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)

Four cases of hepatic angiosarcoma are reported with a review of 99 other cases in the English literature. Angiosarcoma of the liver is associated with chronic exposure to thorotrast, vinyl chloride, arsenicals, radium and possibly copper and with chronic idiopathic hemochromatosis. Although 40% of patients have hepatic fibrosis or cirrhosis at autopsy, the nature of the association between chronic liver disease and hepatic angiosarcoma is unknown. The clinical presentation of hepatic angiosarcoma is nonspecific with abdominal pain, weakness and weight loss common complaints and with hepatomegaly, ascites and jaundice common findings. Liver function tests are usually abnormal but there is no one liver function test or set of tests specific for the tumor. The occurrence of thrombocytopenia and disseminated intravascular coagulation is characteristic of hepatic angiosarcoma and may be related to local consumption of clotting factors and formed blood elements in the tumor. Catastrophic intraabdominal bleeding is also characteristic and occurs in one-fourth of all cases. This complication is likely related to the high incidence of clotting abnormalities and the vascular nature of the neoplasm. Selective hepatic arteriogram and open liver biopsy are the foundations of diagnostic evaluation. Percutaneous liver biopsy should be avoided. Failure to appreciate the possibility of hepatic angiosarcoma in the proper clinical setting, leading to blind percutaneous biopsy, may result in failure to make the diagnosis at the cost of significant morbidity and mortality. Survival of patients with hepatic angiosarcoma is brief; only 3% live longer than 2 years. Treatment of the tumor to date is empirical. There are probably a few patients who might benefit from radical surgery with curative intent. For all others chemotherapy is indicated. Adriamycin is active against hepatic angiosarcoma, but optimal dose and mode of administration require further investigation. Further study is also required to delineate the cause of hepatic angiosarcoma in the 60% of cases without definite epidemiologic association.
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PMID:The clinical features of hepatic angiosarcoma: a report of four cases and a review of the English literature. 36 8

5 cases of IUD perforation of the cervix were encountered during a 5-year period (1973-78). In these cases, the distal end of the stem (vertical limb) of the T had penetrated through the cervical wall into 1 of the fornices of the vagina. Case 3 involves a 31-year old gravida 3, para 1 who presented at the Hasharon Hospital in the 10th week of pregnancy complaining of lower abdominal pain and mild bleeding. Her physician had previously recommended removal of IUD upon finding out of her pregnancy, but she had refused because the IUD removal "might harm the pregnancy". The present examination revealed cervical perforation by the copper T-IUD, which was then removed through the tiny fistula in the cervix. Bleeding and pain disappeared within 3 days. The woman delivered a normal healthy baby 29 weeks later. Case 4 concerns a 24-year old gravida 3, para 2 who presented at the clinic at the 12-monthly check-up. The string of the IUD was found protruding through the cervical os, while the copper-covered long arm of the IUD had perforated the cervix and was felt in the posterior fornix. The fistula disappeared after the IUD was removed. Although cervical perforations rarely consititute a risk to the woman and are easily removed without permanent damage to the cervix, such complications if they do occur should be reported in view of their extensive use world wide. In addition, risk of pregnancy is increased due to the displacement of the device.
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PMID:Secondary cervical perforation by the Copper-T intrauterine device. 40 Aug 70

A case report of ovarian pregnancy in a young white nulligravida, with a Copper 7 IUD in situ, was presented. The patient had the IUD inserted 1 year prior to her January 1977 admittance to the hospital for abdominal pain. After the IUD was removed, laparoscopy revealed blood in the abdominal cavity. The uterus, tubes, and left ovary were normal. The right ovary had a hemorrhagic cystic mass. A corpus luteum was visible near the mass. Microscopic examination of a section of the hemorrhagic mass revealed immature chorionic villi and a corpus luteum separated from the villa by ovarian connective tissue. In the literature on ectopic pregnancy, the risk of ovarian pregnancy was defined as 1/40,000 deliveries. Several studies indicated that the risk was considerably higher for IUD users. The manner in which IUDs enhance the risk of ovarian pregnancy is unknown.
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PMID:Ovarian ectopic pregnancy in association with a copper-7 intrauterine device in situ. 45 25

