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)

Enterocolitis in oncology patients remains an important complication, but there is a lack of insight into its likely severity from microbial, pathological and inflammatory aspects. Paediatric oncology patients admitted with neutropenic fever, who developed abdominal pain and diarrhoea, were monitored by the takers of rectal biopsies, cultures, and inflammatory marker measurements. Twenty-five patients were included (mean age 7.1 years). 8 patients (32%) needed intensive care treatment, 3 (12%) patients died. Gram-positive bacteraemia was diagnosed in 4 patients (16%). Most patients had negative blood and stool cultures. Predictors of a severe clinical course of the enterocolitis were an increased serum interleukin-8 (IL-8) (>1000 pg/ml) level and an increased serum C-reactive protein level (CRP) (>150 mg/l) level, both measured on the first day of clinical illness. Relative risks (RR) for admission to an Intensive Care Unit (ICU) were 11.3 (95% Confidence Interval (CI) 1.6-77.9) for elevated IL-8 levels and 6.4 (95% (CI) 0.92-45.1) for increased CRP levels. Rectal biopsies and pathology could not predict outcome (P=0.22). IL-8 analysis at the onset of enterocolitis symptoms can identify high-risk patients, which might be used clinically to design future intervention trials.
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PMID:Severity of enterocolitis is predicted by IL-8 in paediatric oncology patients. 1496 25

A study in healthy men and women was performed to assess the safety, tolerability, pharmacokinetics (PK) and pharmacodynamics (PD) of orally administered recombinant human interleukin-11 (oprelvekin) (OAO). Four cohorts of 10 subjects each received 3, 5, 10 or 30 mg (8:2/OAO:placebo ratio), first as a single dose with a 7-day washout period, then 7 consecutive daily doses. Safety was assessed by ongoing evaluation of adverse events (AEs) and laboratory values. PK samples were collected on the first and last day of dose administration. The established effects of subcutaneous oprelvekin on C-reactive protein (CRP, upward arrow), platelet count (upward arrow), fibrinogen (upward arrow) and hemoglobin (downward arrow), were evaluated. PK analysis showed that most subjects (27/34, 79%) had undetectable serum levels of IL-11. PD measures showed no changes from baseline between any OAO group and the placebo group. Orally administered oprelvekin was safe and well tolerated at all doses. A total of five AEs (abdominal pain, diarrhea, headache, rhinitis, grade 3 alanine aminotransferase elevation) were reported across all groups. Evaluations of serum IL-11 levels indicate that OAO is not systemically absorbed at levels above the lower limit of the bioanalytic assay. These data in addition to the lack of effect on PD measures suggest that there is a decreased potential of systemic adverse events with OAO.
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PMID:A multiple-dose, safety, tolerability, pharmacokinetics and pharmacodynamic study of oral recombinant human interleukin-11 (oprelvekin). 1538 78

A 47-year-old woman was admitted to our hospital with complaints of fever, upper abdominal pain, and back pain. The serum amylase, C-reactive protein (CRP), and IgG (especially IgG4) were elevated, and abdominal computed tomography (CT) revealed diffuse enlargement of the pancreas and pseudocysts. Endoscopic retrograde pancreatography (ERP) revealed diffuse irregular narrowing of the main pancreatic duct. Histopathological examination of the pancreatic tissue showed fibrotic change with lymphocytic infiltration. Based on these findings, we diagnosed this case as a case of autoimmune pancreatitis. This case also fully satisfied the diagnostic criteria for autoimmune pancreatitis established by the Japan Pancreas Society in 2002. Few reports have been published on cases of autoimmune pancreatitis complicated by the formation of pseudocysts in the pancreas. We, therefore, report this case here to emphasize that cases of autoimmune pancreatitis can be complicated by the development of pseudocysts.
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PMID:Autoimmune pancreatitis with pseudocysts. 1554 56

