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

Hodgkin's disease presenting as spontaneous splenic rupture is rare. A 46-year-old man with a 4-week history of fever, chills, and night sweats developed sudden abdominal pain and hypotension. At surgery, an enlarged, ruptured spleen with a nodular surface was found. Histologically, there was diffuse infiltration of the red pulp by mixed-cellularity Hodgkin's disease with patchy involvement of the white pulp. The histopathologic findings in the three previously reported cases are all dissimilar to this. These differences most likely represent rupture occurring at different stages of splenic infiltration by Hodgkin's disease.
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PMID:Hodgkin's disease presenting as spontaneous splenic rupture. 141 48

Abdominal tuberculosis (TB) continues to give rise to diagnostic and therapeutic challenges. A total of 24 patients with abdominal TB who presented to general surgeons over a 9-year period have been reviewed. Most (92 per cent) of these patients were Asian; only one had a past history of pulmonary TB. The most common presenting complaint was abdominal pain in 21 patients (88 per cent) with the associated symptoms of weight loss in 18 (75 per cent), anorexia in 15 (62 per cent) and night sweats in 13 (54 per cent). A tissue diagnosis was obtained in 18 patients (75 per cent) and 17 patients (71 per cent) underwent laparotomy. These results show that the diagnosis of abdominal TB is still difficult to establish, and that many patients undergo laparotomy despite the existence of less invasive diagnostic procedures.
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PMID:Presentation of abdominal tuberculosis to general surgeons. 849 33

We reviewed the 22 cases of Mycobacterium avium-intracellulare (MAI) infection that occurred among 196 human immunodeficiency virus-infected children seen at the National Cancer Institute Pediatric Branch from December 1986 through April 1991, and an additional 65 charts from children with cultures negative for MAI. All patients with proven MAI were receiving antiretroviral therapy with zidovudine, dideoxyinosine, or a combination of zidovudine and dideoxycytidine. All patients had disseminated MAI infection, except one adolescent who had only evidence of localized lymphadenitis. All cases of MAI but one were diagnosed before death. The overall incidence of MAI was 11% in our patients but increased to 24% in patients whose absolute CD4 cell counts were < 100 cells/mm3. Symptoms most commonly associated with MAI infection included recurrent fever (86% of patients), weight loss or failure to thrive (64%), neutropenia (55%), night sweats (32%), and abdominal pain (27%). Children infected with MAI had a mean CD4 percentage of 2% (range, 0% to 7%) and a mean absolute CD4 count of 12 cells/mm3 (range, 0 to 48 cells/mm3), significantly lower than in the remainder of the clinic population or the group of children with cultures negative for MAI. Of 20 patients with MAI infection who were tested, 10 had measurable p24 antigen with a mean value 939 pg/ml (range, 77 to 3270 pg/ml) compared with 19 of 59 patients without MAI infection in whom the mean positive value was 413 pg/ml. There was no difference in survival time between those children with documented MAI infection (median survival time, 45.5 weeks) and those with similarly low CD4 counts and cultures negative for MAI (median survival time, 50.4 weeks). Future improvements in therapeutic options may make screening of pediatric human immunodeficiency virus-infected patients with low CD4 counts a reasonable plan.
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PMID:Defining the population of human immunodeficiency virus-infected children at risk for Mycobacterium avium-intracellulare infection. 143 13

Abdominal laparoscopy was performed on 200 patients with undiagnosed ascites. It was unsuccessful in one patient with tuberculous peritonitis because of extensive adhesions. A presumptive diagnosis of tuberculous peritonitis based on clinical findings and peritoneal tubercles or adhesions visualized during laparoscopy was made in 90 of these patients. The diagnosis was confirmed in 88 by histopathology, bacteriology, or therapeutic response. Two of the 109 remaining patients who had other presumptive diagnoses made during laparoscopy were eventually confirmed to be cases of tuberculous peritonitis. Of 91 patients with tuberculous peritonitis included in this series, 79% were females, with the majority (79%) of them being of child-bearing age. Half had been ill for longer than one month. The most frequent complaints were abdominal pain, fever, anorexia, night sweats, abdominal swelling, and weight loss. Ascites, fever, wasting, pallor, and abdominal tenderness were common findings. Ultrasonography demonstrated ascites in all patients who underwent this procedure; 21% also had adhesions. Pleural effusion was present in 15% and pulmonary tuberculosis was detected in only two patients. Biopsy samples taken during laparoscopy showed that 60% had noncaseous granulomas and 33% had caseous granulomas. Mycobacterium tuberculosis was detected in 77%, with guinea pig inoculation having the highest sensitivity, followed by culture, and lastly by acid-fast smear. Mycobacterium tuberculosis was isolated more easily from biopsy samples than from ascitic fluid. Nine of 20 M. tuberculosis isolates that were identified as to species were M. bovis. Tuberculous peritonitis, a frequent cause of febrile ascites in Egyptian women, was easily diagnosed by histopathologic and bacteriologic studies of biopsy samples taken at laparoscopy. All patients responded rapidly to antituberculosis therapy.
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PMID:Tuberculous peritonitis in Egypt: the value of laparoscopy in diagnosis. 144 45