Within a 1 year period, 3 patients presenting to the University of Chicago, Chicago Lying-In Hospital with a complaint of lower abdominal pain were diagnosed at laparotomy to have ovarian pregnancies according to the criteria of Spiegelberg. All of the patients were at the time using the Copper 7 IUD for contraception. There are now 50 known cases of ovarian pregnancies in patients using the IUD. The characteristics of these patients do not differ markedly from those previously reported in studies of tubal pregnancies, with and without the IUD, but the presentation of patients tends to be more variable than in tubal pregnancies. 2 factors appear consistently in the studies on IUD-associated pregnancy. 95.3% of the patients presented with abdominal pain and 87% of the patients had positive pregnancy tests. The latter factor may indicate that the ovary may be better able to incorporate trophoblastic tissue than the fallopian tube. The increasing incidence noted here, in a population already known to be particularly prone to pelvic inflammatory disease and therefore ectopic pregnancies in general, lends further credence to a questioning of the desirability of the IUD in such a population.
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PMID:The intrauterine device and ovarian pregnancy. 45 28

Described is the second reported case of isolated abdominal wall actinomycosis associated with use of an IUD. The patient, a 24-year-old white woman, presented with lower abdominal pain, dysuria, urgency, and frequency. Ultrasonography revealed a complex mass in the left lower quadrant of the abdomen that was separate from the uterus, left ovary, and tube. At laparotomy, the patient was found to have an anterior abdominal wall abscess and there was free pus within the abdomen. The omentum was inflamed and adherent to the anterior abdominal wall. The appendix, uterus, ovaries, and tubes were not involved in the inflammatory process. Histologic examination of the omentum demonstrated the typical actinomycotic picture of gram-positive filamentous bacteria within the mass and club-like extensions beyond the periphery of the mass. The patient had a copper-7 IUD in place. The only other reported such case also involved an IUD user. That patient had an isolated anterior wall abscess caused by Actinomyces. The fallopian tubes, ovaries, appendix, omentum, and intestines were normal. The possibility of abdominal wall actinomycosis should be considered in IUD users who present with intra-abdominal abscesses of unknown etiology.
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PMID:Abdominal wall actinomycosis associated with use of an intrauterine device: a case report. 183 39

A case of perforation of the urinary bladder by a Copper 7 IUD inserted in a 32-year old para 5 women 6 months previously is reported. The gynecologist had noted that the insertion was difficult. The patient presented with intermittent abdominal cramping pain and gross hematuria. She had experienced 3 episodes of lower abdominal pain treated with antibiotics and spasmolytic. She has diffuse abdominal tenderness and rebound pain in the pubic region. The only abnormal findings were gross red blood cells in the urine, white blood count of 14,000 and hemoglobin 12.0 g. Real time sonography showed the IUD within the bladder surrounded by hypoechoic echoes found to be blood clots during cystoscopy. A plain abdominal x-ray suggested the IUD was encrusted with calculi. The IUD was removed by cystoscopy. The woman was treated with antibiotics for 10 days and recovered. This is believed to be the 1st published report of an IUD detected by sonography to be in the urinary bladder.
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PMID:Bladder perforation by an intrauterine device. 184 26

Wilson disease presenting as fulminant hepatic failure, severe hemolysis and renal failure is rare in the literature. A ten-year-old boy--complaining of abdominal pain, jaundice, tea-colored urine, and anemia was admitted to this hospital; examination showed Kayser-Fleischer rings, anemia associated with hemolysis, mildly elevated serum transaminases, extremely elevated bilirubin levels, low serum ceruloplasmin level, slightly elevated serum copper, excessive 24-hour urine copper excretion, and severe renal function insufficiencies. Under the impression of Wilson disease with fulminant hepatic failure, the patient was treated by oral D-penicillamine 1 gm per day, intravenous zinc sulphate (about 8 mg per day elemental zinc), and given other supportive treatment. Unfortunately, the patient died of hepatic failure complicated with septic shock 21 days after the onset of symptoms. Autopsy found liver copper content was 586.92 ug/gm dry weight and kidney copper content: 300.19 ug/gm dry weight, abnormally high as compared with normal tissue. A review of the literature led to conclusion that the best treatment for Wilson fulminant hepatic failure is liver transplantation.
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PMID:[Wilson disease presenting as fulminant hepatic failure, acute hemolytic anemia and renal failure: report of one case]. 226 86

