Sample records for abdominal pain bloody

  1. Pathology image of the month: black esophagus detected at autopsy in a patient with abdominal pain and bloody diarrhea.

    PubMed

    Tsao, Christin; Thomas, Louise; McGoey, Robin R

    2014-01-01

    A 73-year-old African-American male was transported to the emergency department due to what emergency personnel described as "coffee ground emesis." He was pronounced dead shortly after arrival. An unlimited autopsy examination was conducted under authorization of the coroner's office. Medical record review revealed that the decedent had been discharged from the hospital just one day prior to his death following a three-day admission for abdominal pain, bloody diarrhea, and a 22-lb unintentional weight loss. Medical history documented hypertension, chronic obstructive lung disease, and a 57-pack-year smoking history. Alcohol abuse was also endorsed, but cessation of use was reported six months prior. During that admit, he was treated for volume-depletion, a urinary tract infection, and suspected infective colitis with antibiotics. Symptoms had resolved on hospital day three, and the patient was discharged home with a two-week course of ciprofloxacin and metronidazole and a follow-up colonoscopy appointment in one month. At the time of autopsy, the decedent was described as cachectic. Figure 1a shows the decedent's esophagus, opened longitudinally. Figure 1b shows the corresponding histology from the esophagus. Other findings documented at autopsy included ischemic bowel disease in the descending colon with patchy superimposed pseudomembranous colitis, emphysematous change, papillary renal cell carcinoma of the right kidney, microscopic prostatic adenocarcinoma, hepatic fibrosis, and intact hepatic hemangiomata. PMID:25311465

  2. Radiology of abdominal pain.

    PubMed

    David, V

    1999-01-01

    Radiology plays an integral role in the evaluation of patients with significant abdominal pain. The cross-sectional modalities (computed tomography, ultrasound, and magnetic resonance imaging) are widely used, but there is sometimes confusion about how to use each test appropriately. We review how each test is done, consider the strengths and weaknesses of each modality, and discuss how to use them in an intelligent, cost-effective manner. PMID:10795217

  3. Recurrent abdominal pain in children.

    PubMed

    Buch, Niyaz A; Ahmad, Sheikh Mushtaq; Ahmed, S Zubair; Ali, Syed Wazid; Charoo, B A; Hassan, Masood Ul

    2002-09-01

    Eighty five children with recurrent abdominal pain(RAP) were studied. Organic cause was noticed in 70 cases and non-organic in 15 cases. Giardiasis was the commonest organic cause in 57 (67.0 percent), either alone or with other parasitic infestations. Other organic causes include gallstones (4.7 percent), urinary infections (4.7 percent), esophagitis/gastritis (3.5 percent) and abdominal tuberculosis (2.3 percent). Single parent, school phobia, sibling rivalry, RAP in other family members and nocturnal enuresis are significant factors associated with nonorganic causes PMID:12368527

  4. Functional Abdominal Pain: "Get" the Function, Loose the Pain.

    PubMed

    Draeger-Muenke, Reinhild

    2015-01-01

    Functional abdominal pain is a mind-body, psychosocial, and self-reinforcing experience with significant consequences for the sufferer and the surrounding support network. The occurrence of unpredictable symptoms and their severity add an element of dread and feeling out-of-control to daily life and often reduce overall functioning in a downward spiral. Two clinical presentations of functional abdominal pain are offered in this article (composites to protect confidentiality) dealing with abdominal pain syndrome and abdominal migraines. The treatment demonstrates the use of hypnotic principles for self-regulation, exploration, and meaning-making. Hypnosis treatment is conducted in combination with mindfulness-based interventions and Traditional Chinese Medicine's (TCM) teachings regarding abdominal health and illness. The clinical examples illustrate medical findings that suggest children with early life stress and an early onset of gastrointestinal somatization may not simply outgrow their functional abdominal pain but may suffer into adulthood. PMID:26046716

  5. Safety of early pain relief for acute abdominal pain

    Microsoft Academic Search

    A. R. Attard; M. J. Corlett; N. J. Kidner; A. P. Leslie; I. A. Fraser

    1992-01-01

    OBJECTIVES--(a) to determine the efficacy of papaveretum in treating pain when administered early to patients presenting with acute abdominal pain and (b) to assess its effect on subsequent diagnosis and management. DESIGN--Prospective, randomised, placebo controlled study. SETTING--Walsgrave Hospital, Coventry. SUBJECTS--100 consecutive patients with clinically significant abdominal pain who were admitted as emergencies to a surgical firm. INTERVENTIONS--Intramuscular injection of up

  6. Recurrent abdominal pain: a psychogenic disorder?

    PubMed Central

    McGrath, P J; Goodman, J T; Firestone, P; Shipman, R; Peters, S

    1983-01-01

    A controlled study of 30 children with recurrent abdominal pain and 30 pain free children failed to show any statistically significant differences between the groups on a variety of psychological variables thought to be associated with psychogenicity. A psychogenic basis has often been assumed as the cause in diagnosis of recurrent abdominal pain when clinical examination and laboratory tests show no organic or medical reason. We emphasise that establishing a psychogenic cause is only indicated where there is positive evidence for psychological factors such as family or school stress, extreme personality characteristics, or modelling of family pain behaviour. PMID:6651325

  7. Case of cytomegalovirus colitis in an immunocompetent patient: a rare cause of abdominal pain and diarrhea in the elderly

    PubMed Central

    Harano, Yumi; Kotajima, Lisa; Arioka, Hiroko

    2015-01-01

    Cytomegalovirus (CMV) colitis usually occurs in immunocompromised patients after undergoing organ transplantation or chemotherapy. We report the case of a 60-year-old immunocompetent Japanese woman who presented with abdominal pain and bloody diarrhea. She was initially diagnosed as having ischemic colitis with pseudomembranous colitis on the basis of her symptoms, Clostridium difficile antigen positivity, and colonoscopic findings, which showed ulcer formation from the sigmoid colon to rectum. In spite of bowel rest and administration of metronidazole, her symptoms did not improve. On follow-up colonoscopy, ulcerations remained unchanged. Biopsy of the ulceration revealed CMV-infected cells leading to a diagnosis of CMV colitis. CMV colitis is a rare but possible differential diagnosis in immunocompetent patients. We recommend endoscopic biopsy in a case of refractory abdominal pain and bloody diarrhea. PMID:25767404

  8. Somatic Pain Sensitivity in Children With Recurrent Abdominal Pain

    Microsoft Academic Search

    Katrin Zohsel; Johanna Hohmeister; Herta Flor; Christiane Hermann

    2008-01-01

    OBJECTIVE:Evidence is accumulating that recurrent abdominal pain (RAP) in children is associated with visceral hyperalgesia. However, it is not known whether somatic sensitivity is altered as well. Therefore, the aim of our study was to assess somatic pain sensitivity in children with RAP and healthy controls at the abdomen and a distal site (thenar).METHODS:We examined 20 children with RAP (age

  9. [Fever, nosebleeding and myalgic abdominal pain].

    PubMed

    Leopold, M; Siepmann, T

    2008-02-20

    A 38 year old patient presented with fever, myalgic abdominal pain, nose bleeding and acute renal failure since five days. A combination of thrombocytopenia, proteinuria, elevated CrP and creatinin is common in hemorrhagic fever with renal syndrome (HFRS) due to Hantavirus infection. The benigne form is called Nephropathia epidemica. Dialysis is infrequently required by patients with the Puumala virus. Other infection (e.g. malaria, leptospirosis, yellow fever) and systemic diseases (e.g. collagenosis or vasculitis) are considered. PMID:18548800

  10. An easily overlooked cause of abdominal pain

    PubMed Central

    Bennett, Kyle; Rettew, Andrew; Shaikh, Bilal; Supplee, Suzanne; Alweis, Richard

    2014-01-01

    A 63 year old female presented to the emergency department with a several month history of intermittent right upper quadrant abdominal pain, early satiety with loss of appetite, and an unintentional weight loss of 8. She underwent a battery of tests that returned negative and subsequently sent for Computed tomographic angiography (CTA) of the abdomen revealing luminal stenosis of the proximal 1 cm of the celiac axis estimating 90% occlusion and a patent SMA and IMA with, typical for median arcuate ligament syndrome. The symptoms, diagnosis, and treatment options are discussed. PMID:25432644

  11. The use of analgesics in patients with acute abdominal pain

    Microsoft Academic Search

    Frank LoVecchio; Neill Oster; Kai Sturmann; Lewis S. Nelson; Scott Flashner; Ralph Finger

    1997-01-01

    Analgesics in patients with acute abdominal pain are often withheld for fear that they may change physical examination findings and thus may be unsafe. We conducted a randomized, prospective, placebo-controlled trial to investigate changes in physical examination following the administration of placebo, 5 mg, or 10 mg of morphine to 49 patients with acute abdominal pain. One patient was withdrawn

  12. Functional Abdominal Pain in Childhood: From Etiology to Maladaptation

    Microsoft Academic Search

    Ilva Elena Schulte; Franz Petermann; Meinolf Noeker

    2010-01-01

    Objective: To review the extant literature on functional abdominal pain in childhood through the lens of the developmental psychopathology perspective and to systematize research results by means of a two-stage pathway model in which the emergence of functional abdominal pain and its potential transition into a somatoform adjustment disorder is outlined. Methods: Using electronic searches for published studies and previous

  13. Psychosocial stress and abdominal pain in adolescents

    PubMed Central

    2010-01-01

    Children and adolescents may express psychiatric symptoms via somatic complaints. Likewise, children with chronic somatic illnesses are likely to experience psychiatric sequelae. We report three cases of adolescents who were admitted to general paediatrics services for abdominal pain and/or nausea and vomiting with a negative medical workup. In each case, a clear psychosocial stressor was evident. It is possible that somatic symptoms without clear medical causes may reflect psychosocial stress, but it is difficult to discern whether the psychosocial issues preceded the somatic complaints or were a result of them. Making an accurate diagnosis is difficult, and broaching such a subject with patients and their families is a delicate matter. More research is needed to determine appropriate screening tools for identifying cases where psychosocial stress may play a relevant role in symptom presentation, as well as potential treatment modalities for such cases. PMID:22477924

  14. Postcholecystectomy Pain Syndrome: Pathophysiology of Abdominal Pain in Sphincter of Oddi Type III

    Microsoft Academic Search

    STEVEN G. DESAUTELS; ADAM SLIVKA; WILLIAM R. HUTSON; ANDREW CHUN; CARLOS MITRANI; CARLO DILORENZO; ARNOLD WALD

    1999-01-01

    Background & Aims: Persistent abdominal pain occurs in many patients after cholecystectomy, some of whom are described as having sphincter of Oddi dysfunction (SOD). Pain in SOD type III is thought to be of biliary origin with little objective data, and treatment is often unsatisfactory. Chronic abdominal pain without a bio- logical disease marker is similar to irritable bowel syndrome,

  15. Functional abdominal pain causing Scurvy, Pellagra, and Hypovitaminosis A

    PubMed Central

    Ho, Edith Y.

    2014-01-01

    Severe vitamin deficiency disease is rarely seen in developed countries. We present an atypical case of a young man with scurvy, pellagra, and hypovitaminosis A, caused by longstanding functional abdominal pain that severely limited his ability to eat. PMID:24715978

  16. Plasma amylase estimation in recurrent abdominal pain in children.

    PubMed Central

    Wheeler, R. A.; Colquhoun-Flannery, W. A.; Johnson, C. D.

    1992-01-01

    In a prospective study of 50 children who were admitted on more than one occasion with undiagnosed abdominal pain, the serum amylase was found to be normal in every case. One case of acute pancreatitis was diagnosed in over 8000 admissions. Serum amylase estimation did not contribute to the management of children with recurrent abdominal pain, and acute pancreatitis is so rare that routine amylase estimations cannot be recommended in paediatric surgical practice. PMID:1384415

  17. Pylephlebitis After Colonic Polypectomy Causing Fever and Abdominal Pain

    PubMed Central

    May, Gary; Kortan, Paul; Bayoumi, Ahmed M.

    2015-01-01

    Pylephlebitis is a rare condition with a high mortality risk if not recognized and treated early. The most common symptoms include fever and abdominal pain, with the majority of cases manifesting with a polymicrobial bacteremia. We report an elderly woman with pylephlebitis presenting with fever, abdominal pain, diarrhea, and vomiting, likely secondary to a polypectomy 6 weeks prior. Abdominal CT revealed portal vein thrombus and blood cultures grew Streptococcus milleri and Haemophilus parainfluenza type V. Pylephlebitis should be considered when symptoms and signs of infection develop following endoscopic procedures, particularly in patients with an underlying hypercoaguable disease.

  18. Supraspinal TRPV1 modulates the emotional expression of abdominal pain.

    PubMed

    Jurik, Angela; Ressle, Andrea; Schmid, Roland M; Wotjak, Carsten T; Thoeringer, Christoph K

    2014-10-01

    The transient receptor potential vanilloid receptor type-1 (TRPV1) is critically involved in peripheral nociceptive processes of somatic and visceral pain. However, the role of the capsaicin receptor in the brain regarding visceral pain remains elusive. Here, we studied the contribution of TRPV1 to abdominal pain transmission at different nociceptive pathway levels using TRPV1 knock-out mice, resiniferatoxin-mediated deletion of TRPV1-positive primary sensory neurons, and intracerebral TRPV1 antagonism. We found that constitutive genetic TRPV1 deletion or peripheral TRPV1 deletion reduced acetic acid-evoked abdominal constrictions, without affecting referred abdominal hyperalgesia or allodynia in an acute pancreatitis model of visceral pain. Notably, intracerebral TRPV1 antagonism by SB 366791 significantly reduced chemical and inflammatory spontaneous abdominal nocifensive responses, as observed by reduced expressions of nociceptive facial grimacing, illustrating the affective component of pain. In addition to the established role of cerebral TRPV1 in anxiety, fear, or emotional stress, we demonstrate here for the first time that TRPV1 in the brain modulates visceral nociception by interfering with the affective component of abdominal pain. PMID:25139591

  19. Support Vector Machine Diagnosis of Acute Abdominal Pain

    NASA Astrophysics Data System (ADS)

    Björnsdotter, Malin; Nalin, Kajsa; Hansson, Lars-Erik; Malmgren, Helge

    This study explores the feasibility of a decision-support system for patients seeking care for acute abdominal pain, and, specifically the diagnosis of acute diverticulitis. We used a linear support vector machine (SVM) to separate diverticulitis from all other reported cases of abdominal pain and from the important differential diagnosis non-specific abdominal pain (NSAP). On a database containing 3337 patients, the SVM obtained results comparable to those of the doctors in separating diverticulitis or NSAP from the remaining diseases. The distinction between diverticulitis and NSAP was, however, substantially improved by the SVM. For this patient group, the doctors achieved a sensitivity of 0.714 and a specificity of 0.963. When adjusted to the physicians' results, the SVM sensitivity/specificity was higher at 0.714/0.985 and 0.786/0.963 respectively. Age was found as the most important discriminative variable, closely followed by C-reactive protein level and lower left side pain.

  20. Altered rectal sensory response induced by balloon distention in patients with functional abdominal pain syndrome

    Microsoft Academic Search

    Tsukasa Nozu; Miwako Kudaira

    2009-01-01

    BACKGROUND: Functional abdominal pain syndrome (FAPS) has chronic unexplained abdominal pain and is similar to the psychiatric diagnosis of somatoform pain disorder. A patient with irritable bowel syndrome (IBS) also has chronic unexplained abdominal pain, and rectal hypersensitivity is observed in a majority of the patients. However, no reports have evaluated the visceral sensory function of FAPS precisely. We aimed

  1. Sudden onset abdominal pain and distension: an imaging sparkler.

    PubMed

    Klair, Jagpal Singh; Girotra, M; Medarametla, S; Shah, H R

    2014-11-01

    We present a case of a middle-aged patient presenting with acute onset abdominal pain and distension who had signs of bowel obstruction on physical exam. He was afebrile, hemodynamically stable with no peritoneal signs. Abdominal radiograph and CT scan were pathognomic for sigmoid volvulus. Through this case report we want to discuss the presentation, diagnosis, management options for sigmoid volvulus and importance of features suggestive of ischemic bowel that necessitates different management options. PMID:25654924

  2. Celiac plexus block in the management of chronic abdominal pain.

    PubMed

    Rana, Maunak V; Candido, Kenneth D; Raja, Omar; Knezevic, Nebojsa Nick

    2014-02-01

    Chronic abdominal pain is a devastating problem for patients and providers, due to the difficulty of effectively treating the entity. Both benign and malignant conditions can lead to chronic abdominal pain. Precision in diagnosis is required before effective treatment can be instituted. Celiac Plexus Block is an interventional technique utilized for diagnostic and therapeutic purposes in the treatment of abdominovisceral pain. The richly innervated plexus provides sensory input about pathologic processes in the liver, pancreas, spleen, omentum, alimentary tract to the mid-transverse colon, adrenal glands, and kidney. Chronic pancreatitis and chronic pain from pancreatic cancer have been treated with celiac plexus block to theoretically decrease the side effects of opioid medications and to enhance analgesia from medications. Historically, the block was performed by palpation and identification of bony and soft tissue anatomy; currently, various imaging modalities are at the disposal of the interventionalist for the treatment of pain. Fluoroscopy, computed tomography (CT) guidance and endoscopic ultrasound assistance may be utilized to aid the practitioner in performing the blockade of the celiac plexus. The choice of radiographic technology depends on the specialty of the interventionalist, with gastroenterologists favoring endoscopic ultrasound and interventional pain physicians and radiologists preferring CT guidance. A review is presented describing the indications, technical aspects, and agents utilized to block the celiac plexus in patients suffering from chronic abdominal pain. PMID:24414338

  3. [13-Year old boy with abdominal pain].

    PubMed

    Thomassen, Irene; Klinkhamer, Paul J J M; van de Poll, Marcel C G

    2012-01-01

    A 13-year old boy presents with pain in the lower right abdomen, showing clinical signs of appendicitis. During McBurney' incision an appendix sana was seen. Histologic examination showed penetrating enterobiasis. This was treated with mebendazol. PMID:22551758

  4. Physical and emotional functioning of adult patients with chronic abdominal pain: Comparison with patients with chronic back pain

    Microsoft Academic Search

    Cynthia O. Townsend; Christopher D. Sletten; Barbara K. Bruce; Jeffrey D. Rome; Connie A. Luedtke; John E. Hodgson

    2005-01-01

    Adults with chronic abdominal pain remain a poorly defined population, despite the debilitation and depression associated with this therapeutically challenging condition. This study compared patients with chronic abdominal pain with an empirically well-known group of patients with chronic pain (back pain) to investigate similarities and differences in their physical and mental functioning. This retrospective, cross-sectional study included 136 patients with

  5. Cognitive-Behavioral Therapy for Children With Functional Abdominal Pain and Their Parents Decreases Pain and Other Symptoms

    Microsoft Academic Search

    Rona L Levy; Shelby L Langer; Lynn S Walker; Joan M Romano; Dennis L Christie; Nader Youssef; Melissa M DuPen; Andrew D Feld; Sheri A Ballard; Ericka M Welsh; Robert W Jeffery; Melissa Young; Melissa J Coffey; William E Whitehead

    2010-01-01

    OBJECTIVES:Unexplained abdominal pain in children has been shown to be related to parental responses to symptoms. This randomized controlled trial tested the efficacy of an intervention designed to improve outcomes in idiopathic childhood abdominal pain by altering parental responses to pain and children's ways of coping and thinking about their symptoms.METHODS:Two hundred children with persistent functional abdominal pain and their

  6. Treatment of acute abdominal pain in the emergency room: a systematic review of the literature.

    PubMed

    Falch, C; Vicente, D; Häberle, H; Kirschniak, A; Müller, S; Nissan, A; Brücher, B L D M

    2014-08-01

    Appropriate pain therapy prior to diagnosis in patients with acute abdominal pain remains controversial. Several recent studies have demonstrated that pain therapy does not negatively influence either the diagnosis or subsequent treatment of these patients; however, current practice patterns continue to favour withholding pain medication prior to diagnosis and surgical treatment decision. A systematic review of PubMed, Web-of-Science and The-Cochrane-Library from 1929 to 2011 was carried out using the key words of 'acute', 'abdomen', 'pain', 'emergency' as well as different pain drugs in use, revealed 84 papers. The results of the literature review were incorporated into six sections to describe management of acute abdominal pain: (1) Physiology of Pain; (2) Common Aetiologies of Abdominal Pain; (3) Pre-diagnostic Analgesia; (4) Pain Therapy for Acute Abdominal Pain; (5) Analgesia for Acute Abdominal Pain in Special Patient Populations; and (6) Ethical and Medico-legal Considerations in Current Analgesia Practices. A comprehensive algorithm for analgesia for acute abdominal pain in the general adult population was developed. A review of the literature of common aetiologies and management of acute abdominal pain in the general adult population and special patient populations seen in the emergency room revealed that intravenous administration of paracetamol, dipyrone or piritramide are currently the analgesics of choice in this clinical setting. Combinations of non-opioids and opioids should be administered in patients with moderate, severe or extreme pain, adjusting the treatment on the basis of repeated pain assessment, which improves overall pain management. PMID:24449533

  7. Misdiagnosis of Abdominal Pain in Pregnancy: Acute Pancreatitis

    PubMed Central

    Samal, Sunita; Gupta, Shweta; Begum, Jasmina; Ghose, Seetesh

    2015-01-01

    We report a case of acute pancreatitis in a pregnant woman who presented to our emergency department with complaints of severe abdominal pain, was misdiagnosed as scar dehiscence and underwent emergency repeat caesarean section at 33 wks for fetal distress. The preterm baby developed severe respiratory distress and succumbed on the second postnatal day. Persistent severe pain in the postoperative period in the mother prompted further evaluation which led to a diagnosis of acute pancreatitis. Conservative and supportive management was instituted leading to an eventual favourable maternal outcome. PMID:25738042

  8. Septic arthritis of the pubic symphysis: an atypical abdominal pain.

    PubMed

    Ghislain, L; Heylen, A; Alexis, F; Tintillier, M

    2015-02-01

    Septic arthritis of the pubic symphysis is a rare infection mostly caused by Staphylococcus aureus, and is traditionally associated with risk factors (sports, female incontinence surgery). Typical features of pubic symphysis infection include abdominal, pelvic, or groin pain that increases upon standing and walking, causing limping to occur. Acute onset of fever is often associated. It is important to distinguish septic arthritis of the pubic symphysis from its aseptic homologue, improperly called 'osteitis pubis' in English literature. This general term is mostly used to designate a mechanical pubic pain and has several aetiological meanings (joint stress, postoperative pain, rheumatic diseases). However, some authors consider the infection of the pubic symphysis as a variant of osteitis pubis, placing the two diseases in the continuum of the same entity. This confusion in pubic pathology related to its rarity and its atypical presentation, may in some cases lead to diagnostic and therapeutic delay. In this article, we would like to make practitioners aware of this uncommon and often ignored anatomical site, so that it can recover its place in the differential diagnosis of abdominal pain. PMID:25227947

  9. Abdominal wall pain in obese women: frequently missed and easily treated

    PubMed Central

    Mishriki, Yehia Yousri

    2009-01-01

    Chronic abdominal pain is a common symptom with an extensive differential diagnosis. The work-up is frequently costly, yet many patients elude definitive diagnosis. We describe 12 obese women with long-standing abdominal pain, many of whom eluded diagnosis but who met criteria for abdominal wall pain. Each patient underwent a focused history and physical examination which included checking for Carnett’s sign and performing a “pinch test”. All patients had positive Carnett’s sign and pinch tests. An injection of local anaesthetic, with or without corticosteroid, completely relieved the pain within 10 min. Of the six patients seen in follow-up, four remained pain free and two responded to a second injection of local anaesthetic. Abdominal wall pain is an under-appreciated cause of chronic abdominal pain. Diagnosis is often straightforward and treatment with a local injection of anaesthetic is both diagnostic and curative. PMID:21686788

  10. Experiences of Indonesian mother managing preschool children's acute abdominal pain in Taiwan.

    PubMed

    Tseng, Chiu-Lien; Huang, Chu-Yu; Park, Jeong-Hwan; Lin, Hung-Ru; Liang, Shu-Yuan; Cheng, Su-Fen

    2015-01-01

    The aim of this study was to understand the Indonesian mothers' experiences of managing preschool children's acute abdominal pain. The descriptive qualitative research design comprises semi-structured interviews with 11 Indonesian mothers. The qualitative content analysis revealed three themes, including (1) insight of abdominal pain, (2) "inheritance of the strategies for assessment of management for abdominal pain from the family of origin", (3) "obstacles and insights related to cultural differences". The results presented that pain management was affected by family, environment, cultural background and religious beliefs. Healthcare providers should provide culturally competent pain management care for the patients of difference nationalities. PMID:25173181

  11. Glass Microparticulate Ingestion: An Unusual and Difficult-to-Diagnose Cause of Chronic Abdominal Pain

    PubMed Central

    Vance, R. Brooks; Mühlbauer, Marcus; Dreesen, Elizabeth B.; Bagnell, C. Robert; Dent, Georgette A.; Herfarth, Hans; Jobin, Christian

    2014-01-01

    In the absence of overt structural abnormalities, the diagnostic approach to chronic abdominal pain can be challenging. Occupational particulate inhalation causing injury to an organ other than the lung is rare. We report a case of inadvertent glass microparticulate ingestion causing chronic abdominal pain with altered local and systemic inflammatory responses.

