Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hernias can lead to significant morbidity in patients on peritoneal dialysis (PD). We studied the natural history and outcome of incarcerated hernia (IH), with or without bowel strangulation (IHS), in PD patients. We performed a retrospective chart review on all PD patients who developed an IH (n = 11) or an IHS (7/11) in the last 12 years. Of the 11 patients, 54% were female. The age range was 36 - 86 years (median: 61 years). Seven patients had a known history of a hernia that went on to become the index hernia that incarcerated with or without strangulation. The hernia types were umbilical (n = 8), inguinal (n = 2), and incisional in the area of the PD catheter (n = 1). Clinical presentations included painless abdominal mass (2 patients); tender and painful abdominal mass (4 patients); and abdominal pain, tenderness, and bowel obstruction (5 patients). Nine hernias were treated surgically--5 of them emergently for bowel ischemia. The other 4 patients who had incarcerated, non strangulated hernias were operated electively. One patient with IHS had the hernia manually reduced, and 1 patient with IHS had the hernia manually reduced and subsequently operated electively. Three patients with IHS and 2 with IH required temporary hemodialysis for between 4 days and 21 days. In PD patients, IHs are most commonly umbilical and have a propensity to strangulate. Patients treated operatively have an excellent prognosis and are usually able to continue PD. Abdominal wall hernias should be referred early to minimize mechanical complications.
Adv Perit Dial 2004
PMID:Natural history and outcome of incarcerated abdominal hernias in peritoneal dialysis patients. 1538 2

A 45-year-old woman on hemodialysis without significant problems for 6 years developed acute onset of anxiety, shortness of breath, and abdominal pain within minutes of initiating her hemodialysis treatment. Her blood pressure was stable throughout the episode. The treatment was discontinued and she was admitted to the hospital. Routine blood chemistries were unremarkable except for mild eosinophilia (5%). An ethylene oxide reaction was suspected. She was dialyzed the following day after rinsing the dialyzer with 2 L of saline. A similar reaction occurred. The following day she was dialyzed on an ethylene oxide-free dialyzer and the hemodialysis treatment was uneventful.
Semin Dial
PMID:Shortness of breath and abdominal pain within minutes of starting hemodialysis. 1546 52

Peritonitis is a serious and common problem in the peritoneal dialysis (PD) population. Abdominal pain, fever, and cloudy PD fluid usually heralds the onset of infective peritonitis. However, in up to 20% of cases, no organism is identified. In these situations, diagnosis can be made only by excluding a microbiological cause and performing a cytological examination of the PD fluid to determine the cellular or noncellular constituents. This review examines the differential diagnosis of sterile peritonitis and uses cytological examination to facilitate the appropriate diagnosis.
Perit Dial Int
PMID:Sterile peritonitis in the peritoneal dialysis patient. 1662 39

Peritonitis is one of the most frequent complications of peritoneal dialysis (PD) and 1% - 15% of episodes are caused by fungal infections. The mortality rate of fungal peritonitis (FP) varies from 5% to 53%; failure to resume PD occurs in up to 40% of patients. The majority of these FP episodes are caused by Candida species. Candida albicans has historically been reported to be a more common cause than non-albicans Candida species, but in recent reports a shift has been observed and non-albicans Candida may now be more common. Unusual, often "nonpathogenic," fungi are being increasingly reported as etiologic agents in FP. Clinical features of FP are not different from those of bacterial peritonitis. Phenotypic identification of fungi in clinical microbiology laboratories is often difficult and delayed. New molecular diagnostic techniques (e.g., polymerase chain reaction) are being developed and evaluated, and may improve diagnosis and so facilitate early treatment of infected patients. Abdominal pain, abdominal pain with fever, and catheter left in situ are risk factors for mortality and technique failure in FP. In programs with high baseline rates of FP, nystatin prophylaxis may be beneficial. Each program must examine its own history of FP to decide whether prophylaxis would be beneficial. Catheter removal is indicated immediately after fungi are identified by Gram stain or culture in all patients with FP. Prolonged treatment with antifungal agents to determine response and attempt clearance is not encouraged. Antifungals should be continued for 10 days to 2 weeks after catheter removal. Attempts at reinsertion should be made only after waiting for 4 - 6 weeks.
Perit Dial Int
PMID:Fungal peritonitis in peritoneal dialysis patients. 1598 67

