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)

Crack cocaine is commonly smoked in a pipe with a metallic filter made from a steel wool scouring pad. We report an unusual complication of smoking crack cocaine: the aspiration and ingestion of a Brillo pad filter. A 34-year-old female presented 7 h after drinking beer and smoking crack. She was concerned that she might have inhaled the "screen" from her crack pipe, a piece of Brillo pad the size of her fingertip. She complained of "burning" in her throat, a foreign body sensation, and change in her voice, but no dyspnea, dysphagia, or abdominal pain. On physical examination, she was afebrile with a pulse of 105 beats/min and respiratory rate of 24 breaths/min. She was tearful and spoke in a whisper. There were no visible oropharyngeal burns and the lungs were clear to auscultation, but she had intermittent inspiratory stridor. The O2 saturation was 96%, and the ethanol concentration was 100 mg/dl. No foreign body or burn was seen on indirect laryngoscopy. A lateral neck x-ray study showed a normal epiglottis and no foreign body. Chest x-ray studies were unremarkable. Fiberoptic laryngoscopy showed left posterior arytenoid edema and swelling. An abdominal x-ray study revealed a foreign body in the right lower quadrant consistent with the Brillo pad filter. The next morning, the patient was asymptomatic and was discharged, recovering without sequellae. While crack pipe screen aspiration is a rarely reported event, physicians should be aware of the potential for foreign body aspiration and ingestion by this mechanism.
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PMID:Brillo pad crack screen aspiration and ingestion. 984 1

Amplification of the human epidermal growth factor receptor 2 protein (HER2) in primary breast carcinomas has been shown to correlate with poor clinical prognosis for certain patients. Trastuzumab (Herceptin, Genentech, Inc., South San Francisco, California) is a highly purified recombinant DNA-derived humanized monoclonal immunoglobulin G1 kappa antibody that binds with high affinity and specificity to the extracellular domain of the HER2 receptor. In vitro and in vivo preclinical studies have shown that administration of trastuzumab alone or in combination with paclitaxel or carboplatin significantly inhibits the growth of breast tumor-derived cell lines that overexpress the HER2 gene product. At therapeutic doses in breast cancer patients, the mean half-life of trastuzumab is 5.8 days. Trastuzumab serum concentrations reach steady state with mean trough and peak concentrations of 79 microg/mL and 123 microg/mL, respectively. In a 222-patient, single-arm clinical study, treatment with a loading dose of trastuzumab 4 mg/kg administered IV followed by weekly IV doses of 2 mg/kg produced an overall response rate of 14% (2% complete remission and 12% partial remission). The beneficial effects were greatest in patients with the greatest degree (3+) of HER2 protein overexpression. In another clinical study, 469 women with metastatic breast carcinoma were randomized to a paclitaxel or anthracycline-plus-cyclophosphamide regimen with or without trastuzumab. The overall response rate was significantly greater in the trastuzumab-plus-chemotherapy group than in the chemotherapy-alone cohort. The magnitude of observed effects was greatest with pacli taxel plus trastuzumab. The most common adverse effects attributed to trastuzumab in clinical studies were fever and chills, pain, asthenia, nausea, vomiting, increased cough, diarrhea, headache, dyspnea, infection, rhinitis, and insomnia. Trastuzumab in combination with chemotherapy can lead to cardiotoxicity, leukopenia, anemia, diarrhea, abdominal pain, and infection. Trastuzumab has been approved by the US Food and Drug Administration as a single agent for the treatment of patients who have metastatic breast cancer involving overexpression of the HER2 protein and who have received 1 or more chemotherapy regimens; in combination with paclitaxel, it has been approved for the treatment of such patients who have not received chemotherapy.
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PMID:Trastuzumab, a recombinant DNA-derived humanized monoclonal antibody, a novel agent for the treatment of metastatic breast cancer. 1021 34