  12. Paroxysmal drastic abdominal pain with tardive cutaneous lesions presenting in Henoch-Schönlein purpura.

    PubMed

    Chen, Xiao-Liang; Tian, Hong; Li, Jian-Zhong; Tao, Jin; Tang, Hua; Li, Yang; Wu, Bin

    2012-04-28

    Henoch-Schönlein purpura (HSP) is a small-vessel vasculitis mediated by IgA-immune complex deposition. It is characterized by the clinical tetrad of non-thrombocytopenic palpable purpura, abdominal pain, arthritis and renal involvement. The diagnosis of HSP is difficult, especially when abdominal symptoms precede cutaneous lesions. We report a rare case of paroxysmal drastic abdominal pain with gastrointestinal bleeding presented in HSP. The diagnosis was verified by renal damage and the occurrence of purpura. PMID:22563183

  13. Continuous intravenous morphine for pain relief after abdominal surgery.

    PubMed Central

    Ray, D. C.; Drummond, G. B.

    1988-01-01

    We studied prospectively 247 consecutive patients given morphine by continuous intravenous infusion for 24 h to provide pain relief following elective abdominal surgery. Using a dose of 1 mg/kg supplemented by additional intramuscular morphine 5 mg as necessary, only 26% required more than two additional intramuscular doses for discomfort. In 71 patients, the infusion was discontinued temporarily, mostly because of low respiratory rates. These patients were older (P less than 0.01), and their mean respiratory rate over the 24 h was significantly less (P less than 0.001) than those in whom the infusion was continuous. The technique was inexpensive, easy to use in a general surgical ward, and safe provided certain rules were observed. PMID:3190130

  14. Partially hydrolyzed guar gum in pediatric functional abdominal pain

    PubMed Central

    Romano, Claudio; Comito, Donatella; Famiani, Annalisa; Calamarà, Sabrina; Loddo, Italia

    2013-01-01

    AIM: To assess the effects of partially hydrolyzed guar gum (PHGG) diet supplement in pediatric chronic abdominal pain (CAP) and irritable bowel syndrome (IBS). METHODS: A randomized, double-blind pilot study was performed in sixty children (8-16 years) with functional bowel disorders, such as CAP or IBS, diagnosed according to Rome III criteria. All patients underwent ultrasound, blood and stool examinations to rule out any organic disease. Patients were allocated to receive PHGG at dosage of 5 g/d (n = 30) or placebo (fruit-juice n = 30) for 4 wk. The evaluation of the efficacy of fiber supplement included IBS symptom severity score (Birmingham IBS Questionnaire), severity of abdominal pain (Wong-Baker Face Pain Rating Score) and bowel habit (Bristol Stool Scale). Symptom scores were completed at 2, 4, and 8 wk. The change from baseline in the symptom severity scale at the end of treatment and at 4 wk follow-up after treatment was the primary endpoint. The secondary endpoint was to evaluate compliance to supplementation with the PHGG in the pediatric population. Differences within groups during the treatment period and follow-up were evaluated by the Wilcoxon signed-rank test. RESULTS: The results of the study were assessed considering some variables, such as frequency and intensity of symptoms with modifications of the bowel habit. Both groups were balanced for baseline characteristics and all patients completed the study. Group A (PHGG group) presented a higher level of efficacy compared to group B (control group), (43% vs 5%, P = 0.025) in reducing clinical symptoms with modification of Birmingham IBS score (median 0 ± 1 vs 4 ± 1, P = 0.025), in intensity of CAP assessed with the Wong-Baker Face Pain Rating Score and in normalization of bowel habit evaluated with the Bristol Stool Scale (40% vs 13.3%, P = 0.025). In IBS subgroups, statistical analysis shown a tendency toward normalization of bowel movements, but there was no difference in the prevalence of improvement in two bowel habit subsets. PHGG was therefore better tolerated without any adverse effects. CONCLUSION: Although the cause of pediatric functional gastrointestinal disorders is not known, the results show that complementary therapy with PHGG may have beneficial effects on symptom control. PMID:23345946

  15. New Bloody Sunday Inquiry

    NSDL National Science Digital Library

    de Nie, Michael Willem.

    1998-01-01

    This week's In the News discusses the recent decision to reopen the investigation into Bloody Sunday. The nine resources discussed provide background information, analysis, and commentary. On January 30, 1972 British paratroopers shot dead thirteen people taking part in a protest march in the Northern Ireland city of Derry. The soldiers insisted that they had come under attack by members of the Irish Republican Army (IRA) and only fired at those possessing weapons. This claim was and continues to be strongly denied by march participants and eyewitnesses. Bloody Sunday has remained an emotive issue in Ireland, partially because of intense dissatisfaction with the official investigation conducted at the time. In a hastily researched report, Lord Widgery granted that none of the victims could be proved to have had weapons when they were shot, but there was "a strong suspicion that some others had been firing weapons or handling bombs in the course of the afternoon." After years of prodding by Catholic nationalists in the North and the government of the Irish Republic, the British government, led by Prime Minister Tony Blair, has announced that they will reopen the investigation into Bloody Sunday as part of their larger efforts to secure a lasting peace in Northern Ireland.

  16. Predictors of Abdominal Pain in Depressed Pediatric Inflammatory Bowel Disease Patients

    PubMed Central

    Srinath, Arvind I.; Goyal, Alka; Zimmerman, Lori A.; Newara, Melissa C.; Kirshner, Margaret A.; McCarthy, F. Nicole; Keljo, David; Binion, David; Bousvaros, Athos; DeMaso, David R.; Youk, Ada; Szigethy, Eva M.

    2015-01-01

    Background Pediatric patients with inflammatory bowel disease (IBD) have high rates of abdominal pain. The study aims were to (1) Evaluate biological and psychological correlates of abdominal pain in depressed youth with IBD, (2) Determine predictors of abdominal pain in Crohn’s disease (CD) and ulcerative colitis (UC). Methods 765 patients ages 9–17 with IBD seen over 3 years at two sites were screened for depression. Depressed youth completed comprehensive assessments for abdominal pain, psychological (depression and anxiety), and biological (IBD-related, through disease activity indices and laboratory values) realms. Results 217 patients with IBD (161 CD, 56 UC) were depressed. 163 (120 CD, 43 UC) patients had complete API scores. In CD, abdominal pain was associated with depression (r=0.33; p<0.001), diarrhea (r=0.34; p=0.001), ESR (r=0.22; p=0.02), low albumin (r=0.24; p=.01), weight loss (r=0.33; p=0.001), and abdominal tenderness (r=0.38, p=0.002). A multivariate model with these significant correlates represented 32% of the variance in pain. Only depression (p=0.03), weight loss (p=0.04), and abdominal tenderness (p=0.01) predicted pain for CD patients. In UC, pain was associated with depression (r=0.46; p=0.002) and nocturnal stools (r=.32; p=.046). In the multivariate model with these significant correlates 23% of the variance was explained, and only depression (p=0.02) predicted pain. Conclusions The psychological state of pediatric patients with IBD may increase the sensitivity to abdominal pain. Thus, screening for and treating comorbid depression may prevent excessive medical testing and unnecessary escalation of IBD medications. PMID:24983975

  17. Celiac plexus neurolysis for the treatment of upper abdominal cancer pain

    PubMed Central

    Teixeira, Manoel Jacobsen; Neto, Eloy Rusafa; da Nóbrega, José Cláudio Marinho; dos Ângelos, Jairo Silva; Martin, Miguel San; de Monaco, Bernardo Assumpção; Fonoff, Erich Talamoni

    2013-01-01

    Optimal treatment of oncologic pain is a challenge to all professionals who deal with cancer and its complications. The management of upper abdominal pain is usually difficult and it is often refractory to conservative therapies. In this context, celiac plexus neurolysis (CPN) appears to be an important and indispensable tool because it alleviates pain, gives comfort to patients and is a safe procedure. In this study, the importance of CPN is reviewed by a retrospective study of 74 patients with pain due to upper abdominal cancer. Almost all cases evaluated (94.6%) had an excellent result after CPN and the majority of side effects were transitory. PMID:23983470

  18. The radiologic evaluation of acute abdominal pain of intestinal origin. A clinical approach.

    PubMed

    Brazaitis, M P; Dachman, A H

    1993-09-01

    The patient with acute abdominal pain presents the attending physician with a wide and varied gamut of diagnostic possibilities. Prompt and accurate diagnosis is essential for the proper care and management of these acutely ill patients. Diagnostic radiology is often an integral part of the emergent evaluation of these patients. This article focuses on some of the key plain-film findings in the patients suffering from acute abdominal pain of intestinal causes and reviews the radiologic evaluation of several major abdominal conditions such as acute appendicitis, diverticulitis, inflammatory bowel disease, bowel ischemia, and infarction. PMID:8371622

  19. Validation of the Diagnostic Score for Acute Lower Abdominal Pain in Women of Reproductive Age

    PubMed Central

    Jearwattanakanok, Kijja; Yamada, Sirikan; Suntornlimsiri, Watcharin; Smuthtai, Waratsuda; Patumanond, Jayanton

    2014-01-01

    Background. The differential diagnoses of acute appendicitis obstetrics, and gynecological conditions (OB-GYNc) or nonspecific abdominal pain in young adult females with lower abdominal pain are clinically challenging. The present study aimed to validate the recently developed clinical score for the diagnosis of acute lower abdominal pain in female of reproductive age. Method. Medical records of reproductive age women (15–50 years) who were admitted for acute lower abdominal pain were collected. Validation data were obtained from patients admitted during a different period from the development data. Result. There were 302 patients in the validation cohort. For appendicitis, the score had a sensitivity of 91.9%, a specificity of 79.0%, and a positive likelihood ratio of 4.39. The sensitivity, specificity, and positive likelihood ratio in diagnosis of OB-GYNc were 73.0%, 91.6%, and 8.73, respectively. The areas under the receiver operating curves (ROC), the positive likelihood ratios, for appendicitis and OB-GYNc in the validation data were not significantly different from the development data, implying similar performances. Conclusion. The clinical score developed for the diagnosis of acute lower abdominal pain in female of reproductive age may be applied to guide differential diagnoses in these patients. PMID:24971177

  20. Day-case laparoscopic surgery for appendicitis and non-specific abdominal pain.

    PubMed

    Ciardo, Luigi Francesco; Agresta, Ferdinando; Bedin, Natalino

    2007-01-01

    Laparoscopy is commonly used in the treatment of appendicular diseases and non-specific abdominal pain. Nevertheless, the role of day-case laparoscopic surgery in these cases is still debated. The aim of this study was to identify which cases of appendicitis or non-specific abdominal pain are most indicated for daycase laparoscopic surgery. From January 1 2000 to December 31 2005 at our institution 424 patients were treated laparoscopically for appendicitis or non-specific abdominal pain. 41 were operated on on a day-case basis. 81% of these (33 patients) were discharged from hospital within 24 hours of surgery. 2 patients could not be discharged because of persistent postoperative pain and 6 had a longer hospitalisation period for non-medical reasons. No major complications and no readmissions to hospital were observed in the 33 regularly discharged patients. Over the same period 61 patients were operated on by traditional "open" surgery for the same pathologies. Their postoperative hospitalisation was considerably longer. None of them were operated on on a day-case basis and none were discharged within 24 hours of surgery. 3 patients needed readmission to our institution within the first 30 postoperative days. Day-case laparoscopic. surgery is valid, safe and effective for the treatment of uncomplicated appendicitis and nonspecific abdominal pain. For successful laparoscopic day-case surgery it is of fundamental importance to ensure adequate preoperative patient selection and to pay proper attention to the treatment of postoperative pain. PMID:17663367

  1. Transcutaneous electric acupoint stimulation at Jiaji points reduce abdominal pain after colonoscopy: a randomized controlled trial

    PubMed Central

    Chen, Yanqing; Wu, Weilan; Yao, Yusheng; Yang, Yang; Zhao, Qiuyan; Qiu, Liangcheng

    2015-01-01

    Background: Transcutaneous electric acupoint stimulation (TEAS) at Jiaji acupuncture points has therapeutic potential for relieving viscera pain and opioid-related side effects. This prospective, randomized, triple-blinded, placebo-controlled trial was to investigate the efficacy of TEAS on abdominal pain after colonoscopy. Methods: Consecutive outpatients with American Society of Anesthesiologists (ASA) physical status I or II underwent selective colonoscopy were randomly assigned into two groups for either TEAS or sham pretreatment. The primary outcomes were the incidence of abdominal pain after colonoscopy. The secondary outcomes included the incidence of abdominal distension, postoperative nausea and vomiting (PONV), duration of PACU stay, and patient’s satisfaction and acceptance. Results: Among the 229 patients analyzed, fewer occurrence of post-procedural abdominal pain (11.4% vs 25.2%, P = 0.007) and distension (1.8% vs 7.8%, P = 0.032) were observed in TEAS group, when compared with the sham group. The duration of PACU stay was significant shortened in TEAS group (P < 0.001). Meanwhile, patients’ satisfaction score to medical service was higher (P < 0.001), and their acceptance to colonoscopy was improved (P = 0.011). Conclusion: Pretreatment with TEAS can reduce post-procedural discomfort, provide more efficient medical resources utilization, and improved patient’s satisfaction and colonoscopy acceptance. PMID:26131193

  2. Cognitive-Behavioral Interventions Via Telehealth: Applications to Pediatric Functional Abdominal Pain

    Microsoft Academic Search

    Amy F. Sato; Lisa M. Clifford; Alan H. Silverman; W. Hobart Davies

    2009-01-01

    This integrative literature review explores the utility of telehealth, specifically videoconferencing, for the delivery of cognitive-behavioral therapy (CBT) to youth with functional abdominal pain (FAP). Children with FAP and their families encounter a number of barriers to treatment that hinder access to traditional in-clinic treatments, such as CBT. Videoconferencing may be a feasible and effective alternative to traditional services and

  3. Sclerosing mesenteritis as a rare cause of upper abdominal pain and digestive disorders.

    PubMed

    Grieser, C; Denecke, T; Langrehr, J; Hamm, B; Hänninen, E Lopez

    2008-09-01

    Sclerosing mesenteritis is a rare inflammatory disease of the bowel mesentery of unknown etiology, which can be mistaken for malignancy. We report a case of a 60-year-old male patient with sclerosing mesenteritis as a rare cause of upper abdominal pain and digestive disorders, and present the corresponding magnetic resonance imaging (MRI) findings indicative of the underlying disease. PMID:19143059

  4. Protein S deficiency present in a pregnant woman with dyspnea, abdominal pains, restlessness, agitation and hypofibrinogenemia

    PubMed Central

    Umazume, Takeshi; Morikawa, Mamoru; Yamada, Takahiro; Akaishi, Rina; Koyama, Takahiro; Minakami, Hisanori

    2015-01-01

    Key Clinical Message Hypofibrinogenemia is rare in pulmonary thromboembolism. A pregnant woman with dyspnea, abdominal pain, restlessness, agitation and protein S deficiency exhibited normal blood oxygenation and high D-dimer (370 ?g/mL) and undetectable fibrinogen levels in the blood. The pathogenesis responsible for present findings may have some features similar to amniotic fluid embolism. PMID:25914811

  5. Impact of Clinical Experience and Diagnostic Performance in Patients with Acute Abdominal Pain

    PubMed Central

    Laurell, Helena; Hansson, Lars-Erik; Gunnarsson, Ulf

    2015-01-01

    Background. The aims were to evaluate the importance of the formal competence of the emergency department physician, the patient's time of arrival at the emergency department, and the use of a structured schedule for investigation of patients with acute abdominal pain. Methods. Patients attending the Mora Hospital with acute abdominal pain from 1997 to 2000 were registered prospectively according to a structured schedule. Registration included history, symptoms, signs, preliminary diagnosis, surgery and final diagnosis after at least one year. ?Results. 3073 acute abdominal pain patients were included. The preliminary diagnosis, as compared with the final diagnosis, was correct in 54% (n = 1659). Previously, during 1996, a base-line registration of 790 patients had a 58% correct diagnoses??(n = 458). A majority of the patients (n = 2699; 88%) were managed by nonspecialists. The proportion of correct diagnoses was 54% (n = 759) for pre-registrar house officers and 55% (n = 443) for senior house officers. Diagnostic performance at the emergency department was independent of patient's time of arrival. Conclusions. A structured schedule for investigation did not improve the diagnostic precision at the emergency department in patients with acute abdominal pain. The diagnostic performance was independent of the formal competence of the physician and the patient's time of arrival. PMID:25685146

  6. Low yield of routine duodenal biopsies for evaluation of abdominal pain

    PubMed Central

    Dubin, Sterling M; Kwong, Wilson T; Kalmaz, Denise; Savides, Thomas J

    2015-01-01

    AIM: To determine the yield of biopsying normal duodenal mucosa for investigation of abdominal pain. METHODS: This is a retrospective chart review of consecutive patients who underwent esophagogastroduodenoscopy (EGD) with duodenal biopsies of normal appearing duodenal mucosa for an indication that included abdominal pain. All the patients in this study were identified from an electronic endoscopy database at a single academic medical center and had an EGD with duodenal biopsies performed over a 4-year period. New diagnoses that were made as a direct result of duodenal biopsies were identified. All duodenal pathology reports and endoscopy records were reviewed for indications to perform the examination as well as the findings; all the medical records were reviewed. Exclusion criteria included age less than 18 years, duodenal mass, nodule, or polyp, endoscopic duodenitis, duodenal scalloping, known celiac disease, positive celiac serology, Crohns disease, or history of bone marrow transplant. Information was collected in a de-identified database with pertinent demographic information including human immunodeficiency virus (HIV) status, and descriptive statistics were performed. RESULTS: About 300 patients underwent EGD with biopsies of benign appearing or normal appearing duodenal mucosa. The mean age of patients was 44.1 ± 16.8 years; 189 of 300 (63%) were female. A mean of 4.3 duodenal biopsies were performed in each patient. In the subgroup of patients with abdominal pain without anemia, diarrhea, or weight loss the mean age was 43.4 ± 16.3 years. Duodenal biopsies performed for an indication that included abdominal pain resulting in 4 new diagnoses (3 celiac disease and 1 giardiasis) for an overall yield of 1.3%. 183 patients with abdominal pain without anemia, diarrhea, or weight loss (out of the total 300 patients) underwent duodenal biopsy of duodenal mucosa resulting in three new diagnoses (two cases of celiac disease and one giardiasis) for a yield of 1.6%. Duodenal biopsies of 19 HIV patients presenting for evaluation of abdominal pain did not reveal any new diagnoses. Information pertaining to new diagnoses is provided. CONCLUSION: Routine biopsy of normal appearing duodena in patients with abdominal pain should be reserved for those with a high pre-test probability given its low diagnostic yield. PMID:26139995

  7. Primary Cardiac Burkitt Lymphoma Presenting with Abdominal Pain

    PubMed Central

    Dewar, Rajan; Luptakova, Katarina; Chang, James D.; Joyce, Robin M.

    2014-01-01

    We describe the case of a 44-year-old woman with primary Burkitt lymphoma of the heart who presented with abdominal bloating and epigastric discomfort secondary to tamponade physiology caused by a large pericardial effusion. The pericardial fluid contained a large number of highly atypical lymphocytes with moderate basophilic cytoplasm, rare punched-out vacuoles, a vesicular nuclear chromatin, large nucleolus, and marginated chromatin that by FISH were positive for the 8;14 translocation. She had no other sites of disease. She was treated with four alternating cycles of modified CODOX-M and IVAC in combination with rituximab and remains in remission more than 5 years since diagnosis. PMID:25431699

  8. [Report of 2 unusual cases of abdominal pain].

