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

Clostridium difficile has been well known to be a pathogen of pseudomembranous colitis. It is characterized by the formation of elevated plaques and pseudomembranes which result in varying degree of diarrhea. This series analysed 20 cases of pseudomembranous colitis diagnosed at Chang Gung Memorial Hospital between January 1985 and December 1989. The male to female ratio was 1:3. Their ages ranged between 13 and 81 years, with a mean of 53.7 years. Sixteen of our patients claimed to have taken antibiotics for upper respiratory tract infection, pneumonia, cellulitis or acute pelvic inflammatory disease within six weeks before onset of symptoms. The antibiotics were mainly in the penicillin group and cephalosporin group. Clinical presentations included diarrhea of varying degree, fever, and abdominal pain. The diagnosis was made by the typical colonic mucosal changes under sigmoidoscopic or colonoscopic examination and pathological findings. The lesions were prominent in the rectum and sigmoid colon. Eleven cases were treated with vancomycin. Of these, one failed and died, and two recurred. The two recurrences were again treated with the same dose of vancomycin and with complete remission. Three of our patients responded to metronidazole. The other six cases with milder symptoms were successfully controlled by using cholestyramine (2 cases) or by supportive treatment (4 cases).
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PMID:[Pseudomembranous colitis: a clinical analysis and review of literatures]. 187 12

A 31-year old salesman living in Seoul developed suddenly abdominal pain due to intestinal obstruction. Exploratory laparotomy exhibited segmental jejunal cellulitis caused by penetrating Anisakis larva. The patient had eaten raw fish. The typical history of intestinal anisakiasis was presented with a short review of Korean patients of anisakiasis.
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PMID:A case of anisakiasis causing intestinal obstruction. 191 30

Unusual infections associated with colorectal tumors may, in some instances, be the sole clue to presence of malignancy. The infections are either related to invasion of tissues or organs in close proximity to the tumor or secondary to distant seeding by transient bacteremia arising from necrotic tumors. The authors present one case of spontaneous crepitant cellulitis in the lower abdominal wall, associated with sigmoid tumor. The patient had abdominal pain in the left iliaca fossa, fever and skin necrosis of the lower abdominal wall in the last 4 hours. At surgery they performed debridement and excision of necrotic tissue (lower abdominal wall) and partial sigmoidectomy with sigmoid colostomy. The patient died 9 months after initial surgery. A study of tumor mass revealed an adenocarcinoma. The presence of crepitant cellulitis in a lower abdominal wall should result in a search for bowel perforation.
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PMID:[Crepitant abdominal cellulitis: a rare clinical presentation of sigmoid tumor]. 215 Dec 44

During a retrospective review of more than 1,000 pediatric pancreas specimens obtained by autopsy or biopsy, 13 cases of primitive interstitial pancreatitis (PIP) were identified. The morphologic diagnosis of PIP is based on the following histological features: presence of abundant, inspissated, PAS-negative intraductal secretions, overdistension and focal rupture of the intrapancreatic ducts, and presence of a focal, extensive inflammatory infiltrate. PIP should be distinguished from cystic fibrosis, necrotizing pancreatitis, and passive secondary interstitial infiltrates associated with extensive retroperitoneal cellulitis caused by septicemia or abdominal surgery. Clinical diagnosis is difficult and was not considered in the ten children under four years of age. In the three children over five, the presence of recurrent abdominal pain with mild ascitis and jaundice led to the correct diagnosis. Pathological findings suggest two possible pathophysiologic hypotheses: lesions may develop proximal to a mechanical malformative obstruction that is, however, only very rarely found, according to a more likely alternative, quantitative and qualitative modifications of pancreatic secretions may occur as a result of severe dehydration or use of drugs (corticosteroids, diuretics), justifying the term "dyschylic pancreatitis" coined by G. Seifert.
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PMID:[Primary interstitial pancreatitis or dyschylic pancreatitis in children. Apropos of 13 cases]. 240 Jan 90

