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)

Icodextrin is a glucose polymer obtained from starch hydrolysis. It is used as an osmotic agent at 7.5% for peritoneal dialysis (PD). Its use in PD has been associated with several side effects separate from the one reported here, the most frequent being sterile peritonitis. Recently, three mechanisms have been proposed to explain the occurrence of sterile peritonitis: allergy to dextrin, production of anti-dextran antibodies, and impurities introduced during manufacture. Here, we report a peritoneal mononucleosis outbreak that is highly suggestive of being a consequence of the last-mentioned mechanism. During the period December 2001 to May 2002, a group of 8 Spanish hospitals whose individual PD programs regularly share information and activity reported 29 cases of sterile peritonitis associated with icodextrin use in continuous ambulatory peritoneal dialysis (CAPD) patients [mean age: 60.7 +/- 14.47 years; 8 women (27.59%), 21 men (72.41%); mean time on PD: 25.21 +/- 35.31 months; mean time on icodextrin: 15.17 +/- 11.03 months]. Of the 29 patients, 51.8% showed no symptoms. The remainder presented with mild abdominal discomfort and anorexia. Only 2 patients showed general malaise, severe nausea, fever, and abdominal pain. The initial white cell count in peritoneal effluent was 512 +/- 386 cells/mL (45.0% +/- 28% neutrophils, 44.92% +/- 32.6% mono-nuclear cells, 7.75% +/- 12% eosinophils). In 5 of the patients, we performed an immunophenotype (CD14) study, demonstrating the monocyte nature of 60%-80% (mean: 70.6%) of the cells. Microbiology cultures were always negative. A rechallenge with the same batches of PD fluid was tried. In 100% of the patients, the clinical and cellular patterns relapsed. No short-term changes in peritoneal function have been observed. The manufacturer informed us that the icodextrin was contaminated with a peptidoglycan. In this sterile peritonitis outbreak with a simultaneous, similar clinical presentation in a group of patients treated with icodextrin solution (presumably contaminated with peptidoglycan), clinical outcome was, for the most part, mild-to-moderate. Symptoms disappeared immediately after icodextrin withdrawal and relapsed after rechallenge with the relevant fluid batches. Monocyte cell counts predominated during the episode. Although we cannot rule out an allergic cause, the massive peritoneal mononuclear cell recruitment suggests a particular mechanism. This is a new mechanism for peritoneal cell recruitment in PD.
 ...
PMID:Severe peritoneal mononucleosis associated with icodextrin use in continuous ambulatory peritoneal dialysis. 1476 60

Polycystic liver disease is the most common extrarenal manifestation of autosomal dominant polycystic kidney disease. Hepatic cysts often are multiple, and in renal transplant recipients, occult infection with or without concurrent kidney cyst infection is a frequent cause of abdominal pain and fever and may require long-term antibiotic use and hospitalization. Rupture and bleeding of hepatic cysts into the peritoneum or viscera are infrequent complications that have been reported. Identification of a single culprit lesion that could be targeted for surgical intervention often is difficult because such imaging studies as computed tomographic scans, magnetic resonance images, or radionuclide-tagged white cell scans often show several inflamed cysts that can persist over several subsequent scans. Treatment may require surgical intervention. Eradication of infection and wound healing also is made difficult by concomitant immunosuppression in renal transplant recipients. We present the case of a renal transplant recipient with an infected dominant polycystic liver cyst that ruptured into the pericardium, leading to tamponade.
 ...
PMID:Rupture of an infected liver cyst into the pericardium in a kidney transplant recipient with polycystic kidney disease. 1753 28

Listeria monocytogenes (LM) is one of the rare microorganisms causing peritonitis in peritoneal dialysis (PD) patients. We report a sporadic case of peritonitis caused by LM in a young female PD patient with lupus receiving corticosteroid therapy, who presented with abdominal pain, cloudy PD effluent, nausea, and conjunctivitis. The effluent showed a high PD effluent white cell count and monocytosis, and gram staining showed gram-positive bacilli in single or short chains and PD effluent culture grew LM. She was treated successfully with beta lactum antibiotics. LM peritonitis should be suspected if a patient presents with gram-positive bacilli and monocytosis in dialysis effluent.
 ...
PMID:Listeria monocytogenes peritonitis in a patient on peritoneal dialysis: a case report and review of the literature. 1856 14