    PubMed

    Koch, N; Cavin, R

    2001-10-01

    We present two cases of rare abdominal pathologies, for which the initial diagnosis appeared simple but turned out to be exceptional pathologies. The first was compatible with simple lithiasic cholecystitis with choledocian obstacle, but was diagnosed as an idiopathic multifocal retroperitoneal fibrosis, also known as Ormond's disease. The second patient presented as an acute appendicitis. After a surgical exploration of the lower right quadrant, which did not allow a diagnosis, a median laparotomy was performed, leading to the diagnosis of ileo-caecal ischemic necrosis caused by lymphocytic phlebitis. PMID:11715287

  9. Abdominal pain and a raised amylase? It's not always pancreatitis. . .

    PubMed

    Oluwatowoju, I O; Abu, O E; Lawson, G

    2013-01-01

    We report the case of a 72 year old man with a history of COPD and heavy alcohol consumption who was initially diagnosed with acute pancreatitis based on a presentation with epigastric pain and elevated serum amylase. Review of his notes revealed several previous similar admissions and extensive normal investigations apart from persistently elevated amylase. Further analysis showed evidence of macroamylasaemia which accounted for the apparently high serum amylase level. PMID:24098876

  10. Clinical Scoring for Diagnosis of Acute Lower Abdominal Pain in Female of Reproductive Age

    PubMed Central

    Yamada, Sirikan; Suntornlimsiri, Watcharin; Smuthtai, Waratsuda

    2013-01-01

    Background. Obstetrics and gynecological conditions (OB-GYNc) are difficult to be differentiated from appendicitis in young adult females presenting with acute lower abdominal pain. Timely and correct diagnosis is clinically challenging. Method. A retrospective data analysis was performed on 542 female patients who were admitted to a tertiary care hospital with a chief complaint of acute lower abdominal pain. Diagnostic indicators of appendicitis and OB-GYNc were identified by stepwise multivariable polytomous logistic regression. Diagnostic performances of the scores were tested. Result. The developed clinical score is comprised of (1) guarding or rebound tenderness, (2) pregnancy, (3) sites of abdominal tenderness, (4) leukocytosis, (5) peripheral neutrophils ?75%, and (6) presence of diarrhea. For diagnosis of appendicitis, the area under the ROC curve was 0.8696, and the sensitivity and specificity were 89.25% and 70.00%. For OB-GYNc, the corresponding values were 0.8450, 66.67%, and 94.85%, respectively. Conclusion. The clinical scoring system can differentiate the diagnosis of acute lower abdominal pain in young adult females. Time spent for diagnosis at the emergency room may be shortened, and the patients would be admitted to the appropriate departments in less time. PMID:24396602

  11. Infection versus ALVAL: acute presentation with abdominal pain.

    PubMed

    Abdul, Nicole; Fountain, James; Stockley, Ian

    2013-01-01

    A 52-year-old man underwent bilateral articular surface replacement (ASR) DePuy in June 2006. Following a right femoral neck fracture 4 days postoperatively, he underwent revision to a cemented C-stem DePuy, a taper sleeve adaptor and a 47 mm diameter cobalt chromium femoral head. The patient recovered well with satisfactory 5-year follow-up. In September 2011 the patient presented to the accident and emergency department with a 5-day history of feeling unwell with right lower quadrant pain. Examination of the right hip was unremarkable apart from painful adduction. Blood tests showed raised inflammatory markers and white cell count. MRI scan showed a right iliopsoas collection which appeared to communicate with the hip joint. The patient underwent a direct exchange of the right hip prosthesis. The intraoperative clinical picture was suggestive of atypical lymphocytic vasculitis and associated lesions. The patient recovered well and was discharged home. At his last clinic visit he was well and pain free. PMID:23761510

  12. Infection versus ALVAL: acute presentation with abdominal pain

    PubMed Central

    Abdul, Nicole; Fountain, James; Stockley, Ian

    2013-01-01

    A 52-year-old man underwent bilateral articular surface replacement (ASR) DePuy in June 2006. Following a right femoral neck fracture 4?days postoperatively, he underwent revision to a cemented C-stem DePuy, a taper sleeve adaptor and a 47?mm diameter cobalt chromium femoral head. The patient recovered well with satisfactory 5-year follow-up. In September 2011 the patient presented to the accident and emergency department with a 5-day history of feeling unwell with right lower quadrant pain. Examination of the right hip was unremarkable apart from painful adduction. Blood tests showed raised inflammatory markers and white cell count. MRI scan showed a right iliopsoas collection which appeared to communicate with the hip joint. The patient underwent a direct exchange of the right hip prosthesis. The intraoperative clinical picture was suggestive of atypical lymphocytic vasculitis and associated lesions. The patient recovered well and was discharged home. At his last clinic visit he was well and pain free. PMID:23761510

  13. Bloody Sunday: Error or Design?

    Microsoft Academic Search

    Niall Ó Dochartaigh

    2010-01-01

    When British Paratroopers shot dead 13 people at a civil rights march in Derry on January 30, 1972 it dealt a hammer blow to British government claims of neutrality and moral authority in dealing with the escalating violence in Northern Ireland. Existing historical accounts of Bloody Sunday treat the killings as the outcome of a more-or-less unified military anxiety at

  14. [Ketoprofen in the prevention of postoperative pain in abdominal surgery. A multicenter study].

    PubMed

    Avila, G; Balbo, G; Biasiato, R; Brighenti, F M; Conte, R; Donini, I; Landi, E; Marzocca, G; Mazzi, U; Morino, F

    1991-01-01

    Two-hundred-forty-eight patients undergoing abdominal surgery were admitted to a multicentric clinical trial. The patients were randomly assigned to a single i.v. dose of ketoprofen or acetylsalicylic acid, 15 minutes after the end of operation. Ketoprofen showed a better analgesic activity with a statistically significant difference at 2 and 4 hours after administration. Two patients treated with ketoprofen reported vomiting and skin rash respectively. The results of this study confirm the efficacy of ketoprofen for the prophylaxis of postoperative pain in abdominal surgery. PMID:1751342

  15. Subcostal transversus abdominis plane phenol injection for abdominal wall cancer pain.

    PubMed

    Restrepo-Garces, Carlos Eduardo; Asenjo, Juan Francisco; Gomez, Carlos Mario; Jaramillo, Santiago; Acosta, Nathalia; Ramirez, Lizeth Jazmin; Lopera, Luz Maria; Vargas, Juan Felipe

    2014-03-01

    A subcostal transversus abdominis plane (TAP) phenol injection was performed on a patient with refractory cancer pain due a metastatic involvement of the abdominal wall. A diagnostic block with local anesthetic was performed under ultrasound guidance (USG), resulting in a decrease of 80% and 100% in dynamic and static visual analog scale (VAS) for pain, respectively, for 20 hours. A phenol injection was then performed under USG. The patient reported 70% and 100% reduction in the dynamic and static VAS for pain and had a 50% decrease in the opioid requirement that was maintained for 2 months. TAP blocks offer an interesting tool for either diagnosis or therapeutic purpose in chronic pain management. USG provides an optimal approach to soft-tissue lesions where fluoroscopy techniques are not useful. PMID:23560547

  16. A 33-year-old Haitian immigrant with 7 months of abdominal pain and progressive distension

    PubMed Central

    Farhadian, Shelli; Shenoi, Sheela V; Villanueva, Merceditas S

    2015-01-01

    SUMMARY We report a case of a 33-year-old previously healthy Haitian immigrant with a 7-month history of abdominal pain, fever and ascites. He had a history of positive tuberculin skin test but never underwent treatment for latent tuberculosis (TB) infection. Initial examination showed abdominal distension. Abdominal CT scan showed mild ascites, abnormal soft tissue in the greater omentum and small bowel mesentery, retroperitoneal adenopathy, peritoneal thickening and dilated loops of small bowel. Paracentesis and thoracentesis were initially non-diagnostic. HIV testing was negative. The differential diagnosis included lymphoma and TB peritonitis. The omental mass was biopsied under ultrasound guidance, and histopathology revealed non-necrotising granulomas. Sputum cultures and omental biopsy cultures subsequently grew Mycobacterium tuberculosis, and a diagnosis was made of pulmonary TB with TB peritonitis. The patient responded well to the initiation of anti-TB treatment. PMID:25008341

  17. Sufentanil Sublingual Tablet System for the Management of Postoperative Pain Following Open Abdominal Surgery

    PubMed Central

    Ringold, Forrest G.; Minkowitz, Harold S.; Gan, Tong Joo; Aqua, Keith A.; Chiang, Yu-kun; Evashenk, Mark A.; Palmer, Pamela P.

    2015-01-01

    Background and Objectives This study evaluates the efficacy and safety of a sufentanil sublingual tablet system (SSTS) for the management of postoperative pain following open abdominal surgery. Methods At 13 hospital sites in the United States, patients following surgery with pain intensity of greater than 4 on an 11-point numerical rating scale were randomized to receive SSTS dispensing a 15-?g sufentanil tablet sublingually with a 20-minute lockout or an identical system dispensing a placebo tablet sublingually. Pain intensity scores were recorded at baseline and for up to 72 hours after starting study drug. The primary end point was time-weighted summed pain intensity difference (SPID) over 48 hours. Secondary end points included SPID and total pain relief (TOTPAR) for up to 72 hours and patient and health care provider global assessments of the method of pain control. Results Summed pain intensity difference over 48 hours was significantly higher in the SSTS group than in the placebo group (least squares mean [SEM], 105.60 [10.14] vs 55.58 [13.11]; P = 0.001). Mean SPID and TOTPAR scores were significantly higher in the SSTS group at all time points from 1 hour (SPID) or 2 hours (TOTPAR) until 72 hours (P < 0.05). In the SSTS group, patient global assessment and health care provider global assessment ratings of good or excellent were greater than placebo at all time points (P < 0.01). Safety parameters, including adverse events and vital signs, were similar for SSTS and placebo. Conclusions These results suggest that SSTS is effective and safe for the management of postoperative pain in patients following open abdominal surgery. PMID:25318408

  18. Functional abdominal pain and irritable bowel syndrome in children and adolescents

    PubMed Central

    Chiou, Eric; Nurko, Samuel

    2011-01-01

    Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are both associated with recurrent abdominal pain and are among the most commonly diagnosed medical problems in pediatrics. The majority of patients with mild complaints improve with reassurance and time. For a distinct subset of patients with more severe and disabling illness, finding effective treatment for these disorders remains a challenge. Based on the biopsychosocial model of functional disease, the Rome III criteria have helped frame FAP and IBS in terms of being a positive diagnosis and not a diagnosis of exclusion. However, the lack of a single, proven intervention highlights the complex interplay of pathologic mechanisms likely involved in the development of childhood FAP and IBS and the need for a multidisciplinary, integrated approach. This article discusses the epidemiology, proposed mechanisms, clinical approach and therapeutic options for the management of FAP and IBS in children and adolescents. PMID:21731470

  19. Abdominal and pelvic floor muscle function in women with and without long lasting pelvic girdle pain

    Microsoft Academic Search

    Britt Stuge; Siv Mørkved; Haldis Haug Dahl; Nina Vøllestad

    2006-01-01

    Approximately 5–20% of postpartum women suffer from long-lasting pelvic girdle pain (PGP). The etiology and pathogenesis of PGP are still unclear. The aim of this study was to examine whether subjects with and without persisting PGP and disability differed with respect to their ability to voluntarily contract the deep abdominals (TrA and IO) and to the strength of the pelvic

  20. IVC Filter Perforation through the Duodenum Found after Years of Abdominal Pain

    PubMed Central

    Jehangir, Asad; Rettew, Andrew; Shaikh, Bilal; Bennett, Kyle; Jehangir, Qasim; Qureshi, Anam; Arshad, Sharjeel; Spiegel, Adam

    2015-01-01

    Patient: Female, 67 Final Diagnosis: IVC filter perforation through duodenum Symptoms: Abdominal pain Medication: — Clinical Procedure: Esophagogastroduodenoscopy Specialty: Gastroenterology and Hepatology Objective: Challenging differential diagnosis Background: The number of IVC filter-related complications has increased with their growing utilization; however, IVC filter perforation of the duodenum is rare. It can manifest with nonspecific abdominal pain, gastrointestinal bleeding, cava-duodenal fistula, or small bowel obstruction. Case Report: A 67-year-old female presented with several years of right upper quadrant abdominal pain which was exacerbated by movement and food intake. She had a history of hepatic steatosis, cholecystectomy, and multiple DVTs with inferior vena cava filter placement. Physical exam was unremarkable. Laboratory tests demonstrated elevated alkaline phosphatase and transaminases. Esophagogastroduodenoscopy revealed a thin metallic foreign body embedded in the duodenal wall and protruding into the duodenal lumen with surrounding erythema and edema, but no active hemorrhage. Further evaluation with non-contrast CT scan revealed that one of the prongs of her IVC filter had perforated through the vena cava wall into the adjacent duodenum. Exploratory laparotomy was required for removal of the IVC filter and repair of the vena cava and duodenum. Her post-operative course was uneventful. Conclusions: In patients with history of IVC filter placement with non-specific abdominal pain, a high clinical suspicion of IVC filter perforation of the duodenum should be raised, as diagnosis may be challenging. CT scan and EGD are valuable in the diagnosis. Excellent outcomes have been reported with open surgical filter removal. Low retrieval rates of IVC filters have led to increased complications; hence, early removal should be undertaken as clinically indicated. PMID:25979859

  1. Restoration of Vagal Tone: A Possible Mechanism for Functional Abdominal Pain

    Microsoft Academic Search

    Richard Gevirtz; Warren Shapiro; Crystal Ebert

    2010-01-01

    Functional abdominal pain (FAP) causes disruption of daily activities\\/missed school days, over utilization of healthcare,\\u000a unnecessary surgeries, and anxiety in 10–15% of children. Its etiology is not clearly understood, however the success of several\\u000a clinical protocols suggests that autonomic dysregulation is a factor. In this study autonomic activity, including heart rate\\u000a variability (HRV), was compared between children with FAP and

  2. Concurrent diagnosis of Crohn's disease and colorectal carcinoma in a young man with abdominal pain.

    PubMed

    Colleran, G; Cronin, K; Hanaghan, J; O'Dowd, M; Bennani, F; Waldron, R

    2008-12-01

    The lead time between diagnosis of Crohn's disease and presentation with a Crohn's related malignancy is generally twenty years from diagnosis. This case outlines that of a young man who presented to the emergency department with abdominal pain and was subsequently discovered to have a malignant stricture complicating underlying Crohn's disease that was previously quiescent and undiagnosed. It demonstrates that a new diagnosis of Crohn's disease does not rule out previously quiescent underlying disease and therefore risk of colrectal carcinoma. PMID:21172234

  3. An Unusual Cause of Abdominal Pain: Three Lead Pellets within the Appendix Vermiformis

    PubMed Central

    Muderris, Vecdi; Yagmurkaya, Orhan; Yalkin, Omer; Celebi, Fehmi

    2015-01-01

    Most ingested foreign bodies usually pass out in the feces uneventfully. Complications such as intestinal perforation and bleeding usually occur with sharp, thin, stiff, long, and pointed objects. This case describes the management of three lead pellets within the appendix vermiformis. A 45-year-old male visited our clinic complaining of a 4-month history of abdominal pain. The patient inquiry revealed that he had eaten hunted rabbit meat on numerous occasions and had unintentionally ingested three lead pellets. Plain abdominal films and a barium enema showed foreign bodies in the right lower abdominal quadrant. Since the lead pellets were thought to have migrated extraluminally, they were removed through laparotomy under fluoroscopic guidance. An appendectomy was performed. Pathologically, three lead pellets were embedded in the appendix, which showed signs of intramucosal inflammation. Foreign bodies causing appendicitis are rare. However, if stiff or pointed objects enter the appendicular lumen, there is a high risk of appendicitis, perforation, or abdominal pain. An appendectomy was required to remove the ingested lead pellets in the appendix. PMID:26106500

  4. A Minimal Contact Cognitive-Behavioral Intervention for Abdominal Pain-Related Functional Gastrointestinal Disorders: Pilot-Study of "Gutstrong".

    E-print Network

    Wassom, Matthew Craig

    2008-08-21

    disorders. Twenty adolescents aged 13-17 attending an abdominal pain clinic were randomly assigned to either the treatment group ("Gutstrong" plus standard medical care) or a wait-list control group (standard medical care only). Participants completed...

  5. A patient presenting with abdominal pain to the general practitioner: a case report

    PubMed Central

    2009-01-01

    Introduction Right-sided upper abdominal pain is a common cause of presentation to general practitioners. Case presentation An otherwise well 46-year-old woman presented to her general practitioner with intermittent abdominal pain that had been present for several months. The only abnormality found at the initial consultation was moderate tenderness in the right upper abdomen. The laboratory tests that were ordered showed elevated parameters of inflammation. Sonography suggested the presence of an echinococcal cyst in segment VIII of the liver. Computed tomography confirmed this finding and showed no other cysts. On the basis of serological tests and the clinical findings, a diagnosis of Echinococcus granulosus infection was made. The patient was therefore admitted to hospital for surgical removal of the cyst. Her postoperative recovery was without complication and she remained free of symptoms. Conclusion Echinococcus granulosus infections are rare in Germany, with an incidence of 1:1,000,000. The sonographic appearances are generally characteristic and permit diagnosis. Treatment is pharmacological (albendazole, mebendazole) and surgical. It is curative in the vast majority of cases. The possibility of echinococcal infection should be considered in patients, especially immigrants, with abdominal pain. PMID:20062621

  6. Modified Severity of Dyspepsia Assessment pain scale: a new tool for measuring upper abdominal pain in osteoarthritis patients taking NSAIDs

    PubMed Central

    Welle, Jennifer; Fort, John; Crawley, Joseph; Cryer, Byron; Dickerhoof, Rene; Turner, Michelle P; Miller, Kimberly L

    2011-01-01

    Background: This study evaluated the electronically administered modified Severity of Dyspepsia Assessment (mSODA) pain scale, a six-item measure of upper abdominal pain intensity, for daily use in osteoarthritis patients taking nonsteroidal anti-inflammatory drugs. Methods: Once the mSODA pain scale was isolated, cognitive debriefing interviews (n = 30) were used to examine its appropriateness in the target population. Following administration of the instrument in two Phase III pivotal trials, the data were analyzed to examine reliability, validity, responsiveness, and the minimal important difference. Results: Using a subset of trial data (n = 90 patients), the mSODA pain scale proved to be a unidimensional, highly internally consistent instrument (? = 0.93) with good test-retest reliability (intraclass correlation coefficient 0.77). Construct validity was established via moderate correlations with other similar patient-reported outcomes. Additionally, known-groups validity demonstrated that the mSODA pain scale could distinguish between subjects who did and did not report gastrointestinal symptoms and antacid use (both P values ? 0.05). The mSODA pain scale was also responsive to change in heartburn at weeks 6 and 12 (Guyatt’s statistic = 1.7 and 2.6, respectively), and the minimal important difference obtained via ½ SD was 5.7 (range 2–47). Conclusion: This research suggests that the mSODA pain scale is both feasible and valid for assessing dyspepsia in patients taking nonsteroidal anti-inflammatory drugs for relief of symptoms of osteoarthritis. PMID:22915974

  7. A 44-year-old man with abdominal pain, lung nodules, and hemoperitoneum.

    PubMed

    Mostafavi, Mariam; Kamangar, Nader

    2015-05-01

    A 44-year-old man presented with a 1-day history of sudden-onset abdominal pain. The pain was characterized as severe, diffuse, sharp, and nonradiating. Associated symptoms included nausea, vomiting, diarrhea, and subjective fevers. He was originally from El Salvador, but had not traveled in >?10 years. Review of systems was positive for 2 weeks of dry cough with associated mild, bilateral, pleuritic chest pain and subjective weight loss. His medical history was notable for gout and end-stage renal disease secondary to chronic nonsteroidal antiinflammatory drug use, for which he attended hemodialysis sessions three times weekly. Surgical history consisted of a currently nonfunctioning left upper extremity fistula, a longstanding right internal jugular PermCath IV access for chronic hemodialysis that had been removed 2 weeks prior to presentation, and a left brachiocephalic fistula. He did not smoke, consume alcohol, or have a history of illicit drug use. PMID:25940261

  8. A Case of Chronic Abdominal Neuropathic Pain and Burning after Female Genital Cutting

    PubMed Central

    Hadid, Vicky; Dahan, Michael Haim

    2015-01-01

    Introduction. Female genital cutting is prevalent in the Middle Eastern and African countries. This ritual entails not only immediate complications such as infection, pain, and haemorrhage, but also chronic ones including dysmenorrhea and dyspareunia. However, there is limited data on neuropathic pain secondary to female genital mutilation when searching the literature. Case. This case discusses a 38-year-old female with a history of infibulation who presented with a chronic burning abdominal and anterior vulvar pain including the related investigations and treatment. Discussion. This case brings to light the additional delayed complication of this ritual: sensory neuropathy. Our goal is to educate health professionals to be aware of these complications and to appropriately investigate and treat them in order to find a solution to relieve the patients' symptoms.

  9. Interprovider variation of celiac disease testing in childhood chronic abdominal pain

    PubMed Central

    2013-01-01

    Background To determine within one tertiary care center: 1) the variation between providers in testing for celiac disease in children with chronic abdominal pain; 2) the characteristics of those children who were more likely to be tested, and 3) the prevalence of celiac disease in those evaluated. Methods Retrospective review of children with a primary complaint of chronic abdominal pain referred to a tertiary care children’s hospital for pediatric gastroenterology evaluation over a 2-year period was conducted. Children with at least two visits and without an identified organic etiology for the pain were included. Results 160 children were evaluated by 16 pediatric gastroenterologists and one nurse practitioner. Celiac serologic testing was completed in 63 (39.4%) children. There was no significant variance in the frequency of celiac serologic testing between providers. Child age, gender, body mass index, and baseline gastrointestinal symptoms did not predict whether celiac serologic testing occurred, though Caucasians (P?abdominal pain did not occur, a large number of these children were not evaluated for celiac disease. Children’s race/ethnicity but not their associated gastrointestinal symptoms predicted whether celiac testing was undertaken. In those tested, celiac disease was identified in a higher percentage than that expected in the general population. PMID:24124697

  10. Parental Influence on Children's Chronic Abdominal Pain Experiences: Exploring the Relationship between Parental Protective Behaviors and Child Quality of Life

    E-print Network

    Kessler, Emily D.

    2011-08-31

    restriction) and Quality of Life (QoL) in a clinical population of children with chronic abdominal pain, while including age and gender as potential moderators. Medical records from initial evaluation at a tertiary pain clinic were reviewed for 430 child...

