Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The causes of abdominal pain in patients with AIDS are different from those of the general population, and there are no guidelines as to which investigations are optimal. We reviewed our experience of 63 patients who presented with abdominal pain as the main reason for admission to the AIDS unit at St Stephen's and Westminster Hospital between January 1988 and January 1990. All patients were assessed within the same structured diagnostic programme. Thirty-five had upper abdominal pain, predominantly in the right upper quadrant in 27; seven had lower abdominal pain, which was concentrated in the right iliac fossa in three; 21 had diffuse abdominal pain. The causes of pain were determined satisfactorily in the majority of patients using routine gastroenterological investigations. The predominant site of pain had considerable predictive value in the diagnosis. The commonest cause of right upper quadrant pain was sclerosing cholangitis (17 of 27); endoscopic retrograde cholangio-pancreatography was necessary for a confident diagnosis. Diarrhoea was frequently associated (15 of 21) with diffuse abdominal pain; the commonest cause (six of 21) was cytomegalovirus colitis. Neoplasia was the cause of abdominal pain in eight patients. The other causes of abdominal pain and the utility of various investigations are discussed. An investigatory route which may provide maximum information has been suggested.
 ...
PMID:Abdominal pain in HIV infection. 164 62

A patient who had recently been started on digoxin developed acute severe right upper quadrant pain shortly after hemodialysis. He underwent an extensive work-up for abdominal pain but all findings were normal. With reduction of digoxin dosage, a substantial relief of pain was achieved. The pain totally resolved when digoxin was discontinued and recurred when it was restarted. Cardiac glycosides may be a cause of abdominal pain in patients undergoing maintenance hemodialysis and this side effect should be considered before costly work-up is performed.
 ...
PMID:Digoxin-induced abdominal pain in a patient undergoing maintenance hemodialysis. 180 39

This report illustrates a case of Fitz-Hugh-Curtis syndrome associated with pelvic inflammatory disease in which the clinical symptom of right upper quadrant pain was severe and persistent despite appropriate antibiotic therapy. Because of the atypical course, an extensive work-up was performed to rule out other possible etiologies for the pain. In this context, a laparoscopy was performed and identified dense adhesions between the liver and the anterior abdominal wall. These adhesions were safely and successfully lysed using a KTP/532 laser through a second puncture site. After surgery the pain was completely resolved, with no further recurrence after 6 months of follow-up.
 ...
PMID:Laparoscopic treatment of painful perihepatic adhesions in Fitz-Hugh-Curtis syndrome. 183 Dec 53

The importance of clinical, laboratory and imaging data in the diagnosis of acute cholecystitis (AC) was studied in 825 patients with right upper quadrant pain hospitalized in the Surgical Clinic of the Fundeni Hospital--Bucharest, between January 1, 1986 and June 30, 1988. A number of 21 parameters were analysed in each case. Of these 825 patients, 259 were considered after surgery as AC. These 259 cases were divided, after the microscopical examination of the surgically-obtained specimens, into two groups: 1) pathologically confirmed AC (137 cases) and 2) pathologically non-confirmed AC (122 cases). The importance of every parameter in establishing a histologically confirmed diagnosis of AC was determined by the diagnostic probability calculated according to Bayes'theorem. The hierarchy of the value of parameters in the diagnosis of AC was based on their capacity to distinguish between the cases histologically confirmed and those detected on surgery, but without microscopically demonstrated changes of AC. The same decision criterion was used in building the decision trees in the exploration of the cases of presumed AC. In the 825 cases with right upper quadrant pain, the main and most frequent cause was chronic calculous cholecystitis (31.8%), followed by AC pathologically confirmed (16.6%), AC non-confirmed (14.7%) and chronic acalculous cholecystitis (12.4%). The most useful parameters in distinguishing between pathologically confirmed AC and pathologically non-confirmed AC were: 1) sudden onset of pain; 2) mild resistance to abdominal palpation; 3) frank peritoneal irritation; 4) stone impacted in the gallbladder neck (ultrasonography); 5) fever; 6) palpable gallbladder; 7) lithiasis (ultrasonography); 8) gallbladder wall with double outline (ultrasonography). Ultrasonography supplied a diagnostic probability of 85% for the correct diagnosis of AC in cases without a clinical picture suggestive for AC. The decision tree analysis supported the same conclusion: only ultrasonography gives a good distinction between pathologically confirmed AC and pathologically non-confirmed AC.
 ...
PMID:Decision analysis in the clinical and imaging diagnosis of acute cholecystitis. 210 Aug 78

Sclerosing cholangitis, an inflammatory disease of the biliary tree that occurs infrequently in childhood, has been recognized in combination with papillary stenosis in adults with the acquired immunodeficiency syndrome. A 10-yr-old child with a familial immunodeficiency syndrome characterized by defective T-cell function and deficiencies of immunoglobulins A and G developed papillary stenosis and sclerosing cholangitis associated with cryptosporidium enteritis. The patient presented with fever, jaundice, right upper quadrant pain, and elevated serum concentrations of transaminases and alkaline phosphatase. The pain and jaundice resolved after endoscopic sphincterotomy, but the biochemical abnormalities persisted. This case demonstrates that the combination of papillary stenosis and sclerosing cholangitis can occur in children as well as adults and may be associated with immunodeficiency syndromes other than the acquired immunodeficiency syndrome. Endoscopic sphincterotomy can provide symptomatic treatment for papillary stenosis in children with this condition, although the effect of sphincterotomy on the natural history of the sclerosing cholangitis is uncertain.
 ...
PMID:Papillary stenosis and sclerosing cholangitis in an immunodeficient child. 271 83

