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

We have examined the changing demographics of adult intussusception and implicate human immunodeficiency virus (HIV)- and acquired immune deficiency syndrome (AIDS)-associated gastrointestinal pathology as risk factors for intussusception in young adults. The clinical index of suspicion for intussusception should be raised for an HIV-positive young adult with intermittent crampy abdominal pain. Over a 10-year period, eight cases of adult intussusception were diagnosed at our institution, and we reviewed the diagnostic computed tomography (CT) scans and records of these patients to correlate them with radiological studies, clinical history, surgical findings, laboratory studies, pathologic analysis, and outcome. Three of the eight patients with adult intussusception had AIDS, all diagnosed by CT scans. Their average age was 41 years, whereas average age of the non-HIV-associated patients was 63. These findings suggest that HIV- and AIDS-associated gastrointestinal pathology provide lead points for intussusception and are significant risk factors for intussusception in young adults. We reviewed the five previously reported cases of AIDS and intussusception and conclude that intussusception should be a diagnostic consideration in an HIV-positive young adult with abdominal complaints. It is clear that AIDS-associated intussusception is a real clinical problem and that CT is an effective method of diagnosing it.
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PMID:AIDS-associated intussusception in young adults. 858 84

Massive steatosis has recently been described among a few human immunodeficiency virus-seropositive patients who were receiving antiretroviral therapy. Although clinical and light-microscopic pathological findings were carefully described, no ultrastructural studies of the liver were performed in these cases. We report the light-microscopic and ultrastructural findings at autopsy of a 35-year-old woman with AIDS who developed severe lactic acidosis and hepatic failure. The patient had been receiving standard doses of zidovudine for 5 months when she was hospitalized because of the rapid onset of abdominal pain, nausea, and vomiting. The most significant findings at autopsy were massive hepatomegaly and steatosis. Ultrastructural examination of the liver and skeletal muscle showed slightly enlarged mitochondria in the liver but no mitochondrial changes in the skeletal muscle. The pathogenesis of mitochondrial toxicity associated with antiviral therapies is briefly discussed.
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PMID:Massive hepatic steatosis and lactic acidosis in a patient with AIDS who was receiving zidovudine. 864 49

From September 1986 to September 1994, 34 emergency laparotomies were performed in human immunodeficiency virus (HIV) seropositive patients. Patients were divided into 2 groups. Group A included 11 HIV seropositive patients without acquired immunodeficiency syndrome (AIDS). In these patients, indications for exploration included right lower quadrant pain consistent with appendicitis in 6 patients, right upper quadrant pain consistent with cholecystitis in 3 patients, small bowel obstruction in 1 patient, and blunt abdominal trauma in 1 patient. No postoperative deaths were observed. Group B included 23 AIDS patients. Indications for exploration were diffuse peritonitis in 8 patients, right lower quadrant pain consistent with appendicitis in 6 patients, right upper quadrant pain consistent with cholecystitis in 5 patients, bowel obstruction in 2 patients, diffuse abdominal pain in 1 patient, and massive rectal hemorrhage in 1 patient. The mortality rate in this group was 35% (8 out of 23 patients). Five of the 8 patients with diffuse peritonitis died postoperatively (62%). The importance of early diagnosis and prompt surgery is emphasized to improve the prognosis in AIDS patients, because of their poor general condition and the severity of abdominal complications.
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PMID:[Abdominal surgical emergencies in human immunodeficiency virus (HIV) infected patients. Apropos of 34 cases]. 878 19