Encapsulating peritoneal sclerosis (EPS) is recognized as a serious complication of continuous peritoneal dialysis. A preliminary diagnosis of EPSis usually based on clinical signs and symptoms, which commonly include abdominal pain, nausea, vomiting, anorexia, abdominal fullness, an abdominal mass, bowel obstruction, and radiologic findings, including abdominal roentgenogram, contrast studies, ultrasound studies, and computed tomography. The diagnosis is confirmed by laparoscopy or laparotomy showing the characteristic gross thickening of the peritoneum enclosing some or all of the small intestine in a cocoon of opaque tissue. A variety of therapeutic approaches to EPS have been reported. This review discusses medical treatment of EPS and includes an overview of the clinical features and diagnostic aspects of the condition.
Perit Dial Int 2005 Apr
PMID:Encapsulating peritoneal sclerosis--a clinician's approach to diagnosis and medical treatment. 1630 Feb 70

Transient bacteremia during and after endoscopic procedures is a well-documented phenomenon. Streptococcus viridans peritonitis is frequently associated with peritoneal dialysis, and the infection is probably attributable to hematogenous spread, dental procedures, or transluminal contamination with oral flora. To our knowledge, no reports exist of peritonitis occurring after gastroscopy in peritoneal dialysis patients. Here, we report the case of a 69-year-old male patient receiving automated peritoneal dialysis who required emergency gastroscopy and sclerotherapy plus heat-probe coagulation to control active bleeding from a duodenal ulcer The next day, this patient developed nausea and abdominal pain. The diagnosis of peritonitis was made based on a cloudy peritoneal effluent and a leukocyte count of 11,500 cells/microL with 98% neutrophils. S. viridans was identified in the peritoneal fluid culture. The patient received ceftazidime for 14 days, followed by clarithromycin for 7 days, and he recovered successfully. Patients receiving peritoneal dialysis who undergo esophagogastroduodenal endoscopy are at risk to develop peritonitis, and so antibiotic prophylaxis is desirable.
Adv Perit Dial 2005
PMID:Streptococcus viridans-associated peritonitis after gastroscopy. 1668 85

Stenotrophomonas maltophilia is increasingly being recognized as an important cause of nosocomial infection. S. maltophilia peritonitis is a rare complication of chronic peritoneal dialysis. Here, we report the case of a 54-year-old female with end-stage renal disease treated with automated peritoneal dialysis. The patient had no previous history of peritonitis or catheter exit-site infection. She presented with fever, abdominal pain, and cloudy peritoneal effluent. The organism isolated from the effluent was S. maltophilia. The patient received trimethoprim 320 mg and sulfamethoxazole 1600 mg for 6 weeks, plus amikacin 200 mg for 14 days. She recovered completely, with no need for catheter removal. No recurrence was observed.
Adv Perit Dial 2005
PMID:Stenotrophomonas maltophilia peritonitis in a patient receiving automated peritoneal dialysis. 1668 86

