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

1. The safety in everyday clinical usage of three 4-quinolone antibiotics, (ciprofloxacin, norfloxacin and ofloxacin), was compared with similar data for azithromycin and cefixime, each agent being examined by Prescription-Event Monitoring (PEM) during the early post-marketing period. 2. In PEM the exposure data are derived from general practitioner prescriptions confidentially provided by the Prescription Pricing Authority. Outcome data are provided by questionnaires (green forms) on which the prescribing medical practitioner records event data. When necessary, further information is obtained from a number of sources which include follow-up of all pregnancies and the patients' life-time medical record. 3. The main outcome measures were demographic information, including the patient's date of birth and sex; the indication for prescribing the drug being monitored; the reason for stopping treatment; the start and stop dates of treatment and the events recorded during and after treatment. 4. The final cohort for each of the five antibiotics exceeded 11000 patients. The only event significantly related to the use of all five antibiotics was nausea/vomiting. This was also the most frequent adverse event causing treatment to be discontinued with norfloxacin, ofloxacin and azithromycin (relevant information was not requested in the studies of ciprofloxacin and cefixime). Vaginal candidiasis was significantly more frequently associated with the use of the three 4-quinolones than with azithromycin and cefixime but it was frequently delayed until the week or two after the cessation of therapy. Within each event, as recorded in these studies, the highest event rates (the number of events per 1000 patients) in the week following the start of therapy were: 9.2 for diarrhoea with cefixime; 4.9 for nausea/vomiting with ofloxacin; 2.4 for rash with azithromycin; 2.2 for abdominal pain with norfloxacin; 1.5 for headache/migraine with ofloxacin; 1.4 for malaise/lassitude with ofloxacin; 1.2 for dizziness with norfloxacin. Uncommon events (reported in less than 1:1000 patients) included rare cases of allergic phenomena, convulsions and pseudomembranous colitis. There were no reports of tendinitis, tenosynovitis or tendon rupture in children but tendon disorders were reported in the two months following the start of treatment in 20 adults. A total of 307 pregnancies were reported. Thirty-eight of the 55 women who received these drugs during the first trimester of pregnancy gave birth to healthy babies. No congenital abnormalities were reported. Apart from one case of unconfirmed pseudomembranous colitis, none of the other 2468 deaths that occurred in these studies was attributed to the antibiotics. 5. These five antibiotics are acceptably safe antimicrobial agents when used in general medical practice. PEM is an effective method for monitoring the safety of recently introduced antimicrobial agents.
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PMID:A comparison of ciprofloxacin, norfloxacin, ofloxacin, azithromycin and cefixime examined by observational cohort studies. 873 Sep 72

In Hong Kong, 70 healthy women aged 16-40 years at the gestational age of 14-20 weeks who requested legal termination of pregnancy were randomly allocated to receive either 400 mg misoprostol or a placebo (vitamin B6) 12 hours before initial administration of intravaginal gemeprost pessary (1 mg) every three hours. This double-blind study aimed to determine whether pretreatment with oral misoprostol can improve the efficacy of intravaginal gemeprost pessary to effect induced abortion. The two groups responded essentially the same in terms of the incidence of nausea, vomiting, dizziness, fatigue, breast tenderness, or lower abdominal pain during the interval between misoprostol administration and gemeprost administration. Similarly, side effects and analgesic requirements did not differ significantly. The complete abortion rate was not significantly different between the two groups (62.9% for misoprostol and 68.6% for placebo). Even though the induction-abortion interval was shorter and the amount of gemeprost required was smaller in the misoprostol group than the placebo group (27.3 vs. 28.2 hours and 4.9 vs. 5.7 mg, respectively), the differences were not significant (p = 0.0863 and 0.0957, respectively). These findings suggest that oral misoprostol does not facilitate termination of second trimester pregnancy by intravaginal gemeprost pessary.
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PMID:Termination of second trimester pregnancy with gemeprost and misoprostol: a randomized double-blind placebo-controlled trial. 880 4

