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

The paper deals with the course of the illness in a 66 years old male, who had taken an amount of 0.2 mg of medigoxin for an unknown period of time, because of chronic heart failure due to atherosclerotic heart disease and chronic atrial fibrillation. He have had a cholelithiasis also and reduced renal reserve. He was admitted by an emergency admittance because of nausea, vomiting, color vision disturbances: blue colored vision, and with other signs of digitalis toxicity: diffuse abdominal pain, an absolute arrhythmia with a slow ventricular rate, and with a short corrected Q-T interval in an electrocardiogram of 0.315 seconds and with high serum digoxin level reacted 3.8 nmol/L. After stopping of a digitalis treatment, in a period of time of four days, all signs of digitalis toxicity including blue color vision disturbances disappeared. In the paper that rare sign of digitalis toxicity is discussed.
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PMID:[Blue color vision as a sign of digitalis poisoning]. 134 44

Simvastatin, a 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor, has been administered to approximately 2,400 patients with primary hypercholesterolemia with a mean follow-up of 1 year in controlled clinical studies and their open extensions. Approximately 10% of this population received simvastatin for a period of greater than or equal to 2 years. The population on whom this safety analysis is based had a mean age of 50 years; 62% were men and approximately 27% had preexisting coronary artery disease. Simvastatin was titrated to the maximal daily dose of 40 mg each evening in 56% of the study population (last recorded dose). The most frequently reported drug-related clinical adverse experiences were constipation (2.5%), abdominal pain (2.2%), flatulence (2.0%) and headaches (1%). Persistent elevations of serum transaminase levels greater than 3 times the upper limit of normal were observed in only 1% of this cohort with only 0.1% of the total population requiring discontinuation of therapy. There were no clinically apparent episodes of hepatitis. Discontinuation of therapy due to myopathy was extremely rare (0.08%). Only minimal increases in the frequency of lens opacities (1%) were observed from baseline to the last lens examination during follow-up, consistent with the expected increase in lens opacity development due to normal aging. Patients who were greater than or equal to 65 years old had a clinical and laboratory safety profile comparable to the nonelderly population.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term safety and efficacy profile of simvastatin. 195 Oct 69

Screening for dyslipoproteinemias should be undertaken in all individuals older than 20 years of age at least once every 5 years. The initial screening, as recommended by the Adult Treatment Guidelines Panel of the National Cholesterol Education Program, is to determine the concentration of total blood cholesterol. This initial determination can be made on blood obtained in the nonfasting state. Further evaluation of the patient's lipoprotein concentrations is dependent upon the presence of other cardiovascular risk factors. in the absence of definite coronary heart disease, hypertension, diabetes mellitus, a family history of coronary artery disease, cigarette smoking, or severe obesity, the patient with a total blood cholesterol concentration less than 200 mg/dL requires no specific instruction and should have a repeated screening performed within 5 years. Patients with blood cholesterol concentrations greater than 200 mg/dL should have their lipoprotein profiles determined if they have atherosclerotic cardiovascular disease or two other cardiovascular disease risk factors. The lipoprotein profile includes the determination of fasting cholesterol and triglyceride and HDL cholesterol concentrations. From these values, the LDL cholesterol concentration can be calculated. This LDL cholesterol concentration is central in selecting the appropriate therapy. HDL cholesterol concentrations may be useful in evaluating patients with ischemic heart disease. Concentrations of HDL cholesterol less than 35 mg/dL are associated with increased risk for coronary artery disease. Although there is currently no convincing evidence that support the specific treatment of depressed HDL cholesterol concentrations, therapy directed to modulating lipoprotein metabolism in patients with heart disease and low HDL concentrations may be of benefit. Patients with recurrent abdominal pain, pancreatitis, and eruptive xanthomatosis frequently have fasting hypertriglyceridemia concentrations exceeding 1000 mg/dL. These patients should be identified in order to effectively reduce their triglyceride concentrations, which can prevent these complications.
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PMID:Detection and evaluation of dyslipoproteinemia. 219 76