  11. Abdominal and pelvic floor muscle function in women with and without long lasting pelvic girdle pain.

    PubMed

    Stuge, Britt; Mørkved, Siv; Dahl, Haldis Haug; Vøllestad, Nina

    2006-11-01

    Approximately 5-20% of postpartum women suffer from long-lasting pelvic girdle pain (PGP). The etiology and pathogenesis of PGP are still unclear. The aim of this study was to examine whether subjects with and without persisting PGP and disability differed with respect to their ability to voluntarily contract the deep abdominals (TrA and IO) and to the strength of the pelvic floor muscles (PFM). Twenty subjects (12 with persisting PGP, 8 recovered from PGP) were examined. Contractions of the deep abdominal muscles (TrA and IO) were imaged by real-time ultrasound. Vaginal palpation and observation were used to assess the women's ability to perform correct a PFM contraction. PFM strength was measured by a vaginal balloon catheter connected to a pressure transducer. The active straight leg raise test was used to assess the ability of load transfer. The results showed no statistical significant difference between the groups in increase of muscle thickness of the deep abdominal muscles (TrA; P = 0.87 and IO; P = 0.51) or regarding PFM strength (P = 0.94). The ability to voluntarily contract the deep abdominal muscles and the strength of the PFMs are apparently not associated to PGP. However, the results are based on a small sample and additional studies are needed. PMID:16386450

  12. Abdominal pain, diarrhea, constipation-which symptom is more indispensable to have a colonoscopy?

    PubMed Central

    Cai, Jia; Yuan, Zhe; Zhang, Shujun

    2015-01-01

    Background: Doctors perform colonoscopies when presented with various symptoms, including unexplained weight loss, rectal bleeding, changes in bowel habits, however many other symptoms such as abdominal pain, diarrhea and constipation may be more popular in outpatient department. As a result, we want to evaluate the three symptoms which is more need to have a colonoscopy. Abdominal pain, diarrhea and constipation are the main reasons for patients to visit the outpatient department of gastroenterology. And the colonoscopy is regularly recommended for outpatients with the above symptoms in China. The aim of this study was to evaluate the value of colonoscopy on the diagnosis of each single symptom of the three above and answer the question of my title-which symptom is more indispensable to have a colonoscopy? Methods: Colonoscopic findings of 580 outpatients with a single of these three common lower gastrointestinal symptoms were systematically analyzed in retrospect. Results: In this study, no significant difference was found in the positive rate of colon polyps, cancer and ulcerative colitis among these three groups divided by symptoms. The incidence of colon polyps, cancer and colitis for the chronic abdominal pain, chronic diarrhea and constipation group are 20.8%, 57.1%, 42.9% respectively. The incidence of colon polyps and cancer increases with age. Among the age groups 13-39 years old, 40-59 years and > 60 years, the incidence is 7.9%, 13.6%, 22.4% respectively. There is no significant difference in the incidence of colon polyps and colon cancer in our groups of symptoms. Conclusion: The results show the prevailing opinion that the indications of colonoscopy just refer to symptom and physical sign nowadays in China is inappropriate and it is best to take a full consideration of patient’s age, auxiliary examinations, family diseases history and other factors. PMID:25755799

  13. Abdominal Pain

    MedlinePLUS

    ... should not be used as a substitute for evaluation and treatment by a physician. Please review our terms of use . Home Symptom Checkup Injury Checkup Disease Checkup Women's Checkup Pregnancy Checkup Baby Checkup Mens Checkup Stephen J. Schueler, M.D. About Stephen ...

  14. New Insights in Abdominal Pain in Paroxysmal Nocturnal Hemoglobinuria (PNH): A MRI Study

    PubMed Central

    De Cobelli, Francesco; Pezzetti, Giulio; Margari, Sergio; Esposito, Antonio; Giganti, Francesco; Agostini, Giulia; Del Maschio, Alessandro

    2015-01-01

    Introduction Abdominal pain in PNH has never been investigated by in-vivo imaging studies. With MRI, we aimed to assess mesenteric vessels flow and small bowel wall perfusion to investigate the ischemic origin of abdominal pain. Materials and Methods Six PNH patients with (AP) and six without (NOP) abdominal pain underwent MRI. In a blinded fashion, mean flow (MF, quantity of blood moving through a vessel within a second, in mL·s-1) and stroke volume (SV, volume of blood pumped out at each heart contraction, in mL) of Superior Mesenteric Vein (SMV) and Artery (SMA), areas under the curve at 60 (AUC60) and 90 seconds (AUC90) and Ktrans were assessed by two operators. Results Mean total perfusion and flow parameters were lower in AP than in NOP group. AUC60: 84.81 ± 11.75 vs. 131.73 ± 18.89 (P < 0.001); AUC90: 102.33 ± 14.16 vs. 152.58 ± 22.70 (P < 0.001); Ktrans: 0.0346 min-1 ± 0.0019 vs. 0.0521 ± 0.0015 (P = 0.093 duodenum, 0.009 jejunum/ileum). SMV: MF 4.67 ml/s ± 0.85 vs. 8.32 ± 2.14 (P = 0.002); SV 3.85 ml ± 0.76 vs. 6.55 ± 1.57 (P = 0.02). SMA: MF 6.95 ± 2.61 vs. 11.2 ± 2.32 (P = 0.07); SV 6.52 ± 2.19 vs. 8.78 ± 1.63 (P = 0.07). We found a significant correlation between MF and SV of SMV and AUC60 (MF:? = 0.88, P < 0.001; SV: ? = 0.644, P = 0.024), AUC90 (MF: ? = 0.874, P < 0.001; SV:? = 0.774, P = 0.003) and Ktrans (MF:? = 0.734, P = 0.007; SV:? = 0.581, P = 0.047). Conclusions Perfusion and flow MRI findings suggest that the impairment of small bowel blood supply is significantly associated with abdominal pain in PNH. PMID:25897796

  15. Influence of posture and body type on the experience of exercise-related transient abdominal pain.

    PubMed

    Morton, Darren P; Callister, Robin

    2010-09-01

    The aim of this study was to evaluate the influence of posture and body type on the experience of exercise-related transient abdominal pain (ETAP). Postural and somatotype assessments were performed on 104 active males and 55 active females aged 18.6+/-0.4 years (mean+/-SD) and were correlated against their self-reported experience of ETAP. Individuals demonstrating kyphosis were more likely to be susceptible to ETAP (p<0.01). Among the individuals susceptible to ETAP, the extent of kyphosis and lordosis influenced the pain severity (p<0.05). There was no relationship between any measure of body type and ETAP. The findings indicate that postural abnormality, particularly in the thoracic region, influences the experience of ETAP. PMID:20022301

  16. Anxiety and Somatic Complaints in Children with Recurrent Abdominal Pain and Anxiety Disorders

    PubMed Central

    Dunn, Madeleine J.; Compas, Bruce E.

    2009-01-01

    Objective?To compare anxiety symptoms and disorders in children and adolescents with recurrent abdominal pain (RAP), anxiety disorders, and healthy control children.?Methods?Twenty-one children with RAP (nine males, mean age = 11.05) were compared to 21 children with anxiety disorders (11 males, mean age = 12.29), and 21 children without pain or anxiety (nine males, mean age = 11.57) using diagnostic interviews and continuous measures of anxiety and other internalizing symptoms.?Results?Sixty-seven percent of children with RAP met criteria for an anxiety disorder. Children with RAP were higher than well children but not significantly different from children with anxiety on total internalizing and anxiety symptoms.?Conclusions?RAP and anxiety are closely related. Further understanding between these disorders is essential to understanding the development and progression of RAP, and to inform the prevention and treatment of the disorder. PMID:18577541

  17. Abdominal implantation of testicles in the management of intractable testicular pain in Fournier gangrene.

    PubMed

    Chan, Cyrus C; Shahrour, Khaled; Collier, Ronald D; Welch, Marlene; Chang, Shiliang; Williams, Mallory

    2013-01-01

    Fournier gangrene (FG) is a necrotizing soft tissue infection involving the superficial and fascial planes of the perineum. In many cases of FG, debridement of the scrotum is necessary, leaving definitive management of the exposed testicles a significant surgical challenge. Frequent incidental trauma to the testicles can cause severe pain, especially in laborers. Practical surgical solutions are few and not well detailed. Various options exist, including creating a neoscrotum with adjacent thigh tissue, split-thickness skin grafts (STSGs), or even creating a subcutaneous thigh pocket. We describe a case of abdominal implantation of bilateral testicles for persistent testicular pain in a case where STSGs did not provide adequate protection, adjacent thigh skin was not available for creation of a neoscrotum, and significant cord contracture occurred. We detail the advantages and disadvantages of the commonly described techniques, including this approach, and how in select individuals this may be a suitable alternative. PMID:24229025

  18. Importance of Addressing Anxiety in Youth With Functional Abdominal Pain: Suggested Guidelines for Physicians

    PubMed Central

    Cunningham, Natoshia R.; Lynch-Jordan, Anne; Mezoff, Adam G.; Farrell, Michael K.; Cohen, Mitchell B.; Kashikar-Zuck, Susmita

    2015-01-01

    Functional abdominal pain (FAP) is a common pediatric disorder associated with impairment in functioning that may persist for the long term. Anxiety is common in youth with FAP, and may be an important factor in predicting youth who are at greatest risk for increased impairment because of pain symptoms. In this article, we examine the relation between anxiety and impairment in youth with FAP. Furthermore, we explore various biopsychosocial factors (eg, neurobiological substrates, coping strategies, social factors) that may be implicated in the relation among FAP, anxiety, and increased impairment. Finally, we propose physician guidelines for screening and treatment of youth with FAP and co-occurring anxiety. Youth with FAP and co-occurring anxiety may benefit from cognitive-behavioral therapy in the context of multidisciplinary care. PMID:23412539

  19. Tongue piercing and chronic abdominal pain with nausea and vomiting--two cases.

    PubMed

    Chung, Myung Kyu; Chung, Danielle; LaRiccia, Patrick J

    2015-01-01

    Chronic upper gastrointestinal (GI) symptoms of unclear etiology are frustrating to patients and physicians alike. The integrative medicine procedures of acupuncture and neural therapy may provide treatment options. Tongue piercing, which is prevalent in 5.6% of the adolescent population, may be a contributing factor in upper gastrointestinal symptoms. The objectives of the study were as follows: (1) To demonstrate the usefulness of an integrative medicine treatment approach in two cases of patients with chronic abdominal pain, nausea, and vomiting of unclear etiology who had failed standard medical management. (2) To identify scars from tongue piercings as a possible contributing factor in chronic upper GI symptoms of unclear etiology. Two retrospective case studies are presented of young adult females who were seen in a private multi-physician integrative medicine practice in the US. The patients were treated with neural therapy and acupuncture. The desired outcome was the cessation or reduction of the frequency of abdominal pain, nausea, and vomiting. Both patients had resolution of their symptoms. From this study, we have concluded the following: (1) Tongue scars from tongue rings may be causes of chronic upper gastrointestinal symptoms. (2) Neural therapy and acupuncture may be helpful in the treatment of chronic upper GI symptoms related to tongue scars. PMID:25457444

  20. Ascending retrocecal appendicitis presenting with right upper abdominal pain: Utility of computed tomography

    PubMed Central

    Ong, Eugene Mun Wai; Venkatesh, Sudhakar Kundapur

    2009-01-01

    Acute appendicitis is a common surgical condition that is usually managed with early surgery, and is associated with low morbidity and mortality. However, some patients may have atypical symptoms and physical findings that may lead to a delay in diagnosis and increased complications. Atypical presentation may be related to the position of the appendix. Ascending retrocecal appendicitis presenting with right upper abdominal pain may be clinically indistinguishable from acute pathology in the gallbladder, liver, biliary tree, right kidney and right urinary tract. We report a series of four patients with retrocecal appendicitis who presented with acute right upper abdominal pain. The clinical diagnoses at presentation were acute cholecystitis in two patients, pyelonephritis in one, and ureteric colic in one. Ultrasound examination of the abdomen at presentation showed subhepatic collections in two patients and normal findings in the other two. Computed tomography (CT) identified correctly retrocecal appendicitis and inflammation in the retroperitoneum in all cases. In addition, abscesses in the retrocecal space (n = 2) and subhepatic collections (n = 2) were also demonstrated. Emergency appendectomy was performed in two patients, interval appendectomy in one, and hemicolectomy in another. Surgical findings confirmed the presence of appendicitis and its retroperitoneal extensions. Our case series illustrates the usefulness of CT in diagnosing ascending retrocecal appendicitis and its extension, and excluding other inflammatory conditions that mimic appendicitis. PMID:19630119

  1. Caesarean Section: Could Different Transverse Abdominal Incision Techniques Influence Postpartum Pain and Subsequent Quality of Life? A Systematic Review

    PubMed Central

    Gizzo, Salvatore; Andrisani, Alessandra; Noventa, Marco; Di Gangi, Stefania; Quaranta, Michela; Cosmi, Erich; D’Antona, Donato; Nardelli, Giovanni Battista; Ambrosini, Guido

    2015-01-01

    The choice of the type of abdominal incision performed in caesarean delivery is made chiefly on the basis of the individual surgeon’s experience and preference. A general consensus on the most appropriate surgical technique has not yet been reached. The aim of this systematic review of the literature is to compare the two most commonly used transverse abdominal incisions for caesarean delivery, the Pfannenstiel incision and the modified Joel-Cohen incision, in terms of acute and chronic post-surgical pain and their subsequent influence in terms of quality of life. Electronic database searches formed the basis of the literature search and the following databases were searched in the time frame between January 1997 and December 2013: MEDLINE, EMBASE Sciencedirect and the Cochrane Library. Key search terms included: “acute pain”, “chronic pain”, “Pfannenstiel incision”, “Misgav-Ladach”, “Joel Cohen incision”, in combination with “Caesarean Section”, “abdominal incision”, “numbness”, “neuropathic pain” and “nerve entrapment”. Data on 4771 patients who underwent caesarean section (CS) was collected with regards to the relation between surgical techniques and postoperative outcomes defined as acute or chronic pain and future pregnancy desire. The Misgav-Ladach incision was associated with a significant advantage in terms of reduction of post-surgical acute and chronic pain. It was indicated as the optimal technique in view of its characteristic of reducing lower pelvic discomfort and pain, thus improving quality of life and future fertility desire. Further studies which are not subject to important bias like pre-existing chronic pain, non-standardized analgesia administration, variable length of skin incision and previous abdominal surgery are required. PMID:25646621

  2. Caesarean section: could different transverse abdominal incision techniques influence postpartum pain and subsequent quality of life? A systematic review.

    PubMed

    Gizzo, Salvatore; Andrisani, Alessandra; Noventa, Marco; Di Gangi, Stefania; Quaranta, Michela; Cosmi, Erich; D'Antona, Donato; Nardelli, Giovanni Battista; Ambrosini, Guido

    2015-01-01

    The choice of the type of abdominal incision performed in caesarean delivery is made chiefly on the basis of the individual surgeon's experience and preference. A general consensus on the most appropriate surgical technique has not yet been reached. The aim of this systematic review of the literature is to compare the two most commonly used transverse abdominal incisions for caesarean delivery, the Pfannenstiel incision and the modified Joel-Cohen incision, in terms of acute and chronic post-surgical pain and their subsequent influence in terms of quality of life. Electronic database searches formed the basis of the literature search and the following databases were searched in the time frame between January 1997 and December 2013: MEDLINE, EMBASE Sciencedirect and the Cochrane Library. Key search terms included: "acute pain", "chronic pain", "Pfannenstiel incision", "Misgav-Ladach", "Joel Cohen incision", in combination with "Caesarean Section", "abdominal incision", "numbness", "neuropathic pain" and "nerve entrapment". Data on 4771 patients who underwent caesarean section (CS) was collected with regards to the relation between surgical techniques and postoperative outcomes defined as acute or chronic pain and future pregnancy desire. The Misgav-Ladach incision was associated with a significant advantage in terms of reduction of post-surgical acute and chronic pain. It was indicated as the optimal technique in view of its characteristic of reducing lower pelvic discomfort and pain, thus improving quality of life and future fertility desire. Further studies which are not subject to important bias like pre-existing chronic pain, non-standardized analgesia administration, variable length of skin incision and previous abdominal surgery are required. PMID:25646621

  3. Pain symptoms and stooling patterns do not drive diagnostic costs for children with functional abdominal pain and irritable bowel syndrome in primary or tertiary care

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The objectives of this study were to (1) compare the cost of medical evaluation for children with functional abdominal pain or irritable bowel syndrome brought to a pediatric gastroenterologist versus children who remained in the care of their pediatrician, (2) compare symptom characteristics for th...

  4. Spontaneous superior mesenteric artery (SMA) dissection: an unusual cause of abdominal pain.

    PubMed

    Watring, Nicole J; Smith, Corbett M; Stokes, Gordon K; Counselman, Francis L

    2010-11-01

    A 44-year-old woman presented to our Emergency Department with a 4-day history of severe, sharp left upper quadrant abdominal pain associated with nausea and vomiting. She had been seen 3 days prior at another Emergency Department, and had a negative work-up including a normal non-contrast computed tomography (CT) scan of the abdomen/pelvis for possible kidney stone. Vital signs were: temperature 36.3°C (97.3°F), pulse 100 beats/min, respiratory rate 18 breaths/min, and blood pressure 141/80 mm Hg. Physical examination was remarkable for marked tenderness in the left upper and middle quadrants and voluntary guarding. Bowel sounds were normal. Although laboratory studies were normal, a CT scan of the abdomen/pelvis with intravenous contrast suggested a superior mesenteric artery dissection. This was confirmed with arteriography. The clinical presentation, diagnostic evaluation, and management of superior mesenteric artery dissection are reviewed. PMID:18180132

  5. Management of functional abdominal pain and irritable bowel syndrome in children and adolescents

    PubMed Central

    Chiou, Eric; Nurko, Samuel

    2010-01-01

    Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are among the most commonly diagnosed medical problems in pediatrics. Symptom-based Rome III criteria for FAP and IBS have been validated and help the clinician in making a positive diagnosis. The majority of patients with mild complaints improve with reassurance and time. For a distinct subset of patients with more severe and disabling illness, finding effective treatment for these disorders remains a challenge. Over the years, a wide range of therapies have been proposed and studied. The lack of a single, proven intervention highlights the complex interplay of biopsychosocial factors probably involved in the development of childhood FAP and IBS, and the need for a multidisciplinary, integrated approach. This article reviews the current literature on the efficacy of pharmacologic, dietary and psychosocial interventions for FAP and IBS in children and adolescents. PMID:20528117

  6. Indacaterol-induced severe constipation and abdominal pain: is there a role for colonic ?3-adrenoceptors?

    PubMed Central

    Carrascosa, Miguel F; Lucena, M Isabel; Bellido, Inmaculada; Salcines-Caviedes, José Ramón

    2013-01-01

    Indacaterol is an ultra-long-acting ?2-adrenoceptor agonist that is indicated for the maintenance treatment of chronic obstructive pulmonary disease. We present a patient with severe chronic constipation and abdominal pain most probably induced by this medicament. Symptoms rapidly disappeared within 2?days after the drug withdrawal. As far as we know, no reports describing severe chronic constipation associated with indacaterol have been published. The Naranjo algorithm score and the Edwards and Aronson scale for causality assessment of suspected adverse drug reactions indicated a probable relationship between indacaterol use and constipation. Indacaterol-induced constipation is an unusual event that could be accounted for the high intrinsic activity of the drug on colonic ?3-adrenoreceptors, resulting in an inhibitory control of smooth muscle function and intestinal secretion. Clinicians should monitor such a possibility when prescribing this drug and maybe avoid its use in patients with a history of difficult bowel evacuation. PMID:23667224

  7. Correlation among academic performance, recurrent abdominal pain and other factors in Year6 urban primary-school children in Malaysia

    Microsoft Academic Search

    C. C. M. Boey; A. Omar; J Arul Phillips

    2003-01-01

    Objective: The present study aimed to investigate the extent to which recurrent abdominal pain and other factors were associated with academic achievement among Year-6 (12 years of age) schoolchildren. Methods: The present study was a cross-sectional survey conducted from September to November 2001. Schoolchildren were recruited from primary schools that were selected randomly from a list of all primary schools

  8. Carbohydrate digestion in congenital sucrase isomaltase deficient and recurrent abdominal pain children assesed by 13C- starch breath test

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Starches contribute about half of the food energy needs to the weaned child's diet. Malabsorption of sucrose is associated with abdominal pain, bloating and diarrhea. A genetic disorder called Congenital Sucrase-Isomaltase Deficiency (CSID) is suspected when these symptoms follow sugar ingestion and...

  9. PAin SoluTions In the Emergency Setting (PASTIES)—patient controlled analgesia versus routine care in emergency department patients with non-traumatic abdominal pain: randomised trial

    PubMed Central

    Rockett, Mark; Creanor, Siobhan; Squire, Rosalyn; Hayward, Chris; Ewings, Paul; Barton, Andy; Pritchard, Colin; Eyre, Victoria; Cocking, Laura; Benger, Jonathan

    2015-01-01

    Objective To determine whether patient controlled analgesia (PCA) is better than routine care in providing effective analgesia for patients presenting to emergency departments with moderate to severe non-traumatic abdominal pain. Design Pragmatic, multicentre, parallel group, randomised controlled trial Setting Five English hospitals. Participants 200 adults (66% (n=130) female), aged 18 to 75 years, who presented to the emergency department requiring intravenous opioid analgesia for the treatment of moderate to severe non-traumatic abdominal pain and were expected to be admitted to hospital for at least 12 hours. Interventions Patient controlled analgesia or nurse titrated analgesia (treatment as usual). Main outcome measures The primary outcome was total pain experienced over the 12 hour study period, derived by standardised area under the curve (scaled from 0 to 100) of each participant’s hourly pain scores, captured using a visual analogue scale. Pre-specified secondary outcomes included total morphine use, percentage of study period in moderate or severe pain, percentage of study period asleep, length of hospital stay, and satisfaction with pain management. Results 196 participants were included in the primary analyses (99 allocated to PCA and 97 to treatment as usual). Mean total pain experienced was 35.3 (SD 25.8) in the PCA group compared with 47.3 (24.7) in the treatment as usual group. The adjusted between group difference was 6.3 (95% confidence interval 0.7 to 11.9). Participants in the PCA group received significantly more morphine (mean 36.1 (SD 22.4) v 23.6 (13.1) mg; mean difference 12.3 (95% confidence interval 7.2 to 17.4) mg), spent less of the study period in moderate or severe pain (32.6% v 46.9%; mean difference 14.5% (5.6% to 23.5%)), and were more likely to be perfectly or very satisfied with the management of their pain (83% (73/88) v 66% (57/87); adjusted odds ratio 2.56 (1.25 to 5.23)) in comparison with participants in the treatment as usual group. Conclusions Significant reductions in pain can be achieved by PCA compared with treatment as usual in patients presenting to the emergency department with non-traumatic abdominal pain. Trial registration European Clinical Trials Database EudraCT2011-000194-31; Current Controlled Trials ISRCTN25343280. PMID:26094712

  10. Quality of life and health care consultation in 13 to 18 year olds with abdominal pain predominant functional gastrointestinal diseases

    PubMed Central

    2014-01-01

    Background Abdominal pain predominant functional gastrointestinal diseases (AP-FGD) are commonly seen in the paediatric age group. It has significant impact on daily activities of affected children. Main objective of this study was to assess the health related quality of life (HRQoL) in children with AP-FGD. Method This was a cross sectional survey conducted in children aged 13–18 years, in four randomly selected schools in Western province of Sri Lanka. Data was collected using a previously validated, self-administered questionnaire. It had questions on symptoms, HRQoL and health care consultation. AP-FGD were diagnosed using Rome III criteria. Results A total of 1850 questionnaires were included in the analysis [males 1000 (54.1%), mean age 14.4 years and SD 1.3 years]. Of them, 305 (16.5%) had AP-FGD [irritable bowel syndrome?=?91(4.9%), functional dyspepsia?=?11 (0.6%), abdominal migraine?=?37 (1.9%) and functional abdominal pain?=?180 (9.7%)]. Lower HRQoL scores for physical (83.6 vs. 91.4 in controls), social (85.0 vs. 92.7), emotional (73.6 vs. 82.7) and school (75.0 vs. 82.5) functioning domains, and lower overall scores (79.6 vs. 88.0) were seen in children with AP-FGD (p?abdominal pain (r?=??0.24, p?abdominal bloating and vomiting (p?