The aim of our study was to further improve the preoperative diagnosis of acute appendicitis in children and adolescents. All diagnostic parameters from the patients' medical history (duration and quality of abdominal pain, stool behaviour), the laboratory (leukocytes, C-reactive protein), the clinic (defense, tenderness on percussion, nausea, vomiting, dry tongue) and repeated ultrasound investigations (visualisation of the appendix, indirect signs of an inflammatory process in the appendix region) were documented prospectively and were re-assessed with regard to their diagnostic value. As an additional parameter, procalcitonin was determined. 1156 patients (593 male/563 female) with a mean age of 9.51 years (+/- 1.2 yrs) (max. 15 yrs/min. 2.3 yrs), referred to the department with acute abdominal pain, were examined. 233 (141 male/92 female; 20.1 %) of these patients with a mean age of 10.47 years (+/- 1.1 yr) had appendicitis. Based on the patients' medical history, laboratory findings, the initial clinical investigation and the initial ultrasound investigation, 173 patients (74.3 % of the later operated 233 children with appendicitis) were diagnosed with certainty. The diagnosis of 60 patients (25.7 %) of this group remained uncertain. These patients received a saline enema (Clysmol, Pharmacia & Upjohn Company) and were subjected to a second clinical and sonographic investigation after approximately four hours of parenteral fluid substitution (Ringer's lactate, Mayrhofer Pharmazeutika Company, 4 ml/kg/h). The other 923 patients (79.83 %) were discharged and were followed up as outpatients in the following days. Based on this stepwise procedure, the percentage of correctly diagnosed appendicitis could be increased to 97.4 %. The measurement of procalcitonin proved to be of no value in the diagnosis of acute appendicitis. It may be concluded that in children with abdominal pain, high diagnostic accuracy can only be achieved by a carefully combined evaluation of all individual diagnostic parameters and repeated investigations.
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PMID:Advancements in the diagnosis of acute appendicitis in children and adolescents. 1563 Jun 42

In order to provide an accurate diagnosis and management strategy for adult patients with acute abdominal pain and peritoneal irritation, it is important to understand the value of various forms of diagnostics modalities. History, physical examination and laboratory results can generally differentiate between an acutely serious and a less serious abdominal problem. Patients with acute abdominal pain and no increase in either the leukocyte count or the concentration of C-reactive protein should be re-evaluated after 12 hours. If laboratory values are increased, then diagnostic imaging is necessary. For patients with diffuse abdominal pain and for patients with signs of shock or respiratory insufficiency, a CT-scan is the imaging method of choice. If symptoms are located in the left upper quadrant, an upright chest radiograph or a plain abdominal film are recommended. If symptoms are located in the right upper quadrant, ultrasonography will be preferred. If the diagnosis is still uncertain, a CT-scan will be performed. A CT-scan is indicated for lower abdominal pain in women with increased inflammatory parameters and in men aged 50 years or older with increased inflammatory parameters. If the cause of the abdominal pain is still unclear following a CT-scan, then diagnostic laparoscopy may be considered for fertile women of childbearing age and for men aged less than 50 years with signs of appendicitis.
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PMID:[Diagnostic modalities in diagnosis of adult patients with acute abdominal pain]. 1590

Hematological and biochemical tests, including white blood cell count (WBC), C-reactive protein (CRP) and other acute-phase reactants, have been used in the diagnosis of acute appendicitis. However, there is controversy among physicians about the value of this practice in children. The objective of our study was to evaluate serum amyloid A protein (SAA) levels in children with confirmed acute appendicitis and to compare the sensitivity and specificity of this marker of inflammation with those for WBC and CRP. A prospective cohort study of 60 children admitted with abdominal pain to rule out appendicitis was used in the study. Of these, 42 underwent surgery, while 18 children who had spontaneous amelioration within 24 h of admission were not operated on and served as controls. WBC and serum SAA and CRP levels were obtained preoperatively. Serum concentrations of the analytes were determined with particle-enhanced immunonephelometric methods. Patients with acute appendicitis had WBC, SAA and CRP levels higher than those of the control group (p<0.001). There was no appendicitis patient with a normal SAA value, while 21.4% of the patients had CRP values within the normal range. The performance of each test was measured by receiver-operating characteristic curves. Area under the curve (AUC) values were 0.849 for WBC, 0.868 for CRP and 0.964 for SAA. The sensitivity and specificity of these methods were 76% and 75% for WBC>10.0 x 10(9) /L, 62% and 94% for CRP>10 mg/L and 86% and 83% for SAA >45.0 mg/L, respectively. Circulating SAA levels have better discriminatory value than WBC or CRP in the assessment of acute appendicitis in children. Thus, this test appears to be of higher value than the current standards of care in the diagnosis of this condition.
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PMID:Serum amyloid A protein levels as a possible aid in the diagnosis of acute appendicitis in children. 1565 42