Mortality from coronary artery disease is a common problem in treated hypertensive patients, and these people have a high prevalence of elevated cholesterol levels. A study was undertaken to determine whether cholesterol could be lowered effectively without major side effects in patients with treated hypertension. Forty-nine patients (mean age 67.6 years) with cholesterol greater than 5.5 mmol/l were placed on a reduced-fat (less than 30% of calories from fat with a ratio of polyunsaturated to saturated fats of less than 1) diet for 3 months. If the cholesterol was between 5.5 and 7.5 mmol/l and total cholesterol divided by high-density lipoprotein cholesterol was greater than 4.5, the patients were randomly allocated either to the simvastatin (24 patients) or the placebo group (25 patients). Diet and placebo caused minor and insignificant falls in cholesterol and no change in triglycerides or lipids. Treatment with simvastatin reduced cholesterol levels from 6.85 to 4.75 mmol/l (P less than 0.001), triglycerides from 2.7 to 2.1 mmol/l (P less than 0.01), low-density lipoproteins from 4.6 to 2.6 mmol/l (P less than 0.001) and high-density lipoproteins rose from 1.09 to 1.18 mmol/l (P less than 0.01). Total cholesterol divided by high-density lipoprotein cholesterol fell from 6.3 to 4.0 (P less than 0.001). The drug was well tolerated and the side-effect profile did not differ from the placebo in clinical or biochemical events. The active drug was stopped in one patient (abdominal pain, dizziness, headache, tiredness) and in two patients taking the placebo (elevated creatine phosphokinase, cardiovascular collapse). Simvastatin effectively lowered total cholesterol and improved the lipoprotein profile. The dose required in most patients was 40 mg/day. Simvastatin may be an acceptable drug to improve the lipoprotein profile in order to determine whether this improves the prognosis in patients treated for hypertension.
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PMID:Simvastatin in the treatment of hypercholesterolaemia in patients with essential hypertension. 233 14

The operative records of 2816 patients undergoing repair for abdominal aortic aneurysm (AAA) from 1955 to 1985 were reviewed. Inflammatory aortic or iliac aneurysms were present in 127 patients (4.5%), 123 men and four women. Most patients were heavy smokers (92.1%). Clinical evidence of peripheral arterial occlusive disease and coronary artery disease was found in 26.6% and 39.4%, respectively. Additional aneurysms occurred in half of the patients; iliac aneurysms were the most common (55 patients), followed by thoracic or thoracoabdominal (17 patients), femoral (16 patients), and popliteal aneurysms (10 patients). Ultrasound and computed tomography suggested the diagnosis in 13.5% and 50%, respectively; angiography was not helpful. Excretory urographic findings of medial ureteral displacement or obstruction suggested the diagnosis in 31.4%. The aneurysm was repaired in 126 patients. Only one patient experienced acute aneurysm rupture, but eight patients had chronic contained leakage. When compared with patients who have ordinary atherosclerotic aneurysms, patients with inflammatory aneurysms are significantly more likely to have an elevated erythrocyte sedimentation rate (ESR, 73% vs. 33%, p less than 0.0001); weight loss (20.5% vs. 10%, p less than 0.05); symptoms (66% vs. 20%, p less than 0.0001); and an increased operative mortality rate (7.9% vs. 2.4%, p less than 0.002). The triad of chronic abdominal pain, weight loss, and elevated ESR in a patient with an abdominal aortic aneurysm is highly suggestive of an inflammatory aneurysm and may be beneficial in the preoperative preparation of the patient for aneurysm repair.
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PMID:Inflammatory abdominal aortic aneurysms: a thirty-year review. 405 44

In 203 patients with clinical symptoms of coronary artery disease, cardiac and extracardiac side effects of the dipyridamole test were investigated. Following dipyridamole (0.75 mg/kg body wt. i.v.), heart rate increased significantly, whereas arterial blood pressure remained almost constant. Dyspnea was noted in 80 cases (40.5%). In 48 patients (23.6%) rhythm disturbances were recorded; 58.1% suffered from extracardiac side effects such as congestion in the head, vertigo, heaviness of arms and legs, sensations of heat, upper abdominal pain, and nausea. A detailed report is given of 4 cases with extraordinary symptoms during or after the injection of dipyridamole. A life-threatening status anginosus with dyspnea, ST-segment elevation, and cardiac arrhythmia was observed in one of these cases. High-dose dipyridamole cannot be considered to be harmless. The test should not be performed without continuous ECG monitoring and other safety measures.
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PMID:[How dangerous is the dipyridamole test?]. 619 53

