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

Peritoneal mesothelioma is a rare neoplasia usually associated with exposure to asbestos. The incidence in the population not in contact with asbestos is of one per million per year. The disease is most common in males over the age of 40, with signs and symptoms of neoplasic disease together with abdominal pain and ascitis with or without a palpable abdominal mass. We report the case of a young male without a history of exposure to asbestos who presented with prolonged fever, leukocytosis and a septated peritoneal exudate. With a presumptive diagnosis of peritoneal tuberculosis, the patient received empirical antituberculosis treatment. Because the clinical picture persisted and microbiological studies remained negative, a second exploratory laparotomy was performed which demonstrated the presence of a malignant epithelial peritoneal mesothelioma.
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PMID:[Malignant peritoneal mesothelioma. An infrequent cause of prolonged fever syndrome and leucocytosis in a young adult]. 756 36

The pattern of tuberculosis has changed and in recent years: extrapulmonary tuberculosis has become more common, especially in immuno-compromised individuals. A case of primary intestinal tuberculosis in a patient with kidney transplant is reported. The patient presented with persistent fever and right-sided abdominal pain. Histopathology of colonic tissue showed granulomatous inflammation containing acid fast bacilli, and culture of the tissue grew Mycobacterium tuberculosis. Clinical improvement occurred after institution of appropriate anti-tubercular treatment.
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PMID:Gastrointestinal tuberculosis in renal transplantation: a case report and review. 757 45

The clinical characteristics of hepatic tuberculosis in 52 cases diagnosed pathologically were analyzed. Fever, abdominal pain and hepatomegaly were the major clinical manifestations; they were present in 96.2%, 42.3% and 88.5% of the patients respectively. The fever had no consistent pattern and the abdominal pain was usually localized to the right hypochondrium and not related to overwork. Hypergrammaglobulinaemia, elevated alkaline phosphatase level and increased ESR were noted in most of the patients (76.9%, 75.0%, 76.5% respectively). 62.5% of the 52 patients was diagnosed by percutaneous liver biopsy. Since there is no consistent clinical pattern in patients with hepatic tuberculosis, the diagnosis should be considered in patients with unexplained fever associated especially with hepatomegaly or hepatosplenomegaly, elevated alkaline phosphatase level, hypergrammaglobulinaemia and increased ESR, Liver biopsy is the most valuable method to confirm the diagnosis of hepatic tuberculosis.
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PMID:[Clinical characteristics of hepatic tuberculosis]. 760 Aug 75

The authors report a retrospective study of 27 cases of "ileo-caecal tuberculosis" collected over a period of 10-years. Sixteen women and eleven men, between 14 and 55 years of age (with a group mean age of 28 years), were included. This is still a common disease in Morocco, despite attempts to achieve universal BCG vaccination. Diarrhoea, abdominal pain and a general physical deterioration are the most indicative signs, but are not specific. Tests for M. tuberculosis hominis are often negative, except in cases in which bacteria proliferate in pulmonary excavations, and this makes it difficult to establish a definite diagnosis. The detection of narrowing of the ileum or colon in a country where infection is endemic suggests the possibility of tuberculosis. Colonoscopy, which is becoming increasingly widespread in Morocco, makes an essential contribution. Although it is rare for caseum to be detected in biopsy fragments, the main value of histopathology is that it can eliminate cancer, making it possible to start antibacterial treatment without a diagnostic laparotomy. The outcome of medical treatment is nearly always positive. Clinical improvement, bacteriology tests and X-ray examinations are criteria that a cure has been obtained.
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PMID:[Ileocecal tuberculosis. Apropos of 27 cases]. 765 83

