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)

We reviewed written and audio records of paramedic-base hospital radio contact to determine whether care differed from that suggested in standard prehospital care protocols. Records of all 659 contacts for seizure, syncope, abdominal pain, or altered mental state during 1987 (28.4% of all contacts) were scored for the use of standard therapies (such as intravenous access, oxygen, naloxone hydrochloride) and unanticipated therapies (intubation, nitroglycerin). Cases that involved unanticipated treatments were reviewed to determine whether they could have been prospectively identified by simple clinical findings. Standard therapies were used in the majority of patients. Unanticipated therapies were administered to 13 patients, all of whom had abnormal vital signs, diaphoresis, respiratory distress, or a second prominent symptom. Data suggest that protocols could replace radio contact for most patients and that the few who might benefit from radio contact can be easily identified. A 90% reduction in radio contacts in Los Angeles county could save $3 million each year.
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PMID:Does paramedic-base hospital contact result in beneficial deviations from standard prehospital protocols? 205 61

Sickle crises frequently manifest as abdominal pain that may simulate intra-abdominal infection. To establish parameters to distinguish these, we retrospectively studied 53 patients with sickle-cell anemia who had abdominal pain (genotype SS 62%, SC 15%, SA 11%, S-other 11%; 30% men and 70% women; mean age 23). A vaso-occlusive crises was responsible for the pain in 57 per cent; 23 per cent had a surgical entity and 20 per cent had a nonsurgical genitourinary disorder. Of the surgical conditions, 9 of 12 patients (95%) had cholecystitis and 4 of 12 patients (33%) had acute appendicitis (one patient had both). Vaso-occlusive crises were diffuse in 15 of 30 patients (50%), compared with proven surgical conditions, and was more often associated with remote pain such as limbs and chest (23 of 30 [77%] P less than 0.005). The pain of vaso-occlusive crises simulated prior crises in 21 of 30 patients (70%) compared with 1 of 12 patients (8%) who had surgical abdominal pain (P less than 0.005). A precipitating event (especially upper respiratory infection) was found in 50 per cent of abdominal vaso-occlusive crises versus 0 per cent of surgical abdomens (P less than 0.010). The pain was relieved with hydration and oxygen in 97 per cent of sickle crises within 48 hours versus 0 per cent of surgical abdomens (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The presentation and management of the acute abdomen in the patient with sickle-cell anemia. 281 19

Anaphylaxis is an often severe, potentially life-threatening symptom complex. Urticaria, airway edema, vascular collapse, asthma, abdominal pain, and diarrhea are common clinical signs. Recently recognized syndromes of anaphylaxis include reactions due to exercise, food preservatives, aspirin, steroids, dialysis, various serums, and human seminal fluid. Initial therapy is directed at maintaining an effective airway and circulatory system. Administration of aqueous epinephrine is always indicated. Other measures may include oxygen delivery by controlled flow, administration of an aerosolized beta agonist, slow infusion of aminophylline, and rapid infusion of intravenous fluid. Patients with severe acute reactions should be monitored in-hospital.
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PMID:Anaphylaxis. Why it happens and what to do about it. 289 Jan 45

The per- and post-operative characteristics of three different i.v. anaesthetic induction agents were studied double-blindly in 75 patients admitted for outpatient gynaecological dilatation and curettage. All the patients were premedicated with midazolam 0.1 mg/kg i.m. Induction started with alfentanil 0.015 mg/kg i.v. 60 s before either: propofol 2.2 mg/kg i.v., or thiopentone 4.0 mg/kg i.v., or methohexitone 2.0 mg/kg i.v. All the patients received 66% nitrous oxide in oxygen. The propofol patients were significantly better relaxed and had a higher incidence of hypotension during the procedure. The methohexitone patients had higher pulse rates and a higher frequency of hiccups during the procedure. Propofol induction resulted in a faster awakening of the patients and a better recovery function compared with methohexitone for the first 15 min and compared with thiopentone for the first 240 min after the procedure. Postoperative side-effects were less frequent in the thiopentone group, and minor abdominal pain was significantly more frequent in the propofol group. There was no significant difference between the groups for any variable after 240 min postoperatively.
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PMID:Comparison of propofol induction with thiopentone or methohexitone in short outpatient general anaesthesia. 306 44

