Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Typhoid fever, a systemic disease caused by Salmonella typhi, is classically characterized by fever and abdominal symptoms. Although now considered uncommon, it seems to have re-emerged in Taiwan in recent years. We conducted a retrospective study of the clinical characteristics and microbiologic findings in 24 confirmed cases of typhoid fever treated over a 7-year period at a medical center in northern Taiwan. There were 11 males and 13 females, including 15 adults (over 18 years in age) and 9 children. Their mean age was 24.7 years (range, 9 months to 58 years). Twelve patients had recently returned from abroad, mostly from Southeast Asia. The most common complaints were fever (24/24), diarrhea (18/24), abdominal pain (10/24), and cough (10/24). The average duration of fever before diagnosis was 14.1 days, with a maximum of 30 days. Relative bradycardia was noted in 6 patients. Leukopenia was noted in 2 patients. S. typhi was isolated from blood culture in 20 cases, from stool culture in 3 cases, and from bone marrow culture in 1 case. Widal test was only positive initially in 7/18 cases. Fever of unknown origin was the most common initial diagnosis. Typhoid or enteric fever was impressed initially in only 2 cases. Almost all isolates of S. typhi were susceptible to antibiotics currently used for typhoid fever, with only 1 isolate resistant to chloramphenicol. All patients survived after antibiotic treatment. Only 1 patient developed recurrence after a 10-day course of ceftriaxone. In conclusion, the diagnosis of typhoid fever is often challenging due to non-specific symptoms and lack of an immediate confirmatory test. It is important to include this disease in the differential diagnosis of febrile patients with abdominal symptoms.
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PMID:Changing characteristics of typhoid fever in Taiwan. 1518 93

Described is a 15-year-old boy who presented with an ulcerative destructive soft palate lesion, skin lesions, and prolonged history of weakness and abdominal pain associated with abnormal liver functions. A midline destructive lesion was considered. However biopsies revealed chronic inflammation. After thorough investigation including colon, liver, skin and uvular biopsies a diagnosis of Inflammatory Bowel Disease in association of Autoimmune Sclerosing Cholangitis was made. Treatment with steroids improved his symptoms, normalized liver functions and enhanced healing of the skin and palatal lesions. This case demonstrates the involvement of the palate in a rare systemic disease and to our knowledge is the first description of Sclerosing Cholangitis presenting as an ulcerative lesion of the soft palate.
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PMID:Inflammatory bowel disease and sclerosing cholangitis with ulcerative lesions on skin and soft palate. 1536 9

The antitumor necrosis factor, infliximab, has been recently shown to be effective in refractory sarcoidosis including the intestinal form of this disease. We have tried this therapy in a 55-year-old woman under immunosuppressive therapy for longstanding sarcoidosis presenting with abdominal pain apparently caused by a colonic localization of the disease. The latter diagnosis was based, as recommended, on the presence of nonnecrotizing granulomas in mucosal biopsies, the presence of systemic disease, and the careful exclusion of other granulomatous diseases, including tuberculosis. After the first IV infusion (10 mg/kg BW), she quickly improved, but the wellbeing lasted approximately 4 weeks. She then received another dose of infliximab, but she soon developed low-grade fever and weakness and shortly succumbed of miliary tuberculosis. Likely, infliximab precipitated a pre-existing mycobacterial infection of the intestine. Given the likelihood of underdiagnosing intestinal tuberculosis--and the risks associated with infliximab treatment--this case suggests that this drug should be used with extreme caution, if at all, when a diagnosis of colonic sarcoidosis is suspected.
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PMID:Colonic sarcoidosis, infliximab, and tuberculosis: a cautionary tale. 1547 56

We report the case of a 44-year-old white man who presented with progressively worsening crampy abdominal pain and distention. Deterioration of his clinical picture along with leukocytosis and radiographic evidence of severe colonic dilation rendered exploratory laparotomy necessary. Greatly distended and inflamed transverse and descending colon were evident and an extended left colectomy was performed. Characteristic changes of leukocytoclastic vasculitis in the serosal and muscular layers of the resected colon were demonstrated at histopathologic examination. Systemic leukocytoclastic vasculitis, usually coexisting with Henoch-Schonlein purpura, commonly affects the small bowel with clinical evidence of ischemia or bleeding. Colon involvement is infrequently reported in the context of systemic disease. Isolated colonic leukocytoclastic vasculitis without extraintestinal manifestations is rare. A previously unreported case of localized leukocytoclastic vasculitis of the left colon resulting in the impressive presentation of megacolon, without the presence of any precipitating factor or associated systemic disease is presented here, with an overview of the related literature.
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PMID:Isolated colonic leukocytoclastic vasculitis causing segmental megacolon: report of a rare case. 1569 Jun 76

