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

The pathogenesis of paradoxical hypertension after resection of coarctation of the aorta was investigated by comparing the course of seven children undergoing repair of coarctation with five acyanotic children undergoing elective cardiovascular surgery. During the first 24 hours after surgery, all coarctation patients demonstrated a rise in systolic blood pressure (35 +/- 15.5 mm Hg; P less than 0.001), a significant depression in cold pressor test response, and only a slight elevation in plasma renin activity. In the next 24-72 hours, coarctation patients developed a rise in diastolic blood pressure (26.8 +/- 10.6 mm Hg; P less than 0.001), plasma renin activity (22.9 +/- 10.2/ml/hr; P less than 0.001) and fluid retention. By contrast, control patients had no significant postoperative changes. Abdominal pain occurred in five coarctation patients during the period of maximal plasma renin activity. The data suggest that the sympathetic nervous system may be responsible for the initial phase of hypertension after coarctation resection and that the renin angiotension system plays a major role in the second phase of hypertension and in the pathogenesis of mesenteric arteritis.
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PMID:Pathogenesis of paradoxical hypertension after coarctation resection. 94 70

A 16-year-old girl was admitted with the complaints of headache, chest pain, low abdominal pain and left hemi-numbness. Her blood pressure was high and plasma renin activity and aldosterone levels were elevated. Renal angiography revealed vascular stenoses and microaneurysms although the renal artery and its main branches were not involved. Polyarteritis nodosa (PN) was strongly suspected and oral prednisolone and intravenous pulse therapy of cyclophosphamide were started. The second renal angiography which was performed 11 days after the therapy was started, showed marked improvement of vascular lesions. This is a case which suggests that the angiographic findings of PN can improve very rapidly with therapy.
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PMID:A young female case of polyarteritis nodosa strongly suspected by typical angiographic findings which improved rapidly after prednisolone and cyclophosphamide therapy. 135 68

Although fibromuscular dysplasia (FMD) rarely occurs, it is the most common cause of renal artery disease in children. Aneurysm formation in FMD is well documented in adults. However, it was rarely described in children, partly because medial fibroplasia with a tendency to aneurysm formation is relatively rare. This report describes a 7-year-old girl with very unusual sets of abnormalities involving the left renal artery. Intimal fibroplasia with multiple small saccular aneurysms was seen. She presented with recent-onset renovascular hypertension, headache and intermittent severe colicky abdominal pain. Angiography revealed multifocal stenosis with multiple aneurysms of the left renal artery. Renal vein renin was twice as high on the involved side than on the contralateral side. After nephrectomy, the hypertension was under control without medication.
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PMID:Primary intimal fibroplasia with multiple aneurysms of renal artery in childhood. 235 68

A case of middle aortic syndrome which was thought to be the thoracoabdominal type of Takayasu's disease was successfully treated with the branched graft bypass. Patient was a 23 year-old woman with hypertension and abdominal pain. The preoperative angiography revealed aortic stenosis from the celiac axis to the left renal artery. The operative procedures were as follows; patient was positioned in supine with her left shoulder and arm raised. Eighth intercostal thoracotomy and midline laparotomy was performed with the thoracoabdominal incision. The branched graft was made previously with woven Dacron (phi 18 mm) and three EPTFEs (phi 8mm). The woven Dacron of the graft was used for the bypass from the descending thoracic aorta to the infrarenal abdominal aorta, and the branched EPTFEs of the graft were used for the bypasses to the common hepatic artery, the superior mesenteric artery and the right renal artery in this order. The bypasses were placed along the anatomical courses in the retroperitoneal space. Postoperatively, the blood pressure dropped and the abdominal pain disappeared. The plasma renin activity decreased and the renal function improved. Two months after operation the bypasses were patent by the angiography and now six months after operation she has returned to her social life healthily. The approach to the aorta and its abdominal branches by thoracotomy and laparotomy and bypass with the three branched graft was useful for middle aortic syndrome.
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PMID:[Revascularization with the branched graft in middle aortic syndrome]. 256 15

Hypokalemia with hyperkaliuresis was diagnosed in a 10 1/4-year-old boy, who presented with spontaneously disappearing abdominal pain. The diagnosis of Gitelman-Syndrome (asymptomatic chronic hypokalemia and -magnesemia) was established after detection of hypomagnesemia, renal magnesium losing but normal renin-angiotensin-aldosterone system and glomerular filtration rate. After oral supplementation of potassium hypokalemia persisted and hyperkaliuresis increased. The substitution was discontinued, the hyperkaliuresis diminished and the child remained asymptomatic during a 24 months follow-up. The substitution of potassium and magnesium can be avoided in children with Gitelman-Syndrome as long as they remain asymptomatic.
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PMID:[Asymptomatic hypokalemia and hypomagnesemia with renal cation loss (Gitelman syndrome)]. 361 31

A three year-old boy was found incidentally to have severe hypertension (around 200/110 mmHg) when he was brought to This Hospital's Emergency Department because of his abdominal pain. After his admission, serial and detailed examinations were performed. These included: basic blood chemistry studies, abdominal and renal sonography, excretory urography, radionuclide scintigraphy and angiography with selective renal vein renin sampling. Diagnosis was made of renovascular hypertension with combination of unilateral renal hypoplasia and bilateral renal artery stenosis. The patient was given oral anti-hypertensive drugs, with resulting satisfactorily controlled blood pressure after two weeks of treatment. He was discharged without surgical intervention.
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PMID:Severe hypertension in hypoplastic kidney and bilateral renal artery stenosis: report of one case. 829 59