  11. Splenic infarction – A rare cause of acute abdominal pain following gastric surgery: A case series

    PubMed Central

    Yazici, Pinar; Kaya, Cemal; Isil, Gurhan; Bozkurt, Emre; Mihmanli, Mehmet

    2015-01-01

    Introduction The dissection of splenic hilar lymph nodes in gastric cancer surgery is indispensable for treating gastric cancers located in the proximal third of the stomach. Splenic vascular injury is a matter of debate resulting on time or delayed splenectomy. We aimed to share our experience and plausible mechanisms causing this complication in two case reports. Case presentations Two male patients with gastric cancer were diagnosed with acute splenic infarction following gastric surgery in the early postoperative period. Both underwent emergent exploratory laparotomy. Splenectomy was performed due to splenic infarction. Discussion Because we observed this rare complication in recent patients whose surgery was performed using vessel-sealing device for splenic hilar dissection, we suggested that extensive mobilization of the surrounding tissues of splenic vascular structures hilum using the vessel sealer could be the reason. Conclusion In case of acute abdominal pain radiating to left shoulder, splenic complications should be taken into consideration in gastric cancer patients performed radical gastrectomy. Meticulous dissection of splenic hilar lymph nodes should be carried out to avoid any splenic vascular injury. PMID:25818369

  12. Organophosphate poisoning presenting with muscular weakness and abdominal pain- a case report

    PubMed Central

    2014-01-01

    Background Organophosphate (OP) poisoning is the most common cause (27.64%) and has the highest death rate (13.88%) of poisoning in Bangladesh. It leads to three main syndromes notably acute cholinergic syndrome, intermediate syndrome, and delayed polyneuropathy. It rarely causes cardiac arrhythmia, pancreatitis and hepatic dysfunction. We present the case of a middle-aged Asian woman suffering from organophosphate poisoning with dual complications. Case presentation A middle aged Asian woman with depression was brought to emergency attention after drinking of 60 milliliter of organophosphate insecticide in a suicidal attempt. She had vomiting, excessive retching, diarrhoea, miosis, hypersalivation and bilateral crepitation on chest during admission. After immediate resuscitation, atropinization was done and it required total of 36 milligram. The patient also received pralidoxime. While on maintenance, features of toxicity re-appeared and she again required atropine in bolus dose. On the fifth day of management she complained of generalized weakness, inability to control her neck and to sit or stand without support. But there was no respiratory muscle involvement and all deep tendon reflexes were normal. On the same day the patient also developed severe upper abdominal pain along with nausea and vomiting. Investigations revealed neutrophilic leucocytosis (30,000/cubic millimeter; 86%) with high serum lipase (770 Unit/Liter) and alanine transaminase (379 Unit/Liter) and low serum potassium (3.0 millimol/Liter). On the basis of above mentioned features organophosphate induced intermediate syndrome and pancreatitis was diagnosed. The patient recovered completely with appropriate management. Conclusion Organophosphate poisonings causes up to 25% mortality worldwide. A major contributing factor for that are different complications. Awareness of these complications can reduce both mortality and morbidity. Early diagnosis of complications and timely therapeutic measures can improve prognosis. PMID:24618147

  13. Effect of Leuprolide Acetate in Treatment of Abdominal Pain and Nausea in Premenopausal Women with Functional Bowel Disease: A Double-Blind, Placebo-Controlled, Randomized Study

    Microsoft Academic Search

    John R. Mathias; Mary H. Clench; Thomas L. Abell; Kenneth L. Koch; Glen Lehman; Malcolm Robinson; Robin Rothstein; William J. Snape

    1998-01-01

    We have previously reported impressive results in using a gonadotropin-releasing hormone analog, leuprolide acetate (Lupron), in the treatment of moderate to severe symptoms (especially abdominal pain and nausea) in patients with functional bowel disease (FBD). Pain is the hallmark of patients with FBD, and there is no consistent therapy for the treatment of these patients. The purpose of the present

  14. The Effect of Intravenous Magnesium Sulfate Infusion on Sensory Spinal Block and Postoperative Pain Score in Abdominal Hysterectomy

    PubMed Central

    Kahraman, Fatih; Eroglu, Ahmet

    2014-01-01

    Aim. The aim of this study was to investigate the effect of i.v. infusion of magnesium sulphate during spinal anesthesia on duration of spinal block and postoperative pain. Methods. Forty ASA physical status I and status II, aged between 18 and 65, female patients undergoing abdominal hysterectomy under spinal anesthesia were enrolled in this study. Patients in the magnesium group (Group M, n = 20) received magnesium sulphate 65?mg?kg?1 infusion in 250?mL 5% dextrose at 3.5?mL/min rate, and control group (Group C, n = 20) received at the same volume of saline during operation in a double-blind randomized manner. Duration of sensory and motor block, systolic, diastolic, and mean arterial blood pressures, heart rates, pain scores (VAS values), and side effects were recorded for each patient. Blood and CSF samples were taken for analysis of magnesium concentrations. Results. Regression of sensorial block was longer in Group M when compared with that in Group C (175 ± 39 versus 136 ± 32?min) (P < 0.01). The VAS scores were lower in Group M than those in Group C at the 2 time points postoperatively (P < 0.01). Conclusion. 65?mg?kg?1 of magnesium sulphate i.v. infusion under spinal anesthesia prolongs spinal sensorial block duration and decreases pain VAS scores without complication in patients undergoing abdominal hysterectomy. PMID:24772415

  15. Incidental detection of ascariasis worms on USG in a protein energy malnourished (PEM) child with abdominal pain.

    PubMed

    Suthar, Pokhraj Prakashchandra; Doshi, Rajkumar Prakashbhai; Mehta, Chetan; Vadera, Khyati P

    2015-01-01

    A 10-year-old child presented with dull aching periumbilical abdominal pain for 15 days. The child was not gaining weight despite a good appetite. Physical examination of the child revealed grade-I protein energy malnourishment (PEM) according to IAP (Indian Academic of Paediatrics) classification. The rest of the systemic examination was normal. Routine blood investigation revealed anaemia with eosinophilia. Abdominal ultrasonography did not show any abnormality with curvilinear transducer (3.5-5 MHz), however, linear ultrasound transducer (7.5-12 MHz) with harmonic tissue imaging showed worms in the lumen of the small intestine with curling movement on real time scanning. Stool examination for the eggs of ascariasis was positive. The patient was treated with antihelminthic drugs. Dietary modification for the PEM was advised. After 3 months of treatment, the patient improved and stool examination for Ascaris was negative on follow-up. PMID:25766437

  16. Comparison of the Effects of pH-Dependent Peppermint Oil and Synbiotic Lactol (Bacillus coagulans + Fructooligosaccharides) on Childhood Functional Abdominal Pain: A Randomized Placebo-Controlled Study

    PubMed Central

    Asgarshirazi, Masoumeh; Shariat, Mamak; Dalili, Hosein

    2015-01-01

    Background: Still there is no consensus on the best treatment for abdominal pain-related functional Gastrointestinal Disorders (FGIDs). Objectives: The purpose of this study was to compare the effects of a synbiotic Lactol (Bacillus coagulans + fructooligosaccharide (FOS)), peppermint oil (Colpermin) and placebo (folic acid) on abdominal pain-related FGIDs except for abdominal migraine. Patients and Methods: This placebo-controlled study was conducted on 120 children aged 4 - 13 years to compare the efficacy of pH-dependent peppermint oil (Colpermin) versus synbiotic Lactol (Bacillus coagulans + fructooligosaccharids (FOS)) in decreasing duration, severity and frequency of functional abdominal pain. The patients were randomly allocated into three equal groups (n = 40 in each group) and each group received Colpermin or Lactol or placebo. Results: Eighty-eight out of 120 enrolled patients completed a one-month protocol and analyses were performed on 88 patients’ data. Analyses showed that improvement in pain duration, frequency and severity in the Colpermin group was better than the placebo group (P = 0.0001, P = 0.0001 and P = 0.001, respectively). Moreover, pain duration and frequency were decreased in the Lactol group more than the placebo (P = 0.012 and P = 0.0001, respectively), but changes in pain severity were not significant (P = 0.373). Colpermin was superior to Lactol in decreasing pain duration and severity (P = 0.040 and P = 0.013, respectively). No known side effects or intolerance were seen with Colpermin or Lactol. Conclusions: The pH-dependent peppermint oil capsule and Lactol tablet (Bacillus coagulans+ FOS) as synbiotics seem to be superior to placebo in decreasing the severity, duration and frequency of pain in abdominal pain-related functional GI disorders. PMID:26023339

  17. The effect of aromatherapy abdominal massage on alleviating menstrual pain in nursing students: a prospective randomized cross-over study.

    PubMed

    Marzouk, Tyseer M F; El-Nemer, Amina M R; Baraka, Hany N

    2013-01-01

    Dysmenorrhea is a common cause of sickness absenteeism from both classes and work. This study investigated the effect of aromatherapy massage on a group of nursing students who are suffering of primary dysmenorrhea. A randomized blind clinical trial of crossover design was used. In the first treatment phase, group 1 (n = 48) received aromatherapy abdominal massage once daily for seven days prior to menstruation using the essential oils (cinnamon, clove, rose, and lavender in a base of almond oil). Group 2 (n = 47) received the same intervention but with placebo oil (almond oil). In the second treatment phase, the two groups switched to alternate regimen. Level and duration of pain and the amount of menstrual bleeding were evaluated at the baseline and after each treatment phase. During both treatment phases, the level and duration of menstrual pain and the amount of menstrual bleeding were significantly lower in the aromatherapy group than in the placebo group. These results suggests that aromatherapy is effective in alleviating menstrual pain, its duration and excessive menstrual bleeding. Aromatherapy can be provided as a nonpharmacological pain relief measure and as a part of nursing care given to girls suffering of dysmenorrhea, or excessive menstrual bleeding. PMID:23662151

  18. The Effect of Aromatherapy Abdominal Massage on Alleviating Menstrual Pain in Nursing Students: A Prospective Randomized Cross-Over Study

    PubMed Central

    Marzouk, Tyseer M. F.; El-Nemer, Amina M. R.; Baraka, Hany N.

    2013-01-01

    Dysmenorrhea is a common cause of sickness absenteeism from both classes and work. This study investigated the effect of aromatherapy massage on a group of nursing students who are suffering of primary dysmenorrhea. A randomized blind clinical trial of crossover design was used. In the first treatment phase, group 1 (n = 48) received aromatherapy abdominal massage once daily for seven days prior to menstruation using the essential oils (cinnamon, clove, rose, and lavender in a base of almond oil). Group 2 (n = 47) received the same intervention but with placebo oil (almond oil). In the second treatment phase, the two groups switched to alternate regimen. Level and duration of pain and the amount of menstrual bleeding were evaluated at the baseline and after each treatment phase. During both treatment phases, the level and duration of menstrual pain and the amount of menstrual bleeding were significantly lower in the aromatherapy group than in the placebo group. These results suggests that aromatherapy is effective in alleviating menstrual pain, its duration and excessive menstrual bleeding. Aromatherapy can be provided as a nonpharmacological pain relief measure and as a part of nursing care given to girls suffering of dysmenorrhea, or excessive menstrual bleeding. PMID:23662151

  19. Pathology Case Study: Bloody Vaginal Discharge

    NSDL National Science Digital Library

    Dickson, H.

    This is a case study presented by the University of Pittsburgh Department of Pathology in which an elderly woman experienced bloody vaginal discharge long after menopause. Visitors are given both the microscopic pap smear and biopsy findings, including images, and are given the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in gynecologic pathology.

  20. Holistic Acupuncture approach to idiopathic refractory nausea, abdominal pain and bloating

    Microsoft Academic Search

    Ann Ouyang; Lihua Xu

    2007-01-01

    AIM: To evaluate the effectiveness of a holistic acupuncture approach on nausea, pain, bloating and electrogastrogram (EGG) parameters in patients with intractable symptoms. METHODS: Twelve patients with no or mild nausea (those without nausea had bloating or pain) and 10 with a history of moderate to severe nausea were referred for acupuncture. All underwent an EGG and were treated at

  1. Autonomic nervous system function in young children with functional abdominal pain or irritable bowel syndrome

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Adults with irritable bowel syndrome (IBS) have been reported to have alterations in autonomic nervous system function as measured by vagal activity via heart rate variability. Whether the same is true for children is unknown. We compared young children 7 to 10 years of age with functional abdominal...

  2. Blood glucose self-monitoring from abdominal skin: a precise and virtually pain-free method

    Microsoft Academic Search

    A. Holstein; E. Thiessen; N. Kaufmann; A. Plaschke; E. H. Egberts

    2002-01-01

    For many diabetic patients, years of blood glucose self-monitoring (SM) with readings taken several times daily is an inevitable\\u000a aspect of insulin therapy. We investigated whether SM from abdominal skin might be an alternative to the established fingertip\\u000a method. A total of 63 diabetic patients and 16 nondiabetic volunteers determined their blood glucose in parallel in capillary\\u000a blood from the

  3. Just another abdominal pain? Psoas abscess-like metastasis in large cell lung cancer with adrenal insufficiency.

    PubMed

    Bernardino, Vera; Val-Flores, Luis Silva; Lopes Dias, João; Bento, Luís

    2015-01-01

    The authors report the case of a 69-year-old man with chronic obstructive pulmonary disease and previous pulmonary tuberculosis, who presented to the emergency department with abdominal and low back pain, anorexia and weight loss, rapidly evolving into shock. An initial CT scan revealed pulmonary condensation with associated cavitation and an iliopsoas mass suggestive of a psoas abscess. He was admitted in an intensive care unit unit; after a careful examination and laboratory assessment, the aetiology was yet undisclosed. MRI showed multiple retroperitoneal lymphadenopathies, bulky nodular adrenal lesions and bilateral iliac lytic lesions. Hypocortisolism was detected and treated with steroids. A CT-guided biopsy to the psoas mass and lytic lesions identified infiltration of non-small lung carcinoma. The patient died within days. Psoas metastases and adrenal insufficiency as initial manifestations of malignancy are rare and can be misdiagnosed, particularly in the absence of a known primary tumour. PMID:26063108

  4. An uncommon cause of visceral arterial embolism in patients presenting with acute abdominal pain: a report of 2 cases.

    PubMed

    Ulenaers, M; Buchel, O C; Van Olmen, A; Moons, V; D'Haens, G; Christiaens, P

    2010-01-01

    We report on 2 cases of visceral arterial embolism presenting with acute abdominal pain. In neither patient a cause could be established on initial clinical, laboratory, echographic or radiological investigation. Both patients were subsequently found to have a mural thrombus in the thoracic aorta, with visceral arterial embolism. Each underwent a successful operative thrombectomy. Both patients had a normal underlying aortic intima at inspection. The first patient was a young male with no known diseases. He regularly used cannabis and tested positive on admission, an association not yet reported with aortic mural thrombus. He was found to have a slightly reduced protein C. The second patient was a middle aged man with non-insulin dependent diabetes, hyperlipidaemia, arterial hypertension and hyperthyroidism. He was found to have an underlying adenocarcinoma of the lung and received chemotherapy. He died due to his cancer, 4 months after first presentation. PMID:20458852

  5. Discriminative Validity of the Behavior Assessment System for Children-Parent Rating Scales in Children with Recurrent Abdominal Pain and Matched Controls

    ERIC Educational Resources Information Center

    Robins, Paul M.; Schoff, Kristin M.; Glutting, Joseph J.; Abelkop, A. Shayne

    2003-01-01

    Examined discriminative validity of the Parent Rating Scale (PRS) of the Behavior Assessment System for Children (BASC; Reynolds & Kamphaus, 1992, Circle Pines, MN: American Guidance Services). Two groups were compared: a cohort with recurrent abdominal pain (RAP) (n = 49) and children from the BASC-PRS standardization sample (n = 49) matched on…

  6. Lemmel's syndrome, an unusual cause of abdominal pain and jaundice by impacted intradiverticular enterolith: case report.

    PubMed

    Kang, Hyo Sung; Hyun, Jong Jin; Kim, Seung Young; Jung, Sung Woo; Koo, Ja Seol; Yim, Hyung Joon; Lee, Sang Woo

    2014-06-01

    Duodenal diverticula are detected in up to 27% of patients undergoing upper gastrointestinal tract evaluation with periampullary diverticula (PAD) being the most common type. Although PAD usually do not cause symptoms, it can serve as a source of obstructive jaundice even when choledocholithiasis or tumor is not present. This duodenal diverticulum obstructive jaundice syndrome is called Lemmel's syndrome. An 81-yr-old woman came to the emergency room with obstructive jaundice and cholangitis. Abdominal CT scan revealed stony opacity on distal CBD with CBD dilatation. ERCP was performed to remove the stone. However, the stone was not located in the CBD but rather inside the PAD. After removal of the enterolith within the PAD, all her symptoms resolved. Recognition of this condition is important since misdiagnosis could lead to mismanagement and therapeutic delay. Lemmel's syndrome should always be included as one of the differential diagnosis of obstructive jaundice when PAD are present. PMID:24932093

  7. Electromechanical delay of abdominal muscles is modified by low back pain prevention exercise.

    PubMed

    Szpala, Agnieszka; Rutkowska-Kucharska, Alicja; Drapala, Jaroslaw

    2014-01-01

    The objective of the research was to assess the effect of a 4-week-long training program on selected parameters: electromechanical delay (EMD) and amplitude of electromyographic signal (EMG). Fourteen female students of the University School of Physical Education participated in the study. Torques and surface electromyography were evaluated under static conditions. Surface electrodes were glued to both sides of the rectus abdominis (RA), external oblique (EO), and erector spinae (ES) muscles. The 4-week-long program was aimed at strengthening the abdominal muscles and resulted in increased EMD during maximum torque production by flexors of the trunk, increased amplitudes of the signals of the erector spinae ( p = 0.005), and increased EMG amplitude asymmetry of the lower ( p = 0.013) and upper part ( p = 0.006) of the rectus abdominis muscle. In a training program composed of a large number of repetitions of strength exercises, in which the training person uses their own weight as the load (like in exercises such as curl-ups), the process of recruitment of motor units is similar to that found during fatiguing exercises and plyometric training. PMID:25307027

  8. Shortness of breath, fever and abdominal pain in a 21-year-old student.

    PubMed

    Whalley, Hugh James; Remoundos, Dionysios-Dennis; Webster, Jonathan; Silva, Michael Anthony

    2013-01-01

    A 21-year-old patient presented with a 3-day history of shortness of breath, productive cough, fatigue, fevers and night sweats, associated with right upper quadrant pain. He had an appendicectomy 3 months previously. The CT images showed a right subphrenic collection, which was indenting the right lobe of the liver, with an appendicolith in the middle. He underwent laparoscopic surgery where the abscess was drained and the appendicolith was retrieved. The patient had an uncomplicated postoperative period and was discharged soon afterwards. Complications from spilled appendicoliths have been reported previously. Retained appendicoliths and gallstones can act as niduses for infection, and thus cause symptoms at a later stage. Surgical notes should include the findings of appendicoliths, and in the event where retrieval is not possible, a clear record of this must be made, and the patient along with the general practitioner need to be informed. PMID:24127375

  9. Sclerosing mesenteritis as a rare cause of abdominal pain and intraabdominal mass: a cases report and review of the literature

    PubMed Central

    2008-01-01

    Sclerosing mesenteritis is a rare, benign, and chronic fibrosing inflammation disease with unknown etiology that affects the mesentery of small bowel and colon. The disease has two well-established histological types: the acute or subacute form known as mesenteric panniculitis and the chronic form known as retractile or sclerosing mesenteritis. Because the sclerosing mesenteritis is lack of special clinical manifestation and typical signs, so the patients are very easy to be misdiagnosed. The correct diagnosis of sclerosing mesenteritis depends on pathological examination and exploratory laparotomy. We report a case of sclerosing mesenteritis in a 52-year-old male who presented with chronic abdominal pain and intraabdominal mass. This patient had a long-term and heavy drinking history. He was misdiagnosed as celiac teratoma by CT examination and then underwent an exploratory laparotomy at March 2 2004. A mass, its diameter being about 5 cm, was detected in mesentery of distal ileum. Although a few small intestines tightly adhered on the mass, the involved intestine had no obstruction. The intraoperative biopsy indicated that it was an inflammatory mass. The mass and adhered intestines were removed. He was diagnosed with sclerosing mesenteritis by histopathological examination of paraffin section. After operation, this patient went well and lives without recrudescence at the time we wrote this paper. PMID:18925952

  10. Sclerosing mesenteritis as a rare cause of abdominal pain and intraabdominal mass: a cases report and review of the literature.

