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

We report a case of gastrojejunal fistula caused by benign gastric ulcer, a very rare condition. The patient was an 81-year-old-woman who had had multiple recurrences of gastric ulcer. She also had diabetes mellitus. She was admitted to our hospital because of a left femoral head fracture, necessitating a mechanical bone head exchange operation. She had severe abdominal pain and anemia on the 48th postoperative day. Gastroendoscopic examination revealed a giant ulcer with a long-axis diameter of more than 5cm on the lesser curvature of the gastric body. She was treated with intravenous famotidine and all oral intake was restricted; her symptoms were alleviated. Two weeks later, a fistula had formed between the stomach and the jejunum just anal to the duodeno-jejunal flexure. She was placed on an ulcer diet, and was discharged with no symptoms on the 151st postoperative day. She has remained asymptomatic for 1 1/2, years to date. Lack of H2-antagonist administration, operative stress, and administration of ipriflavone appeared to have induced gastric ulcer recurrence, and formation of the fistula between the stomach and the jejunum seemed to have been facilitated by the patient being very lean and having minimal mesenteric adipose tissue.
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PMID:Gastrojejunal fistula caused by gastric ulcer. 960 60

The case of a multicystic hemangioma in the liver of a 78-year-old woman is reported. The patient complained of upper abdominal pain and had been seen at a local hospital a few months prior to this admission. An endoscopic examination of the stomach revealed an active gastric ulcer, and ultrasonography (US) of the upper abdomen also incidentally detected a liver tumor. After treating the gastric ulcer, she was then referred to Ryukyu University Hospital in January 1997. US revealed a 3.5-cm, oval-shaped, echogenic tumor with multiple cystic areas in the right lobe of the liver. A CT scan demonstrated a hypodense tumor, that was not enhanced on dynamic CT. Angiography showed a hypovascular tumor that appeared to be a multicystic tumor of heterogeneous high intensity on T2-weighted MRI. The tumor measured 3.5 cm x 3.5 cm in size and was multicystic with a fibrous septum and serous fluid. Histologically the tumor was determined to be cavernous hemangioma of the liver. Atypical hemangiomas should be included in the differential diagnosis when hemangiomas show multicystic features.
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PMID:Multicystic cavernous hemangioma of the liver: report of a case including diagnostic imaging and pathologic correlation. 971 1

We examined fecal specimens of Japanese residents in developing countries in order to know the prevalence of intestinal parasites in the group. One fecal specimen was collected from each 981 (in 1995) and 1275 (in 1996) Japanese living in Asia, the Middle East, Europe, Africa and Latin America. The specimens were fixed with 10% formalin in each area, and were examined in Japan by concentration method (formalin-ether sedimentation) to find protozoan cysts or helminth eggs. The infection rate of intestinal parasites was 3.0% in 1995 and 2.4% in 1996. The rate was high in Africa (1995: 5.7%, 1996: 4.7%) and Asia (1995: 3.8%, 1996: 3.0%). Regarding to the species of the parasites, Giardia lamblia (17 cases), Trichuris trichiura (14) and Ascaris lumbricoides (11) were detected frequently. Additionally, 7 cases of Heterophyes heterophyes infection were found in Asia and the Middle East. The infection rate was higher in adults than that in children, and a positive relationship between the infection rate and duration of stay was observed. Among the Japanese infected with intestinal parasites, abdominal symptoms such as diarrhea or abdominal pain were common (36.8%). It is also noteworthy that 28.1% of the Japanese infected had a history of gastric diseases such as gastric ulcer. Although the infection rate of intestinal parasites among Japanese residents in developing countries was low, compared to that of the natives in the countries, the rate is still higher than that in Japanese living in the home country. It is necessary to continue preventive measures such as health education in order to eradicate intestinal parasitic infections from this group.
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PMID:[Prevalence of intestinal parasites among Japanese residents in developing countries]. 991 14

Relapse of duodenal ulcers was observed endoscopically after Helicobacter pylori eradication therapy for gastric ulcer patients in 2 of 32 successful cases. One patient, a 40-year-old woman, received dual therapy with lansoprazole 60mg and amoxicillin 1000mg for 2 weeks because of an intractable, easily-relapsing gastric ulcer accompanied by duodenal ulcer scars that had not relapsed for 5 years. The H. pylori status was assessed by a rapid urease test, light microscopy, culture, and anti-H. pylori antibody. At 24 months after the cure of H. pylori she had upper abdominal pain and showed relapse not of the gastric ulcer but of the duodenal ulcer. The H. pylori status remained negative. The other patient, a 44-year-old man, showed an active gastric ulcer and duodenal ulcer scars at the first endoscopy. He received the same regimen as described above. Ten weeks after completion of the eradication therapy, endoscopy showed healing of the gastric ulcer and relapse of the duodenal ulcer despite successful eradication. These two cases suggest that H. pylori eradication modifies the pathophysiological condition of gastric acid secretion and facilitates relapse of duodenal ulcers.
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PMID:Relapse of duodenal ulcers after successful eradication of Helicobacter pylori in gastric ulcer patients. 1061 73