Oral prostaglandin E2 (PGE2) is now widely used in conjunction with amniotomy for induction of labor, especially in the parous patient and the primigravida with a favorable cervix. It has been highly successful and the oral tablets now on trial seem to have a low incidence of side effects. The main concern in using a swallowed drink or a tablet was the possible development of uterine hyperstimulation after the longacting dose of uterine stimulant had been given. However, only a few cases have been reported with a wide variety of regimens of PGE2; thus this complication seems rare except with higher intravenous doses. The following case is reported wherein severe uterine hypertonus after induction of labor with low-dose oral PGE2 tablets developed. A 32 year old woman, para 2 had had 2 previous spontaneous vertex deliveries of healthy infants weighing 7 pounds (3.2 kg) and 8 pounds 4 ounces (3.6 kg), after 7 hours and 5 hours of labor. The pregnancy had been uneventful and induction of labor was carried to term plus 9 days by low amniotomy and oral PGE2. The cervix was given an inducibility rating of 6. Within the 1st hour a high baseline intraamniotic pressure was noted (up to 30 mmHg) but this fell spontaneously to under 15 mm. The 4th hourly dose was omitted since the patient was in very good labor and a rise in baseline pressure to 25 mm had again occurred with 80 mm contractions every 2 minutes. 80 minutes after the 3rd dose the patient began to have increasing abdominal pain and prolonged contractions. An intraamniotic baseline pressure showed a rise to over 60 mm for periods of 4, 4, 8, and 10 minutes, with only brief falls to 30 mm in between. The patient was in continuous severe pain unrelieved by 50 mg intravenous pethidine and nursing on her side. The fetal heart fell progressively from a baseline of 125/minute to 60 just prior to delivery. The cervical dilatation was only 5 cm with the vertex 1 cm above the ischial spines 20 minutes before delivery. Labor was clearly progressing rapidly. When the head had entered the pelvic region, preparations were made to expedite delivery with the ventouse, but full dilatation was reached quickly and delivery was achieved with Haig Ferguson forceps. A healthy male child weighing 7 pounds, 4 ounces (3.3 kg) was delivered with an Apgar of 5 but he rapidly responded to simple resuscitation with mucus extraction and oxygen. In spite of the total low dose of PG and the rarity of significant hypertonus reported with PGs, it is clear that the severe hypertonus was due to PG stimulation. It is also unusual since the condition occurred long after the last PG administration. In such a severe case, it might be wise to consider a rapid intravenous infusion of ethyl alcohol.
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PMID:Letter: Uterine hypertonus after oral prostaglandin E2. 413 26

Campylobacter jejuni has recently been recognized as an important cause of human gastroenteritis in many countries. The clinical features of C. jejuni infections vary from those of a mild gastroenteritis to a severe enterocolitis. The most common symptoms of the disease are fever, abdominal pain and bloody diarrhoea. The small intestine is the main site of infection, but the colon may also be involved. The main pathogenesis of C. jejuni appears to be invasion of the wall of the gut as in salmonellosis. Isolation of the organism from faeces requires culture in a selective medium containing antibiotics and incubation under reduced oxygen tension at 42 degrees C. Most cases of campylobacter enteritis are sporadic and it is often difficult to confirm their source. Although cross infection between humans occurs rarely, the disease is mainly a zoonosis with many possible routes of infection. Human infections have been associated with the consumption of contaminated food, especially poultry, unpasteurized milk, and water, as well as contact with domestic animals such as dogs and cats. In most cases campylobacter enteritis is a selflimiting disease and therefore decision on treatment should be taken on clinical grounds. When considered necessary, erythromycin is the drug of choice. Information about C. jejuni infection has accumulated rapidly in recent years, but much remains to be learned, especially about its epidemiology.
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PMID:Campylobacter jejuni enteritis; a review. 639 Aug 86