To determine the public's perception as to the general definition of an emergency medical condition (EMC), and to compare opinions between the general public and healthcare workers (HCW) on which specific medical conditions require emergency department (ED) care, a survey of people at 12 supermarkets and shopping malls in Northern California was conducted over a 6-month period in 1997. Individuals over age 18 were asked in person to complete a survey sheet. It asked participants to choose one of four definitions of "emergency medical condition." In addition, people were asked to determine which of 30 chief complaints they thought needed care in the ED. Demographic information was also collected. A second set of surveys asking the same questions was conducted among nonemergency healthcare providers at hospitals. Healthcare worker was defined as an MD, RN, LVN, or PA. A total of 1,018 members of the public and 126 healthcare workers completed the survey. EMC definitions selected by the public were: 1) an abbreviated federal EMTALA definition: a condition that may result in death, permanent disability, or severe pain (48.7%); 2) the federal definition plus other conditions preventing work (3.0%); 3) the federal definition plus any other conditions outside business hours (16.5%); and 4) any condition at any time as determined by the patient (31.6%). HCWs selected the following: definition 1 (71%); definitions 2 and 3 (0%); and definition 4 (27%). Definitions 1 and 3 were statistically different when comparisons were made between the public and HCWs. On the question of which of the 30 chief complaints needed care in an ED, agreement was seen between the public and HCWs for severe abdominal pain (94% vs. 99%, respectively) and severe chest pain (96% vs. 99%, respectively). However, the two disagreed on the need for ED care for severe headache (58% vs. 91%, respectively); mild chest pain (51% vs. 79%, respectively); and difficulty breathing (77% vs. 98%, respectively). No significant difference in opinions on the need for ED care was seen for some minor conditions: mild headache, sore throat, cough, flu symptoms, minor foot problems. No significant differences in answers occurred when age groups, occupations, or locations were compared. In conclusion, the public has split views concerning the general definition of an emergency medical condition. Approximately half uses a conservative federal definition, and half uses patient self-determined need as the definition. Data on which specific conditions need ED care provide additional insight on agreement between the public and HCWs on most problems. Both groups agree that many perceived minor medical complaints do not require ED care.
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PMID:How do prudent laypeople define an emergency medical condition? 1033 30

A multinational, multicentre, randomized, prospective, parallel-group study compared treatment with ciprofloxacin administered as an oral suspension (500 mg twice daily for 7 days) with co-amoxiclav tablets (625 mg three times daily for 7 days) in patients suffering from acute exacerbations of chronic bronchitis (AECB). A total of 147 of 165 cases treated with ciprofloxacin (89.1%) and 146 of 162 cases treated with co-amoxiclav (90.1%) were classified as being clinical successes at the primary efficacy assessment 7 days after the end of therapy (assessed as reduced cough, improvement in dyspnoea, reduction in 24-h sputum volume or reduced purulence of sputum). Treatment equivalence was statistically confirmed; treatment difference:--1.0%, 95% CI--6.6% and 4.5%. Before treatment, 128 bacterial strains were isolated from 103 patients (60 ciprofloxacin and 68 co-amoxiclav). The most commonly isolated organism was Haemophilus influenzae (60 isolates), followed by Moraxella catarrhalis (12 isolates), Streptococcus pneumoniae (11 isolates) and Staphylococcus aureus (10 isolates). At day 14, 40 of 46 ciprofloxacin-treated patients (87.0%) and 46 of 55 co-amoxiclav-treated patients (83.6%) who were valid for bacteriological analysis were classified as being bacteriological success (classed as eradication, eradication with colonization or presumed eradication; treatment difference: 3.3%, 95% CI--8.3% and 14.9%). The adverse event profile was comparable between treatment groups. Most adverse events considered possibly or probably related to study drug were related to the gastrointestinal system and were of mild or moderate severity: nausea (13% ciprofloxacin, 10.6% co-amoxiclav), flatulence (10.3% ciprofloxacin, 3.9% co-amoxiclav), abdominal pain (7.6% ciprofloxacin, 7.3% co-amoxiclav) and diarrhoea (4.3% ciprofloxacin, 6.7% co-amoxiclav). We concluded that a 7-day course of ciprofloxacin suspension is equivalent to a 7-day course of co-amoxiclav tablets in terms of clinical and bacteriological efficacy and tolerability for the treatment of AECB. Thus, ciprofloxacin suspension may offer a suitable alternative treatment for AECB patients who have difficulty in swallowing, or who prefer liquid medications to tablets.
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PMID:The efficacy and safety of a new ciprofloxacin suspension compared with co-amoxiclav tablets in the treatment of acute exacerbations of chronic bronchitis. 1046 89