In contrast to the experience in the adults, there are limited data concerning the efficacy and safety of upper gastrointestinal endoscopy (UGIE) in paediatric patients. The information on this procedure is very scanty from non-western countries. We analysed 72 children evaluated in Gizan, Saudi Arabia, an area of high endemic hepatitis B and chronic liver disease. The indications comprised abdominal pain (49%), UGI bleeding (24%) and evaluation of suspected portal hypertension. No abnormality was detected in 33 (46%). Mucosal inflammatory lesions (oesophagitis, gastritis and duodenitis) are the commonest abnormal lesions, occurring in 24 (33%). Duodenal ulcer (4 cases) and gastric ulcer (1 case) were relatively few. No case of malignancy was found. Sclerotherapy for variceal bleeding was effective in 4 patients. Helicobacter pylori was detected in 12 of 23 patients and associated with histologically identified gastritis in the majority of these cases. It is concluded that paediatric UGIE is safe and useful in the diagnosis and therapeutic intervention for UGI diseases in children. Our findings provide additional information on the pattern of diseases among Saudi Arabian children.
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PMID:Upper gastrointestinal diseases in Saudi Arabian children. 1069 24

The patient was a 58-year-old woman given curative treatment (pancreatectomy (body and tail) + intraoperative irradiation (25 Gy)) on the basis of a diagnosis of pancreatic carcinoma. Having a favorable postoperative course, she was discharged 24 days after surgery. A week after discharge, she was readmitted for a hemorrhagic gastric ulcer. She was later discharged again on conservative treatment, and followed up at the outpatient clinic, but nine months postoperatively, was readmitted complaining of loss of appetite and abdominal pain. Subsequent tests revealed stricture of the horizontal portion of the duodenum with distension oral to the stricture. Around the celiac artery, the paraaortic lymph nodes were swollen, and a diagnosis of stricture due to recurrent pancreatic carcinoma was made. On the day before bypass surgery was scheduled, the patient vomited blood, so the operation was postponed, conservative treatment such as blood transfusion was administered, and emergency angiography was performed simultaneously. The findings were an aortic pseudoaneurym 1 cm in diameter immediately below the origin of the superior mesenteric artery and between the left and right renal arteries, and a hemorrhage, caused by an aortoduodenal fistula, issuing from the horizontal portion of the duodenum. Hemostasis via a laparotomy was judged difficult, and so an indwelling stent-graft in the aorta was tried to stanch the blood, but without success. Another stent then had to be inserted within the first, thus stopping the flow, but the blood supply to the celiac artery, the superior mesenteric arteries and the renal arteries was impaired, and the patient died about six hours later. Postmortem examination revealed aortoduodenal fistula without recurrence of the carcinoma. The duodenal wall around the fistulous tract showed delayed radiation changes with deep ulceration. The intraoperative radiation may have played an important part in the formation of the fistula.
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PMID:A case of aortoduodenal fistula occurring after surgery and radiation for pancreatic cancer. 1075 Mar 79

Helicobacter pylori infection is usually acquired during childhood, and evidence-based guidelines regarding diagnosis and treatment of infected children have been recently published. Diseases associated with H. pylori infection are gastritis, duodenal ulcers, mucosal-associated lymphoid-type (MALT) lymphoma, and gastric adenocarcinoma. The association of specific symptoms with H. pylori infection in children and adults (ie, recurrent abdominal pain and nonulcer dyspepsia) remains controversial. Additionally, the role of H. pylori in gastroesophageal reflux disease or in extra-gastrointestinal diseases (ie, coronary artery disease) lacks sufficient evidence to demonstrate causality. The diagnosis of H. pylori-associated diseases in children can reliably be made through gastroduodenal endoscopy with biopsies. Clinical trials are underway for the validation of noninvasive diagnostic tests for the H. pylori-infected child, and current guidelines recommend eradication therapy for infected children with duodenal and gastric ulcer, gastric lymphoma, and atrophic gastritis with intestinal metaplasia. The natural history of childhood H. pylori infection is poorly described. Moreover, rational approaches to the prevention and control of childhood H. pylori infection are critically needed, requiring characterization of the determinants for acquisition and persistence and the disease outcomes following eradication.
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PMID:New approaches to Helicobacter pylori infection in children. 1135 61

