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)

To define more precisely the prognostic index for patients with primary carcinoma of the gallbladder in Taiwan, we retrospectively reviewed the data of 74 patients with gallbladder carcinoma treated over a period of 15 years, from 1979 to 1993. Of these patients, 75% had Nevin stage V gallbladder cancer. The most common presenting complaint was abdominal pain, followed by jaundice, fever, and nausea and vomiting. Accurate preoperative diagnosis was made in 29.7% of the patients. Ultrasonography and computed tomography had a diagnostic accuracy of 34.0% and 40.9%, respectively. The most common histologic type was adenocarcinoma. Liver was the organ most commonly invaded (51.9%) by direct extension and/or metastases, followed by regional lymph nodes (38.5%). The overall 5-year survival rate was 4.1%. Age, sex, white cell count, hemoglobulin, SGOT, SGPT, total bilirubin, alkaline phosphatase, and cholelithiasis were not significant prognostic factors. Patients with cancers confined in the gallbladder wall (stages I, II, III) had a better (P < 0.05) cumulative survival rate than did those with regional lymph nodes and distant metastases. Cholecystectomy or extended surgery had a better survival rate than did palliative surgery, but there was no significant difference between cholecystectomy and extended surgery. High index of suspicion of the disease and earlier surgical treatment may improve patient survival.
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PMID:Primary carcinoma of the gallbladder in Taiwan. 854 60

This 13-year-old girl presented with a four-day history of increasing lower abdominal pain associated with heavy vaginal bleeding which was now resolving. Her last normal menstrual period was 19 days before this incident, with a history of regular periods. Repeated questioning revealed a history of the patient engaging, for the first time, in consensual sexual intercourse one day prior to the onset of complaints. The abdominal examination revealed mild lower abdominal tenderness without rigidity or guarding. The pelvic examination failed to reveal any active bleeding, laceration, or findings suggestive of pelvic inflammatory disease. Routine laboratory studies revealed an elevated white cell count. As the patient's pain worsened over the next two to three hours, surgical and obstetric-gynecologic consultations were made, and both services advised overnight observation. Over the next 12 hours her abdominal examination revealed increased rigidity, and the patient was taken to the operating room with the a preoperative diagnosis of ruptured appendix. On exploratory laparotomy a hemoperitoneum was found, and approximately 600 ml of blood were suctioned from the peritoneal cavity. A 2-cm posterior vaginal wall laceration was subsequently repaired and a normal appendix removed.
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PMID:Coital injury presenting in a 13 year old as abdominal pain and vaginal bleeding. 889 44

In contrast to the well known chlorpromazine-induced cholestatic hepatitis, we report the case of a schizophrenic patient who presents a cytolytic hepatitis, without any prior hepatic disease. Mr G. was first hospitalized for depressive symptomatology. A pseudo-nevrotic schizophrenia was diagnosed. Pretherapeutic clinical and biological data were normal. A treatment with chlorpromazine 400 mg/day was given. At day 8, the patient was still anxious and began to be agitated. An increase to 500 mg/day of chlorpromazine posology and an addition of haloperidol 200 mg/day was implemented. At day 10, the following clinical symptoms appeared: 38.6 degrees C fever; headache; myalgia; epigastralgia and hypocondrium pain. Biological hepatitis disturbances (ALAT, 984 U/L; ASAT, 414 U/L) and hypereosinophilia with normal white cell count were found. Clinical and biological investigations were normal. Blood-culture, A, B, C hepatitis, HIV and CMV serologies were negative. Neuroleptic treatment was discontinued. Evolution to normality of the disturbances and biological data suggested a cytolytic hepatitis. Mr G... remained treated with flupentixol without side-effects. Phenothiazine-induced cholestatis is frequent, mild, and recovers spontaneously. The biological mechanism is supposed to be immunologic. Prevalence of biological hepatic disturbances is 10 to 20% with chlorpromazine in long-term treatment. More often, symptomatology is the same; jaundice, pruritus, abdominal pain, fever. Although pharmacological data suggest for a cytotoxic activity of phenothiazines, cytolytic hepatitis is poorly described. Maximum range of transaminase blood level reported in previous studies is about 400 U/l. This level is not clearly correlated with hepatic cell lysis. Few cases of hepatic necrosis have been reported. In all cases, preexistent hepatic injuries were observed. Chlorpromazine-induced cytolytic hepatitis is uncommon and cholestatic hepatitis mild. Biological hepatic parameters investigations remain necessary during neuroleptic treatment.
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PMID:[Cytolytic hepatitis during treatment with phenothiazines: apropos of a case]. 903 96