From January, 1983 to December, 1986, a total of 9 patients, ranging in age from 2 years and 4 months to 36 years, with choledochal cysts were treated. Symptoms were right upper quadrant pain (n = 9), ascending cholangitis (n = 7), and jaundice (n = 6). A right upper quadrant mass was palpable in 7 patients and gallstones were present in 5 patients. Diagnosis was established by intravenous cholangiogram and ultrasound. The operation was performed through a right subcostal laparotomy. The choledochal cyst diameter ranged from 4.5 to 7 cm. The cyst and the common duct were dissected from the hepatic artery and portal vein. The choledochus was sectioned above the duodenum and the distal end was closed by interrupted sutures. The common duct was divided below the hepatic confluence and the diameter enlarged by longitudinal section of the left hepatic duct. A 30-cm-long segment of isolated jejunum was passed through the transverse mesocolon to the right of the middle colic vessels and behind the duodenum and then interposed between the hepatic confluence and the second portion of the duodenum. Biliary-jejunal anastomosis was performed in 1 layer with interrupted absorbable stitches. No mortality or serious complications occurred during follow-up (1-4 years). No cholangitis, fever, or pain have developed. All patients were studied postoperatively by biochemical test, ultrasonography, Tc 99m DISIDA, and barium meal swallow. Good liver function and biliary excretion, and absence of duodeno-jejuno biliary reflux were demonstrated.
 ...
PMID:Choledochal cyst resection and reconstruction by biliary-jejuno-duodenal diversion. 272 69

Over a 6-year period 264 cholecystokinin (CCK) provocation tests have been performed in 174 patients with undiagnosed right upper quadrant pain. All were carried out by one person (T.W.J.L.) as part of a prospective placebo-controlled crossover study. Following infusion of CCK but not saline, 103 patients developed pain (CCK + ve). These patients were offered cholecystectomy and 90 accepted. Seventy patients developed no pain during either infusion (CCK - ve), and one patient experienced pain with both CCK and saline infusions. Of the 90 patients who underwent cholecystectomy, 81 (90 per cent) have been followed up for a mean of 35 months (range 12 months to 5 1/2 years), 67 per cent have had complete resolution of symptoms and a further 24 per cent have had a marked improvement in symptoms. Only 9 per cent of patients did not benefit from cholecystectomy. This compares well with patients undergoing cholecystectomy for uncomplicated calculous gallbladder disease, 88 per cent of whom, in our study, were improved by surgery. Patients with a positive CCK test have an excellent chance of symptomatic improvement following cholecystectomy.
 ...
PMID:Cholecystokinin (CCK) provocation test: long-term follow-up after cholecystectomy. 231 86

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.
 ...
PMID:Clinical acute cholecystitis and the Curtis-Fitz-Hugh syndrome. 340 39

CT and ultrasound have become invaluable diagnostic tools in the radiologic evaluation of the traumatized and acutely ill patient. CT is the imaging modality of choice in blunt abdominal trauma, retroperitoneal injury and some types of pelvic injury. Ultrasound plays an important role in the evaluation of patients presenting with right upper quadrant pain, renal failure, scrotal pain and enlargement, or pain and bleeding during pregnancy. CT should be reserved for patients with complicated pancreatitis or some forms of renal infection. Thus, CT and ultrasound are important imaging modalities in the work-up of many patients treated by the emergency room physician.
 ...
PMID:Computed tomography and ultrasound of the traumatized and acutely ill patient. 389 83

Intraarterial administration of 40-microns degradable starch microspheres (DSM) in a drug solution can temporarily retard flow of the drug-blood column through the arteriolar-capillary bed and lead to increased local drug deposition. Premonitory to Phase II-III efficacy studies applying this concept to regional therapy, it was necessary to determine the DSM dose to use. Patients with hepatic cancers were treated with varying doses of DSM with mitomycin C coadministered into the hepatic artery to define a dose of DSM which produces acceptable toxicity with maximal hepatic drug deposition as determined by a reduction in systemic mitomycin C exposure. Comparison of six patients receiving 6 ml of DSM (6 X 10(6) particles/ml) with ten patients receiving 15 ml showed a lower incidence and decreased severity of acute toxicity in terms of nausea/vomiting (16% versus 50%) and right upper quadrant hepatic pain (none versus 40%) with 6 ml of DSM. Reduction in systemic mitomycin C exposure evaluated by decrements in the area under the concentration curve in peripheral blood with time due to DSM was similar in both groups. Another seven patients were treated with escalating doses of DSM concurrently with 5 mg of mitomycin C. Although all seven patients tolerated 6 ml of DSM, higher doses (9 ml, 12 ml, 15 ml) led to incremental patient drop-out due to severe, acute right upper quadrant pain with only two patients able to receive 15 ml of DSM. In these patients, 6 ml of DSM appeared nearly equivalent to higher doses in terms of systemic exposure to mitomycin C. Eleven additional patients were evaluated for tolerance to repeated 6-ml dosing of DSM. Four patients had epigastric pain correlating with flow to the stomach demonstrated by nuclide angiography. The seven patients with no pain and no flow to stomach were treated with good tolerance for three-plus courses. Thus, 6 ml of DSM appear to be appropriate for Phase II-III studies.
 ...
PMID:Phase I study of hepatic arterial degradable starch microspheres and mitomycin. 392 57


1 2 3 4 5 6 Next >>