The first reported case of simultaneous tubal and intrauterine pregnancy in a woman with an IUD is situ is presented. The incidence of combined pregnancies is estimated as 1 to 2/10.000 gestations. The risk of IUD users to have combined tubal and intrauterine pregnancy is calculated is 1/6,000,000 women years of use. A 32-year old patient, gravida 3, para 2 was admitted because of threatened miscarriage in the first trimester. she had been wearing an IUD for 2 1/2 years. Her symptoms were vaginal bleeding and abdominal pain. Pelvic examination showed an enlarged uterus consistent with a pregnancy of 12 weeks' gestation. A vacuum extraction was performed revealing a Copper-T IUD and intrauterine gestation. In the following days she experienced recurrent abdominal cramps and her physical condition did not improve. The red cell sedimentation test remained slightly elevated. 19 days after the evacuation she still had vaginal bleeding and the pregnancy test was still positive. Pelvic examination now disclosed a right, tender adnexal mass the size of a fist. By laparotomy a ruptured right-sided tubal pregnancy was found surrounded by an organized hematoma containing the right ovary. A right salpingo-oophorectomy was performed after microscopic proof of the existence of tubal pregnancy. The patient with combined pregnancy usually presents symptoms that do not facilitate the diagnosis of this specific disease. The diagnosis may be secured by careful pelvic examination, serial ultra-sound scanning, or eventually laparoscopy.
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PMID:Heterotopic pregnancy. The first case with an IUD in situ. 231 94

3 cases of copper IUDs recovered during laparotomy from the sigmoid colon are presented. One woman was a 24-year old mother of 5 who had had 2 cesarean sections since the disappearance of her Cu-7 IUD in 1980. She had right upper quadrant abdominal pain for 1 year with gall bladder stones. The IUD was found lying 80% in the gut lumen. After colotomy she recovered. The 2nd woman was 31 years old, pregnant for the 4th time after failure of her IUD. She was experiencing a constant left iliac fossa ache. The IUD was shown to be extrauterine by ultrasound, could not be seen at laparoscopy, and was removed by colotomy. The 3rd woman was a 37-year old mother of 5, 19 weeks' pregnant, having a septic miscarriage on admission. She had labor induced, but the IUD was not expelled. Her pain worsened, and fever and tachycardia persisted. Emergency laparotomy revealed a perforated posterior uterine wall with the Cu-7 eroding the serosa of the sigmoid colon. It was removed but the defect was not repaired. She required a subtotal hysterectomy, and a second laparotomy with a temporary colostomy, and her recovery was complicated by pulmonary embolism and cardiac failure. These cases draw attention to the importance of proper management of patients with no visible IUD thread. Ultrasound, and if necessary x-rays and laparoscopy should precede laparotomy. Expulsion of an IUD is rarely unnoticed, nor should pregnancy with an IUD be assumed to be due to an expelled device.
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PMID:Recovery of the intrauterine contraceptive device from the sigmoid colon. Three case reports. 304 19

Appendicitis caused by a misplaced IUD was found in a 29-year-old pregnant woman. The woman had had the device inserted 8 years before. About 5 months after placement and a severe experience of right lower quadrant pain, medical examination revealed that she was pregnant. Abdominal and pelvic X-ray films were thought to be consistent with IUD expulsion, a fairly common occurrence, with an estimated rate of 2-20% within 1 year of placement. Over the next 7 years, the woman continued to experience right lower quadrant pain, but the pain was mild until 20 weeks into her next pregnancy when she was hospitalized with nausea, anorexia, fever, and severe pain. Surgery revealed that her appendix and cecum were bound to an inflamed mass of tissue. During the course of an appendectomy, this tissue mass was found to contain a copper-coated IUD, which was removed by blunt dissection and gentle traction. The IUD had probably partially perforated the uterus on insertion; complete perforation followed in 2-3 months; and copper from the device caused inflammation that eventually involved the appendix. Several months after the appendectomy, it was discovered that the inflammatory mass had been replaced by dense adhesions. This case shows that abdominal and pelvic X-ray examinations may not be sufficient to locate a misplaced IUD in a pregnant woman. If a misplaced device is not clearly visible on X-ray films, further workup may be necessary to avoid the possibility of chronic abdominal pain and complications.
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PMID:IUD appendicitis during pregnancy. 307 60


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