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

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

16 patients of the Medical ambulatory at the University of Basel born between 1940 and 1945 were explored with the State-Trait Anxiety Inventory (STAI) of Spielberger for the presence of anxiety. With this self-rating inventory state anxiety as well as general trait anxiety can be recognized. The examined group was not selected on specific diagnoses. Two patients with a heavy organic disease (Aids, Friedreich's ataxia) showed an increased state anxiety and an increased general trait anxiety. Six patients with hypertension showed decreased, average as well as increased values of state anxiety and general trait anxiety. In one patient with epilepsia decreased general trait anxiety and average state anxiety were manifest. A patient with a depressive neurosis and functional abdominal pain showed increased general trait anxiety and average state anxiety. Finally, in six patients with different diseases, such as patients with different diseases, such as bronchitis, diabetes, coronary and congestive heart disease, obesity and myalgias, no deviation of their state and general trait anxiety values was evident when compared with standard values. The results are discussed.
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PMID:[The assessment of anxiety in somatic patients--a pilot study]. 291 53

In a review of pediatric autopsies from 1951 to 1985, we identified 40 cases in which pancreatitis was diagnosed pathologically. Twenty-six of these patients were under 4 years of age, and the male-to-female ratio was 1.5. Six groups of patients were identified: 10 with hepatobiliary disease, including 9 with biliary atresia; 7 with immunosuppressive therapy for tumors (n = 2), leukemia (n = 4) and aplastic anemia (n = 1); 6 with viral infections; 8 with congenital anomalies, including congenital heart disease (n = 3); and 9 with miscellaneous problems. Several patients had surgery and various intercurrent complications. Clinical features attributable to the pancreatitis included vomiting or excessive nasogastric drainage (60%), pleural effusions (40%), and abdominal pain (25%). However, the diagnosis was suspected clinically in only 5 of 40 patients. Our findings suggest several pathogenic mechanisms exist for childhood pancreatitis: biliary obstruction, infections, drug toxicity, immunosuppression (acting in synergy with drug toxicity, trauma, and low-flow states resulting from shock, heart failure, and vasculopathy.
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PMID:Clinicopathologic studies in childhood pancreatitis. 334 10

A series is presented of 83 patients surgically explored for massive bowel infarction. Old men with previous heart disease and symptoms of peripheral atherosclerosis were primarily affected. Clinical presenting features were abdominal pain (100 per cent), peritonitis (57 per cent), shock (34 per cent) and hypothermia (26 per cent). A third-space syndrome with metabolic acidosis and uraemia was the most common physiological derangement. Age was the only factor that appeared to have influenced the surgeon's decision to perform massive bowel resection (71 years in non-resected versus 64 years in resected patients, P less than 0.006). The overall mortality rate was 71 per cent. Forty-four patients underwent massive bowel resection (mean length of remaining small bowel 60 +/- 40 cm) and twenty-four (54 per cent) survived the procedure. Axillary temperature was higher in survivors (36.7 degrees C versus 36.1 degrees C, P less than 0.03). Early postoperative total plasma protein and albumin concentrations were also higher in survivors (57 versus 46 g/l, P less than 0.005; 27 versus 22 g/l, P less than 0.02). Patients with previous symptoms of atherosclerotic disease and high pre-operative blood urea levels also had a bad prognosis. Survivors had a mean hospital stay of 57 days and parenteral nutrition had to be maintained for a mean of 34 days. The survival rate achieved with massive resection justifies this surgical approach in selected patients with massive bowel infarction.
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PMID:Mesenteric infarction: an analysis of 83 patients with prognostic studies in 44 cases undergoing a massive small-bowel resection. 339 20