Acute abdomen patients present a diagnostic and therapeutic challenge to emergency clinicians. The decision to perform surgery or to treat medically is often difficult to make and requires assimilating patient information, laboratory findings, radiological studies, and DPL. The importance of careful and repetitive PE cannot be overemphasized when managing these patients. If all diagnostics performed are not definitive and the patient continues to exhibit signs of abdominal pain, it is advisable to explore the abdominal cavity while administering supportive measures. Abdominal ultrasonography is emerging as a valuable diagnostic tool for the acute abdomen patient. Laparoscopy, CT, and CAD may also prove useful in certain cases.
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PMID:The acute abdomen. 787 60

Nonocclusive intestinal infarction (NOII) is described as bowel necrosis at celiotomy or autopsy without evidence of thromboembolism, vasculitis, or mechanical obstruction. The mortality for this entity is as high as 90 per cent in some series. From January 1990 to January 1995, we identified 15 patients who met the criteria for NOII identified at celiotomy or autopsy. We collected data on demographics, comorbidities, presenting signs and symptoms, laboratory workup, time to definitive therapy, and outcome. Our goal was to improve our ability to identify and treat this devastating surgical problem. There was a 4.5:1 female to male ratio, and patients had an average age of 73 +/- 10 years. Significant comorbidities included coronary artery disease (87%) and atrial fibrillation (73%). Eleven patients were diagnosed at celiotomy and four at autopsy. Overall mortality was 67 per cent. The most common presenting symptoms were abdominal pain (93%) and distention (80%) and mental status changes (60%). Peritonitis was less common, present in only 40 per cent of the patients. Leukocytosis, bandemia, increased creatinine, metabolic acidosis, and hypoxemia were common among all patients. There was a significant difference in time to definitive therapy in survivors versus nonsurvivors (1.2 +/- 0.89 vs 4.8 +/- 2.0 days; P < 0.02, t test). These data suggest that NOII is a lethal surgical problem. A history of coronary artery disease and atrial fibrillation was common among all patients. Various nonspecific presenting signs, symptoms, and laboratory values are suggestive of this diagnosis. A high index of suspicion in select patients and early intervention may lead to improved outcome.
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PMID:Nonocclusive intestinal ischemia: improved outcome with early diagnosis and therapy. 912 53

We report the case of a 62-year-old woman who presented with severe abdominal pain. The routine chest x-ray showed an anterior mediastinal mass measuring approximately 10 cm in diameter. CT-Scan and angiography demonstrated an aneurysm of the aortic arch compromising the left pulmonary artery and main bronchus. An additional aneurysm of the abdominal aorta and right iliac artery was seen, which apparently led to the abdominal symptoms. Coronary angiography revealed coronary artery disease. The aortic arch aneurysm was treated by interposition of a vascular graft. Aorto-coronary bypass grafts were implanted. The abdominal aneurysm was resected in a staged approach after recovery from the first operation.
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PMID:[Aneurysm of the aortic arch: presenting as mediastinal tumor]. 973 89

Coronary artery disease kills more women than all cancers combined, yet the clinical picture in women is different enough from men that the diagnosis can be missed or delayed. A cardiologist highlights these gender-based differences and explains why certain diagnostic tests are better than others at identifying CAD in women. Coronary artery disease (CAD) is the leading killer of women in the US. After menopause, mortality rates from CAD in women nearly equal those of men. Yet the clinical picture in women is different enough from that in men that it can obscure the correct diagnosis. Women are 10 years older than men, on average, when presenting with CAD, possibly due to delayed diagnosis or presentation. Differences in symptomatology between men and women are important to note. For example, other diseases, such as arthritis or osteoporosis, can obscure CAD symptoms. Further, compared with men, women's chest pain is more often associated with abdominal pain, dyspnea, nausea, and fatigue. More women than men with CAD have diabetes, hypertension, hypercholesterolemia, and a family history of CAD. Clinicians need to know how to assess the gender-specific pretest likelihood of CAD in women, starting with a careful review of the patient's chest pain history. Other risk factors, including smoking, abdominal obesity, and certain comorbidities, should be taken into consideration. The diagnostic accuracy of exercise testing is slightly lower for women than men. Certain diagnostic tests, particularly exercise echocardiography and exercise thallium/sestamibi testing, offer more prognostic information than traditional exercise electrocardiographic studies without imaging. Mortality associated with interventional procedures--such as angioplasty and coronary artery bypass grafting (CABG)--is slightly higher in women, although long-term survival rates are similar for both sexes. Detection of CAD at an earlier stage in women may result in earlier referrals for CABG, with the benefit of lower associated mortality rates.
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PMID:Coronary artery disease in women: understanding the diagnostic and management pitfalls. 980 15


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