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

Three patients with acute intermittent porphyria were noted to have retinal branch vessel occlusion. Branch "vein" occlusion, segmental optic atrophy, and soft exudate were the most common ocular manifestation. Two patients had labile elevated hypertension. When patients present with retinal branch vessel occlusion and a constellation of bizarre symptoms that might include hypertension, abdominal pain, acute psychotic behavior and/or cutaneous photosensitivity, the diagnosis of acute intermittent porphyria should be considered.
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PMID:Retinal branch vessel occlusion in acute intermittent porphyria. 55 59

Small-bowel ischaemia is the least familiar cardiovascular complication of the oral contraceptive but is 1 associated with a high mortality rate and much morbidity. Hoyle et al have recently reviewed 21 cases and found that 1/2 the patients had died and 1/2 had required 2 or more operations, resulting in the removal of much of the small bowel. Small-bowel ischaemia occurs in women taking the oral contraceptive as a result of either mesenteric artery or mesenteric vein thrombosis. The dominant presenting symptom in small-bowel ischaemia, found in all patients, is abdominal pain. Some patients had associated nausea and vomiting; others complained of diarrhea. On examination the patient has usually been found to be febrile with generalized abdominal tenderness. Bowel sounds are present unless infarction has occurred. In nearly all cases reported the diagnosis has been made only at laparotomy, when the bowel was usually infarcted. Since many of the patients had had pain for 2 or more weeks, the condition might be reversible if it could be detected earlier. A diagnosis of small-bowel ischaemia should be carefully considered in any woman taking an oral contraceptive who presents with vague abdominal pain and has an associated condition known to predispose to circulatory disorders: cigarette smoking, hyperlipidaemia, diabetes, hypertension, obesity, or blood group A. If it seems like small-bowel ischaemia is the likely diagnosis, the contraceptive pill should be stopped immediately and treatment started with heparin.
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PMID:Flap lacerations. 62 Jan 42

Prior experience with the rare combination of horseshoe kidney and significant atherosclerotic vascular disease suggests difficulty in intraoperative management, often requiring division of the renal isthmus or sacrifice of some renal tissue. Seven patients have been managed successfully over the past ten years at The Ohio State University Hospital. There were six men and one woman, ranging in age from 39 to 66 years. Of the five patients with abdominal aortic aneurysm, four had a pulsatile abdominal mass, three had abdominal pain, and one had back pain. The other two patients had progressively symptomatic aortoiliac disease. All seven patients had hypertension, easily controlled by medication. Critical diagnostic procedures are preoperative intravenous pyelogram (IVP) and abdominal aortic arteriogram. The IVP detected the previously unsuspected diagnosis in 100% of the cases. The arteriogram accurately located the aneurysm in relation to the renal vascular supply, and disclosed aberrant blood supply in three of four patients with aberrant vessels. All seven horseshoe kidneys were fused at the lower pole. The operative approach involves meticulous dissection of the aberrant blood supply to the kidneys, and mobilization of the isthmus for adequate retrorenal aortic exposure. In six of the seven patients, the grafts were placed posterior to the isthmus. There were no deaths, and there were no complications related to the presence of the horseshoe kidney. In three of the seven patients, hypertension improved. Patients with horseshoe kidney and aortic disease may be safely operated upon without damage to the kidney. IVP and selective angiography are essential to provide preoperative information.
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PMID:Abdominal aortic surgery in the presence of a horseshoe kidney. 66 80

The hemolytic-uremic syndrome consists of microangiopathic hemolytic anemia, acute renal failure, and thrombocytopenia following a prodromal illness of gastroenteritis or upper respiratory infection. The syndrome can present in dramatic fashion with severe abdominal pain and signs of peritonitis suggesting an acute surgical crisis. In a series of 25 patients, 40% had abdominal pain, 25% had abdominal tenderness, and 20% had peritoneal signs. Clues to diagnosis in the early stages of the acute illness were mild to moderate hypertension, abnormal peripheral blood smear, anemia despite dehydration, and proteinuria. Significant abdominal pain and x-ray evidence of colitis may occur before development of typical laboratory findings, and these were evident in at least one case. Three patients underwent laparotomy for suspected bowel perforation. Colitis without perforation was found in all cases. In the absence of documented perforation, toxic megacolon, or intussusception, the decision to perform laparotomy in patients with hemolytic-uremic syndrome who have signs of peritonitis must be individualized. Failure to recognize the underlying renal problem can lead to serious errors in fluid and electrolyte management and delay of appropriate therapy.
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PMID:Hemolytic-uremic syndrome: a diagnostic and therapeutic dilemma for the surgeon. 73 58

This is the first published report in Israel of ischemic colitis in a woman using the contraceptive pill; 20 such cases have been reported in other parts of the world. The patient was a 46 year old married woman with 3 children; she had been in good health except for obesity and chronic hypertension. Her medications included an oral contraceptive for a period of 3 years, and methyldopa for treatment of her hypertension. She presented with abdominal pain and diarrhea of 5 weeks duration. She underwent surgical reanastamosis of the bowel and was doing well at follow-up 1 year after surgery. The presence of ischemic colitis was definitively diagnosed by histological examination; the differential diagnosis included cancer, ulcerative colitis, Crohn's disease, and infectious disease. The authors note that although there is possible association between taking oral contraceptives and the appearance of ischemic colitis, there is not yet any statistical evidence for such a relationship. Similar cases have been reported among young women who were not using oral contraceptives.
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PMID:[Ischemic colitis in a woman on contraceptive pills]. 84 35

