Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A report from Kampala, Uganda, compares the situation in 1991 to the state of chaos 10 years earlier when the regime of Idi Amin had been overthrown by Milton Obote's soldiers with the help of Tanzanian troops. Soldiers went on looting sprees, and 1 victim of their marauding became a 12-year old boy who got shot for refusing to part with his bike. In contrast, in 1991 things were much more peaceful; however, the AIDS epidemic was the new threat. The government radio transmits hourly warnings on HIV. Since President Museveni came to power, economy and security have improved radically. Shops and markets are open until late at night; public transport is reliable, and small scale industry flourished. There would be optimism about the future, if AIDS was not here. There is no doubt that the economy will soon be affected. According to the Kampala blood bank, 40% of the healthy population is already seropositive. In the hospitals the majority of admissions suffer from AIDS with diarrhea and an itching dermatitis; there is more cancer of the cervix and lymphoma; appendicitis is on the increase; and tuberculous lymph nodes are now quite common. Many of these patients have clinical AIDS. The government is frank about the situation and is active in preventive measures and education. Private charities and foreign aid organizations contribute. But the epidemic is so overwhelming, that some Western organizations might soon lose interest owning to meager returns on their efforts. A 6-year-old boy has grossly swollen lymph nodes around his neck, both parotids are painfully swollen, pus pours from the ears. A nonspecific cough and mild diarrhea are also present with an itching and sore herpes zoster on his left chest. the mother is frightened of losing him, and demurs at the hint of AIDS, since for her, AIDS means sexual promiscuity.
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PMID:A tale of one city. 139 51

Sterilization by tubal occlusive methods is not always successful. This fact is not, however, well recognized among general surgeons. When failures occur, ectopic pregnancy is the usual outcome, most commonly in the Fallopian tube. Ectopic pregnancy has a reported mortality of approximately 3.5/1000, with the majority of deaths associated with delay in diagnosis. The failure to consider this possibility of ectopic pregnancy after tubal ligation when female patients present with right-sided abdominal pain causes health personnel to commonly misdiagnose the condition of appendicitis. A 26 year old woman presented to the Accident and Emergency Department of the Royal Hobart Hospital with lower abdominal pain mainly in the right iliac fossa. Pain was intermittent for two weeks prior to presentation. On the morning of presentation, the pain became severe and was exacerbated by coughing and movements. The patient was nauseated, but had not vomited; there was neither fever nor rigors. Four years earlier, in England, the patient had undergone elective laparoscopic sterilization. Sexually active, she believed that she was menstruating at the time of presentation, especially since her last menstruation occurred four weeks previously. The patient was noted upon examination to have a "grey look," pulse rate of 80 beats/minute, blood pressure of 120/80 mmHg, and a generally tender abdomen, maximally in the right iliac fossa. There were no bowel sounds and rectal examination proved to be extremely painful in all directions. The accident and emergency staff took blood for a full blood count, serum human chorionic gonadotrophin, and arranged surgical consultation. The surgical diagnosis was for acute appendicitis and the patient was transferred to the operating theater for appendectomy. Just prior to anesthetic induction, the pathology results became available, indicating a hemoglobin of 10.3 g/dl and a positive serum HCG. The diagnosis was thus revised to ruptured ectopic pregnancy and laparotomy was performed through a Pfannenstiel incision. 1000 ml of blood was removed from the peritoneal cavity, a ruptured tubal pregnancy was found in the right distal tube, and the appendix was normal. A right salpingo-oophorectomy was performed after which the patient recovered uneventfully and was discharged five days postoperatively. Histopathology confirmed a ruptured ectopic gestation.
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PMID:Misdiagnosis of appendicitis in tubally sterilized women. 846 65

The aim of this study was to evaluate the accuracy of different methods of demonstrating right iliac fossa peritonism in appendicitis. The methods used were cat's eye symptom (pain on going over a bump in the road), cough sign, right iliac fossa tenderness, percussion tenderness, rebound tenderness and guarding. A series of 100 consecutive patients with a median age of 25 years (range 4-81 years), presenting with right iliac fossa pain were studied prospectively; the male:female ratio was 39:61. In all, 58 patients underwent operation, 44 had appendicitis confirmed on histology. Fourteen patients had a normal appendix removed; 11 were women aged between 16 and 45 years. Cat's eye symptom and cough sign were sensitive indicators of appendicitis (sensitivity 0.80 and 0.82, respectively), but were not specific (specificity 0.52 and 0.50, respectively) and therefore inaccurate (accuracy 64%). Percussion tenderness was less sensitive (sensitivity 0.57) but more specific (specificity 0.86). Rebound tenderness proved to be sensitive (sensitivity 0.82), specific (specificity 0.89) and accurate (accuracy 86%). Thus, rebound tenderness had a positive predictive value of 86% compared with 56% and 57% for cough sign and cat's eye symptom, respectively. In the difficult diagnostic group of young women, the positive predictive value of rebound tenderness was 88% compared with 58% and 56% for cat's eye symptom and cough sign. Appendicitis remains a difficult diagnosis, particularly in young women. Rebound tenderness still has an important role to play in clinical assessment.
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PMID:Assessment of peritonism in appendicitis. 877 23