    PubMed

    Gu, Guo-Li; Wang, Shi-Lin; Wei, Xue-Ming; Ren, Li; Li, De-Chang; Zou, Fu-Xian

    2008-01-01

    Sclerosing mesenteritis is a rare, benign, and chronic fibrosing inflammation disease with unknown etiology that affects the mesentery of small bowel and colon. The disease has two well-established histological types: the acute or subacute form known as mesenteric panniculitis and the chronic form known as retractile or sclerosing mesenteritis. Because the sclerosing mesenteritis is lack of special clinical manifestation and typical signs, so the patients are very easy to be misdiagnosed. The correct diagnosis of sclerosing mesenteritis depends on pathological examination and exploratory laparotomy. We report a case of sclerosing mesenteritis in a 52-year-old male who presented with chronic abdominal pain and intraabdominal mass. This patient had a long-term and heavy drinking history. He was misdiagnosed as celiac teratoma by CT examination and then underwent an exploratory laparotomy at March 2 2004. A mass, its diameter being about 5 cm, was detected in mesentery of distal ileum. Although a few small intestines tightly adhered on the mass, the involved intestine had no obstruction. The intraoperative biopsy indicated that it was an inflammatory mass. The mass and adhered intestines were removed. He was diagnosed with sclerosing mesenteritis by histopathological examination of paraffin section. After operation, this patient went well and lives without recrudescence at the time we wrote this paper. PMID:18925952

  11. Large twisted ovarian fibroma associated with Meigs’ syndrome, abdominal pain and severe anemia treated by laparoscopic surgery

    PubMed Central

    2014-01-01

    Background The Meigs' syndrome is a rare but well-known syndrome defined as the triad of benign solid ovarian tumor, ascites, and pleural effusion. Meigs' syndrome always requires surgical treatment. However, the optimal approach for its management has not been sufficiently investigated. Case presentation We report a patient with a large twisted ovarian fibroma associated with Meigs’ syndrome, abdominal pain and severe hemolytic anemia that was treated by laparoscopic surgery. This case highlights the difficulties that may be encountered in the management of patients with Meigs’ syndrome, including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the medical and surgical approach and the adverse impact that Meigs’ syndrome can have on the patient’s condition, especially if it is associated with acute pain and severe anemia. Considering the patient’s serious clinical condition and assuming that she had Meigs' syndrome with a twisted large ovarian mass and possible hemolytic anemia, we first concentrated on effective medical management of our patient and chose the most appropriate surgical treatment after laparoscopic examination. The main aim of our initial approach was preoperative management of the anemia. Blood transfusions and glucocorticoid therapy resulted in stabilization of the hemoglobin level and normalization of the bilirubin levels, which confirmed the appropriateness of this approach. Laparoscopic surgery 4 days after admission enabled definitive diagnosis of the tumor, confirmed torsion and removed the bulky ovarian fibroma, resulting in timely resolution of symptoms, short hospitalization, relatively low morbidity and a rapid return to her social and professional life. Conclusions This case highlights the difficulties that may be encountered in the management of patients with Meigs' syndrome, including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the medical and surgical approach, and the adverse impact that Meigs' syndrome can have on the patient's condition, especially if it is associated with acute pain and severe anemia. The present case suggests that laparoscopic surgery for potentially large malignant tumors is feasible and safe, but requires an appropriate medical and gynecological oncology expertise. PMID:24962423

  12. Multivariate morphological brain signatures predict patients with chronic abdominal pain from healthy control subjects.

    PubMed

    Labus, Jennifer S; Van Horn, John D; Gupta, Arpana; Alaverdyan, Mher; Torgerson, Carinna; Ashe-McNalley, Cody; Irimia, Andrei; Hong, Jui-Yang; Naliboff, Bruce; Tillisch, Kirsten; Mayer, Emeran A

    2015-08-01

    Irritable bowel syndrome (IBS) is the most common chronic visceral pain disorder. The pathophysiology of IBS is incompletely understood; however, evidence strongly suggests dysregulation of the brain-gut axis. The aim of this study was to apply multivariate pattern analysis to identify an IBS-related morphometric brain signature that could serve as a central biological marker and provide new mechanistic insights into the pathophysiology of IBS. Parcellation of 165 cortical and subcortical regions was performed using FreeSurfer and the Destrieux and Harvard-Oxford atlases. Volume, mean curvature, surface area, and cortical thickness were calculated for each region. Sparse partial least squares discriminant analysis was applied to develop a diagnostic model using a training set of 160 females (80 healthy controls and 80 patients with IBS). Predictive accuracy was assessed in an age-matched holdout test set of 52 females (26 healthy controls and 26 patients with IBS). A 2-component classification algorithm comprising the morphometry of (1) primary somatosensory and motor regions and (2) multimodal network regions explained 36% of the variance. Overall predictive accuracy of the classification algorithm was 70%. Small effect size associations were observed between the somatosensory and motor signature and nongastrointestinal somatic symptoms. The findings demonstrate that the predictive accuracy of a classification algorithm based solely on regional brain morphometry is not sufficient, but they do provide support for the utility of multivariate pattern analysis for identifying meaningful neurobiological markers in IBS. PMID:25906347

  13. Effect of head and limb orientation on trunk muscle activation during abdominal hollowing in chronic low back pain

    PubMed Central

    2014-01-01

    Background Individuals with chronic low back pain (CLBP) have altered activations patterns of the anterior trunk musculature when performing the abdominal hollowing manœuvre (attempt to pull umbilicus inward and upward towards the spine). There is a subgroup of individuals with CLBP who have high neurocognitive and sensory motor deficits with associated primitive reflexes (PR). The objective of the study was to determine if orienting the head and extremities to positions, which mimic PR patterns would alter anterior trunk musculature activation during the hollowing manoeuvre. Methods This study compared surface electromyography (EMG) of bilateral rectus abdominis (RA), external oblique (EO), and internal obliques (IO) of 11 individuals with CLBP and evident PR to 9 healthy controls during the hollowing manoeuvre in seven positions of the upper quarter. Results Using magnitude based inferences it was likely (>75%) that controls had a higher ratio of left IO:RA activation with supine (cervical neutral), asymmetrical tonic neck reflex (ATNR) left and right, right cervical rotation and cervical extension positions. A higher ratio of right IO:RA was detected in the cervical neutral and ATNR left position for the control group. The CLBP group were more likely to show higher activation of the left RA in the cervical neutral, ATNR left and right, right cervical rotation and cervical flexion positions as well as in the cervical neutral and cervical flexion position for the right RA. Conclusions Individuals with CLBP and PR manifested altered activation patterns during the hollowing maneuver compared to healthy controls and that altering cervical and upper extremity position can diminish the group differences. Altered cervical and limb positions can change the activation levels of the IO and EO in both groups. PMID:24558971

  14. Mammary duct ectasia with bloody nipple discharge in a child

    PubMed Central

    Jung, Yoonju

    2014-01-01

    Mammary duct ectasia is a rare disease in children and often presents as a cystic mass with bloody nipple discharge. The pathophysiology of mammary duct ectasia is unclear, and the differential diagnosis of other cystic masses with hemorrhage, such as complicated lymphangioma, is necessary. Here, we report a 14-month-old boy who exhibited unilateral mammary duct ectasia with bloody nipple discharge that was treated with surgical excision. Because some authors have reported that mammary duct ectasia can be often be resolved without surgery, conservative therapy should be considered first when a child presents with a cystic mass with bloody nipple discharge. However, the optimal duration of follow-up and timing of surgical excision have not yet been established. PMID:24761426

  15. Intravenous acetaminophen is superior to ketamine for postoperative pain after abdominal hysterectomy: results of a prospective, randomized, double-blind, multicenter clinical trial

    PubMed Central

    Faiz, Hamid Reza; Rahimzadeh, Poupak; Visnjevac, Ognjen; Behzadi, Behzad; Ghodraty, Mohammad Reza; Nader, Nader D

    2014-01-01

    Background In recent years, intravenously (IV) administered acetaminophen has become one of the most common perioperative analgesics. Despite its now-routine use, IV acetaminophen’s analgesic comparative efficacy has never been compared with that of ketamine, a decades-old analgesic familiar to obstetricians, gynecologists, and anesthesiologists alike. This doubleblind clinical trial aimed to evaluate the analgesic effects of ketamine and IV acetaminophen on postoperative pain after abdominal hysterectomy. Methods Eighty women aged 25–70 years old and meeting inclusion and exclusion criteria were randomly allocated into two groups of 40 to receive either IV acetaminophen or ketamine intraoperatively. Postoperatively, each patient had patient-controlled analgesia. Pain and sedation (Ramsay Sedation Scale) were documented based on the visual analog scale in the recovery room and at 4 hours, 6 hours, 12 hours, and 24 hours after the surgery. Hemodynamic changes, adverse medication effects, and the need for breakthrough meperidine were also recorded for both groups. Data were analyzed by repeated-measures analysis of variance. Results Visual analog scale scores were significantly lower in the IV acetaminophen group at each time point (P<0.05), and this group required significantly fewer doses of breakthrough analgesics compared with the ketamine group (P=0.039). The two groups had no significant differences in terms of adverse effects. Conclusion Compared with ketamine, IV acetaminophen significantly improved postoperative pain after abdominal hysterectomy. PMID:24465135

  16. Efficacy of Continuous Epidural Analgesia versus Total Intravenous Analgesia on Postoperative Pain Control in Endovascular Abdominal Aortic Aneurysm Repair: A Retrospective Case-Control Study

    PubMed Central

    Özdemir, Abdullah; Kazdal, H?z?r; Tu?cugil, Ersagun

    2014-01-01

    We reviewed our experience to compare the effectiveness of epidural analgesia and total intravenous analgesia on postoperative pain control in patients undergoing endovascular abdominal aortic aneurysm repair. Records of 32 patients during a 2-year period were retrospectively investigated. TIVA group (n = 18) received total intravenous anesthesia, and EA group (n = 14) received epidural anesthesia and sedation. Pain assessment was performed on all patients on a daily basis during rest and activity on postoperative days until discharge from ward using the numeric rating scale. Data for demographic variables, required anesthetic level, perioperative hemodynamic variables, postoperative pain, and morbidities were recorded. There were no relevant differences concerning hospital stay (TIVA group: 14.1?±?7.0, EA group: 13.5?±?7.1), perioperative blood pressure variability (TIVA group: 15.6?±?18.1, EA group: 14.8?±?11.5), and perioperative hemodynamic complication rate (TIVA group: 17%, EA group: 14%). Postoperative pain scores differed significantly (TIVA group: 5.4?±?0.9, EA group: 1.8?±?0.8, P < 0.001). Epidural anesthesia and postoperative epidural analgesia better reduce postoperative pain better compared with general anesthesia and systemic analgesia, with similar effects on hemodynamic status. PMID:24804201

  17. Abdominal Pain Syndrome

    MedlinePLUS

    ... enzymes released when organs like the liver or pancreas are injured), and serology tests that measure antibody levels to various infections. Urine tests include urinalysis (measurement of characteristics and chemicals in urine along with ...

  18. Pelvic ultrasound immediately following MDCT in female patients with abdominal/pelvic pain: is it always necessary?

    PubMed

    Yitta, Silaja; Mausner, Elizabeth V; Kim, Alice; Kim, Danny; Babb, James S; Hecht, Elizabeth M; Bennett, Genevieve L

    2011-10-01

    To determine the added value of reimaging the female pelvis with ultrasound (US) immediately following multidetector CT (MDCT) in the emergent setting. CT and US exams of 70 patients who underwent MDCT for evaluation of abdominal/pelvic pain followed by pelvic ultrasound within 48 h were retrospectively reviewed by three readers. Initially, only the CT images were reviewed followed by evaluation of CT images in conjunction with US images. Diagnostic confidence was recorded for each reading and an exact Wilcoxon signed rank test was performed to compare the two. Changes in diagnosis based on combined CT and US readings versus CT readings alone were identified. Confidence intervals (95%) were derived for the percentage of times US reimaging can be expected to lead to a change in diagnosis relative to the diagnosis based on CT interpretation alone. Ultrasound changed the diagnosis for the ovaries/adnexa 8.1% of the time (three reader average); the majority being cases of a suspected CT abnormality found to be normal on US. Ultrasound changed the diagnosis for the uterus 11.9% of the time (three reader average); the majority related to the endometrial canal. The 95% confidence intervals for the ovaries/adnexa and uterus were 5-12.5% and 8-17%, respectively. Ten cases of a normal CT were followed by a normal US with 100% agreement across all three readers. Experienced readers correctly diagnosed ruptured ovarian cysts and tubo-ovarian abscesses (TOA) based on CT alone with 100% agreement. US reimaging after MDCT of the abdomen and pelvis is not helpful: (1) following a normal CT of the pelvic organs or (2) when CT findings are diagnostic and/or characteristic of certain entities such as ruptured cysts and TOA. Reimaging with ultrasound is warranted for (1) less-experienced readers to improve diagnostic confidence or when CT findings are not definitive, (2) further evaluation of suspected endometrial abnormalities. A distinction should be made between the need for immediate vs. follow-up imaging with US after CT. PMID:21638034

  19. Bloody semen, severe hypertension and a worried man

    PubMed Central

    Ambakederemo, Tamaraemumoemi Emmanuella; Dodiyi-Manuel, Sotonye Tamunobelema; Ebuenyi, Ikenna Desmond

    2015-01-01

    Haematospermia is often associated with severe uncontrolled hypertension. The bloody semen is often very worrisome for the patient and his sexual partner(s). In addition to anti-hypertensive, counselling and lifestyle modification are essential for management of the condition. PMID:26175817

  20. Abdominal x-ray

    MedlinePLUS

    Abdominal film; X-ray - abdomen; Flat plate; KUB x-ray ... Diagnose a pain in the abdomen or unexplained nausea Identify suspected problems in the urinary system, such as a kidney stone Identify blockage in the intestine Locate ...

  1. Breast MRI in Patients with Unilateral Bloody and Serous-Bloody Nipple Discharge: A Comparison with Galactography

    PubMed Central

    Manganaro, Lucia; D'Ambrosio, Ilaria; Gigli, Silvia; Di Pastena, Francesca; Tardioli, Stefano; Framarino, Marialuisa; Ballesio, Laura

    2015-01-01

    Purpose. Assessing the role of breast MRI compared to galactography in patients with unilateral bloody or serous-bloody nipple discharge. Materials and Methods. Retrospective study including 53 unilateral discharge patients who performed galactography and MRI. We evaluated the capability of both techniques in identifying pathology and distinguishing between nonmalignant and malignant lesions. Lesions BIRADS 1/2 underwent follow-up, while the histological examination after surgery has been the gold standard to assess pathology in lesions BIRADS 3/4/5. The ROC analysis was used to test diagnostic MRI and galactography ability. Results. After surgery and follow-up, 8 patients had no disease (15%), 23 papilloma (43%), 11 papillomatosis (21%), 5 ductal cancer in situ (10%), and 6 papillary carcinoma (11%) diagnoses. Both techniques presented 100% specificity; MRI sensitivity was 98% versus 49% of galactography. Considering MRI, we found a statistical association between mass enhancement and papilloma (P < 0.001; AUC 0.957; CI 0.888–1.025), ductal enhancement and papillomatosis (P < 0.001; AUC 0.790; CI 0.623–0.958), segmental enhancement and ductal cancer in situ (P = 0.007; AUC 0.750; CI 0.429–1.071), and linear enhancement and papillary cancer (P = 0.011). Conclusions. MRI is a valid tool to detect ductal pathologies in patients with suspicious bloody or serous-bloody discharge showing higher sensitivity and specificity compared to galactography. PMID:25685810

  2. Recurrent abdominal pain as the presentation of tumor necrosis factor receptor-associated periodic syndrome (TRAPS) in an Asian girl: a case report and review of the literature.

    PubMed

    Chen, Yun-Ju; Yu, Hsin-Hui; Yang, Yao-Hsu; Lau, Yu-Lung; Lee, Wen-I; Chiang, Bor-Luen

    2014-12-01

    Tumor necrosis factor receptor-associated periodic syndrome (TRAPS) is characterized by periodic fever, cutaneous rash, conjunctivitis, lymphadenopathy, abdominal pain, myalgia, and arthralgia. It is a rare autosomal dominant disease and strongly associated with heterozygous mutations in the tumor necrosis factor (TNF) receptor super family 1A (TNFRSF1A) gene. It is believed to be more common in Western countries than in Asian countries. Here, we present the case of a 14-year-old girl with periodic fever and abdominal pain with elevation of inflammatory markers for 2 years. After extensive work-up of infectious etiology with negative results, the diagnosis of TRAPS was made although no gene mutations were identified in the TNFRSF1A gene, MVK gene, and NALP3/CIAS1 gene. She had partial clinical response to corticosteroids and immunomodulatory agents. However, the treatment response to TNF-? inhibitor etanercept was dramatic. She has remained symptom free under regular weekly to biweekly etanercept treatment for 2 years. We also reviewed the related literature and summarized the data of 10 Asian cases of TRAPS. PMID:22921805

  3. A Double-Blind Randomized Controlled Trial Comparing Epidural Clonidine vs Bupivacaine for Pain Control During and After Lower Abdominal Surgery

    PubMed Central

    Abd-Elsayed, Alaa A.; Guirguis, Maged; DeWood, Mark S.; Zaky, Sherif S.

    2015-01-01

    Background Alpha-2 adrenergic agonists produce safe and effective analgesia, but most investigations studying the analgesic effect of alpha-2 adrenoceptor agonists postoperatively included previous or concomitant administration of other analgesics. Because clonidine potentiates the effect of these drugs, its own intrinsic analgesic effect has been difficult to establish. This study was designed to compare the intraoperative and postoperative effects of epidural clonidine vs bupivacaine for patients undergoing lower abdominal surgery. Methods This randomized controlled trial included 40 patients aged 18-50 who were scheduled for elective lower abdominal surgery. Patients were randomly divided into 2 groups. Group I (n=20) received epidural clonidine; Group II (n=20) received epidural bupivacaine. Intraoperative and postoperative hemodynamics, pain scores, and complications were monitored. Results Mean pain scores were significantly lower in Group I compared to Group II (1.5 ± 0.5 compared to 3.4 ± 1.0, respectively) in the first 12 hours after surgery. Sedation was more prominent in Group I until 9 hours after surgery. Opioid requirements were significantly lower in Group I. Respiratory rate was similar in the 2 groups. Group I had larger decreases from baseline in systolic blood pressure and diastolic blood pressure than Group II. Heart rate in Group I was reduced from baseline, while it was increased in Group II. Less postoperative nausea and vomiting, urinary retention, pruritus, and shivering were observed in Group I. Conclusion Compared to bupivacaine, epidural clonidine provided effective intraoperative and postoperative analgesia in selected patients, resulting in a decreased intravenous pain medication requirement and prolonged duration of analgesia after epidural infusion was discontinued.

  4. An extensive DeBakey type IIIb aortic dissection with massive right pleural effusion presenting as abdominal pain and acute anemia: particular case report

    PubMed Central

    Yu, Hui-Chun; Wang, Zhen-Qing; Hao, Yuan-Yuan; An, Feng-Ping; Hu, Yu-Chuan; Deng, Rui-Bing; Yu, Peng; Cui, Guang-Bin; Li, He

    2015-01-01

    We describe the case of a 79-year-old male presented with sudden onset of abdominal pain and mild breathlessness, and complicated acute progressive anemia with haemoglobin which declined from 120 g/L to 70 g/L within five days. An urgent computed tomography angiography showed acute thoracic aortic dissection, DeBakey type IIIb, a dissecting aneurysm in the proximal descending thoracic aorta starting immediately after the origin of the left subclavian artery and extending distally below the renal arteries with evidence of rupture into the right pleural cavity for massive pleural effusion. Plasma D-dimer, brain natriuretic peptide and C reactive protein level were elevated. Our case showed that D-dimer can be used as a ‘rule-out’ test in patients with suspected aortic dissection. A raised BNP may exert a protective role through anti-inflammatory endothelial actions in the systemic circulation. PMID:26089858

  5. Effects of 2 Different Doses of Pregabalin on Morphine Consumption and Pain After Abdominal Hysterectomy: A Randomized, Double-Blind Clinical Trial

    PubMed Central

    Yücel, Aytaç; Özturk, Erdo?an; Aydo?an, M. Said; Durmu?, Mahmut; Çolak, Cemil; Ersoy, M. Özcan

    2011-01-01

    Background Pregabalin has a similar pharmacologic profile to that of its developmental predecessor gabapentin but has shown greater analgesic activity in rodent models of neuropathic pain. Objective The objective of the study was to compare the effects of 2 different doses of pregabalin and placebo on postoperative pain and morphine consumption. Methods Ninety patients who underwent abdominal hysterectomy were included in the study and randomly divided into 3 groups in a doubled-blinded manner. They were given 150 mg of pregabalin (group P300, n = 30), 300 mg of pregabalin (group P600, n = 30), or placebo capsules (group C, n = 30) 4 hours before the induction of anesthesia; they received a second dose of the drug 12 hours postoperatively. Morphine consumption, nausea, and vomiting, visual analogue scale-pain intensity (VAS-PI), sedation scores, and dissatisfaction scores were recorded in the postanesthesia care unit (PACU) and at 2, 4, 6, and 24 hours after operation. Results Morphine consumption at 24 hours was 40.80 (3.42) mg, 33.79 (5.77) mg, and 46.97 (6.67) mg in groups P300, P600, and C, respectively (P < 0.001). VAS-PI scores at movement and at rest in the PACU and at 2, 4, and 6 hours decreased in group P600 (P < 0.01). In the PACU and at 2, 4, and 6 hours, the sedation scores were increased in group P600 compared with the scores in group C (P < 0.001, P < 0.001, P = 0.01, P = 0.006, respectively). Patient satisfaction was higher in group P600 than in group C for all time points (P < 0.001, P < 0.001, P < 0.001, P = 0.001, P < 0.001, respectively). There were no statistically significant differences between the groups for side effects such as nausea, vomiting, and dizziness (P = 0.58). Conclusions Pregabalin at a total dose of 600 mg, administered before operation and at 12 hours postoperatively after abdominal hysterectomy, reduced morphine consumption and pain intensity and increased patient satisfaction. No significant differences in side effects were observed between the study groups. PMID:24648587

  6. Abdominal Adhesions

    MedlinePLUS

    ... abdominal tissues and organs. [ Top ] What is the abdominal cavity? The abdominal cavity is the internal area of the body between ... develop abdominal adhesions. 1 Surgery in the lower abdomen and pelvis, including bowel and gynecological operations, carries ...

  7. C-reactive protein and white blood cell count as triage test between urgent and nonurgent conditions in 2961 patients with acute abdominal pain.

    PubMed

    Gans, Sarah L; Atema, Jasper J; Stoker, Jaap; Toorenvliet, Boudewijn R; Laurell, Helena; Boermeester, Marja A

    2015-03-01

    The purpose of this article is to assess the diagnostic accuracy of C-reactive protein (CRP) and white blood cell (WBC) count to discriminate between urgent and nonurgent conditions in patients with acute abdominal pain at the emergency department, thereby guiding the selection of patients for immediate diagnostic imaging.Data from 3 large published prospective cohort studies of patients with acute abdominal pain were combined in an individual patient data meta-analysis. CRP levels and WBC counts were compared between patients with urgent and nonurgent final diagnoses. Parameters of diagnostic accuracy were calculated for clinically applicable cutoff values of CRP levels and WBC count, and for combinations.A total of 2961 patients were included of which 1352 patients (45.6%) had an urgent final diagnosis. The median WBC count and CRP levels were significantly higher in the urgent group than in the nonurgent group (12.8?×10/L; interquartile range [IQR] 9.9-16) versus (9.3?×10/L; IQR 7.2-12.1) and (46? mg/L; IQR 12-100 versus 10 ?mg/L; IQR 7-26) (P?50 ?mg/L and WBC count >15?×10/L were combined; however, 85.3% of urgent cases was missed.A high CRP level (>50? mg/L) combined with a high WBC count (>15?×10/L) leads to the highest PPV. However, this applies only to a small subgroup of patients (8.7%). Overall, CRP levels and WBC count are insufficient markers to be used as a triage test in the selection for diagnostic imaging, even with a longer duration of complaints (>48 ?hours). PMID:25738473

  8. Gastrointestinal (GI) permeability is associated with trait anxiety in children with functional abdominal pain (FAP) and Irritable Bowel Syndrome (IBS)

    Technology Transfer Automated Retrieval System (TEKTRAN)

    FAP and IBS affect 10-15% of school age children and bear many physiological similarities to irritable bowel syndrome (IBS) in adults (e.g., functional pain, visceral hyperalgesia). Animal models of IBS have suggested a relationship between neonatal stress and increased GI permeability later in life...