Benign tumors of the small bowel are rare. They present with many different manifestations depending on the size and location, and also cause a variety of symptoms that are often nonspecific. These include abdominal pain, dyspepsia, nausea, vomiting, and gastrointestinal bleeding that may be melena or hematemesis. Most of the time patients are asymptomatic and the lesions are discovered as an incidental finding. When bleeding occurs, and it may be severe in certain situations, the patient may develop signs of anemia, such as dyspnea, fatigue, and even high-output cardiac failure. The authors present a patient who was evaluated for melena and who was found to have a duodenal polyp that proved to be a Brunner's gland adenoma on pathology.
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PMID:A Brunner's gland adenoma as a cause of anemia. 1047 86

A 65-year-old man was admitted to our hospital because of thirstyness and left lower abdominal pain. On admission, he was found to have urolithiasis, renal insufficiency (BUN: 73 mg/dl, Crt: 4.4 mg/dl), and hypercalcemia (13.2 mg/dl). Chest X-ray films and computed tomograms showed enlargement and calcification of the hilar lymph nodes, and thickened interlobar fissures in both lungs. Levels of angiotensin converting enzyme (30.2 IU/l) and 1.25 (OH)2VitD3 (66.4 pg/ml) were elevated. Histologic examination of the specimen obtained from transbronchial lung biopsy showed non-caseous epithelioid cell granulomas. Because the level of parathyroid hormone was normal and no malignancies were detected, a diagnosis of sarcoidosis was made. Treatment with extracorporeal shock wave lithotripsy, transurethral lithotomy, saline infusion, and prednisolone (30 mg/day) alleviated the urolithiasis, renal insufficiency, and hypercalcemia. After discharge, the patient was followed up and given prednisolone therapy. About 1 month after the prednisolone dose had been tapered to 15 mg/day, the patient experienced dyspnea and facial and pedal edema. Because congestive heart failure was diagnosed, he was re-admitted to our hospital for a second time. Although he was then placed on intensive therapy, he died of ventricular tachycardia associated with sarcoidosis of the heart.
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PMID:[Sarcoidosis with hypercalcemia, urolithiasis, renal insufficiency, and heart failure]. 1048 65

A 60-year-old woman was admitted to our hospital in February 1993 due to dizziness, dyspnea, abdominal pain, and high susceptibility to bleeding. Physical examination revealed livedo reticularis of the foot, but did not detect hepatosplenomegaly. Examination of the peripheral blood detected pancytopenia, leukoerythroblastosis, and tear-drop erythrocytes. Primary myelofibrosis (PMF) was diagnosed on the basis of bone marrow biopsy findings. Antiphospholipid syndrome (APS) was confirmed by positive response to anti-cardiolipin antibody and recurrent splenic infarction. Because of factor XIII deficiency, the patient experienced severe gingival bleeding after tooth extraction. Her condition was complicated by mesenteric arterial thromboembolism and she died of sepsis 5 years after onset. Although the incidence of immunopathy in PMF patients is high, few studies to date have focused on APS patients presenting with a variety of severe embolic symptoms. Our patient required careful monitoring due to bleeding tendency and thromboemboli.
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PMID:[Primary myelofibrosis with fatal mesenteric arterial thromboembolism caused by antiphospholipid syndrome]. 1049 39

Pheochromocytomas are rare neoplasias of the adrenal medulla which generally present with paroxysmal or sustained hypertension. Cardiogenic pulmonary edema is a common feature of these tumors, but few cases have been described with noncardiogenic pulmonary edema. We report a pheochromocytoma with the principle manifestation of noncardiogenic pulmonary edema and characterize a genetic lesion associated with the disorder. A 30-year-old man was admitted with abdominal pain and breathlessness. x-Ray examination of the chest revealed a massive, diffuse infiltration of the left lung without cardiomegaly. No paroxysmal blood pressure fluctuations or heart failure were evident during the entire course, and the infiltrate and dyspnea resolved in three days without inotropic or diuretic agents. Serum norepinephrine and epinephrine levels were elevated twenty and fifty times above normal, respectively. The patient was ultimately diagnosed with multiple endocrine neoplasia type 2A (MEN 2A). Mutations in the RET proto-oncogene have been described recently in patients with MEN 2A. Mutation analysis of selected RET exonic sequences identified a germline mutation at codon 634 in exon 11 of the RET proto-oncogene. The mutation introduces a transition encoding a non-conservative substitution from TGC (Cys) to CGC (Arg) and creates a novel restriction site recognized by HhaI. We further screened for this mutation among four of the proband's relatives by HhaI restriction analysis. One asymptomatic family member was identified who subsequently elected prophylactic total thyroid removal. Histological examination of this specimen confirmed the presence of medullary thyroid carcinoma.
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PMID:Noncardiogenic pulmonary edema as the chief manifestation of a pheochromocytoma: a case report of MEN 2A with pedigree analysis of the RET proto-oncogene. 1052 79