We experienced 57 episodes of Pseudomonas aeruginosa bacteremia in 55 patients with hematologic disorders in a 16-year period. Ninety-five percent of the patients had hematologic malignancies such as acute leukemia. All but one patient received cytotoxic or immunosuppressive therapy at or prior to the onset of bacteremia. Seventy-seven percent of the episodes occurred during profound granulocytopenia of below 100/mm3. All the patients acquired their infection in the hospital, and 96% had received antibiotic therapy during the preceding two weeks. Periodontal, anorectal, lower respiratory tract, and urogenital infections were the sources of bacteremia in about three-quarters of the episodes. Periodontal infection tended to progress to cellulitis of the face or the floor of the mouth, often resulting in bacteremia of the unimicrobial type, while anorectal infection predisposed to abscess formation, frequently leading to bacteremia of the polymicrobial type. Cellulitis at onset was seen in 35% of the episodes. Most sites of infection did not become apparent until one to three days after the onset of fever, probably because of depressed inflammatory response associated with severe granulocytopenia. The majority of patients complained of gastrointestinal symptoms such as nausea and vomiting, abdominal pain, diarrhea, and abdominal fullness at the onset of bacteremia. Major complications included bacteremic shock (63%), impaired consciousness (25%), ecthyma gangrenosum or hemorrhagic gangrenous cellulitis (18%), and jaundice (12%). Furthermore, there were one case each of endocarditis and disseminated intravascular coagulation. It was thus suggested that the clinical picture of P. aeruginosa bacteremia complicating hematologic disorders is influenced by the predisposing conditions associated with the underlying diseases and their treatment.
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PMID:[Pseudomonas aeruginosa bacteremia associated with hematologic disorders [I]. Predisposing factors and clinical manifestations]. 250 86

Eighteen adult patients with hematologic malignancy developed bacteremia due to Clostridium tertium while neutropenic. Fifteen had accompanying abdominal pain, colonic bleeding, or diarrhea, and three had perianal cellulitis. Fourteen recovered with antibiotic therapy alone; no patient was treated by surgery. C. tertium is an unusual Clostridium because it is resistant to many beta-lactam antibiotics and to metronidazole but is susceptible to vancomycin, trimethoprim-sulfamethoxazole, and ciprofloxacin. It is possible that use of third-generation cephalosporins (cefotaxime, ceftizoxime, ceftazidime) for treating febrile episodes in the absence of any selective intestinal decontamination with trimethoprim-sulfamethoxazole or ciprofloxacin may have resulted in selection for C. tertium in our patients.
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PMID:Clostridium tertium septicemia in patients with neutropenia. 319 41

A 59-year-old man presented with painful subcutaneous nodules on the anterior surfaces of the legs. He had received oral antibiotics and supportive care for presumed cellulitis and thrombophlebitis, but had minimal improvement. Five months earlier, he had undergone pancreaticoduodenectomy for acinar pancreatic carcinoma; at that time, the serum level of amylase had been normal, but the level of lipase was elevated. The patient denied fever, rigors, arthritis/arthralgia, or pleuritic pain. His medications included aspirin, furosemide, ranitidine, and nortriptyline. He denied any allergies. Physical examination revealed numerous firm, tender, erythematous and violaceous, subcutaneous nodules on the lower extremities, with marked bilateral pitting edema (Fig. 1). Skin biopsy of a representative lesion revealed septal panniculitis, consistent with erythema nodosum (Fig. 2). None of the characteristic changes of pancreatic fat necrosis was present. The patient was treated with aspirin, 650 mg orally, q 6 h, and indomethacin, 50 mg orally, q 12 h, but he continued to develop new nodules; prednisone, 60 mg orally was begun. Although he reported improvement in symptoms, the nodules failed to respond clinically and older nodules ulcerated along the medical aspect of the right leg (Fig. 3). The complete blood count was normal, except for hemoglobin, 10.9 mg per dL. Routine serum biochemical studies were also normal, except for albumin, 3.1 mg per dL, LDH, 312 U per L, and SGOT, 51 U per L. Serum amylase was 14 U per L (normal per 30 to 115 U per L) and serum lipase was 54,160 U per L (normal 0 to 200 U per L). Chest roentgenogram and tuberculin skin test were negative. A CT scan of the abdomen revealed extensive liver metastases. A second biopsy of the skin and subcutis of a necrotic nodule revealed lobular panniculitis with the characteristic picture seen in pancreatic fat necrosis (Fig. 4). The patient was presumed to have metastatic pancreatic carcinoma and pancreatic fat necrosis. Nodules subsequently developed on the thighs, arms, hands, wrists, and fingers. He developed arthritis and arthralgias of the ankles, wrists, and hands, bilaterally, and the right knee. Aspiration of a right knee effusion revealed numerous neutrophils, but no evidence of infection. Treatment was begun with the somatostatin analog, octreotide, in increasing doses. During this therapy, the lesions did not progress and new lesions did not appear. There was no change in the lipase level. Inadvertently, octreotide was omitted at discharge, but reintroduction of octreotide was associated with lack of further progression of the nodules, according to the patient's spouse; however the patient became progressively debilitated and his abdominal pain worsened, requiring continuous sedation. His condition deteriorated and he died several weeks after hospital discharge.
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PMID:Fat necrosis with features of erythema nodosum in a patient with metastatic pancreatic carcinoma. 883 28