The epidemiology, pathogenesis, clinical manifestations, and treatment of Mycobacterium avium complex (MAC) infection are reviewed. MAC infection is one of the most common infections in AIDS patients. Its pathogenesis is poorly understood, but it is believed to develop by gastrointestinal colonization followed by systemic invasion. The relatively poor response to treatment may be partly accounted for by the tremendous mycobacterial load present by the time patients develop systemic symptoms. Clinically, MAC infection is difficult to differentiate from the signs and symptoms of AIDS or from other opportunistic infections. Signs and symptoms include fever, malaise, anorexia, night sweats, and weight loss; diarrhea and abdominal pain may also be present. There is no established therapy for MAC infection, although combinations of three to five antimicrobial agents are typically used. There has been consistently poor correlation between in vitro results and in vivo outcomes in the treatment of MAC infection. Currently, the role of treatment is mainly to suppress the progression of infection and to relieve symptoms. Recent in vitro studies and animal studies have revealed possible alternative agents and combinations of agents (e.g., macrolide antibiotics, quinolones, amikacin, cytokines) that may influence therapy of MAC infection. No known therapy for MAC has been shown to prolong survival in AIDS patients, possibly because of the high organism load that exists once patients become symptomatic. Research is needed to find improved methods for earlier detection of MAC infection, determine optimal dosage regimens of current antimycobacterial agents, develop better antimycobacterial drug-delivery systems (e.g., liposomes), and discover new antimicrobials with better activity against MAC and methods of immune modulation that will overcome immune system defects.
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PMID:Current and investigational therapies for AIDS-associated Mycobacterium avium complex disease. 191 27

This study analysed clinical features and laboratory investigations in 145 patients with tuberculous peritonitis diagnosed by peritoneoscopy at this hospital between 1984 and 1988. Tuberculous peritonitis was found in 2% of all patients with tuberculosis and in 59.8% of all those with abdominal tuberculosis admitted to the hospital during the study period. Tuberculous peritonitis was more common in women than men (1.4:1) and was most frequently encountered in the third and fourth decades of life. The commonest presenting symptoms were abdominal swelling (73.1%), fever and night sweats (53.8%), anorexia (46.9%), weight loss (44.1%), and abdominal pain (35.9%). The mean duration of symptoms was 1.5 months. Ascites was the commonest (95.2%) physical sign. Tuberculin skin testing was positive in 57.6% of patients (n = 118). The mean erythrocyte sedimentation rate was 75 mm/1st hour (n = 58). Chest radiography on 98 patients showed pleuropulmonary pathology in 40 patients (40.8%). Sputum examination confirmed active pulmonary tuberculosis in 26 patients. The ascitic fluid was an exudate in 96.4% and a transudate in 3.6% of patients, with 91.3% showing a straw coloured ascites. Cirrhosis, detected by biopsy specimen, was a finding in 6.2% of patients.
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PMID:Symptoms and investigative findings in 145 patients with tuberculous peritonitis diagnosed by peritoneoscopy and biopsy over a five year period. 202 50