This autosomal dominant disorder usually appears in middle life. The most common findings are proteinuria, abdominal pain and palpable kidneys, followed by hematuria, hypertension, pyuria, uremia and calculi. In 15% of patients, death is due to cerebral aneurysm. Family counseling and the detection of "at risk" family members are important elements of management. Statistically, half of the offspring of one affected parent will have the disease.
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PMID:Polycystic kidney disease. 93 Aug 6

The pathogenesis of paradoxical hypertension after resection of coarctation of the aorta was investigated by comparing the course of seven children undergoing repair of coarctation with five acyanotic children undergoing elective cardiovascular surgery. During the first 24 hours after surgery, all coarctation patients demonstrated a rise in systolic blood pressure (35 +/- 15.5 mm Hg; P less than 0.001), a significant depression in cold pressor test response, and only a slight elevation in plasma renin activity. In the next 24-72 hours, coarctation patients developed a rise in diastolic blood pressure (26.8 +/- 10.6 mm Hg; P less than 0.001), plasma renin activity (22.9 +/- 10.2/ml/hr; P less than 0.001) and fluid retention. By contrast, control patients had no significant postoperative changes. Abdominal pain occurred in five coarctation patients during the period of maximal plasma renin activity. The data suggest that the sympathetic nervous system may be responsible for the initial phase of hypertension after coarctation resection and that the renin angiotension system plays a major role in the second phase of hypertension and in the pathogenesis of mesenteric arteritis.
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PMID:Pathogenesis of paradoxical hypertension after coarctation resection. 94 70

In 17 patients (15 women, 2 men) with acute intermittent porphyria in the incidence of 23 clinical symptoms during 49 attacks was calculated. The most frequent symptoms in percentage of attacks were: Red colour of the urine 100%, abdominal pain 92%, tachycardia 88%, hypertension 75%, vomiting 54%, peripheral neuropathy 50%. In 35% of acute attacks a transient normochromic, normocytic anemia developed which is probably due to a disturbance of heme synthesis. Oliguria was found in 25%, azotemia in 12.5% of attacks. 4 patients with an average of 5 preceding acute attacks showed a persistent reduction of renal function during the symptom-free interval, in contrast to 12 patients with an average of 1.7 previous attacks and normal renal function. During the observation period from 1960-1974 3 (= 18%) of the 17 patients died.
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PMID:[Acute intermittent porphyria: report on 17 patients with 49 attacks (author's transl)]. 99 30

Six patients with the diagnosis of acute mania were treated with high doses of the beta-adrenergic blocking agent propranolol. One of these patients was treated during two manic phases. Psychopathologic change during treatment was rated daily by a psychiatrist not informed on the patients medication. The IMPS (Inpatient Multidimensional Psychiatric Scale) was used. Three cases were placebo-controlled under double blind conditions. Four times we had a second medication period, twice with propranolol and once with oxprenolol and dexpropranolol respectively. Propranolol was administered every 4 h (six times per day), starting with single doses of 20-40 mg. Doses were increased individually under control of pulse rate, blood pressure, and ECG. Augmentation of doses was continued until an effect on manic symptomatology was undoubtedly seen or until therapy had to be discontinued because of side-effects. In four patients definite improvement of manic symptomatology could be achieved during altogether five manic phases within usually two treatment periods of 5-15 days. Manic behavior disappeared completely in two of these patients. The effective dosage of propranolol varied between 280 and 2320 mg per day. All of the improved patients relapsed after discontinuation of the drug. In the only case on dexpropranolol (5 days up to 900 mg daily) the effect was questionable. No extrapyramidal side-effects were observed. In one patient treatment was discontinued because of lack of cooperation, in another because of extrasystoles. Gastrointestinal bleeding occurred in the patient who received dexpropranolol. This complication was possibly due to other medication. Other side-effects were insomnia, hypertension, precordial pain, abdominal pain as well as the expected hypotension and bradycardia. The significance of these results regarding the catecholamine hypothesis of manic-depressive illness is discussed.
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PMID:[The effect of the beta-adrenergic blocking agent propranolol in mania (author's transl)]. 99 94

In seven patients with chronic renal failure in an advanced stage 17 episodes of upper abdominal pain, hypertension, vomiting and (in some of them) coma occurred during peritoneal dialysis with sorbitol-containing dialysate. The signs recurred in some of the patients but did not when glucose-containing dialysate of otherwise identical composition was used. Very high levels of sorbitol in CSF and serum were measured in the comatose patients. The precipitating factor is probably a reduced metabolic breakdown of sorbitol in renal failure with preferential intracellular deposition of sorbitol and subsequent cellular oedema. To avoid this dangerous reaction it is necessary to use glucose instead of sorbitol in peritoneal dialysates, despite the technical problems of sterilisation. Where this is not possible, glucose should be added in order to reduce the sorbitol concentration in the dialysate to less than 15g/l.
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PMID:[Severe side-effects during peritoneal dialysis caused by sorbitol-containing dialysate (author's transl)]. 114 25


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