We describe a 65-year-old man who had liver involvement with Churg-Strauss syndrome. He was admitted to the hospital because of fever, weight loss, dyspnea, abdominal pain, skin lesions and paraesthesias. His past medical history revealed a diagnosis of acalculous cholecystitis that had been made eight months earlier. Microscopic examination of a gall bladder biopsy specimen obtained at that time revealed an increase in extravascular eosinophils. There was evidence of a new bilateral pulmonary disease with bronchoconstriction and a transient infiltrated lesion in the right upper lung. The patient's white cell count was 14 620 per cubic millimetre, with 39% eosinophils (5800 per cubic millimetre) and 39% neutrophils. IgE was 503 g/L (normal range, 0 to 100 g/L). Liver function tests were mildly elevated. Fine needle liver biopsy showed active interface hepatitis. A diagnosis of Churg-Strauss syndrome was made. In this patient the syndrome occurred in a rare association with hepatitis, likely due to immunologic events in the liver. The patient was successfully treated with 60 mg/day of prednisolone monotherapy.
 ...
PMID:Churg-Strauss syndrome associated with acalculous cholecystitis and liver involvement. 1919 81

Epiploic appendagitis is a rare cause of focal abdominal pain which, depending on its localisation, can mimic a variety of abdominal diseases. We report a case of 36-year-old woman who presented with a classic signs of acute appendicitis. On examination, the obese, afebrile, and had very strong right iliac fossa tenderness and guarding. The white cell count was 12.82 x 10(9)/L, and C reactive protein count was 15.13MG/DL. She underwent emergency laparoscopic procedure after the acute appendicitis diagnosis has been established. Laparoscopic exploration of the abdominal cavity showed vermiform, no inflamed, appendix and necrotic appendix epiploica of the caecum. The treatment consisted of typical laparoscopic appendectomy and laparoscopic resection of the necrotic appendix epiploica. The patient made rapid recovery and was discharged from the hospital on second day after the operation. Histological investigation of the appendix epiploica revealed gangrenous epiploic appendage.
 ...
PMID:Torsion of epiploic appendage mimic acute appendicitis. 2239 76

Despite advances in treatment and prevention, peritonitis remains a major problem in peritoneal dialysis (PD) patients with often technique failure as a consequence. The last decades the focus of PD peritonitis has changed from lowering peritonitis incidence to improvement of peritonitis outcome. Prognostic factors for peritonitis outcome can influence decision making during the treatment of peritonitis, for example to take out the PD catheter early in the time course of peritonitis and prevent further damage to the peritoneal membrane. In this paper, we give a review of the literature about prognostic factors for peritonitis outcome. In most studies, age, gender, diabetes, time on PD, a precursor of calcitonin:procalcitonin, IL-6 and albumin did not show a significant effect on peritonitis outcome. The following factors have been associated with poor outcome of peritonitis: Gram-negative organisms, Mycobacterium species, fungal peritonitis, polymicrobial peritonitis, concurrent exit site or tunnel infection, Caucasian race, low residual GFR, persistently elevated peritoneal dialysate white cell count, CRP, and low levels of slCAM-1 and hyaluronan at the end of peritonitis treatment. In fungal peritonitis, abdominal pain, bowel obstruction, the catheter remaining in situ and Candidaparapsilosis are factors associated with higher mortality rate and a greater risk of technique failure. Recent antibiotic therapy and peritonitis are associated with poor treatment response in culture-negative peritonitis. Recurrent peritonitis episodes have a poor therapeutic response and high mortality and have a worse prognosis than relapsing ones. Older age, long PD duration and continuous elevated serum CRP levels are predictors of adverse outcomes in PD patients after peritonitis-related catheter removal. Peritonitis remains a serious complication of PD with marked morbidity. It is a common cause of technique failure. The rate of PD-related peritonitis has decreased over the last decades due to advances in treatment and prevention. Nowadays, the focus moved from lowering peritonitis incidence towards improving peritonitis outcome. It is useful to have prognostic factors for peritonitis outcome, because they can influence decision-making during the treatment of peritonitis, for example to take out the PD catheter early in the time course of peritonitis and prevent further damage to the peritoneal membrane. In the last decades, many publications appeared about prognostic factors for peritonitis outcome. This article summarizes those prognostic factors, based on an extensive review of the literature.
 ...
PMID:Prognostic factors for peritonitis outcome. 2265 48

