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

The role of lactose malabsorption was studied prospectively in 80 schoolchildren with recurrent abdominal pain. Malabsorption was documented in 40 per cent (16 of 59 whites, 12 of 16 blacks and four of five Hispanic children) on the basis of elevated levels of hydrogen in their breath. Those with lactose malabsorption, however, were not clinically distinguishable on the basis of past milk ingestion (P greater than 0.05), weekly pain frequency (median, five vs. six times), presence of diarrhea (40 vs. 27 per cent) or symptom response to lactose load. In children with malabsorption who completed a six-week diet trial, 70 per cent reported increased frequency of pain (P less than 0.002) when placed on their usual lactose-containing diet. Lactose malabsorption has a substantial role in the symptoms of children with recurrent abdominal pain, and it should be considered before performing invasive procedures or assuming a psychogenic origin.
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PMID:Recurrent abdominal pain of childhood due to lactose intolerance. 44 86

The degree of a patient's emotional maturity and the supportive value of his home, working, and recreational environments were scored by psychosociological methods preoperatively in a group of 47 patients who were intensively investigated with regard to the dumping syndrome. After surgery, the result of the operation was independently assessed as a success or a failure. At that time, a careful review was performed of each patient's clinical state, with particular reference to postgastrectomy syndromes. Positive associations were found between surgical failure and emotional instability, recorded by an Eysenck personality inventory, and scored social deprivation. Failure also correlated with the sum of the postgastrectomy syndromes and with recurrent pain, heartburn, episodic diarrhoea, and psychiatric illness in particular. The dumping syndrome itself did not contribute to failure.
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PMID:Psychological, social, and surgical factors which influence success or failure after gastric operations. 48 58

Small-bowel ischaemia is the least familiar cardiovascular complication of the oral contraceptive but is 1 associated with a high mortality rate and much morbidity. Hoyle et al have recently reviewed 21 cases and found that 1/2 the patients had died and 1/2 had required 2 or more operations, resulting in the removal of much of the small bowel. Small-bowel ischaemia occurs in women taking the oral contraceptive as a result of either mesenteric artery or mesenteric vein thrombosis. The dominant presenting symptom in small-bowel ischaemia, found in all patients, is abdominal pain. Some patients had associated nausea and vomiting; others complained of diarrhea. On examination the patient has usually been found to be febrile with generalized abdominal tenderness. Bowel sounds are present unless infarction has occurred. In nearly all cases reported the diagnosis has been made only at laparotomy, when the bowel was usually infarcted. Since many of the patients had had pain for 2 or more weeks, the condition might be reversible if it could be detected earlier. A diagnosis of small-bowel ischaemia should be carefully considered in any woman taking an oral contraceptive who presents with vague abdominal pain and has an associated condition known to predispose to circulatory disorders: cigarette smoking, hyperlipidaemia, diabetes, hypertension, obesity, or blood group A. If it seems like small-bowel ischaemia is the likely diagnosis, the contraceptive pill should be stopped immediately and treatment started with heparin.
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PMID:Flap lacerations. 62 Jan 42

Sixty-one cases of the Zollinger-Ellison syndrome, encountered over a 2-year period, have been treated with cimetidine, half of them for over 1 year. Two-thirds of the patients responded to 300 mg of the drug every 6 hr by mouth. Others required up to 600 mg every 6 hr. In adequate doses the drug was highly effective: it controlled pain and dyspepsia, restored weight, abolished diarrhea, and allowed healing of ulcers and other inflammatory conditions. Missed or reduced doses led to rapid return of symptoms. Progression of the basic neoplastic process, with associated secretory drive, was unimpeded. Patient acceptance of the drug was 100 percent, and apart from minor transient abnormalities, gynecomastia (5 cases) and liver dysfunction (3 cases), which resolved while treatment continued, no serious adverse effects were seen. Of 61 patients 48 are still on the drug, 3 who were well controlled were treated surgically, 5 died for reasons unrelated to therapy, and 5 had significant problems. The drug provides an alternative to total gastrectomy and can be recommended with confidence for the suitably selected patients. The drug was also beneficial in some cases of the short bowel syndrome, systemic mastocytosis, and endogenous hyperhistaminemia due to leukemia.
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PMID:Report on the United States experience with cimetidine in Zollinger-Ellision syndrome and other hypersecretory states. 62 Sep 13

A distinction is drawn between coeliac-mesenteric occlusion in intestinal infarct, vascular insufficiency, and fully compensated occlusion. The clinical picture of the first is that of acute abdomen with serious circulatory shock syndrome, whereas chronic insufficiency is marked by episodic pain triggered by eating, effort, drugs, etc., canalisation disturbances, meteorism, constipation or diarrhoea, intestinal stenosis, wasting and malabsorption. Their medical management and its principles, possibilities and limits are discussed.
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PMID:[Clinical aspects and medical therapy of celiac-mesenteric vascular insufficiency]. 62 74

