symptom, marked abdominal pain due to intussusception, may arouse suspicion of carcinoid. The precise preoperative diagnosis in the absence of the classic syndrome is impossible and the only way to diagnose it is by colonoscopic biopsy of the terminal ileum. The case described illustrates such a preoperative diagnosis in a 59-year-old woman with severe abdominal pain, nausea, vomiting and weight loss. X-ray studies aroused suspicion of tumor intussusception as the cause of the intestinal obstruction. Colonoscopic biopsy revealed the presence of a carcinoid tumor. However, there had been no symptoms of the carcinoid syndrome, nor was there increased urinary 5-hydroxy indoleacetic acid. On operation the tumor was found to be disseminated and unresectable, so surgical intervention was limited to palliative ileo-transversostomy.
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PMID:[Preoperative diagnosis of carcinoid of the terminal ileum in the absence of carcinoid syndrome]. 247 74


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