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)

The causes of extra-arterial dislocation of indwelling catheter (EAD), which was one of the serious complications in arterial infusion chemotherapy, were examined. Subjects were six cases of EAD among the 45 cases of gastric cancer with liver metastases treated with hepatic arterial infusion chemotherapy. According to the route of cannulation, EAD occurred more frequently in the cases of cannulation via gastroduodenal artery (18.5%) than in those via subclavian artery (5.5%). Concerning the drugs and their administration, all cases of EAD were treated by continuous injection of 5-fluorouracil (5-FU). Main symptoms of EAD were high fever, abdominal pain and anemia, which developed after administration of total doses from 4.0 g to 30.5 g of 5-FU. In conclusion, it was strongly suggested that arterial destruction due to the toxicity of 5-FU caused EAD in hepatic arterial infusion chemotherapy, especially in cases of cannulation via gastroduodenal artery due to the high concentration of 5-FU in a limited part of the arterial wall.
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PMID:[Extra-arterial dislocation of indwelling catheter in hepatic arterial infusion chemotherapy--special reference to tissue destruction by 5-fluorouracil]. 938 44

A case of a 38-years-old patient with carcinoid syndrome (paroxysmal skin flush, diarrhoea, abdominal pain) is documented although the search of the primary tumor was not able to localise it (possibly an intestinal one). Confirmatory diagnosis had a biochemical support in 262 mg/24 h urinary elimination of 5 HIAA (metabolic of serotonine). Particular aspects of the case are illustrated through intravitam documentation of the liver metastases (via portal vein) and the damage of the right heart (Hedinger syndrome) resulting from the involvement of the tricuspid valve apparatus (with clinical, phonomechanographic and echocardiographic abnormalities). The fatal evolution of the patient was due to uncontrolled aggravation of the portal high blood pressure syndrome (refractory ascites to diuretic treatment). It was impossible to us to obtain the morphopathological data. The specific elements of the carcinoid syndrome (including a convincing indirect illustration) with right cardiac involvement (known as Hedinger syndrome) are discussed, as well as the hypothetical place in pancreas of the primary carcinoid tumor.
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PMID:[The heart: bystander or participant in neoplasms? The Hedinger syndrome (carcinoid cardiopathy)]. 945 74

Chemoembolisation has been an effective treatment-option for unresectable colorectal liver metastases, however it frequently fails because of tumour progression outside the liver. We conducted a pilot study to assess the toxicity and efficacy of combined regional and systemic chemotherapy for patients having liver dominant disease. Three cycles of chemoembolisation using 50 mg adriamycin, 8 mg mitomycin C, 50 mg cisplatinum admixed with 10 ml of lipiodol were given at 6 weeks intervals. The systemic therapy consisted of 425 mg/m2 5-fluorouracil and 20 mg/m2 leucovorin by intravenous infusion 1-5 days repeated every 28 days. 41 patients were treated for the period 1st January 1994-31st December 1996. Out of these 27 were male, 14 female with a medium age of 62 years (40-78). Primary site of tumour was colon in 30 cases and rectum in 11 cases. 14 patients received prior chemotherapy (5 adjuvant, 9 palliative). Mean follow up time is 18 months (4-36) in this study. 27 partial and 1 complete remissions were achieved at the average response rate of 68%. Mean time of progression was 10.7 months (4-18), overall survival time was 15 months (4-36). Common toxicity was the postembolisation syndrome consisting of abdominal pain, fever, chills, reversible elevated liver enzymes. Four patients had drug-induced cholangiohepatitis. At 15 patients we experienced grade 3, toxicity (5 diarrhoea, 3 mucositis, 2 vomiting, 2 leukopenia, 2 thrombocytopenia, one skin rush). No treatment related death or catheter complications were observed. Although these treatment results are superior to our historical experience, a controlled clinical trial will be acquired to establish this approach.
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PMID:[Combined therapy of metastatic liver neoplasms: intrahepatic chemoembolization and systemic chemotherapy]. 960 65

We report three cases of giant gastric leiomyosarcoma. Diagnosis was made prior to surgery using various diagnostic modalities. The patients were two women (77 and 77 years old) and one man (40 years old) whose chief complaints were abdominal pain, anorexia, and tarry stool. All patients presented with a large palpable mass in their upper abdomen at the time of admission. Based on characteristic findings from a gastric barium study, computed tomography (CT), and angiography, the patients were diagnosed as having gastric leiomyosarcomas displaying extramural growth. In the first case, a patient received a total gastrectomy, while local resection was performed in the second case because of pedunculated extragastric development. In the third case, total gastrectomy was combined with splenectomy and resection of the pancreatic tail. Twenty-two months after the original operation, the first case had multiple liver metastases. We present the three cases here, and review the literature.
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PMID:Three cases of the giant gastric leiomyosarcomas. 965 68