Comparing 105 patients with mesenteric infarction, the typical attributes of the underlying diseases, arterial embolization (aE) (n = 26), arterial thrombosis (aT) (n = 40), venous thrombosis (vT) (n = 32) and combined arterio-venous occlusion (n = 7) could be demonstrated. Present heart disease, diabetes and arterial hypertonia, rapid onset of symptoms, severe abdominal pain and signs of peritonitis, extended gangrene of bowel and a high mortality of about 90% is the typical combination for aE. Over 70 years old patients with higher incidence of arteriosclerosis, more digitalis intake, longer duration of symptoms and with bowel problems in the past have a higher incidence of aT and a slightly better prognosis. Risk of thrombosis, long-standing symptoms and a clearly better prognosis are typical for the vT.
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PMID:[Are there differences in prodromal illnesses, symptoms and prognosis for various forms of mesenteric infarct?]. 343 2

Although aortic dissection is rare in children, it does occur, particularly in those with congenital heart disease, connective tissue disorders or severe trauma. Prompt diagnosis is essential. Aortic dissection should be considered in children and adolescents with severe abdominal pain, especially pain that migrates. The patient is often much more uncomfortable than can be explained on the basis of physical findings. Criteria have been established for choosing medical or surgical therapy.
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PMID:Aortic dissection in adolescence. 375 41

Analysis of the fine ridge configurations on the digits of the palms and soles (dermatoglyphics) may sometimes help in the diagnoses of certain medical disorders. Dermatoglyphic patterns have been reported to be associated with congenital anomalies, such as congenital heart disease, duodenal ulcer, abdominal pain, and constipation. The palmar dermatoglyphic patterns of 77 children with constipation (39 functional and 38 organic constipation) were recorded. The control group consisted of 84 children with inguinal hernia. Those patients with at least one arch identified on any digit of either hand were termed arch positive. There was no significant correlation between arch positivity and constipation (functional or organic), or inguinal hernia (chi square, P = 0.9211). Therefore, the presence of palmar arches cannot be used as a screening device for children with chronic constipation, especially of organic etiology.
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PMID:Dermatoglyphic patterns in children with chronic constipation. 762 62

The usual complication of abdominal aortic aneurysms is rupture. Although thrombosis of peripheral aneurysms is common, thrombosis of abdominal aortic aneurysms is rare. Sudden thrombosis of abdominal aortic aneurysms constitutes a surgical emergency, with a mortality of 50 percent. The patient often presents with cool and mottled skin, and with severe pain from the umbilicus to the lower extremities. Femoral pulses are rarely present, and neurologic deficits below the level of occlusion are common. We reviewed four recent patients with thrombosed abdominal aortic aneurysms. They presented with a range of symptoms that included impotence, abdominal pain, lower extremity pain, coolness, and weakness. Angiography in three of the patients revealed complete occlusion of the aorta. The fourth patient did not undergo angiography because of hemodynamic instability. Three of the four patients underwent thrombectomy, aneurysmectomy, and bypass grafting. The other patient underwent axillofemoral bypass grafting in lieu of aneurysmectomy because of severe coronary arteriosclerotic heart disease. All patients did well postoperatively. Our limited experience suggests that prompt diagnosis and surgical management of patients with thrombosed aortic aneurysms can lead to a successful outcome.
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PMID:Thrombosis of abdominal aortic aneurysms. 794 47