The yield of upper gastrointestinal endoscopy (esophago-gastroduodenoscopy; EGD) in human immunodeficiency virus (HIV)-infected patients based on presenting symptoms has not been well studied. We studied consecutive patients with documented HIV infection undergoing EGD at a large innercity hospital between August 1, 1990 and December 31, 1993; all had presenting symptoms and indications for EGD prospectively recorded at the time of EGD. All endoscopic abnormalities were routinely subjected to biopsy, and extensive histopathological evaluation was performed. EGD was considered helpful when the findings stimulated specific therapeutic intervention other than antifungal or antacid medications. The specific indications for EGD in 156 patients were as follows: esophageal symptoms, 102 patients (65%); abdominal pain, 18 (12%); upper gastrointestinal bleeding, 25 (16%); refractory nausea and vomiting, 11 (7%). Overall, pathologic findings were identified in 116 patients (74%): in refractory esophageal symptoms, 82%; upper gastrointestinal bleeding, 92%; abdominal pain, 39%; nausea and vomiting, 27%. EGD with biopsy identified a specifically treatable opportunistic disorder other than Candida in 80 patients (51%), including idiopathic esophageal ulcer (22%) or viral esophagitis and/or duodenitis (29%). EGD was not helpful in 22.3% of cases, those involving Candida (12.3%) and peptic ulcer disease (PUD)-related causes (10%). The mean CD4 count of patients with opportunistic pathologic findings (24/mm3, n = 79) was significantly lower than that of patients with PUD/gastroesophageal reflux disease (GERD) (167/mm3, n = 9) or negative EGDs (165/mm3, n = 35). Overall, the results of EGD influenced patient management in 78% of cases. We conclude that selective symptom-specific use of EGD, particularly in patients with esophageal symptoms refractory to antifungal therapy or gastrointestinal bleeding, usually identifies specifically treatable abnormalities, whereas EGD is less useful for the evaluation of abdominal pain or nausea and vomiting.
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PMID:Symptom-specific use of upper gastrointestinal endoscopy in human immunodeficiency virus-infected patients yields high dividends. 895 33

Immunoglobulin deficiency, especially deficiency of IgA, has been described in patients with celiac sprue (CS). Our study was performed in an area of high prevalence of CS to determine the prevalence of immunodeficiency states in patients with CS, to examine their clinical characteristics, response to treatment, and HLA phenotypes compared with a group of age- and sex-matched persons with CS but without immunoglobulin deficiency. Fourteen of 604 patients with CS were identified as being selectively deficient in IgA, whereas one had common variable immunodeficiency. At diagnosis, anemia was present in 8 of 14 IgA-deficient patients compared with 10 of 42 controls (p = 0.047), whereas abdominal pain was more common in controls with CS. Autoimmunity and recurrent infection were more prevalent in the IgA-deficient group. Response to gluten-free diet was similar in both groups in terms of histologic structure and recovery of intestinal brush-border enzyme activity. IgA-deficient participants with CS had no increased risk of associated malignancy or lymphoma. HLA phenotypes were similar in both groups. The prevalences of selective IgA deficiency and common variable immunodeficiency in this series of patients with CS are 2.31 in 100 and 0.16 in 100, respectively. Although this group is unique in character, close follow-up coupled with conscientious compliance with a gluten-free diet, remains the mainstay of treatment for these patients.
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PMID:Celiac sprue and immunodeficiency states: a 25-year review. 941 41

To evaluate a potential pharmacokinetic interaction of coadministration of fluconazole, and indinavir, a human immunodeficiency virus (HIV) protease inhibitor, 13 patients were enrolled in a multiple-dose, three-period, placebo-controlled, crossover study. Patients were randomly assigned to receive indinavir at 1,000 mg every 8 h for 7 1/3 days (with fluconazole placebo), fluconazole at 400 mg once daily for 8 days (with indinavir placebo), and indinavir with fluconazole in combination. The pharmacokinetics of both drugs were measured on day 8 of each treatment period. The peak concentration in plasma (Cmax) and the time to reach Cmax were obtained by inspection, and the area under curve (AUC) was calculated for indinavir and fluconazole for each treatment period in which the respective drugs were administered. There was a marginally (P = 0.08) statistically significant decrease in the AUC from 0 to 8 h (AUC(0-8)) for indinavir when it was administered with fluconazole. However, the magnitudes of the decreases in Cmax and the concentration at 8 h postdosing (C8) were not as great as the decrease in AUC(0-8). Although the 90% confidence interval for the geometric mean ratio was within the hypothesized limits, the clinical significance is not clear. Indinavir coadministration with fluconazole had no statistically (P > 0.5) or clinically significant effect on the Cmax and C8 of indinavir. Fluconazole coadministration with indinavir had no statistically or clinically significant effect on the pharmacokinetics of fluconazole. One patient was discontinued because of mild to moderate abdominal pain and diarrhea while on indinavir and fluconazole in combination. No serious adverse experience according to the results of laboratory tests was noted. Total bilirubin levels in serum were mildly increased in most patients treated with indinavir. This was not clinically significant and was not affected by the coadministration of fluconazole. Although the values of the pharmacokinetic parameters for indinavir decrease in the presence of fluconazole, indinavir and fluconazole can be administered concomitantly to HIV-infected patients without adjustment of the dose of either drug, and both drugs are generally well tolerated.
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PMID:Effect of fluconazole on indinavir pharmacokinetics in human immunodeficiency virus-infected patients. 998 36