Dengue is a mosquito borne disease with worldwide distribution. Depending on virulence factors and host immune status, infection can manifest as a severe but non fatal viral syndrome or a rapidly progressive and a frequently fatal haemorrhagic fever. During the course of an outbreak of viral fever in Karachi, Pakistan from June, 1994 to September, 1995, we studied 145 cases admitted at the Aga Khan University Hospital. 43% of the cases were between the age group of 20-30 years, majority of these being male (75%). Amongst the clinical signs and symptoms, the most frequent findings were fever, vomiting and abdominal pain. Spontaneous hemorrhagic manifestations occurred in 66 patients and of these petechiae and mucosal bleed were the commonest, that is, 42% and 38% respectively. At presentation thrombocytopenia (platelet count < or = 50,000) per cubic millimeter) was present in 78%, leucopenia (white cell count < 4,000 per cubic millimeter) in 34%. Apart from one patient who died from hemorrhagic shock on the 5th day of admission, the remaining patients recovered and their platelet counts normalized on an average in 9 days. This is the first reported epidemic in Karachi of dengue infection.
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PMID:An epidemic of Dengue fever in Karachi--associated clinical manifestations. 930 Nov 57

The increase in immigration to the United States is associated with diseases, such as amebiasis, that are endemic to developing countries. We retrospectively reviewed 49 public-hospital patients with hepatic amebiasis occurring between 1985 and 1995. Most patients were immigrants (47) from Latin America (43), male (43), and young (mean age, 39.8 years). Symptoms noted by more than half were abdominal pain and fever. Ultrasonography showed single lesions in 70% and right-sided involvement in 85%. Serologies against Entamoeba histolytica were noted in 86%. After treatment, the median interval from admission to defervescence was 2 days, to normalization of white cell count 3 days, and to resolution of abdominal pain 4 days. Morbidity (one case of pericarditis) and mortality (one death in a cirrhotic man) were low. Hepatic amebiasis continues to be diagnosed in the United States, primarily among Hispanic and Asian immigrants. When appropriately considered, current diagnostic and therapeutic modalities result in rapid improvement and excellent outcome.
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PMID:Hepatic amebiasis among patients in a public teaching hospital. 974 53

This paper evaluates the management of 31 patients with bile leaks identified over a 7-year period. Leaks complicated cholecystectomy in 19 patients (11 laparoscopic, 8 open), interventional procedures in 10 (including surgery in 1), trauma in one and was spontaneous in one case. Confirmation of the diagnosis typically lagged behind the onset of symptoms (mean for the group 4.2 days), indicating that a high index of suspicion is required in at-risk patients with typical symptoms. These include abdominal pain or distension, fever, bile leaking along a drain, jaundice, abnormal liver function tests and elevated white cell count. Two post-surgical bile leaks required surgical drainage of abdominal cellections. The remainder were successfully managed by non-operative methods including percutaneous drainage, endoscopic retrograde cholangiography with or without sphincterotomy or stent placement and percutaneous stenting. The spontaneous leak and all bile leaks complicating interventional procedures were managed non-operatively, although six patients in this group died due to the underlying malignant pathology. Only the patient with self-inflicted transection of the bile duct died directly from the complications of the bile leak. Although this is a varied, small series, we conclude that the majority of bile leaks can be managed by non-operative techniques. Whilst endoscopy is the primary modality for treatment, percutaneous techniques are crucially important for the management of complex cases and endoscopic failure.
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PMID:Causes, clinical features and non-operative management of bile leaks. 986 70