A total of 42 cases of large symptomatic parapelvic or pararenal lymphatic cysts has been reported since 1890, of which 54% were associated with hypertension and 14% were bilateral. We report on a patient in whom during a 3-month period abdominal pain and distention developed successively on both sides associated with hypertension. Initially, ultrasound and computerized tomography revealed a large multicystic pararenal lymphatic mass on the right side and small parapelvic hilus lesions on the left side. Two months after resection and marsupialization of the large cyst on the right side the small hilus lesions on the left side developed into large pararenal cysts requiring the same therapeutic measures. Hypertension was reversible after surgery in both instances; at the second operation high preoperative and lower postoperative renin activity, active renin, total renin, aldosterone and atrial natriuretic factor in plasma were noted. Immunoreactive active and total renin levels in the lymph fluid were elevated, a finding that may be explained by the renal origin of the lymph. Marsupialization is a kidney preserving measure that reverses all symptoms of large pararenal cysts, including Page kidney hypertension.
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PMID:Hygroma renale: pararenal lymphatic cysts associated with renin-dependent hypertension (Page kidney). Case report on bilateral cysts and successful therapy by marsupialization. 834 18

A 10-year-old boy was admitted to our hospital with severe hypertension due to unusual aortic coarctation at the level of the diaphragm without renal artery stenosis. We made left interior thoracotomy and left para-rectal incision through extraperitoneal approach, and extra-anatomic bypass was established with a 16 mm knitted Dacron graft from the descending aorta to the infrarenal abdominal aorta, under a circulatory assist. Postoperatively, he complained of abdominal pain with residual hypertension and required an intensive anti-hypertensive treatment to avoid intestinal necrosis. Pressure gradient between upper and lower extremities disappeared 3 weeks after repair. High level of plasma renin activity still continued 4.5 months after surgery in spite of oral administration of beta blockade and ACE inhibitor.
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PMID:[Surgical treatment of congenital atypical coarctation of the aorta and postoperative management for hypertension]. 881 61

Polyarteritis Nodosa (PAN) is a rare disease in childhood. No single pattern of clinical presentation characterizes this disease, but abdominal pain, central or peripheral nervous system disease, arthritis, myalgia and skin lesions occur at some time during the course of the illness. In this case a 16-year-old boy who presented with abdominal pain, elevated sedimentation rate associated with hypertension, and a high level of renin, all of which were detected during his hospitalization, suggested the diagnosis of PAN, and renal angiography was performed. Characteristic renal aneurysms were visualized and the diagnosis was confirmed.
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PMID:Diagnostic value of renal arteriography in polyarteritis nodosa. 881 29

We experienced two Duchenne muscular dystrophy patients with advanced congestive heart failure, who showed abrupt severe hyponatremia, hyperkalemia and metabolic acidosis. Two patients received respiratory management, parenteral nutrition, and drugs including angiotensin converting enzyme inhibitors (ACEI). The patient 1 who was 19 years old showed abdominal pain, hematuria, diarrhea and disorientation. Laboratory findings were as follows; Na 120 mEq/L, K 7.3 mEq/L, BUN > 140 mg/dl (scale over), ACTH 20.2 pg/ml, cortisol 25 micrograms/dl, renin 40.7 ng/ml/hr and aldosterone 203 ng/dl. Arterial blood gas analysis (ABG) showed metabolic acidosis (pH 7.232). Combination therapy with hydrocortisone, glucose-insulin therapy (GIT) and NaHCO3 successfully rescued this patient. The patient 2 (28 years of age) was admitted to our hospital because of congestive heart failure. Laboratory findings were as follows; Na 129 mEq/L, K 5.5 mEq/L, BUN 60 mg/dl, cortisol 21 micrograms/dl, renin 36 ng/ml/hr and aldosterone 47 ng/dl. He complained abdominal discomforts from the next day of admission. Ten days after the admission Na, K and BUN were 111 mEq/L, 6.2 mEq/L and 154 mg/dl, respectively. ABG showed compensated metabolic acidosis. He fell into shock during GIT therapy. Laboratory findings at that time were as follows; Na 108 mEq/L, K 3.2 mEq/L, ACTH 77.6 pg/ml, cortisol 24 micrograms/dl, renin 58 ng/ml/hr and aldosterone 24 ng/dl. Although hydrocortisone was introduced, he could not recover and died. There are some reports about life-threatening electrolyte abnormalities and metabolic acidosis in the patients receiving ACEI. These phenomena were more frequent in patients with renal dysfunction and/or congestive heart failure. Hyponatremia, hypovolemia, combination therapy with nonsteroidal anti-inflammatory drugs (NSAID) and/or potassium sparing diuretics were reported as risk factors. We could not prove the correlation between the acute changes in our cases and ACEI. However ACEI is suspicious, because many of these risk factors were observed in our cases. Aldosterone was extremely elevated in the patient 1 when potassium was severely elevated. On the other hand, the patient 2 showed lower aldosterone level after correction of potassium than that on admission. Potassium is regarded as a major secretion factor of aldosterone for patients receiving ACEI. The fact the patient 2 fell into shock during GIT, tells us that we should use steroid simultaneously when we try to correct potassium quickly in severe cases, because acute reduction of potassium may decrease aldosterone. Today, ACEI is a common drug for CHF, so we should pay attentions that ACEI could cause such acute changes. To prevent such acute changes, excessive restriction of water and sodium intake should be avoided. If possible, NSAID and potassium sparing diuretics also should be avoided. Steroid therapy must be introduced rapidly when needed.
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PMID:[Electrolyte abnormalities and metabolic acidosis in two Duchenne muscular dystrophy patients with advanced congestive heart failure]. 1100 25


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