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

In a prospective study of 154 AIDS patients, 48 (31%) complained of pain on swallowing both liquids and solids and 32 (21%) of these also had dysphagia. While candidiasis was the most common cause of symptoms (26 patients), discrete ulceration of the oesophagus occurred in 12 instances in 10 patients (four cytomegalovirus, four herpes simplex virus, three aphthous ulcer, one peptic ulcer). One patient had a diffuse oesophagitis caused by Mycobacterium avium intracellulare. No cause was found for the oesophageal symptoms in four patients. Kaposi's sarcoma (KS) was found in seven patients associated with other pathology in four. All 26 patients with oesophageal candidiasis only, also had oral involvement. All the patients with herpes simplex virus (four) and aphthous ulcers (three) had obvious perioral involvement. Three of the four patients with cytomegalovirus ulceration had evidence of disease elsewhere (colon or retina). All patients with Kaposi's sarcoma lesions had skin and buccal cavity involvement. The cause of oesophageal disease was usually obvious at endoscopy. The appearance of candidiasis was typical and the various ulcerating lesions also had different macroscopic configurations. Cytomegalovirus infection produced deep linear ulcers in the distal oesophagus, herpes simplex oesophagitis is similar in appearance to the typical perioral lesions of fluid filled vesicles. Diagnostic radiology was not helpful in most patients. In nine of 17 patients with candidiasis, the barium swallow examination performed within 24 hours of presentation was normal. In only three of seven patients with oesophageal ulceration (three cytomegalovirus, two herpes simplex virus, one aphthous, one peptic) was there evidence of an abnormality. Treatment produces symptomatic relief. All patients with candidiasis responded to ketoconazole, the four with herpes simplex virus to acyclovir and one of three with aphthous ulceration had a dramatic response to thalidomide. The three patients with cytomegalovirus infection who were treated with foscarnet had a prolonged remission of symptoms. The overall prognosis of patients with oesophageal symptoms is poor, with an average survival time from a definitive diagnosis of five months (range one to 13).
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PMID:Oesophageal symptoms, their causes, treatment, and prognosis in patients with the acquired immunodeficiency syndrome. 254 33

After reviewing all 123 of these patients, here are some suggestions which may improve the accuracy of diagnosis of appendicitis. 1. Proceed slowly with any patient with equivocal history and physical exam +/- WBC less than 10,000. 2. Seriously consider U.T.I. or other renal pathology in patients with greater than 20 RBC +/or greater than 30 WBC/hfp (w/bacteria) as cause of RLQ pain, rather than appendicitis; i.e. only 1 of 81 patients with appendicitis had a coexistent U.T.I. 3. Be aware that pain starting in the RLQ is less common in appendicitis than in other conditions mimicking appendicitis. 4. Be wary of all women presenting with RLQ pain on days 1 through 10 of their menstrual cycle. 5. Consider a barium swallow or enema study in patients in categories 1-4 above looking for a normally filled appendix while a) observing patient and b) awaiting outstanding lab results (i.e. ur. cult., cerv. os cult., etc.). 6. Follow closely all patients in all of the above categories and operate for worsening condition. 7. Require classic or near classic history and physical findings in patients with WBC less 10,000 suspected of having appendicitis, prior to surgery. Footnotes to these suggestions are as follows: 1. Understand that following these suggestions may result in an increase in the incidence of perforation coincident with an increase in diagnostic accuracy. 2. Be less hesitant to operate on patients over 50 y.o. because of a) their frequent atypical presentations, and b) the known higher incidence of perforation in this age group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Improving diagnostic accuracy in appendicitis. 261 Jan 91

The clinical and pathological features of 11 cases of large bowel endometriosis are reported, one of which also had lesions in the small intestine. All of the cases had rectal or rectosigmoid involvement. Altered bowel habit and pain were common symptoms but were rarely associated with the menstrual cycle. Sigmoidoscopy was generally unhelpful. Rectal or vaginal examination and barium enema often revealed a mass which was usually diagnosed preoperatively as a malignancy. A correct diagnosis was made preoperatively in only two cases; carcinoma was suspected in four and carcinoid in one case. Histological evidence of recent hemorrhage was confined to those cases where endometriosis seemed to be the major cause of intestinal symptoms. The colonic mucosa overlying the endometriotic deposits was commonly histologically abnormal. It showed a range of changes resembling colitis, solitary ulcer, prolapse or even neoplasm. An appreciation of these mucosal alterations is important to those reporting colonic and rectal biopsies; when observed to be focal in a female patient they should arouse a suspicion of endometriosis.
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PMID:Endometriosis of the large bowel: a report of 11 cases. 263 15

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.
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PMID:Choledochal cyst resection and reconstruction by biliary-jejuno-duodenal diversion. 272 69

The records of 99 patients admitted for inflammatory appendiceal mass were evaluated. Eight of these patients (8%) had a malignancy of the right colon with, in four cases, secondary inflammation of the appendix. Remnants of inflammation limited to the appendix were present in 64 patients. These two groups were compared to a group of 21 patients treated in the same period for a palpable malignancy of the right colon. In patients older than 50 years absence of pain, symptoms which last more than one week, a painless palpable mass in the right lower abdomen and the presence of anemia indicate (underlying) colonic malignancy. Barium enema of the colon remains the most reliable method for a correct preoperative diagnosis of colonic malignancy and should be done in every patient older than 50 years who presents with an appendiceal mass, as well as in younger patients with a protracted course of the disease.
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PMID:Colonic malignancy mimicking an appendiceal mass. 273 49