Many of the adverse events induced by rifampin have been considered allergic in origin. The flu-like syndrome and other hypersensitivity reactions seem to be caused by immune complexes, although their pathogenetic mechanisms are not fully elucidated. Many cases have been reported of the flu-like syndrome, thrombocytopenia, hemolytic anemia, and renal failure caused by rifampin. In almost all of the patients in whom they were sought, nonreaginic antirifampin antibodies were detected. On the other hand, anaphylactic reactions seem to be IgE-mediated. We have analyzed the 18 reported cases of anaphylactic reactions severe enough to cause marked hypotension. The interval between the onset of treatment and the anaphylactic reaction was highly variable. Most patients presented with prodromes, mainly rash, before the development of anaphylactic symptoms, and, in most cases, the reaction occurred after reexposure to rifampin. Clinical findings include a variety of symptoms, such as fever, exanthem, dyspnea, abdominal pain, and vomiting. Seven of the 9 patients in whom HIV status was known were seropositive, including the only 2 patients who died. We believe that, in case of a non-life-threatening adverse reaction caused by immune complexes, rifampin could be readministered, if necessary, at a more frequent and reduced dose, perhaps with the addition of corticosteroids. In case of anaphylactic reactions the drug should be avoided, although desensitization procedures may be useful. Certain laboratory findings may serve as a clue to predict anaphylactic reactions in patients who have experienced minor adverse events to rifampin. However, the diagnostic value of such findings is not well established and, therefore, patients with previous adverse reactions should be carefully monitored if reexposure to rifampin is essential.
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PMID:Hypersensitivity reactions to rifampin. Pathogenetic mechanisms, clinical manifestations, management strategies, and review of the anaphylactic-like reactions. 1057 18

We report anesthetic management of an emergency surgery for panperitonitis during an asthmatic attack in a patient with angina pectoris. A 71-year-old male patient, complaining of abdominal pain and dyspnea, was diagnosed as having panperitonitis and asthmatic attack by surgeons in the emergency room. General anesthesia was induced by intravenous injection of propofol (30 mg), ketamine (30 mg), fentanyl (200 micrograms), suxamethonium (60 mg) and diltiazem (5 mg) following cannulation of the left radial artery for continuous monitoring of direct arterial pressure. Anesthesia was maintained by continuous infusion of propofol (4-10 mg.kg-1.h-1) and ketamine (1 mg.kg-1.h-1) in combination with intermittent epidural injection of local anesthetics. Although sudden onset of increased peak airway pressure occurred 45 minutes after starting operation, 50 mg of propofol injection and 500 mg of aminophyline infusion could relieve this high airway pressure. Because increased peak airway pressure appeared frequently and this could not be relieved by bolus injection of propofol, we changed the intravenous anesthesia to nitrous oxide-oxygen-isoflurane (GOI). After this change, no asthmatic attack occurred during the operation. While the mechanical ventilation was required during the early postoperative period along with infusion of aminophyline and inhalation of beta-stimulants, the patient was weaned successfully from the mechanical ventilation 12 hours postoperatively. It was speculated that the intraoperative asthmatic attack might have been caused by light level of anesthesia with propofol and ketamine. We concluded that other analgesics, such as fentanyl or epidural local anesthetics, must have been supplemented at proper timing during the continuous infusion of propofol and ketamine during the surgery.
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PMID:[Anesthetic management of an emergency surgery for panperitonitis during an asthmatic attack]. 1075 22


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