Observing pediatric patients in an OU (whether a pediatric or combined or hybrid unit) has many advantages: better patient care, a decrease in missed diagnoses and acuity, better risk management, decreased malpractice liability, cost effectiveness, increased patient and family satisfaction, and psychosocial benefits. Key principles of observation medicine (purpose, time frame, general patient inclusion and exclusion criteria, administration, CQI, and so forth) are equivalent for pediatric and adult observation patients, but there are important differences. Unique characteristics of pediatric observation patients include specific diagnosis, decreased length of stay, less need for cardiac monitoring, a highly variable admission rate, and a decreased percentage or admission rate to the OU from the ED. Whereas the adult OU is primarily a cardiac-monitoring unit, the pediatric OU is a respiratory and infectious disease unit with a frequent need for an i.v. therapy and hydration. Types of pediatric patients commonly treated in an OU include respiratory illnesses (asthma, croup, bronchiolitis, pneumonia), gastrointestinal disorders (gastroenteritis, abdominal pain), dehydration, infections (fever, cellulitis, lymphangitis, pyelonephritis or UTI), overdoses or poisonings, and seizures.
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PMID:Pediatric observation medicine. 1121 2

This paper describes two studies in children with fever in which the safety of ibuprofen was compared with that of paracetamol. The Boston University Fever Study aimed to assess the risk of rare but serious adverse events in febrile children. There were 795 admissions among 84,192 children during the study. There were no significant differences between the drugs in the risk of admission or the risk of secondary endpoints (admissions for asthma or cellulitis, or physician visits for abdominal pain or dyspepsia) and no evidence of clinically significant impairment of renal function. However, ibuprofen was associated with a significantly lower risk of physician visits for asthma: the incidence associated with ibuprofen was 3.0% (CI95% 2.1, 4.1) compared with 5.1% (CI95% 3.5, 7.1) for paracetamol (P = 0.02). The second study was a case control study to investigate a possible association between antipyretic medication, varicella infection and necrotising fasciitis. We identified 52 children aged under 19 years who were admitted to hospital with varicella and Group A streptococcal infection and 172 matched controls with uncomplicated varicella. The risk of invasive Group A streptococcal infection was associated with demographic and environmental factors and persistent high fever. There was no association with the use of ibuprofen or paracetamol alone, but the use of both agents was significantly associated with streptococcal infection. These studies demonstrate that children with fever tolerate treatment with ibuprofen as well as treatment with paracetamol. Neither agent is associated with an increased risk of necrotising soft tissue infections.
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PMID:The safety of ibuprofen suspension in children. 1272 48

Streptococcal toxic shock syndrome (STSS) is the most severe form of invasive infections caused by group A streptococci. In this report, a 36-years-old man who was admitted to our clinic with the complaints of fever, rash, skin lesions, abdominal pain, weakness and anuria for 2 days, has been presented. His body temperature was 39.5 degrees C and blood pressure was 50/20 mmHg. In physical examination, diffuse erythematous rash on the body, cellulitis on left leg and foot, fungal lesions on the toes, and abdominal tenderness were noted. Laboratory results revealed a dramatic increase in leukocyte count, increased sedimentation rate, elevated blood urea nitrogen, cretinine, liver enzymes and bilirubin levels. Group A streptococci were isolated from the blood culture of the patient. Despite supportive (intravenous saline, dopamine) and antibiotic (clindamycin-ceftriaxone combination) therapies, adult respiratory distress syndrome has developed in two days, and he died on the third day. This case was presented to draw attention to STSS, which was a rare clinical entity with rapid progression to mortality despite aggressive medical therapy.
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PMID:[Streptococcal toxic shock syndrome: a case report]. 1474 69


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