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

A prospective evaluation of 185 consecutive patients with abdominal pain or suspected hepatic malignancy was performed to compare the diagnostic accuracy of contrast material-enhanced incremental dynamic computed tomography (IDCT) scans with plain CT scans for detection of hepatic masses and fatty infiltration of the liver. After a series of nondynamic plain CT scans, patients were examined at 7.5 scans/min during intravenous injection of 50 g of iodinated contrast material. Enhanced IDCT study was found to be an accurate, reproducible technique for liver evaluation. Of 155 neoplasms measured in 59 patients, liver-to-lesion differences of less than 10 HU were seen in only two tumors in IDCT scans as compared with 31 in plain CT scans. These differences were not significantly affected by lesion size for neoplasms greater than 6 mm in diameter. A confident diagnosis of fatty infiltration (23 patients) could be made when the spleen-minus-liver difference was 25 HU on enhanced IDCT scans and 10 HU on plain CT scans. In eight patients with liver metastases, there was little variation in the attenuation values of normal-appearing liver between serial examination studies (8 HU average).
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PMID:Focal hepatic masses and fatty infiltration detected by enhanced dynamic CT. 394 Mar 96

Twenty-eight peritoneovenous shunts were placed to relieve ascites in 26 patients with a variety of underlying malignancies. Nine of the patients had documented liver metastases and hyperbilirubinemia. Severe thrombocytopenia with laboratory evidence of disseminated intravascular coagulation (DIC) occurred in four of these nine patients following shunt placement. Relative or absolute thrombocytopenia was also commonly observed in this series. Other complications included pulmonary edema, ventricular tachycardia, culture-negative fever, pneumonia, and late shunt occlusion. Good palliation, with relief of abdominal pain or respiratory compromise, was achieved in 57% of these patients. Our experience suggests that DIC following peritoneovenous shunts in patients with malignancy may be more common than previously reported, although not as frequent as the incidence of DIC associated with shunt placement for cirrhotic ascites. Platelet aggregation or Factor X activation by ascitic fluid and failure of the liver to inactivate activated clotting factors may play a role in this coagulopathy. Because of the risk of potentially fatal DIC, palliative peritoneovenous shunts should be considered with caution in patients with liver metastases and hyperbilirubinemia.
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PMID:Thrombocytopenia and laboratory evidence of disseminated intravascular coagulation after shunts for ascites in malignant disease. 399 80

In a retrospective analysis, we studied 24 cases of malignant small bowel tumors. Apart from 9 cases of a carcinoid tumor, there occurred 6 cases of leiomyosarcoma and another 7 cases of adenocarcinoma. One case of malignant schwannoma and another case of lymphoma were also seen. Sonography and contrast-study of the GI-tract were the decisive diagnostic tools. Nevertheless, months and even years elapsed before diagnosis was established. Only in 13 patients curative resection could be accomplished. In the remainder of patients, hepatic metastases were found or the tumor could not be resected any more owing to its size. In 6 patients with synchronous and in 7 patients with metachronous liver metastases we carried out palliative regional intraarterial chemotherapy of the liver. The mean survival time of the whole patient group was 19 months. Patients, having submitted themselves to a complete resection of the tumor, had a significantly longer period of survival (mean survival time 25 months) in contrast to patients, having undergone a mere palliative operative procedure (mean survival time 14 months). Mean survival time for leiomyosarcoma was 38 months, for adenocarcinoma 14 months, and for carcinoid tumors 22 months. Owing to difficulties in establishing diagnosis, a tumor of the small intestine should be considered in any patient complaining of abdominal pain.
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PMID:[Malignant tumors of the small intestine]. 752 78

A 48-year-old man was admitted to our hospital because of upper abdominal pain, and a cervical tumor, on Oct. 23, 1992. Chest X-ray, CT scan and MRI revealed a tumor (left-S10) and enlarged mediastinal lymph nodes. A pathological diagnosis of small cell lung cancer was made by transbronchial biopsy. Ultrasonography showed liver metastases. He received four courses of chemotherapy (Carboplatin, Ifosfamide, Etoposide). Three days after the completion of chemotherapy, his serum transaminase level was markedly increased, and he was disorientated on March 4, 1993. In spite of plasma exchange, the patient died due to hepatic failure on March 6, 1993. Fulminant hepatitis in a patient with lung cancer receiving chemotherapy is rarely reported.
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PMID:[A case of small cell lung cancer associated with fulminant hepatitis B]. 779 62