In immunocompromised patients, cryptosporidial diarrhoea is a debilitating and potentially life-threatening infection for which no effective specific therapy exists. In an uncontrolled study of 24 AIDS patients with diarrhoea exclusively due to Cryptosporidium spp., treatment with roxithromycin, 300 mg bd for 4 weeks, produced symptomatic improvement of diarrhoea in 79% of cases, with 50% of patients achieving complete response. The response rate was 100% in a subgroup of five patients with no previous or concomitant opportunistic infections. In complete responders, improvement was rapid, occurring within 3-5 days, and the duration of response was at least 6 months. Response did not appear to be correlated with the degree of immunodeficiency. The most limiting adverse effects were abdominal pain (two patients), elevated hepatic enzymes (two patients) and abdominal pain with elevated hepatic enzymes (one patient). Minor symptoms, such as gastrointestinal upset, occurred in nine patients. We conclude that roxithromycin is relatively well tolerated and effective against cryptosporidial diarrhoea in AIDS patients. Further studies to optimize dosing regimens are required.
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PMID:AIDS-related cryptosporidial diarrhoea: an open study with roxithromycin. 957 19

Hereditary angioedema is caused by a defect in C1 inhibitor activity (C1INH). Its occurrence is rare and it is associated with an autosomal dominant mode of inheritance. We describe seven patients (4M:3F), age from 12 to 50 years old, who are affected by hereditary angioedema; four of them belong to the same family. The main clinical manifestations were: angioedema of face, hands and feet (6/7) and abdominal pain (2/7). No triggering factors were associated with symptoms in 4/7 patients and trauma (2/7) and menses (1/7) were reported in the other three ones. One patient was submitted to laparotomy for partial intestinal resection, before diagnosis. Laboratory complement analysis revealed the absence of hemolytic function of complement, reduced C4 (6/7) and low C1INH levels. All patients received Danazol (100 mg/day) with clinical control. Hereditary angioedema has to be considered in the differential diagnosis of angioedema, since an early diagnosis of this immunodeficiency, leading to specific treatment in order to decrease the complications.
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PMID:[Hereditary angioedema: clinical and laboratory aspects of 7 cases]. 965 39

The colon is a frequent site of gastrointestinal complications in patients with HIV infection, and these colonic disorders increase in frequency as immunodeficiency worsens. The most common clinical manifestations of colonic disease in AIDS are diarrhea, lower gastrointestinal bleeding, and abdominal pain. Toxic megacolon, intussuseption, typhlitis, idiopathic colonic ulcer, and pneumatosis intestinalis also have been described. In the HIV-infected patient with preserved immunity, the most common cause of colitis is bacterial, but as the degree of immunodeficiency worsens, opportunistic pathogens (CMV, protozoa, mycobacteria, fungi) and neoplasms become more frequent. The frequent use of antibiotics, chemotherapeutic agents, and frequent hospitalization increase the susceptibility to cf2Clostridium difficule cf1colitis. Endoscopy plays an integral role in the management of many colonic disorders in AIDS.
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PMID:Diagnosis and treatment of colonic disease in AIDS. 973 Sep 38

Gastrointestinal involvement is reported in approximately 50% to 93% of patients with human immunodeficiency virus. It is frequently the result of coinfection with several microorganisms. Selective Leishmania intestinal involvement presents with atypical symptoms for visceral leishmaniasis, and may appear as a relapse or as the first manifestation of the disease. The authors present a patient with acquired immune deficiency syndrome who has a history of treated leishmaniasis and gastrointestinal infection by showed Mycobacterium avium intracellulare (MAI). After the new onset of abdominal pain, an intestinal biopsy showed the presence of both MAI and Leishmania in duodenum. Intestinal infection by Leishmania must be included in the differential diagnosis in patients with a previous history of leishmaniasis or travel to an endemic area.
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PMID:Simultaneous intestinal leishmaniasis and mycobacterial involvement in a patient with acquired immune deficiency syndrome. 980 64


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