We describe an inflammatory tumor in the Spiegel lobe of the liver of an 81-year-old woman. The patient was referred to our hospital for evaluation of a fever of over 39 degrees C and upper abdominal pain. Both conditions had persisted for five days in spite of antibiotic treatment. Initial laboratory tests revealed a serum C-reactive protein concentration of 20.9 mg/dL and white blood cell count of 15,500/microL. Abdominal ultrasound showed a hypoechoic lesion measuring 4 cm in diameter in the Spiegel lobe of the liver. A follow-up abdominal ultrasound revealed that the hypoechoic lesion was not decreased in size. Computed tomography showed a moderate-to-high-density area in the arterial phase and a low-density area in the Spiegel lobe on delayed phase. Magnetic resonance imaging showed a faint low-intensity lesion on T1-weighted imaging and moderate-to-high-intensity lesion on T2-weighted imaging in the Spiegel lobe. Angiography showed a slight hypervascularity in the area of the Spiegel lobe. Antibiotics and nu-globulin were commenced soon after admission and the fever gradually improved. Ultrasound-guided liver biopsy revealed that the hepatic parenchyma was almost completely replaced by dense hyalinized fibrous tissue and inflammatory cells. These findings were construed to indicate a benign lesion, but the tumor remained unchanged. Malignant disease could not be completely ruled out. Segment 1 of the liver was resected. Macroscopic examination of the resected specimen revealed a gray, fibrotic, solid tumor. The border of the tumor was well-circumscribed but not encapsulated. Microscopically, the tumor showed a marked fibrotic background with infiltration by a mixed population of lymphocytes, plasma cells, histiocytes, and reactive, plump spindle cells. The postoperative course was uneventful. The patient has remained well in the 10 months since the resection without recurrence.
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PMID:Inflammatory pseudotumor in the Spiegel lobe of the liver of an elderly woman. 1594 20

A 74-year-old woman was admitted to our hospital because of vomiting and abdominal pain. She had been well until 24 hours before admission, when she had had her last meal. She had not eaten anything unusual. She developed pain in the left lower abdominal quadrant, and difficulties with her bowel movements. An enema was given unsuccessfully. There was progressive distension of the abdomen. The patient started to vomit gastric and later bilious contents. No history of abdominal symptoms or weight loss was reported. She currently takes oral antidiabetic agents and an angiotensin II blocker because of hypertension. On physical examination she was not in distress and was afebrile, blood pressure 130/100 mmHg, pulse rate 88 beats/min. On auscultation increased bowel sounds with rushes of high-pitched sounds were heard. Her abdomen was distended and a large tender mass filling the whole left lower quadrant without signs of peritoneal irritation was found. There were no faeces on rectal examination. The leucocyte count was 10.2 mmol/L, haemoglobin 7.2 mmol/L, C-reactive protein 36 mg/l and lactate dehydrogenase 535 U/l. Under suspicion of a mechanical bowel obstruction without signs of peritonitis, the patient was treated with a nasogastric tube, fasting and enemas on which she improved. An abdominal X-ray in bed taken on day two showed no bowel distension (figure 1). After removing the nasogastric tube on day two the nausea returned. Abdominal examination was unchanged. An abdominal computed tomography (CT) scan after drinking oral contrast and intravenous contrast was performed (figure 2).
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PMID:A patient with abdominal distension. 1595 87

We report a case of spontaneous bacterial peritonitis caused by Klebsiella pneumoniae in a 34-year-old male recipient shortly after kidney transplantation. On posttransplant day 10, the patient started complaining of severe abdominal pain and nausea. Body temperature was 38.4 degrees C. The abdomen was diffusely tender with rigidity and rebound. Laboratory data showed a normal erythrocyte sedimentation rate and serum creatinine level but a slightly elevated C-reactive protein concentration and leukocytosis of 36,200 cells/mm(3) with 88% neutrophils. Explorative laparotomy revealed diffuse purulent peritonitis without an intraabdominal source of infection, such as intestinal perforation. The peritoneal fluid revealed greater than 1000/mm(3) white blood cells and many gram-negative bacilli. Fluid cultures yielded growth of Klebsiella pneumoniae. The patient responded to antibiotic therapy; he was discharged in good condition. This case report draws attention to the impaired host defense that may predispose to spontaneous bacterial peritonitis in renal transplant recipients and alerts the clinician to the possibility of this rare disease.
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PMID:Klebsiella pneumoniae peritonitis shortly after kidney transplantation. 1596 56

A 40-year-old Japanese man who developed upper abdominal pain, weight loss, and hypertension was diagnosed as suffering with polyarteritis nodosa (PAN) with lesions of the superior mesenteric artery (SMA). Three-dimensional computed tomographic angiography (3D-CTA) and conventional angiography revealed smooth segmental luminal narrowing of the branches of the SMA. In addition, an enhanced abdominal CT scan demonstrated diffuse thickening of the wall of the affected SMA. Treatment with high-dose corticosteroids resulted in immediate improvement of the abdominal manifestations and normalized the serum C-reactive protein levels. Furthermore, the subsequent enhanced CT and 3D-CTA revealed improvement of the wall thickening and luminal narrowing of the SMA and its branches during the treatment period. In addition to possessing the diagnostic usefulness of conventional angiography, 3D-CTA is also less invasive and facilitates the prompt and accurate diagnosis of PAN. Furthermore, thickening of the wall of medium-sized arteries evidenced by enhanced CT scan may also support a diagnosis of PAN.
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PMID:A case of polyarteritis nodosa with lesions of the superior mesenteric artery illustrating the diagnostic usefulness of three-dimensional computed tomographic angiography. 1604 7


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