We present here the case of a continuous ambulatory peritoneal dialysis (CAPD) patient who developed sclerosing calcifying peritonitis with gross macroscopic calcification of the small bowel, a rare and life-threatening complication of sclerosing peritonitis. A 40-year-old female had been on CAPD for 7 years. A peritoneal biopsy during an open cholecystectomy for cholelithiasis showed sclerosing peritonitis, but the patient refused to change dialysis modality. She remained free of symptoms for 3 years, but then was admitted with cloudy effluent, abdominal pain, and referred pain to the left shoulder. A white blood cell count showed 25,000 cells/microL, and a peritoneal cell count showed 1000 cells/microL. An abdominal computed tomography scan was nondiagnostic. The patient was started on intraperitoneal antibiotics, but 3 days later she was taken for surgery because of acute abdomen. Laparotomy revealed a tanned and thickened peritoneum and a small bowel with significant fibrosis and foci of calcification on the antimesenteric surface. Enterectomy and primary anastomosis was performed. Pathology revealed extensive mural fibrosis, calcium deposition, and localized inflammatory infiltration of the small bowel. The patient developed an anastomotic leak and, despite a second operation, died in the intensive care unit from septic shock. Although some authors report successful outcomes in similar cases by using surgery or other treatments (parenteral nutrition, immunosuppression), or both, we urgently recommend that, if sclerosing calcifying peritonitis is diagnosed, the patient be switched promptly to hemodialysis.
Adv Perit Dial 2006
PMID:Gross calcification of the small bowel in a continuous ambulatory peritoneal dialysis patient with sclerosing peritonitis. 1698 50

Twenty-one patients with myeloperoxidase-antineutrophil cytoplasmic autoantibody (MPO-ANCA)-associated vasculitis were treated using cytapheresis. Of these, 17 were treated for glomerulonephritis and four were treated for pulmonary hemorrhage. The overall survival rate was 85.7% with a follow-up duration of 24.0 +/- 13.8 months. In the 17 patients with MPO-ANCA-associated glomerulonephritis, pretreatment creatinine was 3.2 +/- 1.6 mg/dL, and renal function recovered in 76.5%. Pulmonary hemorrhage was ameliorated in all four patients. Abdominal pain occurred in three of the 21 patients but symptoms resolved soon after the cytapheresis procedure was completed. No other adverse effects occurred during cytapheresis. From these results, cytapheresis can be considered a safe and effective treatment for MPO-ANCA-associated vasculitis. As for the mechanism of its action, soluble tumor necrosis factor receptor 1 (sTNFR), sTNFR2 and interleukin 1 receptor antagonist were elevated soon after cytapheresis and those levels 2 h after the cytapheresis procedure were higher than before the procedure in some cases. These elevations might be related to the efficacy of cytapheresis.
Ther Apher Dial 2006 Oct
PMID:Cytapheresis for the treatment of myeloperoxidase antineutrophil cytoplasmic autoantibody-associated vasculitis: a pilot study of 21 patients. 1709 95

We report the case of a patient who developed eosinophilia during hemodialysis and became intolerant to dialysis therapy. The patient, a 40-year-old woman, was initiated on hemodialysis for end-stage renal failure caused by chronic glomerulonephritis. After starting on dialysis, her eosinophil count gradually increased. During the ninth session, she developed abdominal pain of an unknown cause after approximately 1 h of dialysis. The symptom, which persisted in the following sessions, was considered to be a dialysis-related complication. We attempted different dialyzers and anticoagulants, but without improvement. The dialysis therapy was discontinued and steroid treatment was given. The hypereosinophilic condition improved rapidly and dialysis therapy was restarted successfully without causing abdominal pain. To investigate the cause of this problem, we measured the leukocyte count and anaphylatoxin C3a level in peripheral blood during dialysis, and compared the results before and after steroid treatment. The results showed that the significant decrease in the leukocyte count observed before steroid treatment was reduced to a mild decrease after steroid treatment. In contrast, C3a did not show a significant difference between the values obtained before and after steroid treatment. These findings suggest that eosinophilia played an important role in the etiology of dialysis intolerance and that C3a was not involved in the decrease in leukocytes under the conditions experienced by the present patient.
Ther Apher Dial 2007 Feb
PMID:A case report of hemodialysis intolerance with eosinophilia. 1730 78


<< Previous 1 2 3 4 5 Next >>