A 29-year-old man who had been abroad for several years (mainly Mexico) fell ill with fever (up to 39.8 degrees C), night sweats, weight loss of 10 kg in 6 months (height 181 cm, weight 50.5 kg) and abdominal pain. Computed tomography of the abdomen revealed many enlarged abdominal lymph nodes. Serological tests were positive for HIV antibodies. Fine-needle biopsy of one of the enlarged lymph nodes revealed numerous macrophages with round inclusions, typical for Histoplasma capsulatum. Disseminated histoplasmosis was confirmed by direct antigen demonstration in serum and urine. The patient's serious clinical condition clearly improved and lymph node enlargement regressed after starting specific i.v. treatment with amphotericin B (initially 20 mg/dl, then 50 mg/dl). Although complete cure of the histoplasmosis in connection with the HIV infection is not to be expected, the patient has remained without symptoms for four months on 50 mg weekly of amphotericin B i.v., later changed to imidazole derivatives (400 mg ketoconazole or 200 mg itraconazole, respectively.
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PMID:[Disseminated histoplasmosis as the first manifestation of HIV infection]. 220 23

2 cases of pelvic Actinomycosis both in women 40 years of age, with IUDs in place for 8 and 10 years respectively, were diagnosed with the aid of radiologic techniques including barium enema, computed tomography (CT) and magnetic resonance imaging (MR). The 1st woman had experienced malaise, night sweats and a weight loss of 15 lb. over 2-3 months, then felt an epigastric mass for 5 days. She has endometritis, elevated white blood cell count, and large, tender, bilateral adnexal masses. Inflammatory changes and multilocular fluid collections were demonstrated by enhanced CT. Aspiration of the epigastric mass yielded sulfur granules and anaerobic bacteria. She was successfully treated with penicillin, gentamycin and clindamycin. The 2nd woman had a 2-month history of abdominal pain, a pelvic mass and an elevated white blood cell count. Enhanced CT, barium enema and sigmoidoscopy demonstrated a mass between the uterus and bowel, with mural invasion of the sigmoid colon. A 5 x 6 cm left-sided tubo-ovarian abscess adhering to the colon, bladder and left pelvic sidewall was excised at laparotomy. She remained asymptomatic at 6 months. This lethal but curable condition is caused by Actinomyces israelii, an opportunistic gram-positive bacteria usually introduced by foreign bodies, surgery or trauma. CT and MR were helpful in diagnosing the relatively nonspecific signs and symptoms in these cases.
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PMID:Pelvic actinomycosis associated with intrauterine devices. 291 83

Local hepatic tuberculosis is an unusual form of extrapulmonary tuberculosis. The authors describe the case of a 39-year-old woman with this disease who posed diagnostic difficulties. She presented with abdominal pain, minimal constitutional symptoms, hepatomegaly and radiologic findings of a focal hepatic lesion. Laparotomy was required for diagnosis. A literature review revealed that most individuals with local hepatic tuberculosis have fever, night sweats and weight loss. Hepatomegaly is often the only abnormal physical sign. Minimally elevated serum bilirubin and alkaline phosphatase levels are common. Ultrasonography and computerized tomography will demonstrate a lobulated, hypoechoic liver mass. Definitive diagnosis requires demonstration of acid-fast bacilli in biopsy material obtained by percutaneous techniques or at laparotomy. Cultures of the diseased liver are usually negative. Antituberculous drug therapy appears to be the preferred method of treatment.
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PMID:Local hepatic tuberculosis, the cause of a painful hepatic mass: case report and review of the literature. 309 51

Abdominal tuberculosis, although rare, occurs mainly in immigrants from the Indian subcontinent. Such people comprise 13.5% of our local population and contributed 90% of a series of 72 patients presenting in the last 16 years; a local disease incidence of 1:6000 for Asian immigrants. Men and women were equally affected, but on average women were much younger. Diagnosis was made from one month to 10 years after immigration. No clinical feature was diagnostic, but abdominal pain, night sweats and weight loss occurred in more than half the patients. The erythrocyte sedimentation rate (ESR) was elevated in 95% and no patient tested had a negative Mantoux test. In 20 patients diagnosis was by clinical suspicion and response to therapeutic trial. In 52, including 39 who had a laparotomy, histological and culture material was obtained but these patients fared no better. Only one organism was resistant (to streptomycin) and rapid response to chemotherapy was the rule. Successful outcome was not related to the type of presentation, operative findings or specific chemotherapeutic agents. We would suggest that in Asians presenting with difficult-to-diagnose abdominal symptoms accompanied by malaise, raised ESR and a positive Mantoux test, a therapeutic trial of anti-tuberculous therapy should precede diagnostic laparotomy.
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PMID:Abdominal tuberculosis in East Birmingham--a 16 year study. 365 61


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