We describe a rare case of a neuroendocrine carcinoma of the ovary in a 22-year-old woman who presented with abdominal pain and a pelvic mass. Exploratory laparotomy revealed a right ovarian tumor weighing 2100 g. A right salpingo-oophorectomy and an appendectomy were performed. There was no evidence intraoperatively or postoperatively of metastatic disease. Microscopic examination of the ovary revealed solid nests of tumor cells with a neuroendocrine appearance, high mitotic rate, necrosis, and vascular invasion; the tumor was associated with a predominantly borderline mucinous neoplasm with a small focus of mucinous carcinoma. Neuroendocrine differentiation was confirmed by Grimelius stains, immunohistochemical assays (chromogranin), and electron microscopy. The appendix was histologically unremarkable. The patient received a course of chemotherapy; 3 months after completing chemotherapy, she developed multiple liver metastases and died of disease a week later. To our knowledge, this case report is the second one involving a primary neuroendocrine carcinoma of the ovary occurring in association with a mucinous neoplasm. Mixed mucinous and neuroendocrine carcinoma of the ovary may represent a rare neoplasm with extremely aggressive behavior.
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PMID:Ovarian neuroendocrine carcinoma associated with a mucinous neoplasm. 794 90

A 67-year-old man complained of abdominal mass, abdominal pain and tarry stool. He was diagnosed as having jejunal leiomyosarcoma and multiple liver metastases after examination. The jejunal leiomyosarcoma was resected by operation. Unrectable liver metastases were repeatedly treated by transarterial embolization with carboplatin and Lipiodol, and a significant reduction was achieved. TAE with carboplatin and Lipiodol was considered evaluating efficiency therapy without side effect. He has remained well presently for 1 years 10 months after operation.
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PMID:[Hepatic metastases from jejunal leiomyosarcoma treated effectively by repeated transarterial embolization with carboplatin]. 838 Jun 84

A total of 121 consecutive patients with midgut carcinoid tumors underwent regular clinical control and 158 laparotomies for abdominal symptoms with 1 to 11 years (mean 5.2 years) of follow-up. Metastases were present in 93% of the patients at study inclusion and developed at initially uninvolved sites with an overall probability of 0.38. Patients without initial tumor spread developed mesenteric or liver metastases with the probability of 0.25 (mean delay 12 years), whereas those with mesenteric metastases exhibited a probability 0.56 to develop liver metastases (mean delay 6.1 years). Spread to extraabdominal sites in patients with mesenteric and liver metastases exhibited a probability of 0.22 (mean delay 4.3 years), and this spread was especially frequent (probability 0.60) in patients with only liver metastases at inclusion. Patients without the carcinoid syndrome (52%) mainly suffered from more or less episodic abdominal pain, nausea, and diarrhea. Marked mesenteric fibrosis detected at surgery (n = 59) generally was accompanied by symptoms of abdominal pain and weight loss, and it often required urgent intervention due to intestinal obstruction or ischemia. Complete or partial symptom alleviation was accomplished in 82% of the operated patients, and generally was most auspicious after primary acute or subacute procedures (n = 54). The complete or partial symptom improvements after surgery lasted for mean 5.3 years and tended to be longer after elective (n = 50) than acute operations. The findings substantiate encouraging results of laparotomy in a compromised cohort of patients with midgut carcinoid tumors. Because the patients also displayed a generally slow progression of metastases, liberal indications for laparotomy should prevail in symptomatic and possibly also asymptomatic individuals with midgut carcinoid tumors.
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PMID:Progression of metastases and symptom improvement from laparotomy in midgut carcinoid tumors. 867 69