Both of tuberculous mesenteric lymphadenitis and tuberculous peritonitis are now rather rare in parallel with the decrease of the incidence of tuberculosis as a whole. Here, we report a case of tuberculous mesenteric lymphadenitis complicated with tuberculous peritonitis. A 28-year-old man was admitted to our hospital with pulmonary tuberculosis. Antituberculous chemotherapy was started and his chest X-ray findings were improved. After 11 weeks of the treatment, high fever of 39.0 degrees C developed suddenly and he complained right lower abdominal pain. During laparotomy performed on suspicion of acute appendicitis, swelling of mesenteric lymph-nodes, numerous miliary tubercles on mesentery and turbid ascites were noticed. Diagnoses of tuberculous mesenteric lymphadenitis and tuberculous peritonitis were confirmed by bacteriological and histological examinations of lymph-nodes and tubercles. Ileocecal resection was performed and clinical course after the surgery was favourable.
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PMID:[A case of tuberculous mesenteric lymphadenitis and peritonitis with symptoms of acute abdomen]. 769 78

Lupus anticoagulant has been described in association with many autoimmune disorders. Here we describe its occurrence in a patient with ANCA-associated microscopic polyarteritis with medium vessel involvement. A 62-year-old man presented with mononeuritis multiplex and abdominal pain and was demonstrated to have multiple aneurysms on visceral angiography, consistent with the diagnosis of medium vessel vasculitis or classical polyarteritis nodosa. In addition he had active tuberculosis. He developed a deep venous thrombosis at this admission and, on one occasion, had a prolonged APTT but this was not confirmed to be due to a lupus anticoagulant. Two years later when the patient was readmitted with fevers, headaches and nasal discharge, both ANCA and a lupus anticoagulant were demonstrated in his serum, although there was no evidence of a venous thrombosis. Six months later the patient was demonstrated for the first time to have dysmorphic urinary RBC consistent with glomerular bleeding; at the same time he developed a deep venous thrombosis. ANCA was still present, but the lupus anticoagulant could not be detected. The patient was treated with cyclophosphamide and prednisolone and a Greenfield filter inserted into his inferior vena cava.
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PMID:Lupus anticoagulant in anti-neutrophil cytoplasmic antibody-associated polyarteritis. 773 54

The clinical and pathological features of 22 patients, 11 males and 11 females 17-70 years of age (48.0 +/- 16.0 years), with hepatic tuberculosis were reviewed. Five patients had no evidence of extrahepatic tuberculosis (local form), and 17 had the miliary form. The clinical features of the miliary and local forms were similar with pyrexia, abdominal pain, hepatomegaly and body weight loss as the main manifestations. The biochemical findings were also quite similar in reversed albumin and globulin (A/G) ratio (2.9/3.5 vs. 3.2/3.4 g/dl) and disproportionate elevation of alkaline phosphatase (ALP) in comparison with bilirubin values but lower levels of alanine aminotransferase (ALT) (40.4 +/- 51.0 vs. 170.8 +/- 209.4 U/l; p < 0.05) and ALP (208.5 +/- 138.9 vs. 389.5 +/- 271.1 U/l; p < 0.05) in the miliary form. Patients with the local form had higher albumin (3.2 +/- 0.8 vs. 2.9 +/- 0.7 g/dl), aspartate aminotransferase (AST) (160.4 +/- 221.7 vs. 65.9 +/- 69.7 U/l), and gamma glutamyl-transpeptidase (gamma GT) (217.0 +/- 144.0 vs. 136.0 +/- 92.1 U/l), although the differences were not significant. The histopathological features of the miliary form were also similar to the local form with granuloma, caseation, acid-fast bacilli, fatty change and portal fibrosis as the main findings. The local form revealed more severe signs of hepatocytic damage while the miliary form was more wasting. The results suggest that the miliary and local forms of hepatic tuberculosis had quite similar clinical presentations and pathological features. The biochemical tests suggesting hepatic tuberculosis were reversed A/G ratio and disproportionate elevation of ALP.
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PMID:Hepatic tuberculosis: comparison of miliary and local form. 774 92