The purpose of this study was to determine the frequency with which general pediatricians perform a rectal examination on children with a complaint of acute abdominal pain and to determine factors associated with performing a rectal examination. Children were eligible for the study if they were 2 to 12 years of age and presented to the clinic or emergency department of a municipal teaching hospital with a complaint of abdominal pain of less than or equal to three days' duration. Measured variables included demographic characteristics and presenting signs and symptoms. For each patient, a clinical reviewer (1) assigned a final diagnosis, (2) determined whether a rectal examination had been performed, and (3) assessed the clinical contribution of the rectal examination findings. For 1,140 children presenting for a nonscheduled visit with acute abdominal pain, a rectal examination was performed on 4.9% (56/1,140). Using multiple logistic regression, children were more likely to have a rectal examination performed if they had abdominal tenderness (odds ratio [OR] = 3.3 and 95% confidence interval [CI], 1.8 to 6.0), a history of constipation (OR = 6.0 and 95% CI, 2.3 to 15.3), or a history of rectal bleeding (OR = 9.1 and 95% CI, 2.9 to 29). Children were less likely to have had a rectal examination performed if they presented with associated symptoms of cough (OR = 0.32 and 95% CI, 0.14 to 0.74), headache (OR = 0.15 and 95% CI, 0.05 to 0.46), or sore throat (OR = 0.28 and 95% CI, 0.08 to 0.91). The final diagnoses of 12 children who had clinically contributory findings on rectal examination included: constipation (5), gastroenteritis (3), appendicitis (2), abdominal adhesions (1), and abdominal pain of unclear etiology (1). General pediatricians infrequently perform a rectal examination on children who present with a complaint of acute abdominal pain. Clinical factors affect the likelihood of whether a rectal examination is performed.
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PMID:Use of the rectal examination on children with acute abdominal pain. 959 98

Giving an analgesic to patients with right lower quadrant (RLQ) pain causes greater alteration of abdominal signs predictive of appendicitis than placebo. A randomized double-blinded controlled trial of 68 patients who received either tramadol or placebo. Absence or presence of seven abdominal signs (tenderness on light and deep palpation, tenderness in the RLQ and elsewhere, rebound, cough, and percussion tenderness) and pain (100 mm Visual Analog Scale [VAS]) at 0 and 30 minutes were recorded. The predictive value of each physical finding (PF) was measured using an 11-point PF score weighted by likelihood ratios. There was significant reduction in mean VAS of 14.2 mm (95% CI 5.6 to 22.8) in analgesic group versus 6.5 mm (95% CI 1.6 to 11.4) in placebo group. The analgesic group had less normalization of signs as measured by the PF score in all patients [32 of 154 (20.8%) versus 40 of 121 (33.1 %) (P = .031)] and in those with proven appendicitis [4 of 33 (12.1%) versus 10/22 (45.5%) (P = .014)]. Parenteral use of tramadol in emergency department patients with RLQ pain resulted in significant levels of pain reduction without concurrent normalisation of abdominal examination findings indicative of acute appendicitis.
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PMID:Prospective randomized study of analgesic use for ED patients with right lower quadrant abdominal pain. 1110 23

A previously fit and well 18-year-old woman presented to the accident and emergency department following referral by her general practitioner with a provisional diagnosis of appendicitis. The history obtained from the patient revealed the presence of a bitemporal headache with associated neck stiffness, photophobia and vomiting for approximately 1.5 weeks. The patient complained of abdominal pain localised to her right iliac fossa and anorexia for approximately 1 week. She also noted the presence of a cough productive of green sputum for 3 weeks. A chest radiograph was obtained which showed a large area of consolidation in the right lower lobe consistent with infection and a linear density in keeping with a metallic foreign body. Following review of the chest radiograph, the patient was interviewed further and recalled having inhaled a pushpin approximately 1 year before her presentation. Aspiration of foreign bodies is relatively common in children and is often associated with delayed diagnosis and high morbidity. To prevent delayed diagnosis, characteristic symptoms and clinical and radiological signs of foreign body aspiration should be checked in all suspected cases and a low index of suspicion for ordering additional imaging or using bronchoscopy for diagnostic purposes should be employed.
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PMID:Delayed presentation following accidental inhalation of a pushpin. 2002 18