Vaginal suppositories containing 15(S)15-methyl-PGF2alpha-methyl ester (prostaglandin, PG) were tested for legal abortion of pregnancies (36-60 days after last menstrual period) in 42 women; 4 suppositories each containing 1 or 1.5 mg of PG were given every 3 hours. Serum levels of human chorionic gonadotropin (HCG), estradiol-17 beta, and progesterone were measured before and up to 3 weeks after the abortion. Blood loss during, after, and during a menstrual period 2-4 months after the abortion (in 30 women) was determined. Abortion without retention of major products of conception occurred in 93% of the cases. However, 18% of these successful cases had a slow decline in HCG, indicating incomplete expulsion of viable chorionic tissue. Average blood loss was 37 ml during the 1st 24 hours after insertion, with an additional loss of 94 ml in the next 11 days (range, 5-25 days). Heavy blood loss after abortion was significantly related to slow decline in serum HCG. Later menstrual flow was strikingly heavy overall (mean, 74 ml). There was no difference in efficacy or incidence of slow HCG decline between the PG dose of 1 mg and 1.5 mg, but side effects of uterine pain, vomiting, and diarrhea (50% overall, in no case severe) were more marked with the 1.5-mg dose.
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PMID:Early abortion by vaginal prostaglandin suppositories. Blood loss in relation to elimination of serum chorionic gonadotrophin, progesterone and estradiol-17 beta. 63 Aug 88

Functional disroders are the most important cause for complaints in the gastrointestinal tract. Dysfunction may concern one or more physiologic properties like tonus, motility, secretion, sometimes also resorption and digestion, or their interaction. Functional disorders of the esophagus (esophagospasm and achalasia) become manifest as dysphagia. Halitosis, bad taste, burning tongue, and flatulent abdomen are frequent symptoms of functional disorders of the gastrointestinal tract. Irritable bowel syndrome is probably the functional disorder most freqently found in the gastrointestinal tract. Characteristic symptoms are pain in the lower and upper middle abdominal region, obstipation and/or diarrhea, flatulent abdomen, mucous discharge with the stools and urgent defecation with cramps relieved after discharge. Prognosis quoad vitam is good, the course, however, is subject to many changes. Therapie is symptomatic. Diagnostic and psychotherapeutic measures are intended to help remove carcinophobia and to overcome conflicts and fears.
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PMID:[Functional disorders of the gastrointestinal tract (author's transl)]. 68 14

Twenty-four cases of Legionnaires' disease were diagnosed at the Wadsworth Veterans Administration Hospital during a 5-month period. All cases occurred in persons exposed to the hospital environment during the usual incubation period of Legionnaires' disease. The clinical illness was quite characteristic. All patients complained of weakness, malaise, anorexia, and cough. Rigors, diarrhea, and pleuritic pain were frequent symptoms. All patients had a maximum temperature of greater than or equal to 39.4 degrees C. Thirteen of 22 patients had relative bradycardia. Chest roentgenograms documented pneumonia in all patients. Leukocytosis, hyponatremia, hypophosphatemia, and abnormal liver-function test results were typical. Diagnosis was made by serologic criteria in 20 patients, postmortem examination of tissue in two, and both serology and tissue examination in two. Four patients in whom the disease was not suspected died of Legionnaires' disease. One patient died of unrelated causes. Fifteen of 19 survivors received erythromycin therapy. The presentation of Legionnaires' disease was characteristic enough to allow early, specific therapy.
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PMID:Legionnaires' disease: clinical features of 24 cases. 68 39

In a rural 116-bed skilled nursing facility, a study was made of the influence of a Consultant Pharmacist on drug usage over a one-year period. Lines of communication were established with the six attending physicians by means of work rounds, telephone calls, and both official and unofficial memoranda. Daily pharmacy rounds were conducted with health-care students and the nursing supervisor, who facilitated physician-pharmacist communication. The physician-nurse-pharmacist team studied each patient's problems, the status of the therapeutic endpoint, and the need of and usage of each regularly scheduled or pro re nata (PRN) drug. Stop-order and standing-order protocols were developed. During the one-year period, the number of regularly scheduled drugs per patient was reduced from 3.30 to 2.66 (19.4 percent decrease), and of PRN drugs from 3.92 to 2.12 (45.9 percent decrease). The overall significant reduction was associated with the protocol and stop-order discontinuances of routinely scheduled drugs, and with the duplicated orders for drugs to relieve pain, nausea, vomiting, diarrhea, colds and cough. Implications for optimal care of the patients, and for the economics of this federally-mandated system of consultant pharmacists are discussed.
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PMID:Contribution of the consultant pharmacist to rational drug usage in the long-term care facility. 70 4

Over a period of 14 1/2 years, 26 instances of amoebic perforation of the bowel occurring in 25 patients were treated surgically. Nineteen perforations occurred in males and 7 in females, whose ages ranged from 3 to 74 years. The duration of symptoms varied from 12 h up to 5 months (average 15 days). All patients were toxic and a right lower quadrant mass was present in 14. The correct diagnosis was made or suspected in 14 (54 per cent). Amoebic perforation of the bowel should be suspected in patients presenting with an acute abdomen if a past history of fever, pain and diarrhoea is obtained, particularly if a large tender mass is present in the right iliac fossa. Resectional surgery was performed in 7 patients, with a mortality of 71 per cent, whereas procedures designed to divert the faecal stream were carried out in 19, with a mortality of 43 per cent. All 6 patients with concomitant liver abscesses died. If these patients are excluded, the mortality from resections was 60 per cent and from faecal diversion 27 per cent. Faecal diversion with wide drainage is the treatment of choice for amoebic perforation of the colon.
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PMID:Amoebic perforation of the bowel: experiences with 26 cases. 70 86


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