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

Twenty-one children were admitted to a single paediatric institution between 1964-1990 with histologically proven primary liver tumours. The diagnosis was hepatoblastoma (HBL) in 15 patients, hepatocellular carcinoma (HCA) in 2, rhabdomyosarcoma (RMS) in 2, non-Hodgkin's lymphoma (NHL) in 1, and haemangioendothelioma (HE) in 1. The common presenting clinical features were anaemia, abdominal mass, and abdominal pain. Serum alpha-foetoprotein was useful in establishing a diagnosis in HBL and in monitoring disease activity. Computed tomographic (CT) scan, ultrasound, and angiography were useful preoperative investigations for assessing site and resectability of tumour. There were no survivors in patients with malignant hepatic tumours (n = 10) who had surgery alone prior to 1981. Of 7 patients with HBL diagnosed after 1981 who had adequate surgical resection and chemotherapy, 5(72%) are currently alive and disease free between 15 months and 8 years from diagnosis. We conclude that adequate surgical resection and adjuvant chemotherapy can improve disease free survival for children with HBL. Optimal treatment has yet to be devised for other malignant hepatic tumours.
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PMID:Primary hepatic tumours in children: a 26-year review. 131 8

From 1 January 1986 to 30 June 1989, 15 pregnant women were diagnosed as having urolithiasis. Patients presented in the last two trimesters with an infection of the lower part of the urinary tract (60 per cent), flank and abdominal pain (27 per cent) and hematuria (13 per cent). Ultrasonographic findings confirmed the diagnosis in 47 per cent of the patients. Other roentgenologic procedures were required in the remaining patients. Initially, therapy was conservative in all, and in 67 per cent of patients, no further intervention was necessary. Only 33 per cent required invasive measures; cystoscopic passage of an internal ureteral stent was the initial procedure of choice at our institution. Three of five patients who underwent invasive procedures had surgical intervention for relief of ureteral obstruction. Intensive care management was necessary for one of these three patients who had acute hemorrhage occur during the procedure. These data emphasize the need for the accurate diagnosis of urolithiasis during pregnancy. Ultrasonography was a valuable diagnostic technique, but a limited excretory urogram is safe and appropriate when there is uncertainty. Conservative management (hydration, analgesia and antibiotics as indicated) of obstructive uropathy was successful in the majority of instances. A specific clinical algorithm facilitated the successful management of patients necessitating operative intervention. Optimal management requires clinical suspicion and a precise diagnostic and therapeutic plan.
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PMID:An algorithm for diagnosis and therapy of management and complications of urolithiasis during pregnancy. 198 41

Sclerosis of the peritoneum, with encapsulation of the small bowel is one of the most serious complications of continuous ambulatory peritoneal dialysis (CAPD), and carries a high mortality. The abnormalities seen on ultrasound are described for 14 patients and comprise increased small bowel peristalsis, tethering of the bowel to the posterior abdominal wall, intraperitoneal echogenic strands and, in the late stages of the disease, membrane formation. Optimal visualization of these features in the early stages of the disease was obtained by examining the patients with dialysis fluid present in the abdomen. Sclerosing peritonitis should be suspected in patients being treated by CAPD who develop abdominal pain and progressive loss of ultrafiltration and subsequent investigation should include the use of ultrasound.
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PMID:Ultrasound changes in sclerosing peritonitis following continuous ambulatory peritoneal dialysis. 201 92

Forty-one patients with pure immature teratoma of the ovary treated at The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston from 1944 to 1985 were reviewed. The median age of these patients was 17 years. The most common symptom was abdominal pain, which occurred in 39 (95%) patients. FIGO stages included 24 patients with stage I, four with stage II, 12 with stage III, and one stage IV. The tumors ranged in size from 6 to 31 cm in greatest diameter, with a median of 17 cm. Of 39 cases reexamined microscopically, four were grade 1 tumors, 22 were grade 2 tumors, and 13 were grade 3 tumors. Initial surgery included ovarian cystectomy in one patient, unilateral salpingo-oophorectomy in 27 patients, and bilateral salpingo-oophorectomy in 13 patients. Fifteen of 16 patients treated with surgery alone developed recurrent disease; 11 are surviving after further therapy. Two patients died after treatment with radiotherapy plus chemotherapy. Twenty-one patients received a combination of vincristine, actinomycin-D, and cyclophosphamide postoperatively, and 18 are alive and well. One of two patients who received other combination regimens is alive and well. Therefore, 29 of the 41 patients (71%) are alive and well. Optimal management of patients with pure immature teratoma of the ovary consists of initial surgery (with preservation of a normal contralateral ovary in most patients) followed by combination chemotherapy in all patients except those with stage I, grade 1 disease; the latter may be treated safely with surgery alone.
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PMID:Immature teratoma of the ovary. 376 73

Acute jejunogastric intussusception is a rare complication following gastric surgery. Three patients were treated for this condition during the past 15 years. Common presenting manifestations are vomiting, hematemesis, upper abdominal pain, and palpable abdominal mass within the left hypogastrium. The diagnosis is established by gastroscopy or upper gastrointestinal radiographs. Four categories of classification are described. Optimal operative management consists of prompt laparotomy. Manual reduction of the intussusception is followed by resection of compromised bowel. Procedures to prevent recurrence are individualized.
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PMID:Acute jejunogastric intussusception. 403 47