A 59-year-old man presented with painful subcutaneous nodules on the anterior surfaces of the legs. He had received oral antibiotics and supportive care for presumed cellulitis and thrombophlebitis, but had minimal improvement. Five months earlier, he had undergone pancreaticoduodenectomy for acinar pancreatic carcinoma; at that time, the serum level of amylase had been normal, but the level of lipase was elevated. The patient denied fever, rigors, arthritis/arthralgia, or pleuritic pain. His medications included aspirin, furosemide, ranitidine, and nortriptyline. He denied any allergies. Physical examination revealed numerous firm, tender, erythematous and violaceous, subcutaneous nodules on the lower extremities, with marked bilateral pitting edema (Fig. 1). Skin biopsy of a representative lesion revealed septal panniculitis, consistent with erythema nodosum (Fig. 2). None of the characteristic changes of pancreatic fat necrosis was present. The patient was treated with aspirin, 650 mg orally, q 6 h, and indomethacin, 50 mg orally, q 12 h, but he continued to develop new nodules; prednisone, 60 mg orally was begun. Although he reported improvement in symptoms, the nodules failed to respond clinically and older nodules ulcerated along the medical aspect of the right leg (Fig. 3). The complete blood count was normal, except for hemoglobin, 10.9 mg per dL. Routine serum biochemical studies were also normal, except for albumin, 3.1 mg per dL, LDH, 312 U per L, and SGOT, 51 U per L. Serum amylase was 14 U per L (normal per 30 to 115 U per L) and serum lipase was 54,160 U per L (normal 0 to 200 U per L). Chest roentgenogram and tuberculin skin test were negative. A CT scan of the abdomen revealed extensive liver metastases. A second biopsy of the skin and subcutis of a necrotic nodule revealed lobular panniculitis with the characteristic picture seen in pancreatic fat necrosis (Fig. 4). The patient was presumed to have metastatic pancreatic carcinoma and pancreatic fat necrosis. Nodules subsequently developed on the thighs, arms, hands, wrists, and fingers. He developed arthritis and arthralgias of the ankles, wrists, and hands, bilaterally, and the right knee. Aspiration of a right knee effusion revealed numerous neutrophils, but no evidence of infection. Treatment was begun with the somatostatin analog, octreotide, in increasing doses. During this therapy, the lesions did not progress and new lesions did not appear. There was no change in the lipase level. Inadvertently, octreotide was omitted at discharge, but reintroduction of octreotide was associated with lack of further progression of the nodules, according to the patient's spouse; however the patient became progressively debilitated and his abdominal pain worsened, requiring continuous sedation. His condition deteriorated and he died several weeks after hospital discharge.
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PMID:Fat necrosis with features of erythema nodosum in a patient with metastatic pancreatic carcinoma. 883 28

Seven patients with unresectable liver metastases from colorectal carcinoma were treated with low-dose CDDP plus 5-FU continuous hepatic arterial infusion chemotherapy. A hepatic artery catheter was placed into the gastroduodenal artery at laparotomy or percutaneously placed into the proper hepatic artery via left subclavian artery. Through an injection port placed beneath the skin, 5-FU (300 mg/m2/day) was continuously infused for 5 days; CDDP (6 mg/m2/day) was infused for 5 successive days a week. One cycle consisted of 4 weeks. The response rate was 71% (1 CR, 4 PR, 2 NC). The CEA level decreased in all cases. The median survival was 17 months. Major toxicities were abdominal pain and appetite loss due to extrahepatic perfusion of the drugs. Failure in maintaining the catheter was a problem in most cases. The pharmacokinetic study demonstrated high hepatic extraction of CDDP and 5-FU (40% and 90%, respectively). These results suggest that continuous hepatic arterial infusion chemotherapy with low-dose CDDP plus 5-FU is effective for patients with unresectable liver metastases from colorectal carcinoma.
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PMID:[Continuous hepatic arterial infusion chemotherapy with low-dose CDDP plus 5-FU for liver metastases from colorectal carcinoma]. 885 71

The case of a patient with sudden onset of abdominal pain, hepatomegaly and laboratory findings which indicated necrosis of a parenchymal organ is reported. Patient died soon after the admission to hospital after fulminant disease development. At the time of admission diagnosis of hepatic vein occlusion, i.e., Budd-Chiari syndrome was made based on ultrasonographic finding. Obduction confirmed this finding showing lung adenocarcinoma with liver metastases as well as occlusion of all hepatic vein branches with thrombi. This report emphasizes the role of ultrasonographic diagnostics in the early diagnosis of Budd-Chiari syndrome.
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PMID:[The Budd-Chiari syndrome--case report of a patient with hepatic vein occlusion and adenocarcinoma of the lung]. 937 21


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