Incarcerated obturator hernia is an uncommon entity that on occasion may produce specific radiographic findings and clinical signs (Howship-Romberg sign) that permit diagnosis prior to celiotomy. A case is reported in which the diagnosis was suggested when pain in the thigh was elicited during the course of a barium enema examination.
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PMID:Incarcerated obturator hernia: case diagnosed at barium enema fluoroscopy. 274 May 20

Acute diverticulitis of the colon should be considered in the differential diagnosis in young adult (younger than 40 years) patients with pain and tenderness in the lower abdomen. Among young adults, men are afflicted more commonly than women and the disease runs a more virulent course. Complications are commonly encountered, and the key to diagnosis is a high index of suspicion. Barium enema examination without bowel preparation is useful and safe in this age group. In patients with acute diverticulitis with perforation and abscess, the most appropriate therapy is surgical, as demonstrated in the three cases reported here.
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PMID:Diverticular disease in young adults. 275 52

A 51-year-old man was hospitalized with complaints of gross hematuria and terminal micturition pain. Cystoscopy revealed a low columnar tumor at the dome of the bladder. Ultrasonography and X-ray CT also demonstrated the same shape of tumor and no evidence of invasion to adjacent organs. Gastrointestinal examination, including upper gastrointestinal series and barium enema failed to reveal any primary tumor. The serum CEA level was 2.3 ng/ml, which was not elevated. Total cystectomy with ileal conduit and adjuvant chemotherapy consisting of cyclophosphamide, adriamycin and cisplatinum was performed. He died of a recurrent tumor 2 years and 2 months after the operation. Besides our experience of primary signet ring cell carcinoma of the urinary bladder, a review of the literature is reported.
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PMID:[A case of signet ring cell carcinoma of the urinary bladder]. 282 84

We reviewed the records of patients with cecal volvulus at three affiliated hospitals of Eastern Virginia Medical School to elucidate its incidence, patterns of presentation, and current methods of surgical management. We identified 109 patients in whom a discharge diagnosis of intestinal obstruction due to volvulus was made from 1966 to 1985. In 12 patients (11%) laparotomy showed the volvulus at the terminal ileum and cecum. The presenting symptoms in this group were distention in ten (83%), pain in seven (58%), obstipation or constipation in two (17%), and diarrhea in one (8%). Diagnosis was achieved by plain abdominal films in five (45%); barium enema was obtained in six patients and was diagnostic in five (83%). Two patients had delay in diagnosis with subsequent gangrene of cecum; one of them died. No deaths occurred in the group with viable bowel. Treatment was by simple detorsion without fixation in two (17%), detorsion with cecopexy in two (17%), tube cecostomy in three (25%), and ileocolectomy in three (25%). Simple detorsion was not followed by recurrence of the volvulus in any case in this series. Cecopexy for viable colon and ileocolectomy for gangrenous colon appeared to have the lowest rates of complications.
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PMID:Cecal volvulus: review of 12 cases. 317 30

Intestinal obstruction is a common postoperative complication and is usually related to peritoneal adhesion formation. A less well-recognized cause is postoperative intussusception (POI). Thirty-six instances of POI in children (aged 1 month to 18 years) were treated between 1970 and 1987. POI followed Nissen fundoplication in 9 patients, neuroblastoma resection in 5, small-bowel procedures in 4, inguinal herniorrhaphy in 3, pull-through procedures in 3, ureterostomy in 2, thoracic procedures in 2, ventral hernia in 1, nephrectomy in 1, hepatic resection in 1, Heller myotomy in 1, ventriculo-atrial shunt in 1, and gastrocystoplasty in 1. Initial symptoms included bilious vomiting or increased nasogastric drainage (after initial return of gut function) in 26 patients, abdominal distension in 24, irritability in 10, intermittent pain in 7, palpable abdominal mass in 2, rectal bleeding in 2, and lethargy in 1. The symptoms occurred 1 to 24 days (mean, 8 days) after the initial surgery. Plain abdominal radiographs revealed multiple air-fluid levels in 31 and an "adynamic ileus" in five patients. Barium contrast techniques could successfully reduce two ileocolic and one distal ileo-ileal lesions. The remainder necessitated operative management. Manual reduction was possible in 29 cases, and four children with diagnostic delay required bowel resection and an anastomosis for intestinal necrosis. The site of intussusception was ileo-ileal in 23 patients, jejunojejunal in 6, ileocolic in 5, and jejuno-ileal in 2. The diagnosis of POI should be considered in children with signs of bowel dysfunction in the early postoperative period. Contrast studies are of limited value, since most cases are confined to the small bowel. A high index of suspicion and prompt laparotomy will usually allow manual reduction of the lesion. Diagnostic delay may result in bowel necrosis.
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PMID:Postoperative intussusception: experience with 36 cases in children. 317 73


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