A 45-year-old man who was admitted with nausea, vomiting, and abdominal pain was found to have severe metabolic alkalosis, with a PaCO2 of 11.4kPa (85.5 mm Hg), PaO2 of 5.8 kPa (43.5 mm Hg), pH of 7.61, and plasma bicarbonate concentration of 82.0 mmol/l. He was treated with oxygen, intravenous physiological saline, and phenytoin and improved within 48 hours. Radiographs showed gastric outlet obstruction secondary to peptic ulcer, which was treated by surgery. Though sever, the rise in carbon dioxide concentration in this patient was probably lifesaving. The PaCO2 was therefore allowed to fall gradually as the alkalosis was treated. The return of both PaCO2 and plasma bicarbonate values to normal in parallel suggests that hypoventilation compensated for the metabolic alkalosis and emphasises the importance of conservative treatment in cases of metabolic alkalosis.
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PMID:Severe metabolic alkalosis: a case report. 679 44

A 13-yr-old boy was scheduled for emergency appendicectomy because of abdominal pain. His preoperative medical history was complicated by a recent hospital admission for management of asthma. He had presented to hospital seven days earlier because of dyspnoea, tachypnoea and oxygen desaturation to 77% on room air. Following admission, he required intensive nonventilatory management of his asthma, including intravenous salbutamol, methylprednisolone, and aminophylline, as well as use of an ipratroprium bromide inhaler and 100% oxygen by mask. He was discharged to the ward, and continued on prednisone (delta-cortisone), beclomethasone inhaler, ipratroprium inhaler, and salbutamol inhaler. During his ICU stay, he complained of nonspecific abdominal pain, interpreted as gastro-oesophageal reflux. After four days, he was discharged to the ward. On his sixth hospital day, he began to experience right-sided lower abdominal pain and right shoulder pain. A surgeon was consulted, and the patient was found to have a very tender right lower quadrant with guarding and rebound pain. He was therefore scheduled for appendicectomy; antibiotic therapy with ampicillin, gentamicin, and metronidazole was initiated.
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PMID:Anaesthetic management of an asthmatic child for appendicectomy. 806 95

Pouchitis is a significant long-term complication of restorative proctocolectomy. Pouchitis is characterized by diarrhoea, fever, malaise, abdominal pain and in few a patients a worsening of already present extraintestinal manifestations may occur. The estimated probability of pouchitis occurring within five years is approximately 35%. Standard diagnostic criteria have not yet been established, but clinical symptoms, endoscopic and histological features should be included. The cause of pouchitis is unknown, bacterial over-growth, faecal stasis, oxygen free radicals, secondary and deconjugated bile acids, shortchain fatty acids, gastrointestinal hormones and an immunologically-mediated reaction have all been suggested as possible etiological factors. Metronidazole is the most commonly used treatment and has prompt effect in more than 90% of the patients. Steroids and 5-aminosalicylic acid derivatives also seem to be effective. A diverting ileostomy is necessary in only five to seven percent of the patients, and in less than one percent does pouchitis result in excision of the pouch. Controlled trials with uniform diagnostic criteria are required to assess the effectiveness of the individual regimens.
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PMID:[Pouchitis: acute inflammation in the pelvic ileal reservoir. Diagnostic criteria, frequency, possible etiological factors and treatment]. 835 64

We present a 53-year-old female with pulmonary embolism (PE), who had been taking oral contraceptive for 13 years. She was admitted to our hospital with upper abdominal pain and was found to be in shock. The diagnosis of PE was made from chest X-ray examination, electrocardiogram and pulmonary angiography. Pulmonary hypertension was observed on right heart catheterization, and an anticoagulant was administered. Multiple defects of the right pulmonary artery were detected on lung perfusion scan, and there were no significant findings on leg phlebogram. Home oxygen therapy was effective for the treatment of pulmonary hypertension and chronic hypoxemia which still persisted after her recovery from the acute stage. We are concerned that wide spread use of oral contraceptives will increase the incidence of PE in the near future in this country. We conclude that contraceptive users should be warned of their higher risk of PE, and that they should visit a clinic for examination.
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PMID:[A case of pulmonary embolism probably induced by long term use of oral contraceptive]. 846 29


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