  9. Chronic rupture of abdominal aortic aneurysm with vertebral erosion: an uncommon but important cause of back pain.

    PubMed

    Singla, Veenu; Virmani, Vivek; Modi, Manish; Kalra, Naveen; Khandelwal, Niranjan

    2014-11-01

    Chronic contained rupture of the aorta is a rare condition that may present with varied patient symptomatology. We present a case of contained rupture of an abdominal aortic aneurysm causing vertebral erosion in an elderly male patient who had chronic backache and presented to the emergency services with a recently developed throbbing epigastric mass. Early use of computed tomography enabled prompt diagnosis and the condition was managed by endovascular stenting. The clinical and imaging findings of this potentially fatal condition are described, awareness of which is important to the physicians, orthopedicians, surgeons, and radiologists. PMID:25017777

  10. Double-blind, placebo-controlled, randomized clinical trial of homoeopathic arnica C30 for pain and infection after total abdominal hysterectomy.

    PubMed Central

    Hart, O; Mullee, M A; Lewith, G; Miller, J

    1997-01-01

    Homoeopathic potencies of arnica have been used for many years to aid postoperative recovery. The effects of arnica C30 on pain and postoperative recovery after total abdominal hysterectomy were evaluated in a double-blind, randomized, controlled study. Of 93 women entered into the study, 20 did not complete protocol treatment: nine were excluded because they failed to comply with the protocol, nine had their operations cancelled or changed within 24 h and two had to be withdrawn because of the recurrence of previously chronic painful conditions. Those who did not complete protocol treatment were equally divided between the arnica (nine patients) and placebo groups (11 patients). 73 patients completed the study, of whom 35 received placebo and 38 received arnica C30. The placebo group had a greater median age and the arnica group had slightly longer operations; nevertheless, no significant difference between the two groups could be demonstrated. We conclude that arnica in homoeopathic potency had no effect on postoperative recovery in the context of our study. PMID:9068434

  11. Pain

    MedlinePLUS

    ... that may be adding to your pain l deep breathing exercises —helps you to relax l guided ... Independence Ave SW, Room 712E Washington, DC 20201 web site: www.womenshealth.gov/faq/ carpal.htm www. ...

  12. Pain relief for infants undergoing abdominal surgery: comparison of infusions of i.v. morphine and extradural bupivacaine.

    PubMed

    Wolf, A R; Hughes, D

    1993-01-01

    We have undertaken a prospective, randomized double-blind study to compare extradural bupivacaine infusions with i.v. morphine infusions for postoperative analgesia in 32 infants younger than 4 yr undergoing abdominal surgery. "Sham" extradural or i.v. catheters were used to maintain the blinded nature of the study. Both techniques provided adequate analgesia for most of the 36-h postoperative period; differences in the pattern or quality of the analgesia were not detected. Patients in the i.v. morphine group were significantly more sedated; this was accompanied by slower ventilatory frequencies (26.7 (SD 1.8) b.p.m.) compared with the extradural group (33.6 (1.3) b.p.m.). Similarly, oxygen saturation was significantly less (P < 0.01) in patients receiving morphine (medians and quartiles of 94.0 (93-96)% compared with 96.0 (93-96)%). Mean systolic arterial pressure was similar in the two groups and there were no life-threatening complications. The lack of sedation was troublesome in three patients in the extradural group. PMID:8431313

  13. Pitfall: a pseudo tumor within the left liver lobe presenting with abdominal pain, jaundice and severe weight loss.

    PubMed

    Widjaja, A; Rosenthal, H; Bleck, J; Walter, B; Gölkel, C; Rademaker, J; Holstein, A; Gebel, M; Manns, M P

    1999-12-01

    A 51 year old male patient with a history of chronic alcohol consumption and recurrent pancreatitis was referred to our hospital with jaundice, epigastric pain, severe diarrhoea and weight loss of 28 kg within the last 12 months. A CT scan of the abdomen 4 months before admission had shown a pancreatitis with free fluid around the corpus and tail of the pancreas as well as dilated intrahepatic bile ducts and a cavernous transformation of the portal vein. Moreover, a tumor (3.5 x 3.0 x 3.6 cm) with irregular contrast enhancement was seen within the left liver lobe. The patient was referred to us for further evaluation and treatment. The initial B-Mode sonogram revealed a bull's eye like well defined lesion (8.1 x 7.5 x 7.0 cm) within the left liver lobe, consistent with a tumour or abscess. Prior to a diagnostic needle biopsy a PTCD was performed in this case presenting with dilated intrahepatic bile ducts and having a history of Billroth II operation. An additional colour coded Duplex Doppler ultrasonography demonstrated a visceral artery aneurysm and prevented us from performing the diagnostic puncture. The aneurysm was assumed to originate from a variant or a branch of the left hepatic artery. Angiography revealed a pseudoaneurysm of the pancreaticoduodenal artery and coil embolization was performed because of the increasing size and the risk of a bleeding complication. Postinterventional colour duplex ultrasound measurement showed no blood flow within the aneurysm. Retrospectively, the pseudoaneurysm must have led to a compression of the common bile duct, since the patient did not develop cholestasis after embolization and removal of the PTCD. Thus, a pseudoaneurysm of the pancreaticoduodenal artery must be included in the differential diagnosis of liver tumours in patients with chronic pancreatitis, despite its unusual localization near the liver. Therefore, we suggest that colour coded ultrasonography should be applied to any unclear, bull's eye like lesion, even though this method alone cannot exactly determine the origin of the pseudoaneurysm. Interventional angiography remains the gold standard for the diagnosis and therapy of visceral artery aneurysm. PMID:10670073

  14. Premedication with gabapentin, alprazolam or a placebo for abdominal hysterectomy: Effect on pre-operative anxiety, post-operative pain and morphine consumption

    PubMed Central

    Joseph, Tim Thomas; Krishna, Handattu Mahabaleswara; Kamath, Shyamsunder

    2014-01-01

    Background and Aims: Utility of gabapentin for pre-operative anxiolysis as compared to commonly administered alprazolam is not evident. The aim of the present study was to compare the effects of pre-operative oral gabapentin 600 mg, alprazolam 0.5 mg or a placebo on pre-operative anxiety along with post-operative pain and morphine consumption. Methods: Seventy five patients scheduled for abdominal hysterectomy under general anaesthesia were included. Groups gabapentin, alprazolam and placebo, received oral gabapentin 600 mg, alprazolam 0.5 mg and one capsule of oral B-complex forte with Vitamin C respectively, on the night prior to surgery and 2 h prior to surgery. Visual analogue scale (VAS) was used to measure the anxiety and post-operative pain. All patients received patient-controlled analgesia. Statistical tests used were Kruskal–Wallis test, Wilcoxon signed rank test and one-way ANOVA. Results: Alprazolam provided significant anxiolysis (median [interquartile range] baseline VAS score 35 [15.5, 52] to 20 [6.5, 34.5] after drug administration; P = 0.007). Gabapentin did not provide significant decrease in anxiety (median [interquartile range] VAS score 21 [7.5, 41] to 20 [6.5, 34.5]; P = 0.782). First analgesic request time (median [interquartile range in minutes]) was longer in group gabapentin (17.5 [10, 41.25]) compared to group placebo (10 [5, 15]) (P = 0.019) but comparable to that in group alprazolam (15 [10, 30]). Cumulative morphine consumption at different time periods and total morphine consumption (mean [standard deviation]) at the end of study period (38.65 [18.04], 39.91 [15.73], 44.29 [16.02] mg in group gabapentin, alprazolam and placebo respectively) were comparable. Conclusion: Gabapentin 600 mg does not have significant anxiolytic effect compared to alprazolam 0.5 mg. Alprazolam 0.5 mg was found to be an effective anxiolytic in the pre-operative period. Neither alprazolam nor gabapentin, when compared to placebo showed any opioid sparing effects post-operatively. PMID:25624531

  15. Functional Abdominal Pain in Children

    MedlinePLUS

    ... disease which is a sensitivity to cereal grains, food allergies, inflammation of the liver (hepatitis), gall bladder problems, ... constipation, lactose intolerance, infections, IBD, celiac disease, and food allergies. If no specific cause is found and functional ...

  16. A Randomized, Double-Blind, Placebo-Controlled, Multicenter, Repeat-Dose Study of Two Intravenous Acetaminophen Dosing Regimens for the Treatment of Pain After Abdominal Laparoscopic Surgery

    Microsoft Academic Search

    Steven J. Wininger; Howard Miller; Harold S. Minkowitz; Mike A. Royal; Robert Y. Ang; James B. Breitmeyer; Neil K. Singla

    2010-01-01

    BackgroundIntravenous acetaminophen has been approved in Europe and elsewhere for the treatment of acute pain and fever, and was recently approved by the US Food and Drug Administration (FDA) for the man-agement of mild to moderate pain, the management of moderate to severe pain with adjunctive opioid anal-gesics, and the reduction of fever.

  17. 21 CFR 884.5225 - Abdominal decompression chamber.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...Identification. An abdominal decompression chamber is a hoodlike device used to reduce pressure on the pregnant patient's abdomen for the relief of abdominal pain during pregnancy or labor. (b) Classification. Class III (premarket...

  18. 21 CFR 884.5225 - Abdominal decompression chamber.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...Identification. An abdominal decompression chamber is a hoodlike device used to reduce pressure on the pregnant patient's abdomen for the relief of abdominal pain during pregnancy or labor. (b) Classification. Class III (premarket...

  19. 21 CFR 884.5225 - Abdominal decompression chamber.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...Identification. An abdominal decompression chamber is a hoodlike device used to reduce pressure on the pregnant patient's abdomen for the relief of abdominal pain during pregnancy or labor. (b) Classification. Class III (premarket...

  20. 21 CFR 884.5225 - Abdominal decompression chamber.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...Identification. An abdominal decompression chamber is a hoodlike device used to reduce pressure on the pregnant patient's abdomen for the relief of abdominal pain during pregnancy or labor. (b) Classification. Class III (premarket...

  1. 21 CFR 884.5225 - Abdominal decompression chamber.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...Identification. An abdominal decompression chamber is a hoodlike device used to reduce pressure on the pregnant patient's abdomen for the relief of abdominal pain during pregnancy or labor. (b) Classification. Class III (premarket...

  2. Abdominal aortic aneurysms: case report

    PubMed Central

    Hadida, Camille; Rajwani, Moez

    1998-01-01

    A 71-year-old male presented to a chiropractic clinic with subacute low back pain. While the pain appeared to be mechanical in nature, radiographic evaluation revealed an abdominal aortic aneurysm, which required the patient to have vascular surgery. This case report illustrates the importance of the history and physical examination in addition to a thorough knowledge of the features of abdominal aortic aneurysms. The application of spinal manipulative therapy in patients with (AAA) is also discussed. ImagesFigure 1Figure 2Figure 3

  3. Gut-directed hypnotherapy in children with irritable bowel syndrome or functional abdominal pain (syndrome): a randomized controlled trial on self exercises at home using CD versus individual therapy by qualified therapists

    PubMed Central

    2014-01-01

    Background Irritable bowel syndrome (IBS) and functional abdominal pain (syndrome) (FAP(S)) are common pediatric disorders, characterized by chronic or recurrent abdominal pain. Treatment is challenging, especially in children with persisting symptoms. Gut-directed hypnotherapy (HT) performed by a therapist has been shown to be effective in these children, but is still unavailable to many children due to costs, a lack of qualified child-hypnotherapists and because it requires a significant investment of time by child and parent(s). Home-based hypnotherapy by means of exercises on CD has been shown effective as well, and has potential benefits, such as lower costs and less time investment. The aim of this randomized controlled trial (RCT) is to compare cost-effectiveness of individual HT performed by a qualified therapist with HT by means of CD recorded self-exercises at home in children with IBS or FAP(S). Methods/Design 260 children, aged 8-18 years with IBS or FAP(S) according to Rome III criteria are included in this currently conducted RCT with a follow-up period of one year. Children are randomized to either 6 sessions of individual HT given by a qualified therapist over a 3-month period or HT through self-exercises at home with CD for 3 months. The primary outcome is the proportion of patients in which treatment is successful at the end of treatment and after one year follow-up. Treatment success is defined as at least 50% reduction in both abdominal pain frequency and intensity scores. Secondary outcomes include adequate relief, cost-effectiveness and effects of both therapies on depression and anxiety scores, somatization scores, QoL, pain beliefs and coping strategies. Discussion If the effectiveness of home-based HT with CD is comparable to, or only slightly lower, than HT by a therapist, this treatment may become an attractive form of therapy in children with IBS or FAP(S), because of its low costs and direct availability. Trial registration Dutch Trial Register number NTR2725 (date of registration: 1 February 2011) PMID:24894077

  4. Abdominal Adhesions

    MedlinePLUS

    ... to change position for additional pictures. • A lower GI series is an x-ray exam that is ... ultrasound. However, abdominal x rays, a lower gastrointestinal (GI) series, and computerized tomography (CT) scans can diagnose ...

  5. Quantitative modeling for risk assessment of Vibrio parahaemolyticus in bloody clams in southern Thailand.

    PubMed

    Yamamoto, Akio; Iwahori, Jun'ichiro; Vuddhakul, Varaporn; Charernjiratragul, Wilawan; Vose, David; Osaka, Ken; Shigematsu, Mika; Toyofuku, Hajime; Yamamoto, Shigeki; Nishibuchi, Mitsuaki; Kasuga, Fumiko

    2008-05-10

    A risk assessment of Vibrio parahaemolyticus in bloody clams (Anadara granosa) consumed in southern Thailand was conducted. This study estimated the prevalence and concentration of pathogenic V. parahaemolyticus in bloody clams at harvest and retail stages; and during this process, methods to detect the total and pathogenic V. parahaemolyticus were investigated. Consumption of bloody clams and cooking efficiency were studied using interviews and on-site observation of consumers. A beta-Poisson dose-response model was used to estimate probability of illness applying estimation methods for the most likely parameter values presented by USFDA. Microbial and behavioral data were analyzed by developing a stochastic model and the simulation gave a mean number of times a person would get ill with V. parahaemolyticus by consuming bloody clams at 5.6 x 10(-4)/person/year. Sensitivity analysis demonstrated the fraction of people who did not boil the clams properly was the primary factor in increasing risk. This study serves as an example of how a microbiological risk assessment with limited data collection and international cooperation leads to valuable local insight. PMID:18405992

  6. The NOTA study: non-operative treatment for acute appendicitis: prospective study on the efficacy and safety of antibiotic treatment (amoxicillin and clavulanic acid) in patients with right sided lower abdominal pain

    PubMed Central

    Giorgini, Eleonora; Biscardi, Andrea; Villani, Silvia; Clemente, Nicola; Senatore, Gianluca; Filicori, Filippo; Antonacci, Nicola; Baldoni, Franco; De Werra, Carlo; Di Saverio, Salomone

    2011-01-01

    Background Case control studies that randomly assign patients with diagnosis of acute appendicitis to either surgical or non-surgical treatment yield a relapse rate of approximately 14% at one year. It would be useful to know the relapse rate of patients who have, instead, been selected for a given treatment based on a thorough clinical evaluation, including physical examination and laboratory results (Alvarado Score) as well as radiological exams if needed or deemed helpful. If this clinical evaluation is useful, the investigators would expect patient selection to be better than chance, and relapse rate to be lower than 14%. Once the investigators have established the utility of this evaluation, the investigators can begin to identify those components that have predictive value (such as blood analysis, or US/CT findings). This is the first step toward developing an accurate diagnostic-therapeutic algorithm which will avoid risks and costs of needless surgery. Methods/design This will be a single-cohort prospective observational study. It will not interfere with the usual pathway, consisting of clinical examination in the Emergency Department (ED) and execution of the following exams at the physician's discretion: full blood count with differential, C reactive protein, abdominal ultrasound, abdominal CT. Patients admitted to an ED with lower abdominal pain and suspicion of acute appendicitis and not needing immediate surgery, are requested by informed consent to undergo observation and non operative treatment with antibiotic therapy (Amoxicillin and Clavulanic Acid). The patients by protocol should not have received any previous antibiotic treatment during the same clinical episode. Patients not undergoing surgery will be physically examined 5 days later. Further follow-up will be conducted at 7, 15 days, 6 months and 12 months. The study will conform to clinical practice guidelines and will follow the recommendations of the Declaration of Helsinki. The protocol was approved on November 2009 by Maggiore Hospital Ethical Review Board (ID CE09079). Trial Registration ClinicalTrials.gov identifier: NCT01096927. PMID:22021722

  7. Lifting bloody footwear impressions using alginate casts followed by chemical enhancement.

    PubMed

    Wiesner, Sarena; Izraeli, Elad; Shor, Yaron; Domb, Avi

    2013-05-01

    A method for lifting bloody footwear impressions using alginate casts and enhancing the lifted impressions with amido black is presented. On rough or dark substrates, background interferences may conceal significant details of footwear impressions. Illumination with alternative light sources and chemically enhancing the bloody footwear impressions may reveal additional details, but sometimes, lifting footwear impressions prior to enhancing is the only way to expose hidden details (by using blood reagents not adequate on the original). Several cast formulations were tested for lifting the footwear impressions. The best results were achieved using Aroma fine®. Enhancement of the footwear impressions was attempted with several reagents prior to lifting, during the casting process, and on the lifted footwear impressions. Applying amido black to footwear impressions lifted with alginate produced the sharpest and most detailed footwear impressions. Alginate castings followed by chemical enhancement with amido black may produce high-quality footwear impressions for comparison. PMID:23488772

  8. Traumatic abdominal wall hernia: a case report.

    PubMed

    Bansal, Somendra; Vyas, Kailash C

    2015-04-01

    Traumatic abdominal wall hernias are rare injuries despite the high incidence of blunt abdominal traumas. The mechanism of this injury includes a sudden increase in intra-abdominal pressure and extensive shear forces applied to the abdominal wall. We report a case of traumatic hernia of the anterior abdominal wall in a 42-year-old woman presented with blunt injury of the upper abdomen. She was attacked by a bull. She had a clinically evident abdominal fascial disruption with intact skin and was hemodynamically stable. The presence of localized pain, bruising and a reducible swelling or a cough impulse suggested the diagnosis. An emergency mesh repair of the defect was performed, and she recovered well. PMID:25972694

  9. Abdominal Aortic Aneurysms: Treatments

    MedlinePLUS

    ... Minimally Invasive Treatments Snapshots Multimedia Multimedia Archive Abdominal Aortic Aneurysms Interventional Radiologists Treat Abdominal Aneurysms Nonsurgically Interventional radiologists ...

  10. Abdominal rigidity

    MedlinePLUS

    Rigidity of the abdomen ... is a sore area inside the belly or abdomen, the pain will get worse when a hand ... Causes can include: Abscess inside the abdomen Appendicitis ... small intestine, large bowel, or gallbladder ( gastrointestinal ...

  11. Abdominal mass

    MedlinePLUS

    Mass in the abdomen ... the doctor make a diagnosis. For example, the abdomen is usually divided into four areas: Right-upper ... pain or masses include: Epigastric -- center of the abdomen just below the rib cage Periumbilical -- area around ...

  12. Level II scour analysis for Bridge 10 (NORWTH00120010) Town Highway 012 Bloody Brook, Norwich, Vermont

    USGS Publications Warehouse

    Ayotte, Joseph D.

    1996-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure NORWTH00120010 on town highway 12 crossing Bloody Brook, Norwich, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). A Level I study is included in Appendix E of this report. A Level I study provides a qualitative geomorphic characterization of the study site. Information on the bridge, available from VTAOT files, was compiled prior to conducting the Level I and Level II analyses and can be found in Appendix D. The site is in the New England Upland physiographic province in east-central Vermont. The 8.98-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the left bank upstream and the left and right banks downstream are forested. The immediate right bank upstream is covered by shrub and brush with pasture on the overbank. Town Highway 12 runs along the valley of Bloody Brook; however, at structure NORWTH00120010 the road crosses Bloody Brook at a 90-degree angle. In the study area, Bloody Brook has a sinuous channel with a slope of approximately 0.014 ft/ft, an average channel top width of 41 ft and an average channel depth of 3 ft. The predominant channel bed materials are gravel and cobble (D50 is 51.0 mm or 0.167 ft). The geomorphic assessment at the time of the Level I site visit on October 31, 1994, indicated that the reach was unstable. The town highway 12 crossing of Bloody Brook is a 34-ft-long, two-lane bridge consisting of one 30-foot clear span (Vermont Agency of Transportation, written commun., July 29, 1994). The bridge is supported by vertical, concrete abutments with wingwalls. The right abutment is protected by sparse type-2 stone fill (less than 24 inches diameter). The channel is skewed 0 degrees to the opening and the opening-skew-to-roadway is 0 degrees. Additional details describing conditions at the site are included in the Level II Summary and Appendices D and E. Scour depths and rock rip-rap sizes were computed using the general guidelines described in Hydraulic Engineering Circular 18 (Richardson and others, 1993). Scour depths were calculated assuming an infinite depth of erosive material and a homogeneous particle-size distribution. The scour analysis results are presented in tables 1 and 2 and a graph of the scour depths is presented in figure 8.

  13. Bloody Ejaculation

    MedlinePLUS

    ... should not be used as a substitute for evaluation and treatment by a physician. Please review our terms of use . Home Symptom Checkup Injury Checkup Disease Checkup Women's Checkup Pregnancy Checkup Baby Checkup Mens Checkup Stephen J. Schueler, M.D. About Stephen ...