Between January 1983 and August 1998, a total of 18 patients (14 men, 4 women; median age 58 years, range 36-75 years) with primary adenocarcinoma of the duodenum underwent surgical therapy. Main clinical symptoms were upper abdominal pain (61%), weight loss (44%) and anaemia (38%). The tumors were resectable in 10 patients (56%), and eight Whipple operations and two segmental duodenectomies were performed. Tumor classification according to the TNM system was pT2 (n = 2), pT3 (n = 6) and pT4 (n = 2). In eight patients, local lymph nodes were tumor positive (pN1), and in two patients synchronous liver metastases were excised. The UICC stage of the resected tumors was: stage I (n = 1), stage II (n = 1), stage III (n = 6) and stage IV (n = 2). In irresectable cases (n = 8), the patients underwent palliative (n = 6) or explorative (n = 2) operations. With no operative mortality, overall morbidity was 22% (4/18). Patients' survival was 90%, 66.7% and 53.3%, respectively, at 1, 3 and 5 years after resection. None of the patients with irresectable tumors survived longer than 25 months. Survival was significantly better for the resection group (P = 0.0027). Due to the often unspecific symptoms, the diagnosis of duodenal adenocarcinoma is frequently established at advanced tumor stages, resulting in a low resectability rate. Radical surgical resection of the tumors, however, is able to provide a more favorable prognosis for duodenal carcinoma than for other periampullary tumors.
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PMID:[Results of surgical therapy of primary adenocarcinoma of the duodenum]. 1041 1

Thirty patients with primary hepatocellular carcinoma or liver metastases were entered into a program of chemoembolization with cisplatin, lipiodol, and escalating doses of thiotepa. Doses of cisplatin were 100/m2, and thiotepa doses ranged from 9 mg/m2 to 24 mg/m2. Two of three patients with ocular melanoma had partial responses in the liver metastases for 3+ and 16 months. In patients with either hepatocellular carcinoma (15 patients) or primary cholangiocarcinoma of the liver (three patients), there were two partial responses, for 22 and 33 months. Five patients had minor responses: four with a 40% reduction in tumor and one with a mixed response. There were four early deaths, which involved sepsis in two patients, respiratory failure in one, and acute myocardial infarction in one. Otherwise, toxicity was tolerable and reversible and included abdominal pain and transient elevation of serum creatinine, bilirubin, and transaminases. Less common toxicities included ototoxicity and peripheral neuropathy. Chemoembolization of the liver with cisplatin, thiotepa, and lipiodol can produce responses, but toxicity can be significant. The recommended starting phase II dose for future studies is thiotepa 24 mg/m2 and cisplatin 100 mg/m2.
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PMID:A phase I study of chemoembolization with cisplatin, thiotepa, and lipiodol for primary and metastatic liver cancer. 1044 Jan 93

A 65-year-old man was admitted to our hospital complaining of upper abdominal pain, nausea and appetite loss during the treatment for the prostatic carcinoma. Computed tomography revealed multiple liver metastases. The patient was treated by intra-arterial infusion chemotherapy with, cisplatinum (CDDP) and Ifosfamide using an implantable port. The metastatic lesions were significantly decreased in size and number but CR was not achieved. CDDP was ceased at the total dose of 960 mg. The patient died due to brain metastases 20 months after the start of intra-arterial chemotherapy.
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PMID:[A case of metastatic liver tumors from prostatic cancer responding to intra-arterial infusion chemotherapy with CDDP and ifosfamide using implantable port]. 1044 91

A 56-yr-old man with complaint of abdominal pain and body weight loss was admitted to our hospital. Contrast-enhanced computed tomography on admission revealed a pancreatic tumor. Contrast-enhanced computed tomography 1 m.o. after admission revealed rapid growth of this tumor. We performed exploratory laparotomy with only a needle biopsy of the unresectable tumor because of extensive spread, including liver metastases. Further histological and immunohistochemical examination revealed that both the pancreatic tumor and the hepatic metastases featured malignant spindle-shaped cells. Despite radiotherapy, the patient died 40 d after laparotomy.
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PMID:A pancreatic anaplastic carcinoma of spindle-cell form. 1073 98

With adequate medical management the midgut carcinoid tumor generally is an indolent malignancy associated with substantial life expectancy and appreciable life quality, even in the presence of liver metastases and significant tumor burden. Abdominal complications may occur in this entity of carcinoids owing to entrapment of intestines and encasement of mesenteric vessels by mesenteric metastases and associated marked mesenteric fibrosis. This may be the cause of abdominal pain, disabling diarrhea, weight loss to the extent of malnutrition, and eventually the risk of death with acute or chronic intestinal obstruction or intestinal gangrene. Operative removal of the mesentericointestinal lesion is often indicated to prevent or treat these complications but may be technically difficult when mesenteric metastases extend in the vicinity of major vessels in the mesenteric root. At laparotomy 56 patients with advanced midgut carcinoids underwent removal of the mesenteric tumor with a method for preserving the mesenteric vessels. This was feasible by mobilizing and releasing the right colon and mesenteric root from posterior adhesions, identifying the mesenteric artery below the pancreas, and free-dissecting this artery on the tumor capsule in the mobilized mesentery. Dissection was successful even with tumors initially judged inoperable unless tumor growth completely surrounded the mesenteric vessels or extended retroperitoneally. One patient was subjected to distal intestinal artery bypass. Symptom relief was been substantial and often of long duration after mesenteric tumor removal in patients who prior to surgery often had threatening intestinal ischemia. Patients with advanced midgut carcinoids may benefit markedly from dissectional removal of mesenteric tumors, which (conceivably better than conventional wedge resection) preserves the length of the remaining intestine.
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PMID:Method for dissection of mesenteric metastases in mid-gut carcinoid tumors. 1103 14