The purpose of this case report is to detail an initial periodontal manifestation of Crohn's disease in a 6-year-old boy. The first clinical diagnosis, localized aggressive periodontitis, was based on the microbiological isolation of Actinobacillus actinomycetemcomitans from subgingival sites. On examination, gingival lesions, together with bleeding on probing, edema, and erythema, were observed. Although an increased probing depth was detected, no radiographically visible alveolar bone loss was observed. According to these findings, periodontitis as a manifestation of a systemic disease was assumed. Furthermore, fissural ulcerations of the lips were noted. The patient also reported a swelling of the upper lip in the morning. Oral hygiene procedures, scaling, root planning, and the application of metronidazole and amoxicillin were not successful. Metabolic and several immunological tests, however, showed normal values. Two months after the first periodontal signs, the child suffered from severe malnutrition, accompanied by diarrhaea and abdominal pain. Active colitis with multiple granulomas was detected histopathologically from biopsies. Crohn's disease was then diagnosed by the internist. If in doubt, medical examinations in every case of childhood periodontitis are recommended to determine whether the findings speak for initial symptoms of a systemic disorder (eg, Crohn's disease).
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PMID:Periodontitis as manifestation of Crohn's disease in primary dentition: a case report. 1587 51

Anaplastic large cell lymphoma (ALCL) is predominantly a systemic disease with nodal involvement, but extranodal involvement can occur either as the primary presentation or during the disease course. Primary epiphyseal involvement is extremely rare with lymphomas. This case report illustrates an 8-year old boy who first presented with pain over the right upper extremity, which was initially treated as epiphyseal osteomyelitis. A few weeks later, he presented with abdominal pain and an abdominal wall mass, which on biopsy proved to be an anaplastic large-cell lymphoma.
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PMID:Anaplastic large cell lymphoma presenting as an epiphyseal lytic lesion--a case report with clinico-pathologic correlation. 1653 39

Vomiting and abdominal pain are common pediatric complaints encountered by emergency physicians. The differential diagnosis of abdominal pain is extensive. Herein, we report 2 cases with fatal myocarditis who initially presented with abdominal pain and vomiting. Both cases were presented with abdominal pain, vomiting, and loose stools. On arrival at our emergency department, hypotension, tachycardia, and cyanotic extremities were found. Their serum troponin-I levels were elevated. The echocardiogram demonstrated poor left ventricular performance and a decreased ejection fraction. In both cases, an arrhythmia and a coma developed within hours and were shortly followed by death. The clinical presentations of acute myocarditis are variable, ranging from an initial mild discomfort to acute progressive heart failure, and at times, even death. Abdominal pain may be a manifestation of systemic disease, an extra-abdominal lesion, or myocarditis. Although myocarditis associated with abdominal pain or vomiting remains a diagnostic challenge to physicians, it should be considered in the differential diagnosis of children with gastritis and hypotension or who are refractory to rehydration therapy.
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PMID:Myocarditis presenting as gastritis in children. 1680 47

The clinical features of adult onset Still's disease (AOSD) have rarely been described in Thai patients. We report the clinical manifestations, laboratory findings, and outcome of 16 Thai patients with AOSD, and compare these findings with those of the western and other oriental series. Fourteen patients (87.5%) had the onset of their disease between 16-35 years of age. The most common features presented were fever (100%), arthralgia and myalgia (100%), significant weight loss (84.6%), arthritis (81.3%), skin rashes (68.8%), sore throat (62.5%), elevated erythrocyte sedimentation rate (100%), leukocytosis (93.8%), and liver dysfunction (75%). Pleuro-pericarditis and abdominal pain were uncommon. All but 2 patients required corticosteroids to control their systemic disease activity. The clinical course of 13 patients, who were followed for more than 12 months, was monocyclic systemic disease in four cases, polycyclic systemic disease in five, chronic articular monocyclic systemic in one, and chronic articular polycyclic systemic in three. When compared with western and other oriental series, the AOSD in Thai patients shared similar clinical features and laboratory findings, suggesting that mechanisms of pathogenesis may be similar in patients from widely different genetic backgrounds and geographic locations. Corticosteroids were frequently required and dramatically effective.
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PMID:Adult onset Still's disease: clinical features and outcome in 16 Thai patients. 1703 60