In March 1941, two months after her wedding, Karen Blixen was diagnosed as having syphilis in the second stage. She was treated initially with mercury and later on in Denmark with salvarsan. Years later she received more treatment with mercury, salvarsan and bismuth, but in fact she was cured already in 1915 and told so by her venerologist Carl Rasch. However, she did not believe him, and several physicians, including well-known specialists in internal medicine and neurology told her many years later that she had to accept the diagnosis tabes dorsalis, i.e., syphilis in the third chronic stage. This paper claims, based on her medical records from several hospitals, that her physicians' attitude resulted in the delay of right treatment for her real disease for many years and led to at least one unwarrented surgical procedure (chordotomy). In 1956 she finally received surgical treatment of her stomach ulcer which for many years had caused her attacks of abdominal pain. The procedure was delayed for ten years because of a lumbar sympathectomy, which removes the pain for some years but not the ulcer itself, nor the bout of vomiting. Many doctors (and biographers) have been puzzled by her life-long bowel symptoms. It was often called tropic dysentery, in spite of the fact that this diagnosis was never confirmed by stool analyses. Instead it is suggested that most likely the Baroness caused the symptoms. She misused strong laxatives during her whole adult life. She did not tell her doctors about this until very late in her life and then it was far too late. Many times barium enemas showed a severe chronic condition with dehaustration and dilatation. The reason for her misuse was the fact that she was afraid of gaining too much weight. She used amphetamine during her life in Denmark after her return in 1931 in order to reduce her appetite, and probably she used Chat in Africa. She also constantly smoked cigarettes which in combination with minimal food intake facilitated the development of her stomach ulcer. It is concluded that Karen Blixen would have had a much better life, if communication between her and her physicians had been better. She should have told them and they should have been better to listen to that which was unsaid.
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PMID:[Karen Blixen and her physicians]. 1256 2

Since two decades transarterial chemoembolization (TACE) of liver metastases has been investigated in numerous studies. However, no standardized therapeutic procedure exists so far. The present study retrospectively investigated survival, response and side effects after TACE of liver metastases in 21 patients with colorectal cancer and results are compared with previous literature. A total of 68 TACE procedures were performed. A suspension of degradable starch microspheres (DSM, Spherex) and Mitomycin C was applied selectively into hepatic arteries via a transfemoral approach. DSM effect a temporary arterial occlusion. Follow-up studies were performed by contrast enhanced spiral computed tomography (CT). The median survival was 13.8 months. Therapeutic response (according to WHO) was observed only in three patients. The progression free interval was 5.8 months. Patients developed a postembolization-syndrome (abdominal pain, fever, nausea) and increased transaminases in 27-43% of all interventions. A gastric ulcer occurred after four, cholecystitis after two TACE. As already shown in most previous studies, regardless of the used agents, also this investigation underlines the moderate therapeutic effect of TACE on colorectal liver metastases. So far, no significant survival benefit has been shown in the literature and the response rates are rather limited. In general, complications of TACE seem to be rare, but should not to be underestimated. Compared to TACE with long or permanent arterial occlusion, postembolization syndrome seems to be less pronounced using DSM. As TACE is rather a palliative therapeutic approach, DSM therefore might be more suited. Further studies on TACE of liver metastases should focus on to the patients' quality of life.
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PMID:[Transarterial chemoembolization of liver metastases of colorectal carcinoma using degradable starch microspheres (Spherex): personal investigations and review of the literature]. 1531 15

A 59-year-old man with a history of melena and upper abdominal pain was referred to our hospital. An upper endoscopy was performed, and a gastric ulcer was found bordering the antrum and stomach body. Multiple biopsies from the lesion showed monoclonal plasmacytic infiltration of the mucosa, consistent with the diagnosis of plasmacytoma. Helicobacter pylori was also identified. Triple therapy failed and quadruple therapy eradicated the H. pylori, confirmed by repeated biopsies. Healing of the gastric lesion followed the treatment. Multiple biopsies from the scar and the entire stomach showed complete regression of the plasmacytoma. The association between gastric plasmacytoma and H. pylori is discussed.
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PMID:Gastric plasmacytoma and Helicobacter pylori infection. 1559 12


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