We prospectively evaluated the initial presenting symptoms in 261 patients with Zollinger-Ellison syndrome (ZES) over a 25-year period. Twenty-two percent of the patients had multiple endocrine neoplasia-type 1 (MEN-1) with ZES. Mean age at onset was 41.1 +/- 0.7 years, with MEN-1 patients presenting at a younger age than those with sporadic ZES (p < 0.0001). Three percent of the patients had onset of the disease < age 20 years, and 7% > 60 years. A mean delay to diagnosis of 5.2 +/- 0.4 years occurred in all patients. A shorter duration of symptoms was noted in female patients and in patients with liver metastases. Abdominal pain and diarrhea were the most common symptoms, present in 75% and 73% of patients, respectively. Heartburn and weight loss, which were uncommonly reported in early series, were present in 44% and 17% of patients, respectively. Gastrointestinal bleeding was the initial presentation in a quarter of the patients. Patients rarely presented with only 1 symptom (11%); pain and diarrhea was the most frequent combination, occurring in 55% of patients. An important presenting sign that should suggest ZES is prominent gastric body folds, which were noted on endoscopy in 94% of patients; however, esophageal stricture and duodenal or pyloric scarring, reported in numerous case reports, were noted in only 4%-10%. Patients with MEN-1 presented less frequently with pain and bleeding and more frequently with nephrolithiasis. Comparing the clinical presentation before the introduction of histamine H2-receptor antagonists (pre-1980, n = 36), after the introduction of histamine H2-receptor antagonists (1981-1989, n = 118), and after the introduction of proton pump inhibitors (PPIs) (> 1990, n = 106) demonstrates no change in age of onset; delay in diagnosis; frequency of pain, diarrhea, weight loss; or frequency of complications of severe peptic disease (bleeding, perforations, esophageal strictures, pyloric scarring). Since the introduction of histamine H2-receptor antagonists, fewer patients had a previous history of gastric acid-reducing surgery or total gastrectomy. Only 1 patient evaluated after 1980 had a total gastrectomy, and this was done in 1977. The location of the primary tumor in general had a minimal effect on the clinical presentation, causing no effect on the age at presentation, delay in diagnosis, frequency of nephrolithiasis, or severity of disease (strictures, perforations, peptic ulcers, pyloric scarring). Disease extent had a minimal effect on symptoms, with only bleeding being more frequent in patients with localized disease. Patients with advanced disease presented at a later age and with a shorter disease history (p = 0.001), were less likely to have MEN-1 (p = 0.0087), and tended to have diarrhea more frequently (p = 0.079). A correct diagnosis of ZES was made by the referring physician initially in only 3% of the patients. The most common misdiagnosis made were idiopathic peptic ulcer disease (71%), idiopathic gastroesophageal reflux disease (GERD) (7%), and chronic idiopathic diarrhea (7%). Other less common misdiagnosis were Crohn disease (2%) and various diarrhea diseases (celiac sprue [3%], irritable bowel syndrome [3%], infectious diarrhea [2%], and lactose intolerance [1%]). Other medical disorders were present in 55% of all patients; patients with sporadic disease had fewer other medical disorders than patients with MEN-1 (45% versus 90%, p < 0.00001). Hyperparathyroidism and a previous history of kidney stones were significantly more frequent in patients with MEN-1 than in those with sporadic ZES. Pulmonary disorders and other malignancies were also more common in patients with MEN-1. These results demonstrate that abdominal pain, diarrhea, and heartburn are the most common presenting symptoms in ZES and that heartburn and diarrhea are more common than previously reported. The presence of weight loss especially with abdominal pain, diarrhea, or heartburn is an important clue suggesting the presence of gastrinoma. The presence of prominent gastric body folds, a clinical sign that has not been appreciated, is another important clue to the diagnosis of ZES. Patients with MEN-1 presented at an earlier age; however, in general, the initial symptoms were similar to patients without MEN-1. Gastrinoma extent and location have minimal effects on the clinical presentation. Overall, neither the introduction of successful antisecretory therapy nor widespread publication about ZES, attempting to increase awareness, has shortened the delay in diagnosis or reduced the incidence of patients presenting with peptic complications. The introduction of successful antisecretory therapy, however, has dramatically decreased the rate of surgery in controlling the acid secretion and likely led to patients presenting with less severe symptoms and fewer complications. (ABSTRACT TRUNCATED)
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PMID:Zollinger-Ellison syndrome. Clinical presentation in 261 patients. 1114 36


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