Autoimmune pancreatitis is a rare form of chronic pancreatitis. Its clinical relevance, however, cannot be dismissed, as it can be difficult to distinguish autoimmune pancreatitis from malignant pancreatic cancer and in contrast with the majority of chronic pancreatitis forms it can be efficiently treated, even complete remission can be achieved on steroid therapy. The clinical picture of autoimmune pancreatitis is not characteristic, obstructive jaundice, abdominal pain, weight loss are frequently observed. Imaging studies often show diffuse pancreas enlargement and irregular narrowing of the main pancreatic duct. Elevated serum IgG4 immunoglobulin concentrations, some autoantibodies and the presence of IgG4 positive immune cells were observed in addition to other histological features. Apart from pancreatic manifestations, other organs may also be affected, thus associations with sclerosing cholangitis, sialoadenitis, retroperitoneal fibrosis, Riedel thyroiditis and inflammatory bowel diseases have been described. Based on these findings, autoimmune pancreatitis should be regarded as a systemic disease, as a manifestation of systemic IgG4-related sclerosing disease.
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PMID:[Autoimmune pancreatitis]. 1870 20

Primary esophageal small cell carcinoma (PESCC) is a relatively rare and aggressive tumor with poor prognosis. Systemic spreading and metastasis often occur at diagnosis. Although 5-year survival rate of superficial squamous cell carcinoma of the esophagus can be 86.1%, 5-year survival rate of superficial PESCC is still relatively low. This study mainly retrospectively analyzed clinicopathological and immunohistochemical features of 15 cases of superficial PESCC in our hospital from 1990 to 2004, in order to find suitable diagnostic markers and applicable therapies for this disease. The records mainly included presenting symptoms, demographics, diagnostic method, histopathology, follow-up, and therapy. Immunohistochemical staining of chromogranin A (CgA), neuron-specific enolase (NSE), synaptophysin (Syn), neuronal cell adhesion molecules (CD56), thyroid transcription factor-1 (TTF-1), cytokeration 34betaE12 (CK34betaE12), cytokeratin (AE1/AE3), and cytokeratin 10/13 was performed. Incidence of superficial PESCC accounted for 4.8% of that of superficial carcinoma of the esophagus during the same period. Initial symptoms of all patients were dysphagia or accompanied with retrosternal pain and upper abdominal pain, and duration of these symptoms was 75 days averagely. Mean age of patients was 58.8 years old, and the male-to-female ratio was 2.75 : 1. Lesions were mainly located at middle thoracic esophagus. One, 2, and 5-year survival rates were 66.7, 33.3, and 6.7%, respectively. The median survival time was 19 months and mean survival time was 23.7 months after diagnosis. The percentages of PESCC samples with positive immunoreactivity were NSE 100%, Syn 100%, AE1/AE3 100%, CD56 93.3%, TTF-1 60%, CgA 53.3%, CK34betaE12 6.7%, and cytokeratin 10/13 0%, respectively. Our study suggested that PESCC was a rare and aggressive tumor with high malignancy. Superficial PESCC had rapid progression and poor prognosis compared with superficial squamous cell carcinoma of the esophagus at the same stage. The systemic therapy based on combination of postoperative chemotherapy and radiotherapy might be an effective approach for the treatment of superficial PESCC as a systemic disease. Higher proportion of positive labeling of NSE, Syn, AE1/AE3, CD56, TTF-1, and CgA in PESCC was valuably applied in diagnosis and differential diagnosis.
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PMID:Superficial primary small cell carcinoma of the esophagus: clinicopathological and immunohistochemical analysis of 15 cases. 1951 93


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