Between 1990 and 1994, a series of prospective studies were conducted to optimize the treatment of multidrug-resistant falciparum malaria on the borders of Thailand. The tolerance of various treatment regimens containing either mefloquine 15 mg/kg (M15) or 25 mg/kg (M25) was evaluated in 3673 patients aged between 6 months and 88 years. Early vomiting (within 1 hour) is an important determinant of treatment outcome in these areas, despite re-administration of the dose. Overall, 7 % of the patients vomited within an hour. Significant risk factors were age < or = 6 years (relative risk (RR), 3.9) or > or 50 years (RR, 2.7), the higher mefloquine dose (M25) (RRm 2.7), vomiting < 24 hours before enrolment (RR, 2.5), axillary temperature > 38.0 degrees C (RR, 1.6), and parasitaemia > 10,000/microliter (RR, 1.3). In children < or = 2 years, 30% vomited with M25, and 13% did not tolerate a repeat dose. Vomiting was reduced 40% by splitting the higher dose (RR, 0.6; 95% CI, 0.4-0.8), and 50% by giving mefloquine on the second day in combination with artesunate (RR, 0.5; CI, 0.3-0.9). Anorexia, nausea, vomiting, dizziness, and sleeping disorders were 1.1-1.4 times more frequent with M25 than M15 in the three days following treatment, but were similar in the single or split-dose M25 groups, despite twofold higher mefloquine concentrations obtained with the latter. There was no evidence that diarrhoea, headache, and abdominal pain were associated with mefloquine use. High-dose mefloquine is well tolerated but should be given as a split dose.
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PMID:Mefloquine treatment of acute falciparum malaria: a prospective study of non-serious adverse effects in 3673 patients. 884 89

Four hundred and thirty six pupils in two primary schools in Kibwezi, Kenya aged between seven and sixteen years and positive for S. mansoni were treated as follows: 320 pupils with a single dose of praziquantel at 40 mg/kg body weight and 116 controls with a placebo. Immediate and delayed side effects of praziquantel were observed. The main side-effects were abdominal pain (36.3%), headache (35.3%) and nausea (13.1%). There was correlation between frequencies of these side-effects and intensity of infection measured as eggs per gram of faeces. Other side-effects included dizziness (9.7%), fever (7.8%), urticaria and bloody diarrhoea. Overall, the side-effects of praziquantel were mild and transient, and did not require any intervention. For ethical reasons, all pupils who served as controls were treated with praziquantel after the study.
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PMID:Praziquantel side effects during treatment of Schistosoma mansoni infected pupils in Kibwezi, Kenya. 889 62

A questioning survey was carried out to determine the acceptability to patients of various aspects of day-case laparoscopy in Korle-Bu Teaching Hospital. One hundred consecutive patients were interviewed within 2 weeks after operation. Sources of dissatisfaction include inadequate explanation about the operation and its aftermath, hospital reporting time, the waiting times at various stages of the process, the mechanism for sending patients from the ward to the theatre and the total length of time spent in hospital. Almost half the patients felt they were not well enough to be sent home at the time of discharge. More than half would have preferred overnight stay postoperatively. The main causes of morbidity were dizziness, abdominal pain, shoulder pain, nausea and vomiting. To make day-case laparoscopy more acceptable to patients a dedicated day care surgery unit with formal anaesthetic cover should be established. The operation and its aftermath should be fully explained to patients well before the day of operation. Stricter criteria should be established for patient discharge, and where appropriate, patients should be allowed the option of overnight stay post-operatively.
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PMID:Day-case laparoscopy in a Ghanaian teaching hospital: the patient's perspective. 893 26

