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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Seven cases of acute cholecystitis (4 women and 3 men, mean age 73 years) were observed in a series of 192 patients treated by endoprosthesis for cancerous obstruction of the bile ducts between october, 1984 and october, 1986. The suspected clinical diagnosis was confirmed by ultrasonography. Cholecystostomy was performed by percutaneous puncture under ultrasonic guidance. A catheter was positioned in the gallbladder by the Seldinger technique in 3 cases and by the trocar technique in 4 cases. Pain in the right hypochondrium was relieved in all patients immediately after emptying of the gallbladder. Five patients were cured. One patient developed purulent peritonitis which was treated by surgery. A female patient died of her pancreatic cancer 3 days after cholecystostomy. Provided a number of precautions are taken to prevent leakage of the infected bile into the peritoneal cavity, percutaneous cholecystostomy is the treatment of choice for acute cholecystitis consecutive to biliary endoprosthesis.
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PMID:[Acute cholecystitis after placement of biliary endoprosthesis. Treatment by percutaneous cholecystostomy]. 296 50

Cholelithiasis and cholecystitis, with their complications, remain major health problems in the United States. At this time, cholecystectomy is the treatment of choice for all patients with symptomatic gallstones and those with acute cholecystitis, except those who are too ill to undergo surgery. Present therapeutic options may be summarized as follows: Asymptomatic patients and those with flatulence and dyspepsia who have gallstones should be observed. Those who have symptoms of biliary pain, gallstone-induced pancreatitis, or common duct stones should have corrective surgery. Those who refuse surgery or who aren't surgical candidates might be treated with dissolution therapy. Dissolution of gallstones with chemical agents and extracorporeal shock-wave lithotripsy show some promise. We need a better understanding of the etiology and formation of gallstones to address the disease from a preventive standpoint and reduce the incidence of cholelithiasis and cholecystitis, and their complications.
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PMID:Cholecystitis and cholelithiasis. 304 94

Reported injuries from vibrating tools include vibration syndrome, arthropathies, pneumomediastinum, and rupture of the sigmoid colon. The use of jackhammers in particular is associated with these injuries. The authors have identified a construction worker who suffered torsion of the omentum as a result of using a 42.75-kg (95 lb) jackhammer. His clinical presentation of right upper-quadrant pain and fever was confused with acute cholecystitis, and it was not until laparotomy that the correct diagnosis was made. This diagnosis should be suspected in workers who experience acute abdominal pain and are exposed to vibration or repetitive blunt abdominal trauma.
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PMID:Primary torsion of the omentum in a jackhammer operator: another vibration-related injury. 273 21

Recent research suggests that disturbances in gallbladder mucosal functions are important in the initiation of acute cholecystitis and its progression. Prostaglandins have pathophysiological significance and prostaglandin synthesis inhibitors such as indomethacin inhibit fluid secretion by gallbladder mucosa, reduce distension and relieve pain. Nerves in the gallbladder wall are involved in disturbed mucosal function, and the benefits of opiates may derive from reduction of active fluid secretion in the inflamed and obstructed gallbladder as well as from central analgesic effects.
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PMID:Pathophysiology of acute obstructive cholecystitis: implications for non-operative management. 332 79

When patients are admitted with clinically diagnosed acute cholecystitis, no cause will be found for their pain in 9-13% (4.5). Our retrospective study shows that women between 15-35 years are most likely to be in this group. Our prospective study of all patients in the 15-35 year age group admitted with clinical 'acute cholecystitis', showed that in 6 out of 7 patients with 'undiagnosed' pain, the Curtis-Fitz-Hugh syndrome was the cause. We suggest that screening for the Curtis-Fitz-Hugh syndrome is performed in all patients with right upper quadrant pain who have a normal ultrasound scan.
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PMID:Clinical acute cholecystitis and the Curtis-Fitz-Hugh syndrome. 340 39