The prevention of cerebral toxoplasmosis and of Pneumocystis carinii pneumonia is an essential objective in the management of patients infected with HIV. Given that roxithromycin is active in vitro against Toxoplasma gondii and that in 1989 Dolermann reported the effective treatment of P. carinii respiratory infections with erythromycin, a randomized pilot study was undertaken in 52 patients infected with HIV. Patients were treated with either: a monthly dose of pentamidine aerosol (300 mg); roxithromycin once a week (300 mg t.i.d.); or a combination of pentamidine aerosol and roxithromycin. Intention to treat analysis was applied to these 52 patients, all of whom received at least one treatment dose. Five out of 18 patients treated with pentamidine aerosol, 1/17 patients treated with pentamidine aerosol + roxithromycin and none of the 17 patients treated with roxithromycin developed cerebral toxoplasmosis (p = 0.038). P. carinii pneumonia was diagnosed in one patient in the pentamidine aerosol-treated group, in one patient treated with roxithromycin and in none of the patients treated with pentamidine aerosol + roxithromycin (non-significant difference). Four cases of Mycobacterium tuberculosis and Mycobacterium avium-intracellulare infection were seen in the pentamidine aerosol-treated group (p = 0.028) and none in the roxithromycin groups. Adverse events leading to the discontinuation of treatment occurred in 5/34 (14.7%) patients treated with roxithromycin. Nausea, abdominal pain and raised transaminases occurred in four patients and a skin allergy in the final patient. Roxithromycin appears to be effective in the prevention of pulmonary pneumocystis infection and of cerebral toxoplasmosis in HIV-infected patients. However, these results require confirmation in a larger study.
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PMID:Prevention of Pneumocystis carinii pneumonia and of cerebral toxoplasmosis by roxithromycin in HIV-infected patients. 778 14

Tuberculosis (TB) is the most common opportunistic infection worldwide in human immunodeficiency virus (HIV)-infected patients. Intraabdominal TB includes lymphadenopathy and focal lesions of solid viscera. Symptomatic expression of tuberculous invasion of the pancreas (supplemented by demonstration of a mass on imaging) is rare among HIV-infected patients. We report the case of an HIV-infected patient with a tuberculous pancreatic abscess and review nine similar cases. All patients presented with persistent fever and abdominal pain. The diagnosis was made on the basis of detection of pancreatic mass lesions on computed tomographic (CT) scans and the results of cultures and/or acid-fast stains of peripancreatic abscess material and/or other body fluids. Despite an excellent response to antituberculous therapy, three patients died of unrelated causes. In the setting of a febrile illness with abdominal symptoms, tuberculous pancreatic abscess should be considered in the differential diagnosis for HIV-infected patients with a CT-identified mass lesion.
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PMID:Tuberculous pancreatic abscess as an initial AIDS-defining disorder in a patient infected with the human immunodeficiency virus: case report and review. 779 90

A 22-year-old Pakistani man presented with a 1-year history of recurrent attacks of pancreatitis of unknown etiology that had required hospitalization and extensive investigation in Pakistan. He was admitted with abdominal pain, fever, and weight loss. An ultrasound and computed tomographic scan of the abdomen revealed abdominal lymphadenopathy, bulky and inhomogeneous pancreas, and a large fluid collection anterior to the right lobe of the liver. The collection was aspirated but Gram-stain, Ziehl-Neelsen stain for acid-fast bacilli, and DNA analysis by a highly specific polymerase chain reaction-based assay were negative. Because of a strong clinical suspicion of tuberculosis, the patient was started on antituberculous chemotherapy; 4 weeks later the aspirate grew Mycobacterium tuberculosis (hominis). The patient improved rapidly and has remained well after 18 months follow-up. A high index of clinical suspicion and appropriate microbiological investigation is required for the diagnosis of this rare, but potentially curable cause of pancreatitis.
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PMID:Tuberculous pancreatitis: a diagnostic problem. Case report and review of literature. 779 34


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