A 19-year-old woman presented to the emergency department with abdominal pain 10 h after ingesting a capsule endoscope. The pain subsequently localised to the right iliac fossa with guarding and cough/percussion tenderness. Follow-up pelvic ultrasound showed a tender non-compressible appendix consistent with appendicitis. The patient underwent a laparoscopic appendectomy with good recovery. This report describes an unusual presentation of appendicitis following ingestion of a capsule endoscope.
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PMID:Appendicitis following capsule endoscopy. 2633 84

BACKGROUND Deep vein thrombosis (DVT) is a type of venous thromboembolism with diverse clinical and environmental risk factors. Very few cases of DVT with multiple high risk factors have been reported. Here, we report an uncommon DVT case with multiple etiological causes, including appendicitis/appendectomy, morbid obesity, immobilization, positive phosphatidylserine IgG, and heterozygous factor V Leiden mutation. CASE REPORT A 43-year-old female was brought to the emergency room because of 2-week history of pain and swelling and ultrasound revealing evidence of DVT in the right leg. One month ago, she underwent an exploratory laparotomy because of subacute appendicitis. After surgery, the patient stayed at home in bed with very limited activity. She did not have a cough, hemoptysis, chest pain, or shortness of breath. She was morbidly obese, and had a past medical history of diabetes, hypertension, and hyperlipidemia. A full coagulation workup was completed, including Protein C, Protein S, and antiphospholipid antibody, as well as factor V and prothrombin gene mutation screen. Her D-dimer was positive. Computed tomography (CT) angiography of the lungs ruled out major emboli but was unable to rule out minor emboli. A heterozygous factor V Leiden R506Q mutation was detected. Of interest was a significantly positive phosphatidylserine IgG with a value of over 42. She was started with enoxaparin (120 mg, twice a day), and warfarin was added on day 2 when pulmonary embolism was ruled out by CT angiography. The International Normalized Ratio (INR) was monitored daily to adjust warfarin dose. CONCLUSIONS Multiple etiological factors present in this patient may have contributed to her lower-limb DVT, including appendicitis/appendectomy, morbid obesity, immobilization, positive phosphatidylserine IgG, and factor V Leiden mutation. Therefore, it is important to follow the complete workup for hypercoagulable states. This can help with diagnosis and therapy, and also give insight into the pathogenicity, which can help with prevention of recurrence and severe complications of DVT.
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PMID:An Uncommon Case of Lower Limb Deep Vein Thrombosis with Multiple Etiological Causes. 2834 60

BACKGROUND Paracoccidioidomycosis is an endemic mycosis in Central and South America caused by the thermally dimorphic fungus Paracoccidioides brasiliensis. Despite its self-limited course and usually asymptomatic infection, some patients may present with a systemic illness mimicking multiple conditions and thus question the general state of their immune system. CASE REPORT A 28-year-old male presented to the hospital with fever, dry cough, and non-pruritic rash with no characteristic distribution for the past 10 days. Past medical history revealed that the patient had worked as a farmer three years ago, had abused cocaine paste over the same period, and also had in the last month presented to the hospital for acute appendicitis. Initial laboratory tests revealed hypereosinophilia greater than 10,000 eosinophils/mL. Infection of P. brasiliensis was confirmed by lymph node, skin, and colonoscopy biopsies. After treatment with itraconazole, the patient's eosinophil count returned to normal and his symptoms resolved. CONCLUSIONS Paracoccidioidomycosis may present as a systemic illness with only marked eosinophilia on initial diagnostic tests. Furthermore, in our patient's case, the high degree of eosinophilia may have contributed towards the patient's appendicitis in the weeks preceding the subacute infection. It is possible that the patient's history of working at a farm and abusing cocaine paste may have contributed to the initial colonization by the fungus.
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PMID:Hypereosinophilia Secondary to Disseminated Paracoccidioidomycosis. 2904 30

Mesenteric lymphatic malformations are rare benign tumors that are most commonly found in children. The presentation of these tumors can be variable. It has been suggested that mesenteric lymphatic malformations are congenital; however, there is evidence that their size may be increased by infection. A 3-year 10-month-old boy presented with rhinorrhea and cough followed by acute abdominal pain. Ultrasonography revealed a lobulated mass in the lower abdomen. Computerized tomography scan of the abdomen diagnosed an inflamed appendix with perforation. Laparotomy revealed a multicystic mass within the mesentery closely adherent to the ileum; with omentum wrapped around. The appendix was dilated and firm. An ileal resection and an appendicectomy were performed. Histology confirmed acute transmural appendicitis with concurrent cystic lymphangioma of the ileal mesentery. Although rare, cystic lymphangioma must be considered in the differential of pediatric acute abdomen. Surgeons must be aware of this association and be reminded to inspect the rest of small bowel during appendicectomy especially if the preoperative imaging is suspicious.
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PMID:Ileal Cystic Lymphangioma presenting with Acute Appendicitis. 2938 63


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