The US Food and Drug Administration has not yet approved combined estrogen/progesterone compounds for postcoital contraception (PCC), yet administering them has been an accepted practice for at least 10 years. The health service at the University of Rochester in New York has a formal protocol to dispense PCC to female students who have had unprotected intercourse and wish to prevent pregnancy. The women must have experienced unprotected intercourse within 72 hours prior to presenting at the clinic. The clinicians screen the women for absolute contraindications to oral contraceptives (OCs), which include blood clotting disorders, stroke, heart disease, cancer of the breast or reproductive tract, and liver tumors. They also determine whether conception has occurred. If indeed it has occurred, and the patient has given written consent, the clinicians administers 2 times the dosage of 1 OC to the patient and a repeat dose 12 hours later. She is seen at the clinic 3 weeks later. Clinic workers review their protocol every 6-12 months as part of the quality assurance program. Providers who do not approve of PCC are asked not to see students requesting PCC. Between March, 1985, and February, 1991, the service's staff administered PCC 209 times. 18.7% of PCC patients took PCC more than once. Date rape was responsible for 3 episodes of unprotected intercourse. Pregnancy occurred in 4 of the 209 PCC episodes (1.9%). 3 of these pregnancies were not midcycle exposures. All 4 cases had received PCC within 24 hours of unprotected intercourse. They all underwent an abortion. The expected pregnancy rate for unprotected intercourse without PCC would be 11-14%. Side effects were nausea (19%), vomiting (13%), and other symptoms (8%), including headache, cramps, menstrual irregularities, or abdominal pain. Another possible PCC is mifepristone, which was 100% effective in a study in Scotland. It probably will not be available soon in the US because of the controversy surrounding its use as an abortifacient.
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PMID:Six years of clinical experience using postcoital contraception in college women. 824 18

The disease is named after George H. Whipple who, in 1907, was the first to describe an intestinal "lipodystrophy". Although Whipple's disease is generally recognized as a multisystem chronic granulomatous disease, primarily involving the digestive system, it can also appear as a primary neurological disorder in rare cases. Most often it is manifested with loss of weight, diarrhea, malabsorption, abdominal pain, lymphadenopathy, cardiopathy, hyperpigmentation and hypotension. The presence of periodic acid-Schiff (PAS)-positive macrophages in biopsy specimens (not only jejunal) and demonstration of "Whipple's bacilli" visible by electron microscopy, are diagnostic signs of active Whipple's disease. Whipple's disease confined to the CNS is rare. It is rarely found in the differential diagnosis of patients with progressive neurological deterioration. The most common neurological picture includes progressive dementia, external ophalmoplegia, myoclonus, seizures, ataxia, hypothalamic dysfunction (sleep disorders, hyperphagia, polydipsia) and meningitis. Oculofacial-skeletal myorhythmia as a movement disorder, associated with Whipple's disease, is reported. Fulminant course of cerebral Whipple's disease is unusual and unfavourable. The confusing and nonspecific clinical appearance is typical for primary CNS involvement. It has recently been suggested that CNS involvement occurs in all cases, although only 10-20% of patients may show it. The CNS is the most common site of disease relapse. The CT scans and MRI of the brain are often normal, but may show cortical/subcortical atrophy, hydrocephalus, focal or intracerebral mass lesions. The cerebrospinal fluid can sometimes contain PAS-positive macrophages. Brain biopsy is suggested as a diagnostic method in cases of high suspicion of CNS Whipple's disease. However, the lesions are frequently inaccessible and false negative. Without extended antibiotic therapy, the course of Whipple's disease is lethal. Now, the prognosis is good, although the optimal antimicrobial regimen is not clearly established. Initial parenteral therapy (tetracycline, penicilline, streptomycine, chloramphenicol, ampicilline) and peroral long-term treatment with trimetoprime-sulphametoxasole, are recommended. As CNS relapse of Whipple's disease may occur after several years, long-term treatment should include antibiotics that are able to cross the blood-brain barrier. The CNS relapse, in contrast to the systemic ones, is resistant to the treatment. Appropriate therapy instituted earlier in the course of the disease is associated with a better neurological outcome. Early recognition can be critical in Whipple's disease because of irreversible neurological sequelae seen later in the course of this potentially treatable condition. In cases with high clinical suspicion in which Whipple's disease cannot be diagnosed with procedures such as jejunal biopsy, antibiotic therapy is recommended. Recovery of an established neurological deficit may rarely occur. Longterm follow-up studies would help to identify the optimal antibiotic regimen and duration of treatment.
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PMID:[Neurologic disorders in Whipple's disease]. 910 28


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