Helicobacter pylori (H. pylori) is currently considered the most important exogenous factor in the genesis of gastritis and peptic ulcer disease. However, the optimum regimen for the eradication of H. pylori remains unclear. The purpose of this study was to evaluate the eradication rate of H. pylori, the side effects, and the patients' compliance with regard to various drug regimens. We also analyzed factors influencing the eradication of H. pylori. One hundred and eighty patients were included and divided into four groups: 42 patients (Group I) received tripotassium dicitrato bismuthate (240 mg b.i.d.), metronidazole (250 mg t.i.d.) and amoxicillin (500 mg t.i.d.) for 14 days; 55 patients (Group 2) received omeprazole (20 mg b.i.d.) and amoxicillin (1000 mg b.i.d.) for 14 days; 36 patients (Group 3) were treated with omeprazole (20 mg b.i.d.), metronidazole (250 mg t.i.d.) and amoxicillin (500 mg t.i.d.) for 14 days; and 47 patients (Group 4) received omeprazole (20 mg q.d.) and amoxicillin (500 mg t.i.d.) for 14 days and then tripotassium dicitrato bismuthate (240 mg b.i.d.) and nizatidine (150 mg q.d.) for 14 days. The diagnosis of H. pylori was made by histology. The eradication of H. pylori was defined both by histology (H&E and Giemsa stain) and by rapid urease test (CLOR) showing negative for H. pylori 4 weeks after the completion of therapy. Of the 180 patients, 95 patients had non-ulcer dyspepsia, 40 patients had gastric ulcer and 45 patients had duodenal ulcer. The eradication rate of H. pylori was highest (89.3%) in Group 3, as compared with Group 1 (68.9%), Group 2 (65.4%), and Group 4 (48.9%). The eradication rate was significantly higher in Group 3 than in Groups 2 and 4 (p < 0.05). There was no significant difference in the eradication rate among clinical diagnosis, sex and age. But, in the conventional triple therapy (Group 1), the eradication rate was higher in male (78.6%) than in female (46.2%). The side effects in order, were nausea (22.1%), dizziness (19.5%), abdominal pain (11.6%) and diarrhea (97%), and there was no difference among the drug regimens. The compliance of the patients was good (more than 80% irrespective of drug regimen). On the basis of these findings, the side effects of the drugs seemed minimal, and the compliance of patients was good irrespective of the drug regimen. In conclusion, the triple therapy with omeprazole, metronidazole and amoxicillin was the most effective regimen and could be recommended for H. pylori eradication.
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PMID:Evaluation of therapeutic regimens for the treatment of Helicobacter pylori infection. 894 97

An investigator-blind, parallel-group, multicentre study was undertaken to compare the efficacy and tolerability of once-daily, sustained-release (s-r) ibuprofen and diclofenac sodium in patients (mean age 59.8 years) suffering from painful osteoarthritis affecting chiefly the knee and/or hip. Patients attending eight Swiss centres received either two s-r tablets of ibuprofen (daily dose 1600 mg; n = 30) or a single s-r diclofenac 100 mg tablet (n = 31) each evening for 21 days. Clinical assessments were performed prior to initiating therapy and after 7 and 21 days of treatment. Both treatments were efficacious, but statistically significant differences in favour of s-r ibuprofen were observed for the principal measure of efficacy, the investigator's assessment of the overall change in clinical condition; by Day 21, 37% of ibuprofen-treated patients vs 10% of diclofenac-treated patients were 'much improved' (p = 0.04). Patients' assessments of the efficacy of their treatment also favoured s-r ibuprofen at Day 7 for the relief of night pain (p = 0.048), at Day 21 for alleviation of day pain (p = 0.006) and for the ability to carry out normal activities (p = 0.01), and at both Days 7 and 21 for quality of sleep (p = 0.04 and 0.03, respectively). The patients' overall opinion of treatment was also significantly in favour of s-r ibuprofen, which was rated 'good or excellent' by 80% (24/30), compared with only 38% of patients (11/29) receiving s-r diclofenac sodium (p = 0.002). Two patients (6%) receiving s-r diclofenac sodium ceased treatment owing to dizziness and severe diarrhoea, respectively; there were no withdrawals in the ibuprofen-treated group. Ten (32%) patients in the s-r diclofenac group reported a total of 12 adverse events (mostly gastrointestinal in nature), compared with three (10%) patients in the s-r ibuprofen group who reported only three events (abdominal pain, insomnia and constipation). In conclusion, although both NSAID treatments improved the clinical condition of patients with painful osteoarthritis, statistically significant differences in favour of once-daily s-r ibuprofen (1600 mg) were demonstrated in terms of efficacy, indicating a potential therapeutic advantage for this formulation. Ibuprofen was also better tolerated than diclofenac sodium (100 mg/day), the latter being associated with gastrointestinal side effects in a significant proportion of patients. Sustained-release ibuprofen (Brufen Retard) thus represents an important addition to the available therapeutic armamentarium of once-daily NSAID formulations.
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PMID:Ibuprofen and diclofenac sodium in the treatment of osteoarthritis: a comparative trial of two once-daily sustained-release NSAID formulations. 901 Jun 10