In a prospective study of 100 patients presenting with acute right hypochondrial pain and diagnosed clinically by a qualified surgeon as having acute cholecystitis, we have shown that the diagnostic error can be considerable. Twenty-five of these patients were found to have a different diagnosis on subsequent investigation and in a further 11 patients, no definite diagnosis could be established. This emphasises the need for careful investigation of patients with this presenting complaint.
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PMID:Is it acute cholecystitis? 351 30

Sonograms of 45 consecutive patients with histologically proven acute cholecystitis were retrospectively reviewed. The following sonographic criteria were evaluated for the presence of: thickening of the gallbladder wall; enlargement of the transverse diameter; gallbladder pressure pain (Murphy's sign); local hypoechoic areas in the bladder wall, and finally the indistinct internal appearance. All 4 patients (8.9%) with acalculous cholecystitis were detected by ultrasound. Its sensitivity as a test to detect acute cholecystitis is 88.9%, its specificity and accuracy 97.8 and 96.1%, respectively.
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PMID:Ultrasonography of acute cholecystitis: clinical and histological correlation. 353 83

Thirteen patients presenting with acute cholecystitis and considered high surgical risks were treated with a percutaneous needling procedure under ultrasonic guidance. The gallbladder was drained following simple needle puncture in six cases while a drainage catheter was inserted in seven. A premedication of 0.5 mg of atropine and 50 mg of pethidine was given. The gallbladder became decompressed in all cases, and pain was instantly relieved. Impacted stones were freed from the cystic duct in two cases and from the papilla of Vater in another two cases. The patients' condition improved and elective cholecystectomy was performed in four cases, while a further three patients await surgery. In five cases the acute stage of the disease subsided; surgical treatment was refrained from because of gallbladder carcinoma with metastases in one patient and other diseases in the remainder. One patient died of gastric carcinoma. One patient with ischemic heart disease had systemic hypotension for six hours after the drainage and one had slight haemorrhage for four hours. No other complications were noted. In addition, the procedure was also carried out as a diagnostic study in one patient in whom the site of bile leakage was determined by filling the biliary tree with contrast medium from the gallbladder. Guided aspiration and percutaneous drainage of the gallbladder is helpful in patients with severe acute cholecystitis attended with a high surgical risk.
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PMID:Ultrasonic guidance for percutaneous puncture and drainage in acute cholecystitis. 354 97

Indomethacin was recently shown to have a potent analgesic effect on biliary pain. The underlying mechanism is not fully clear, although reduction of increased gallbladder pressure by inhibition of prostaglandin synthesis had been suggested. For further clarification of this mechanism, the effect of intravenous indomethacin on the intraluminal gallbladder pressure was investigated in patients undergoing operation for acute cholecystitis. After laparotomy, gallbladder pressure was measured continuously during 25 min in 20 patients, 10 of whom received 100 mg indomethacin intravenously, while 10 were untreated controls. High intraluminal gallbladder pressure was found in all patients. Indomethacin reduced the average pressure by 11% in 20 min, whereas the corresponding pressure in the controls was constant. The results indicate that acute cholecystitis is associated with substantially raised intraluminal pressure, and that the analgesic action of indomethacin on biliary pain may be attributable to a local effect on gallbladder function, resulting in reduction of intraluminal pressure.
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PMID:Indomethacin reduces raised intraluminal gallbladder pressure in acute cholecystitis. 389 96

Three children presenting with HAV hepatitis had an initial clinical onset suggestive of acute cholecystitis (pain and guarding in the right hypochondrium, fever and delayed jaundice) associated with important ultrasonographic abnormalities, also very suggestive of acute cholecystitis: bladder wall thickness greater than 10 mm (3 cases), the presence of 2 or 3 layers of different echogenicities (3 cases), presence of an ultrasonographic Murphy's sign (one case), contents of the gallbladder echogenic (one case). The authors discuss the hypothesis of an actual initial acute cholecystitis.
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PMID:[Acute cholecystitis disclosing A virus hepatitis]. 390 76


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