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

A total of 126 children with chronic idiopathic thrombocytopenic purpura, including 35 splenectomized cases, were investigated in a long-term follow-up study, with regard to residual hematologic and immunologic abnormalities, complications and physical growth. Such hemorrhagic symptoms as petechiae, ecchymosis and epistaxis were still observed in about 22%-28% of the patients with a period of morbidity ranging from 3 to 15 years after onset. Residual thrombocytopenia below 150,000/microliters was found in 62% of patients within 5 years, 59% within 5 to 9 years and 57% within 10-14 years after onset. Other abnormalities were mild anemia, low serum level of IgA or IgM, positive antinuclear antibody, rheumatoid factor, and positive Coombs test in a small number of patients. Increased platelet-associated IgG was still obtained in patients with subnormal platelet counts whose morbid periods were 6 to 27 years after onset. Investigation of the patients by questionnaire revealed such complications as obesity, striae atrophicae, abdominal pain, headache, cataract, Perthes' disease, and cardiac complication in some patients. No apparent disturbances except for obesity were observed in their physical growth.
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PMID:Long-term follow-up study of children with chronic ITP. 275 63

High risk splenectomy is often encountered in cases of hypersplenism with massive splenomegaly (10 times usual weight of 150-200 g) resulting from myelophthisic processes. Intra-operative ligation of the splenic artery through the lesser sac is a technically useful method of gaining vascular control prior to mobilizing the challenging spleen. However, a massive or inaccessible spleen imposes mechanical limitations during surgery and may be complicated by torrential intra-operative hemorrhage in the setting of severe thrombocytopenia refractile to platelet transfusions. The authors describe pre-operative intravascular proximal splenic artery control in four adult patients (3 men, 1 woman) with extreme splenomegaly (2,250-10,000 g). The massive splenomegaly in this group resulted from chronic myelogenous leukemia (n = 2), isolated splenic lymphoma (n = 1), and agnogenic myeloid metaplasia (n = 1). Chief symptom manifestations included left upper quadrant abdominal pain, early satiety, post-prandial emesis, dyspnea, petechiae, and associated easy bruising. Prior to surgery, all the patients were taken to the radiology suite where either detachable silastic balloons or stainless steel coils were placed selectively into the splenic artery under fluoroscopic guidance requiring approximately 35 minutes. Splenic artery occlusion aided normalization of thrombocytopenia (average increases 19,000/microliter to 215,000/microliter) with prolongation in survival of platelets. Successful splenectomy was subsequently performed with no additional transfusion requirements and was made technically easier by reducing splenic bulk. There were no adverse consequences of intravascular occlusion and no peri-operative morbidity or mortality. Preoperative intravascular selective splenic artery occlusion, used as an important potential adjunct to anticipated high risk splenectomy, is recommended.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Preoperative splenic artery occlusion as an adjunct for high risk splenectomy. 317 46

A case of transient stenosing ureteritis in a boy presenting with the clinical features of Henoch-Schoenlein purpura (diffuse articular swelling, petechiae, abdominal pain) complicated by macroscopic haematuria with blood clots is reported. On urography the right collecting system and the right ureter up to the distal lumbar portion were dilated owing to tight ureteral stenosis at that level. Above the stricture, numerous ring-like functional ureteral wall defects were detectable. On the left a stenosis was evident at the lumbo-sacral level with mild dilatation of the ureter. A small filling defect due to subephitelial haemorrhage was evident in the upper part of this ureter. Three months later, after prednisone therapy, the urography was normal on the right: residual mild stenosis was still evident on the left. Radiological findings in Henoch-Schoenlein purpura and the possible differential diagnosis of this condition are discussed.
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PMID:[Transient stenosing ureteritis in childhood. A rare complication of rheumatoid purpura]. 408 56

One patient with multiple myeloma and four patients with acute leukemia presented with severe abdominal pain. Pertinent findings included numerous petechiae in the skin and buccal cavity, and diffuse abdominal guarding and tenderness, suggesting peritoneal involvement. Severe thrombocytopenia was found in all patients. Laparotomy was performed in the patient with multiple myeloma, and revealed numerous petechiae throughout the peritoneum. All five patients responded to platelet transfusions with disappearance of the abdominal signs and symptoms. Severe thrombocytopenia should be considered among the causes of acute surgical abdomen in patients with malignant hematological disorders, and platelet transfusions should be administered before any surgical intervention.
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PMID:Acute surgical abdomen caused by thrombocytopenia in patients with acute leukemia and multiple myeloma. 658 56

Although ischemic colitis is not rare in the elderly with episodes of ischemia involving the heart and brain, clinical features of mild cases (transient type) have seldom been reported. Whereas the diagnostic findings of ischemic colitis are said to be longitudinal ulcers and stricture, longitudinal ulcers were noted only in 38% of the transient type in our series. For the correct diagnosis of the transient type, it was necessary to observe slight mucosal changes such as edema, congestion and petechiae by colonoscopy. It is emphasized that for the diagnosis of the mild transient type of ischemic colitis emergency colonoscopy must be performed as soon as possible after the onset of abdominal pain or rectal bleeding.
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PMID:Analysis of the clinical features of ischemic colitis. 687 95