A 73-year-old man presented to the surgical assessment unit with recurrent episodes of central abdominal pain and vomiting for 18 months. He has the past medical history (PMH) of hypertension and has been using his denture for 35 years; he had no past surgical history; he drinks alcohol socially and not a smoker. This patient was investigated for iron deficiency anaemia with upper and lower gastrointestional endoscopy, as the patient had positive faecal occult blood; rectal biopsy showed no sign of inflammation and no evidence of malignancy; blood investigation showed Hb 9.8 g/dl, white cell count 14.8, mean cell volume 86.3, mean cell haemoglobin 26.9 and C reactive protein 13. This patient underwent a CT scan of the chest, abdomen and pelvis; the latest one showed that there is a short segment of the middle part of the small bowel that looks thickened and within which there is a high-density calcified shadow which is reported as an ingested foreign body or a tooth fragment; the patient underwent laparotomy and the histology results revealed 30 mm well differentiated/moderately differentiated adenocarcinoma.
 ...
PMID:Small bowel adenocarcinoma: a case of atypical CT scan appearance. 2268 78

We present the case of an 82-year-old Caucasian lady with a 16-day history of colicky lower abdominal pain and reduced appetite. When presenting to hospital she was haemodynamically stable with no fever. Examination revealed a soft but tender abdomen with normal bowel sounds. No masses or hernias were present. Per-rectal examination revealed an empty rectum. Investigations showed raised inflammatory markers, white cell count 11.9 and C reactive protein 24, in addition to which she had dilated loops of small and large bowel on the abdominal radiograph. The patient underwent an emergency laparotomy where a mass in the descending colon was found to be intussuscepting into the proximal sigmoid colon for which a Hartmanns procedure was performed. Histopathology confirmed a Dukes B T3 N0 Mx adenocarcinoma.
 ...
PMID:Intussusception in the elderly. 2335 55

Plexiform fibromyxoma (plexiform angiomyxoid myofibroblastic tumor) is a rare benign mesenchymal tumor of stomach. The plexiform growth of bland-looking spindly cells in a richly vascularized fibromyxoid stroma is distinctive. The described cases are solid tumors associated with ulceration, with the patients presenting with symptoms related to the ulcer or mass effect of the tumor. We report an unusual case presenting as a fistulating abscess. A 42-year-old woman presented with abdominal pain, fever, and elevated white cell count. Computed tomography scan revealed a 12-cm cavitating mass in the gastric antrum, with fistulation to the gastric lumen through an ulcer. Histologic examination showed transmural involvement of the stomach by plexiform islands of fibromyxoid tumor with interspersed delicate capillaries. There was a pseudocyst-like component. The unusual presentation therefore broadens the clinical and pathologic spectrum of this rare tumor type.
 ...
PMID:Plexiform fibromyxoma (plexiform angiomyxoid myofibroblastic tumor) of stomach: an unusual presentation as a fistulating abscess. 2379 94

Salmonella cholecystitis is a rare but important complication of Salmonella typhi infection. We are reporting an 11 years old female child who presented with complaints of high-grade fever, jaundice and right sided abdominal pain (Charcot's triad). Her examination showed tender hepatomegaly. Initial blood results revealed high white cell counts with left shift, deranged liver function tests. Abdominal ultrasonography revealed distended gallbladder with minimal layer of sludge seen within its lumen along with streak of pericholecystic fluid. Blood culture grew Salmonella typhi. She was successfully treated with intravenous ceftriaxone.
...
PMID:Salmonella cholecystitis: atypical presentation of a typical condition. 2416 98


<< Previous 1 2 3 4 5 6 Next >>