A case of torsion of the vermiform appendix is described in a five-year-old boy with a two-day history of right-sided abdominal pain. No associated abdominal tenderness was reported, no vomiting nor fever. The pain was localized in the same place for 24 hours and became more severe and constant. Blood film showed a normal white cell count. After two ultrasonographic examinations in the course of 24 hours, the sign of a distended intestinal loop became constant. With the diagnosis of mucous-producing appendicular lesions or appendicular torsion, a laparotomy was performed. The appendix was severely congested and gangrenous; there was a 360-degree anticlockwise twist in its base. The related literature is reviewed and the value of the ultrasound scanner images and the possible mechanism involved is discussed.
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PMID:Torsion of vermiform appendix: value of ultrasonographic findings. 992 11

We performed a structured retrospective chart review to describe clinical characteristics of Emergency Department (ED) patients diagnosed by history, physical examination, and abdominal computed tomography (CT) scan with epiploic appendagitis (EA). EA is a disease caused by inflammation of the appendix epiploica, subserosal adipose tissue along the colon. It may mimic surgical causes of acute abdominal pain, but is treated conservatively with pain management. There were 19 patients diagnosed with EA, with follow-up performed on 85%. All had focal, nonmigratory symptoms. Common findings included left lower quadrant pain and guarding, and a normal temperature and white cell count. No patient required operation. This preliminary work characterizes some common clinical features of ED patients diagnosed with EA. As use of emergency CT scan for abdominal pain increases, clinicians will encounter this more often. These features should also prompt the clinician to consider CT scan in patients with similar signs and symptoms. Accurate diagnosis may avoid unnecessary surgery.
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PMID:Epiploic appendagitis: the emergency department presentation. 1180 50

There is mounting concern that internal hernia formation after laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity remains unrecognized until complications develop. In this report we present our experience with this complication. Out of 100 patients who underwent LRYGB we identified five patients who were diagnosed with postoperative internal hernia formation. The medical records and operative details of these patients were reviewed. Of the five patients four were female and the average age was 36 years (range 30-43). All Roux limbs were placed in a retrocolic position. The average time interval to presentation was 104 days (range 4-305). All patients had abdominal pain and four patients experienced vomiting. One patient had obstipation. Only one patient had fever (38.1 degrees C) and the highest white cell count was 14,500. The average loss in body-mass index was 5.21 kg/m2 (range 2.5-14.8). Plain abdominal films revealed dilated bowel in the upper abdomen in three patients. Contrast bowel series was diagnostic in only one patient. One patient had a CT scan, which was diagnostic of small bowel obstruction. All patients underwent operative reduction of the internal hernia; two of these were completed laparoscopically. All hernias had occurred at the mesocolic window and were caused by sutures that had pulled through tissue at the dorsal and lateral aspect of the initial repair. One patient had a nonviable segment of small bowel. There were no deaths. Patients who undergo LRYGB are at a 5 per cent risk for developing small bowel obstruction secondary to internal hernia formation at the mesocolic window. Clinical evaluation and traditional study modalities may not be effective diagnostic tools. A high index of suspicion and low threshold to explore these patients may be the best way to avoid serious sequelae. Modification of operative techniques may reduce the occurrence of internal hernia formation.
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PMID:Internal hernia formation after laparoscopic Roux-en-Y gastric bypass for morbid obesity. 1213 50

The translocation between chromosomes 2 and 8, t(2;8), is well known for its strong association with high-grade Burkitt lymphoma. However, the significance of this translocation in indolent lymphoproliferative disorders is not clear. We present the case of a 75-year-old white male with left upper quadrant abdominal pain, splenomegaly, and an elevated white cell count of 30.3x10(9) cells/L (84% large lymphoid cells with scanty cytoplasm and prominent central nucleoli). Immunophenotyping revealed a clonal B-cell population coexpressing CD5, CD19, and CD20 with weak CD23 and CD25 and very weak, restricted, surface lambda. The cytogenetic analysis showed all 20 cells with t(2;8)(p12;q24.3). In addition, four of the 20 cells also showed a second translocation: t(12;17)(p13;q21). Molecular analysis using c-myc and p53 probes showed normal results with no indication of amplification of C-MYC or deletion of TP53. The patient was managed as an indo-lent/low-grade lymphoproliferative disorder with excellent response to eight cycles of fludarabine.
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PMID:An indolent B-cell lymphoma with t(2;8)(p12;q24) abnormality and absence of C-MYC amplification and TP53 deletion. A new variant? 1281 Feb 61


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