Forty-one patients with pure endodermal sinus tumor of the ovary who were treated at the M. D. Anderson Hospital from 1944 to 1981 are retrospectively reviewed. The median age of these patients was 19 years. The most common presenting symptom was abdominal pain, occurring in 33 patients (80%). No bilateral ovarian involvement was noted at initial surgery. With the exception of 1 patient treated by surgery alone, only patients treated with postoperative combination chemotherapy survived. Twenty-one of the 41 patients are alive and well. Sixteen of 22 patients treated with vincristine, actinomycin-D, and cyclophosphamide have survived. The roles of second-look laparotomy and alpha-fetoprotein monitoring are discussed. Optimal treatment seems to consist of surgery followed by aggressive combination chemotherapy.
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PMID:Endodermal sinus tumor of the ovary: the M. D. Anderson experience. 618 92

Forty-two patients with mixed germ cell tumors of the ovary who were treated at The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston from 1944 through 1983 are retrospectively reviewed. The median age of these patients was 16 years. The most common symptom was abdominal pain, occurring in 38 patients (90%). Detailed analysis of clinical and pathologic features is presented. Twenty of 42 patients are alive and well. Current management of mixed germ cell tumors, including the roles of second-look laparotomy and monitoring of tumor markers, is discussed. Optimal treatment consists of surgery followed by combination chemotherapy.
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PMID:Mixed germ cell tumors of the ovary. 620 58

In general pregnancy is not associated with an increase in the incidence of gastro-intestinal (GI) conditions, but it is associated with an increase in the severity of these conditions. This is largely due to a delay in making the diagnosis. Delay is caused by a combination of factors. These include mimicry of symptoms and signs with pregnancy-related conditions, a change in the usual clinical presentation, reluctance to use radiological diagnostic aids and a higher threshold for performing invasive investigative procedures. However before resorting to invasive investigations, it is imperative that appropriate non-invasive investigations are performed and evaluated first. This is especially relevant to liver conditions in pregnancy which can present with abdominal pain. Optimal management of GI conditions in pregnancy requires both surgeons and obstetricians to be aware of the problems of diagnosis, communicate promptly and investigate without delay in order to make a diagnosis and avert a GI crisis. This article discusses the clinical presentation, diagnosis and management of the common GI conditions occurring in pregnancy.
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PMID:Gastro-intestinal crises during pregnancy. 822 11

Increasing evidence exists of the occurrence of sphincter of Oddi dysfunction in patients with an intact gallbladder. Optimal therapy for such patients has not been defined. From 1989 to 1991, 35 patients with sphincter of Oddi dysfunction (abnormal basal sphincter pressure > 40 mm Hg) and an intact gallbladder were identified. The patients with abnormal ductography (except for duct dilation), pancreas divisum, or pancreato-biliary malignancy were excluded. All patients had disabling upper abdominal pain, which was quantified on a 0 = none to 10 = severe pain scale. All patients received standard endoscopic biliary sphincterotomy and were followed up for 4 to 26 months with a mean of 13 months. Initially, 27 of 35 patients (77%) showed at least 50% improvement in the pain score, whereas only 15 of the 27 remained improved throughout the follow-up interval. Patients who were unimproved or had relapses were offered cholecystectomy and 11 patients underwent the procedure. These patients were followed up after cholecystectomy for 2 to 24 months, with a mean of 13 months. Eight of 11 were improved. In summary, the combination of endoscopic sphincterotomy and selective cholecystectomy and minimal medical treatment resulted in a good and excellent response rate of 68%. Better techniques are needed to select patients who will respond to these therapies.
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PMID:Sphincter of Oddi dysfunction in patients with intact gallbladder: therapeutic response to endoscopic sphincterotomy. 836 21

The Precose Resolution of Optimal Titration to Enhance Current Therapies (PROTECT) study is an ongoing Phase IV clinical trial designed to assess the effectiveness, tolerability, and safety of acarbose tablets in patients with type II diabetes when the dosage is slowly titrated upward. This multicenter, open-label, 28-week trial will enroll approximately 7,000 type II diabetic patients. The present report describes the interim results for 2,139 patients who completed the trial as of November 1, 1996. Patients with type II diabetes enrolled in the study were inadequately controlled either with diet alone or with a sulfonylurea. The dosage of acarbose was titrated from 25 mg three times a day (TID) to 100 mg TID based on tolerability and efficacy. Efficacy of glycemic control was assessed by changes in glycated hemoglobin A1c (Hb A1c) and 1-hour postprandial plasma glucose (PPG) levels. Tolerability and safety were determined by patient reports of treatment-emergent adverse events and by review of laboratory tests. The PROTECT study confirms the previously demonstrated efficacy and safety of acarbose in improving glycemic control in patients with type II diabetes regardless of a patient's age, body weight, ethnic background, time since diagnosis, or severity of disease. mean 1-hour PPG levels declined throughout the entire treatment period, with a mean decrease from baseline of -47 mg/dL at the end of treatment. Hb A1c, the most reliable indicator of long-term glycemic control, decreased over the course of treatment, resulting in a mean decrease of -0.7% (P < 0.001). Although all patient types enrolled in the study responded positively to therapy, certain subgroups responded particularly well, such as those patients diagnosed with the disease less than 1 year ago, those treated with acarbose as monotherapy, and those with higher baseline Hb A1c levels. Adverse events were experienced by 36% of all patients and consisted primarily of gastrointestinal disturbances (flatulence, diarrhea, abdominal pain). Moderate renal insufficiency (serum creatinine levels between 1.5 and 2 mg/dL) was present in 259 patients, and no patients developed serum hepatic transaminase levels more than twice the normal range.
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PMID:PROTECT interim results: a large multicenter study of patients with type II diabetes. Precose Resolution of Optimal Titration to Enhance Current Therapies. 915 67


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