Algorithms for the diagnosis of ectopic pregnancy are applied independent of the patient population. However, patients may require care at various times of gestation or for different reasons. To examine the utility of the same diagnostic criteria for identifying an ectopic pregnancy in different patient populations, we evaluated women from the infertility clinic and the residents' gynecology clinic at Yale-New Haven Hospital. Sixty women with nonemergency ectopic pregnancies were identified, 38 from the infertility clinic and 22 from the residents' clinic. Although the most common symptoms were the same in both groups (abdominal pain, spotting/bleeding >3 days, dizziness, shoulder pain), they were significantly more frequent in women form the residents' clinic. Despite care by the same attending physicians, ruptured ectopic pregnancies were more than 3 times as likely to occur in the noninfertility patients, and half as likely to be treated laparoscopically (p<0.01). Patients from the residents' clinic also were more likely to have postoperative complications (p<0.5), and had over a threefold higher risk of receiving a blood transfusion. We conclude that criteria for diagnosis and intervention in ectopic pregnancy may have to be modified on the basis of characteristics of the patient population.
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PMID:Failure of standard criteria to diagnose nonemergency ectopic pregnancies in a noninfertility patient population. 905 Apr 75

Cabergoline (CAB), a new, potent, and long-lasting PRL-lowering agent, was shown to be effective in tumoral hyperprolactinemia. The aim of this study was to investigate the effectiveness of CAB in patients with prolactinoma proven to be resistant to bromocriptine (BRC) and quinagolide (CV 205-502). Twenty-seven patients (19 macro- and 8 microprolactinomas) were treated with CAB at a weekly dose of 0.5-3 mg for 3-22 months. All patients were previously shown to be resistant to BRC, and 20 of them were resistant to CV 205-502 as well. Basal serum PRL levels before CAB treatment ranged from 108-3500 micrograms/L in macroprolactinomas and from 64-205 micrograms/L in microprolactinomas. Gonadal failure was present in all patients, whereas symptoms of tumor expansion, such as visual field defects and headache, were present in 10 of 27 patients. Eight macroprolactinomas had previously undergone surgery and/or radiotherapy. CAB treatment normalized serum PRL levels in 15 of 19 macroprolactinomas and in all 8 microprolactinomas. In 3 of the remaining 4 patients it caused a notable decrease in prolactinemia (89%, 80.5%, and 68.7% of the baseline). Only 1 patient was withdrawn from CAB therapy after 3 months at the weekly dose of 2 mg due to the absence of any significant clinical, hormonal, or radiological improvement. Gonadal function was restored in 18 of 27 patients, galactorrhea disappeared in 5 of 6 women, and headache improved in 7 of 8 patients. A significant tumor shrinkage was detected by computed tomography and/or magnetic resonance imaging in 9 macroprolactinomas and 4 microprolactinomas. CAB was well tolerated by all patients, except 6 who referred slight and short-lasting nausea, postural hypotension, abdominal pain, dizziness, and sleepiness at the beginning of treatment. In particular, CAB was well tolerated by 19 patients previously shown to be poorly tolerant to BRC and CV 205-502. In conclusion, CAB may represent, at the moment, the only successful therapy for prolactinoma-bearing patients resistant to BRC and CV 205-502, as it normalized PRL levels in 22 of 27 patients, reduced tumor size in 13 of 27 patients, and improved clinical symptoms in 25 of 27 patients in the present study.
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PMID:Prolactinomas resistant to standard dopamine agonists respond to chronic cabergoline treatment. 925 67

A retrospective study at the Poison Control Center of Costa Rica describes the pattern of pesticide poisoning that occurred during 1996. A total of 1274 pesticide exposures were reported. Occupational exposures were the most frequent (38.5%), followed by accidental situations (33.8%) and suicidal attempts (22.5%). The male to female ratio was 2.4:1. Eighty-percent of the patients had symptoms at the moment of the consult. Organophosphates, carbamates and bipyridyliums were the agents mostly involved (46%); clinical findings with these products were nausea, vomiting, abdominal pain, dizziness and headache. Calls came mainly from hospitals and clinics (75%) followed by home calls (18.2%). Education of the users of pesticides and the community in general is essential to creating an awareness of the toxicity of these agents and to reduce morbidity cases.
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PMID:Pesticide poisoning in Costa Rica during 1996. 946 10


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