Fifteen patients with ischemia of the colon are presented. The majority showed a similar clinical presentation with hematochezia, abdominal pain, and diarrhea in an elderly patient population having associated disease. Colonoscopy was abnormal in all patients studied. Three endoscopic stages were recognized; (1) acute stage characterized by petechiae, pallor, and hyperemia; (2) subacute stage consisting of ulceration and exudation; and (3) chronic stage characterized by stricture, decrease in haustrations, and mucosal granularity. Conventional barium enemas were abnormal and suggested ischemic colitis in six of 15 patients. Rigid proctoscopy was normal or demonstrated nonspecific proctitis in 12 of 15 patients studied. Colonoscopic biopsies demonstrated superficial inflammatory changes in all patients. Thirteen patients had complete mucosal healing endoscopically in 2 weeks to 3 months with stricture developing in four patients. Because ischemic colitis is a distinct subtype of ischemic bowel disease most often limited to the superficial mucosa, colonoscopy is an alternative and usually safe modality in the diagnosis of this entity and proved more accurate that conventional x-ray and proctoscopy.
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PMID:Colonoscopy in ischemic colitis. 729 23

The clinical characteristics of serologically verified nephropathia epidemica, the Scandinavian form of hemorrhagic fever with renal syndrome, were studied in Swedish children who were < 15 years of age. In 1990 to 1992, 14 cases were prospectively followed. A retrospective survey during 1984 to 1990 disclosed another 18 cases. Among the 32 cases (20 boys, 12 girls, 3 to 15 years of age; median age, 11 years), the most common symptoms were fever (100%), headache (100%), abdominal pain (93%), vomiting (91%) and back pain (76%). Laboratory findings included elevated serum creatinine concentration (19 of 28) and thrombocytopenia (7 of 22). Urinalysis showed proteinuria (31 of 31 patients) and hematuria (24 of 30). Six children had mild hemorrhagic manifestations (epistaxis, metrorrhagia, and petechiae). No severe complications occurred. The clinical symptoms of children with nephropathia epidemica seem to be similar to those found among adult nephropathia epidemica cases.
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PMID:Nephropathia epidemica (hemorrhagic fever with renal syndrome) in children: clinical characteristics. 790 97

Quinine-induced immune thrombocytopenia with hemolytic uremic syndrome (HUS) is a recently defined clinical entity. In this paper we have attempted to characterize the natural history and laboratory abnormalities typical of quinine-induced immune thrombocytopenia associated with hemolytic uremic syndrome in nine patients experiencing ten episodes of the disease. In addition, review of other reported cases of probable quinine-induced HUS is presented. The disease was characterized by the onset of chills, diapheresis, nausea and vomiting, abdominal pain, decreased urine output, and petechiae following quinine exposure. All patients experience significant anemia, severe thrombocytopenia, increased lactate dehydrogenase, elevated serum creatinine, and oliguria. Quinine-dependent platelet-reactive antibodies were identified in eight of nine using flow cytometry. Unexpectedly, drug-dependent antibodies reactive with red cells and granulocytes were identified in four and eight patients, respectively. All patients were treated with plasma exchange (range 1-12 procedures), and seven required hemodialysis. All survive without residual abnormality. Our experience with nine patients with quinine-induced HUS and the nine additional cases reported by others and reviewed in this paper establishes this condition as a distinct clinical entity. Adult patients presenting with HUS should routinely be asked about exposure to quinine in the form of medication or beverages. The mechanism by which quinine-dependent antibodies produce renal failure is uncertain, but preliminary studies (described elsewhere) suggest that drug-induced antibodies reactive with endothelial cells and possibly margination of granulocytes in renal glomeruli may be responsible for this complication. The prognosis in quinine-induced HUS is better than in other forms of adult HUS.
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PMID:Quinine-induced immune thrombocytopenia with hemolytic uremic syndrome: clinical and serological findings in nine patients and review of literature. 797

In a prospective case controlled study, we evaluated the adverse effects of long-term fluoride ingestion on the gastrointestinal tract. Ten patients with otosclerosis who were receiving sodium fluoride 30 mg/day for a period of 3-12 months, and 10 age- and sex-matched healthy volunteers were included. They were all evaluated clinically and subjected to a real time ultrasound examination, upper gastrointestinal endoscopy, and biopsies from the gastric antrum and duodenum. The biopsies were subjected to a rapid urease test as well as light and electron microscopic examinations. Ionic fluoride was estimated in the serum, urine, and drinking water using an ION 85 Ion Analyzer. Seven subjects (70%) ingesting fluoride had abdominal pain, vomiting, and nausea. Petechiae, erosions, and erythema were seen on endoscopy in all the subjects, but not in the controls. Histological examination of the gastric antral biopsy showed chronic atrophic gastritis in all the subjects but in only one (10%) healthy volunteer. Scanning electron microscopic examination showed "cracked-clay" appearance, scanty microvilli, surface abrasions, and desquamated epithelium in the subjects ingesting fluoride, but not in the controls. We conclude that long-term fluoride ingestion is associated with a high incidence of dyspeptic symptoms as well as histological and electron microscopic abnormalities.
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PMID:Toxic effects of chronic fluoride ingestion on the upper gastrointestinal tract. 803 13

A patient infected with hantavirus, with resultant hemorrhagic fever with renal syndrome (HFRS), is reported. The patient was a 38-year-old man, living in Tainan, Taiwan, who had been visiting Mainland China for 3 months when he suddenly developed fever and chills, generalized myalgia, abdominal pain and petechiae on his chest. He sought treatment in Mainland China. His clinical course progressed through febrile, hypotensive, oliguria and polyuria phases. Supportive care included one course of hemodialysis. He returned to Tainan in partial defervescence. Serologic studies undertaken in Taiwan confirmed Hantaan virus infection, with one of the currently identified hantavirus strains. Hospitalization with supportive care produced further clinical improvement. Clinicians should be alert to the possibility of HFRS when examining patients who have been in endemic areas and complain of fever associated with renal dysfunction, hemorrhage or abdominal pain or both.
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PMID:Hemorrhagic fever with renal syndrome: first imported case of hantavirus infection in Taiwan. 877 56


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