  14. Abdominal Pathology in Patients With Diabetes Ketoacidosis.

    PubMed

    Pant, Nicole; Kadaria, Dipen; Murillo, Luis C; Yataco, Jose C; Headley, Arthur S; Freire, Amado X

    2012-01-20

    INTRODUCTION: The objective is to describe the incidence and nature of significant abdominal pathologies in patients with diabetes ketoacidosis (DKA) and abdominal pain. METHODS: Retrospective chart review (N = 86) of patients with DKA from January 1, 2005, to January 31, 2010, was performed. Data included demographics, comorbidities, compliance, chief complaints and physical findings, blood count, metabolic profile, lactic acid, glycosylated hemoglobin (HbA1C), amylase, lipase, anion gap, arterial gases, imaging and final diagnosis. Continuous variables were described as mean ± standard deviation and compared with the Student's t test. Categorical variables were expressed as percentages (%) and compared with the Mantel-Haenszel ? test. Univariate analysis was conducted among patients with and without significant abdominal pain and also with and without significant abdominal pathology. Two lipase strata were created at 400 U. Multivariate model to identify limits (confidence interval) of the estimated risk imposed by the predictor found significant in univariate analysis. A P value of ?0.05 was considered significant. Stat View 5.0 (SAS Institute, Cary, NC) was used for the statistical analysis. RESULTS: In patients with abdominal pain, 17% had significant abdominal pathology mainly acute pancreatitis (AP). Serum amylase and lipase level were found to be an indicator of significant underlying pathology (both P values ?0.001). The logistic model created showed that patients with lipase level ?400 U have a 7% increased risk of having AP with confidence interval of 0.01 to 0.6. CONCLUSIONS: Patients with DKA and abdominal pain with lipase >400 U have an increased risk of significant underlying abdominal pathology (AP). PMID:22270401

  15. Abdominal wall surgery

    MedlinePLUS

    Abdominal wall surgery is surgery that improves the appearance of flabby, stretched-out abdominal (belly) muscles and skin. It ... tummy tuck" to more complicated, extensive surgery. Abdominal wall surgery is not the same as liposuction, which ...

  16. Abdominal aortic aneurysm presenting as meralgia paraesthetica.

    PubMed Central

    Brett, A; Hodgetts, T

    1997-01-01

    A case of abdominal aortic aneurysm is reported in a patient with long standing low back pain, presenting as meralgia paraesthetica and an increase in the severity of back pain. The case highlights the need for objective assessment of new symptoms arising in a chronic condition, and for a systematic approach to the assessment of radiographs performed in the accident and emergency department. Images p50-a PMID:9147718

  17. Abdominal symptoms: do they disappear after cholecystectomy?

    Microsoft Academic Search

    M. Y. Berger; T. C. olde Hartman; A. M. Bohnen

    2003-01-01

    Objective: To evaluate the effect of cholecystectomy in patients with gallstones on preoperative abdominal symptoms. Methods: A systematic search was made of the Medline database in combination with reference checking. Articles were excluded if patients aged Results: The pooled relief rate for “biliary pain” was high 92% (95% confidence interval 86 to 96%). Symptom relief rates were consistently higher in

  18. Chronic non-bloody diarrhoea: a prospective study in Malmö, Sweden, with focus on microscopic colitis

    PubMed Central

    2014-01-01

    Background Chronic non-bloody diarrhoea affects up to 5% of the population. Microscopic colitis is one of the most common causes, encompassing the subtypes collagenous colitis and lymphocytic colitis. The diagnosis of microscopic colitis is made by histological examination of colonic mucosal biopsy specimens. The aim of this investigation was to determine whether laboratory parameters or questions about disease history or concomitant disease could be helpful in discriminating patients with MC from those with a histologically normal colonic mucosa. Findings Patients admitted for colonoscopy because of chronic non-bloody diarrhoea (>2 loose stools for >3 weeks) at endoscopy units in Malmö during 2007 and 2009, were enrolled. A total number of 78 patients were included (60 women, 18 men, median age 59, IQR 45–69 years). Out of these 78, 15 patients (19%) had microscopic colitis (CC; n?=?10, LC; n?=?5). MC was especially prevalent in patients above the age of 50 (25%). No differences were found between those with normal histology and MC in laboratory analyses (inflammatory and liver parameters). Neither were differences shown in questions regarding symptoms, environmental factors or concomitant diseases except for an association with celiac disease (p?=?0.019) and a trend maybe indicating an inverse association with appendectomy (p?=?0.057). Conclusions Microscopic colitis is associated with female gender, celiac disease and consumption of NSAIDs. Trends were observed indicating that age above 50 years, acute onset and absence of appendectomy may be associated with MC. No associations were observed with other symptoms, calprotectin levels or liver parameters. PMID:24731750

  19. JAMA Patient Page: Abdominal Hernia

    MedlinePLUS

    JAMA PATIENT PAGE Abdominal Hernia Common abdominal hernias Inguinal hernia Indirect inguinal hernia Direct inguinal hernia Intestinal loop Umbilical annulus Peritoneum Peritoneum Abdominal wall Intestinal ...

  20. Abdominal Tuberculosis: A Diagnostic Dilemma

    PubMed Central

    Saxena, Manoj; Ahmad, Faiyaz; Kumar, Ashutosh; Dutta, Shyamoli

    2015-01-01

    Background Abdominal tuberculosis (TB) is the sixth most common form of extra-pulmonary site of infection after lymphatic, genitourinary, bone and joint, miliary and meningeal TB with a rising incidence in recent years. TB can affect any part of the gastro-intestinal (GI) tract including anus, peritoneum and hepato-biliary system. The clinical manifestations of abdominal tuberculosis are non-specific and mimic various GI disorders and cause delay in diagnosis and management. Aim To evaluate the various clinical, radiological and microbiological findings of abdominal tuberculosis and to define the role of histopathological examination in establishing the diagnosis in resource poor settings and to analyze the compliance and response to anti-tubercular treatment. Materials and Methods A five year retrospective study (January 2010 to December 2014) was done in a tertiary teaching hospital in Northern India and all the cases diagnosed as abdominal tuberculosis during the study period, were included. The relevant clinical informations, laboratory results, microbiological and radiological investigations were recorded. Histopathological examination of all the resected / excised specimens was done and Ziehl-Neelsen (ZN) staining to detect the tubercular bacilli and Periodic acid-Schiff (PAS) stain to rule out fungal infection was done in all the cases. Results Out of 48 cases with abdominal tuberculosis, the average age of presentation was 27.4 years with a slight male predominance (Male:Female=1.4:1). Abdominal pain (100%) was the most common presenting symptom followed by anorexia (98%), fever (88%) and intestinal obstruction (88%). The ileum was the most common site of involvement. All the 45 resected / excised tissue specimens (34 cases of intestinal resection and 11 cases of intesinal, omental and lymph nodes biopsies) showed epithelioid granulomas along with necrosis (in 38 cases) and Langhans giant cells (in 42 cases). Acid Fast Bacilli (AFB) positivity was seen in 5 tissue specimens only. All patients were put on anti-tubercular treatment and majority showed good response to therapy. Conclusion Abdominal tuberculosis should be considered as a differential diagnosis in patients with vague GI symptoms. Study of histopathological findings can aid in the diagnosis in the settings where advanced molecular methods of diagnosis are not available, leading to early diagnosis and management.

  1. The Integrative Approach for Management of Pediatric Pain Acupuncture

    Microsoft Academic Search

    Shu-Ming Wang

    \\u000a Chronic pain in the pediatric population is a ­significant problem. It is estimated that 15–20% of children were affected\\u000a by chronic pain (Goodman and McGrath 1991). The common pediatric chronic pain symptoms include headache, abdominal pain, and\\u000a complex-regional pain syndromes (type I and type II). Other pain syndromes can be cerebral palsy (spasticity), malignant tumors,\\u000a scoliosis, benign tumor, cystic fibrosis,

  2. Bloody Traditional Procedures Performed During Infancy in the Oropharyngeal Area Among HIV+ Children: Implication from the Perspective of Mother-to-Child Transmission of HIV

    Microsoft Academic Search

    Yifru Berhan Mitke

    2010-01-01

    Although bloody traditional procedures are very common in Ethiopia, this is the first report on infants. None of the literature\\u000a attributed such practices as risk factor for mother-to-child transmission (MTCT) of HIV. Analysis was done to 1,163 children\\u000a and found that 552 (47.5%) bloody traditional procedures were performed in the oral cavity to 399 (34.3%): uvulectomy 41.8%,\\u000a milk tooth extraction

  3. Symptoms and visceral perception in patients with pain-predominant irritable bowel syndrome

    Microsoft Academic Search

    Tony Lembo; Bruce Naliboff; Julie Munakata; Steve Fullerton; Lynn Saba; Scott Tung; Max Schmulson; Emeran A Mayer

    1999-01-01

    OBJECTIVE:Abdominal pain is thought to be a hallmark of the irritable bowel syndrome (IBS), although currently used symptom criteria do not differentiate between abdominal pain and discomfort. By focusing on viscerosensory symptoms, we sought to determine: 1) which type of symptoms are most commonly reported by IBS patients, and 2) whether patients who report pain as their most bothersome symptom

  4. Advanced abdominal pregnancy: a case report.

    PubMed

    Tungshevinsirikul, R; Charutragulchai, P; Khunpradit, S; Herabutya, Y

    1990-02-01

    A 37-year-old, gravida 5 with 41 weeks of gestation was admitted because of slight vaginal bleeding, abdominal pain, and absence of fetal movements for a few days. Previously she had been admitted to a provincial hospital with sudden severe abdominal pain and fainting at the second month of her pregnancy and ectopic pregnancy was suspected. She was discharged the following morning, after all signs and symptoms had completely disappeared without any special investigation. On her last admission all clinical examinations were normal but fetal heart sound was absent. The cervix was closed and uneffaced. Abdominal X-ray showed signs of fetal death. Sonography confirmed a dead fetus in utero but with placenta previa totalis. A laparotomy was performed. A macerated female fetus, weighting 3,800 g was found in the amniotic sac lying in the abdominal cavity. The placenta was attached to the dorsal surface of her abdomen close to the large intestine and the omentum; the entire placenta was untouched and left in the peritoneal cavity. There were no postoperative complications. She recovered well and was discharged after 7 days. PMID:2351905

  5. Abdominal Decompression in Children

    PubMed Central

    Ejike, J. Chiaka; Mathur, Mudit

    2012-01-01

    Abdominal compartment syndrome (ACS) increases the risk for mortality in critically ill children. It occurs in association with a wide variety of medical and surgical diagnoses. Management of ACS involves recognizing the development of intra-abdominal hypertension (IAH) by intra-abdominal pressure (IAP) monitoring, treating the underlying cause, and preventing progression to ACS by lowering IAP. When ACS is already present, supporting dysfunctional organs and decreasing IAP to prevent new organ involvement become an additional focus of therapy. Medical management strategies to achieve these goals should be employed but when medical management fails, timely abdominal decompression is essential to reduce the risk of mortality. A literature review was performed to understand the role and outcomes of abdominal decompression among children with ACS. Abdominal decompression appears to have a positive effect on patient survival. However, prospective randomized studies are needed to fully understand the indications and impact of these therapies on survival in children. PMID:22482041

  6. Gastric trichobezoar: abdominal mass in a child with sickle cell disease.

    PubMed

    Sciarretta, Jason D; Bond, Sheldon J

    2011-11-01

    Abdominal pain is a frequent occurrence among the pediatric population and can be a diagnostic challenge. Trichobezoar is a differential diagnosis that is often neglected. Different from previously reported cases, we present a 3-year-old girl with sickle cell disease with complaints of acute abdominal pain, suspecting sickle cell splenic sequestration. The child presented to the emergency department with sharp epigastric pain and an associated palpable upper abdominal mass. This case illustrates a large obstructing gastric trichobezoar and summarizes both the diagnostic modalities and treatment. PMID:22068059

  7. Abdominal trauma in war

    Microsoft Academic Search

    Daniel P. Rignault

    1992-01-01

    In war, the percentage of casualties with abdominal wounds on battle-fields is near 20%. Roughly half of these casualties die almost immediately from bleeding. Wounding agents are most often either bullets or fragments from various detonating devices. Severity of pathology induced by these agents and prolonged lag time between injury and treatment constitute major differences between peace and war abdominal

  8. The Impact of Adverse Childhood Events on Temporal Summation of Second Pain

    E-print Network

    You, Dokyoung Sophia

    2012-10-19

    with various chronic pain problems.55, 75, 102 Such chronic pain problems include fibromyalgia,5, 10, 123, 133 chronic pelvic pain,66, 67, 135 musculoskeletal pain,71, 73, 74, 134 abdominal pain,134 and irritable bowel syndrome.100, 135, 136 Treatment... by innocuous stimuli.142 Laboratory pain testing reveals that allodynia lasts shorter and affects smaller area than hyperalgesia.65 Both This thesis follows the style of Clinical Journal of Pain. 2...

  9. Pain management in chronic pancreatitis: taming the beast

    PubMed Central

    Enweluzo, Chijioke; Tlhabano, Letlhogonolo

    2013-01-01

    Abdominal pain is a principal and in many cases, the only observable symptom of chronic pancreatitis. Like all chronic pain conditions, managing abdominal pain in chronic pancreatitis remains an onerous task for health care providers. Different mechanisms have been postulated in trying to better understand the pathogenesis of pain in chronic pancreatitis. This review seeks to take a broad look at the various options that are available to providers in trying to achieve pain relief and a better quality of life for chronic pancreatitis patients. PMID:24039444

  10. The preemptive analgesic effect of lornoxicam in patients undergoing major abdominal surgery: A randomised controlled study

    Microsoft Academic Search

    Yucel Karaman; Eyup Kebapc?; Alp Gurkan

    2008-01-01

    IntroductionThe aim of this study was to examine the effect of lornoxicam used in preemptive analgesia on the intensity of pain and requirement for analgesics in the perioperative period for major abdominal surgery.

  11. Psychosocial factors associated with chronic pain in adolescents

    Microsoft Academic Search

    Vivian P. B. M Merlijn; Joke A. M Hunfeld; Johannes C van der Wouden; Alice A. J. M Hazebroek-Kampschreur; Bart W Koes; Jan Passchier

    2003-01-01

    A number of psychosocial factors have been associated with the onset, exacerbation and\\/or maintenance of chronic pain in adolescents. The present study was conducted to evaluate the relative importance of vulnerability, reinforcement, and modeling. We compared 222 adolescents with chronic pain and no documented physiological etiology (headache, back, limb and abdominal pain) with 148 controls and their (respectively 183 vs.

  12. Intra-abdominal hypertension and abdominal compartment syndrome

    Microsoft Academic Search

    K.-M. Sieh; Kent-Man Chu; John Wong

    2001-01-01

    Background: The effects of increased intra-abdominal pressure in various organ systems have been noted over the past century. The concept of abdominal compartment syndrome has gained more attention in both trauma and general surgery in the last decade. This article reviews the current understanding and management of intra-abdominal hypertension and abdominal compartment syndrome. Methods: Relevant information was gathered from a

  13. Multiple ectopic hepatocellular carcinomas arising in the abdominal cavity.

    PubMed

    Miyake, Toru; Hoshino, Seiichiro; Yoshida, Yoichiro; Aisu, Naoya; Tanimura, Syu; Hisano, Satoshi; Kuno, Nobuaki; Sohda, Tetsuro; Sakisaka, Shotaro; Yamashita, Yuichi

    2012-09-01

    Ectopic hepatocellular carcinoma (HCC) is a very rare clinical entity that is defined as HCC arising from extrahepatic liver tissue. This report presents a case of ectopic multiple HCC arising in the abdominal cavity. A 42-year-old otherwise healthy male presented with liver dysfunction at a general health checkup. Both HCV antibody and hepatitis B surface antigen were negative. Laboratory examination showed elevations in serum alpha-fetoprotein and PIVKA-II. Ultrasonography and computed tomography revealed multiple nodular lesions in the abdominal cavity with ascites without a possible primary tumor. Exploratory laparoscopy was performed, which revealed bloody ascites and multiple brown nodular tumors measuring approximately 10 mm in size that were disseminated on the perineum and mesentery. A postoperative PET-CT scan was performed but it did not reveal any evidence of a tumor in the liver. The tumors resected from the peritoneum were diagnosed as HCC. The present case of HCC was thought to have possibly developed from ectopic liver on the peritoneum or mesentery. PMID:23139654

  14. Complementary and alternative medicine (CAM) use in children with functional abdominal pain (FAP) and irritable bowel syndrome (IBS) differs in tertiary vs. primary care and is related to mother's view of child disability

    Technology Transfer Automated Retrieval System (TEKTRAN)

    We sought to determine if CAM use was greater in children in tertiary vs. primary care, and whether child or parent report of pain characteristics, and/or child and mother's psychological characteristics differed between those who did/did not use CAM. We identified children 7-10 years of age with FA...

  15. Abdominal CT scan

    MedlinePLUS

    Computed tomography scan - abdomen; CT scan - abdomen; CAT scan - abdomen ... An abdominal CT scan makes detailed pictures of the structures inside your belly (abdomen) very quickly. This test may be used to ...

  16. Segmental abdominal zoster paresis.

    PubMed

    Jandolo, B; Biolcati, G; Montanari, U; Pietrangeli, A; Fazio, M

    1987-01-01

    A case of uncommon feature of herpes zoster, a segmental abdominal paresis, is described. The importance of searching a motor defect in the thoracoabdominal segments and the utility of the electromyographic examination are stressed. PMID:2961042

  17. Normal Abdominal CT

    NSDL National Science Digital Library

    Shaffer, Kitt

    Set of normal abdominal CT images with various important anatomic structures outlined, for cine viewing to gain a 3D view of the structure and its relationship to adjacent organs.Annotated: trueDisease diagnosis: Normal

  18. Abdominal wall competence in transverse abdominal island flap operations.

    PubMed

    Hartrampf, C R

    1984-02-01

    This study critically evaluates the abdominal wall in 82 patients following breast and chest wall reconstruction using the transverse abdominal island flap operation. Experience with these patients led to an awareness of the important muscle and ligamentous structures in the anterior abdominal wall. An operative procedure is presented for selective harvesting of the transverse abdominal island flap in a manner that preserves viability of the flap and at the same time reestablishes abdominal competence. PMID:6230981

  19. Acupuncture is a feasible treatment for post-thoracotomy pain: results of a prospective pilot trial

    Microsoft Academic Search

    Andrew J Vickers; Valerie W Rusch; Vivek T Malhotra; Robert J Downey; Barrie R Cassileth

    2006-01-01

    BACKGROUND: Thoracotomy is associated with severe pain that may persist for years. Acupuncture is a complementary therapy with a proven role in pain control. A randomized trial showed that acupuncture was effective in controlling pain after abdominal surgery, but the efficacy of this technique for the treatment of thoracotomy pain has not been established. We developed a novel technique for

  20. Pylephlebitis: a rare complication of an intra-abdominal infection

    PubMed Central

    Wong, Katherine; Weisman, David S.; Patrice, Kelly-Ann

    2013-01-01

    Pylephlebitis is defined as an inflamed thrombosis of the portal vein. It is a rare complication of an intra-abdominal infection, and the diagnosis is often missed due to its nonspecific clinical presentation. Symptoms may include abdominal pain, fever, chills, fatigue, nausea, and vomiting. It is important to consider this differential when a patient presents with signs of abdominal sepsis since it has a high mortality rate and is often diagnosed postmortem. Pylephlebitis can be diagnosed via abdominal ultrasound or CT demonstrating a thrombus in the portal vein, and it must be treated early and aggressively with broad-spectrum antibiotics. We are presenting a case of pylephlebitis as well as discussing the diagnosis and treatment of this potentially lethal condition. PMID:23882407

  1. Chest pain

    MedlinePLUS

    ... pain that may feel like tightness, heavy pressure, squeezing, or crushing pain. The pain may spread to ... Call 911 if: You have sudden crushing, squeezing, tightening, or ... or between your shoulder blades. You have nausea, dizziness, ...

  2. A case of abdominal apoplexy because of the rupture of the short gastric vessel

    PubMed Central

    Osunkunle, Olaoluwakitan A.; Al-Shoek, Ihsan

    2015-01-01

    Abdominal apoplexy or idiopathic spontaneous intraperitoneal haemorrhage is defined as the presence of free blood within the peritoneal cavity. Non-traumatic and non-iatrogenic causes may cause abdominal apoplexy. It has a variable clinical presentation, with abdominal pain being an early and non-specific symptom. We report a rare case of a 23-year-old male with abdominal apoplexy because of rupture of the short gastric artery. He presented to our department with abdominal pain. Later, he developed signs of shock, and was found to have haemoperitoneum on laparotomy. We ligated the short gastric artery, which was the bleeding source, and he had an uneventful postoperative course. We also review the literature on existing cases of short gastric vessel rupture. PMID:25759171

  3. Abdominal Aortic Aneurysms

    PubMed Central

    Fortner, George; Johansen, Kaj

    1984-01-01

    Aneurysms are common in our increasingly elderly population, and are a major threat to life and limb. Until the advent of vascular reconstructive techniques, aneurysm patients were subject to an overwhelming risk of death from exsanguination. The first successful repair of an abdominal aortic aneurysm using an interposed arterial homograft was reported by Dubost in 1952. A milestone in the evolution of vascular surgery, this event and subsequent diagnostic, operative and prosthetic graft refinements have permitted patients with an unruptured abdominal aortic aneurysm to enjoy a better prognosis than patients with almost any other form of major systemic illness. Images PMID:6702193

  4. Huge pelvi-abdominal malignant inflammatory myofibroblastic tumor with rapid recurrence in a 14-year-old boy

    Microsoft Academic Search

    Chia-Hsun Lu; Sheung-Fat Ko; Chang Gung; Kaohsiung Hsien; Hsuan-Ying Huang; Han-Koo Chen; Jiin-Haur Chuang; Ko SF; Huang HY; Niao-Sung Hsiang

    2010-01-01

    Inflammatory myofibroblastic tumor (IMT) is an uncom - mon benign neoplasm with locally aggressive behavior but malignant change is rare. We report an unusual case of pelvic-abdominal inflammatory myofibroblastic tumor with malignant transformation in a 14-year-old boy pre- senting with abdominal pain and 9 kg body weight loss in one month. Computed tomography revealed a huge pelvi-abdominal mass (30 cm),

  5. Pain management in patients with inflammatory bowel disease: insights for the clinician

    PubMed Central

    Srinath, Arvind Iyengar; Walter, Chelsea; Newara, Melissa C.

    2012-01-01

    Abdominal pain is a common symptom in patients with inflammatory bowel disease (IBD) and has a profound negative impact on patients’ lives. There are growing data suggesting that pain is variably related to the degree of active inflammation. Given the multifactorial etiologies underlying the pain, the treatment of abdominal pain in the IBD population is best accomplished by individualized plans. This review covers four clinically relevant categories of abdominal pain in patients with IBD, namely, inflammation, surgical complications, bacterial overgrowth, and neurobiological processes and how pain management can be addressed in each of these cases. The role of genetic factors, psychological factors, and psychosocial stress in pain perception and treatment will also be addressed. Lastly, psychosocial, pharmacological, and procedural pain management techniques will be discussed. An extensive review of the existing literature reveals a paucity of data regarding pain management specific to IBD. In addition, there is growing consensus suggesting a spectrum between IBD and irritable bowel syndrome (IBS) symptoms. Thus, this review for adult and pediatric clinicians also incorporates the literature for the treatment of functional abdominal pain and the clinical consensus from IBD and IBS experts on pharmacological, behavioral, and procedural methods to treat abdominal pain in this population. PMID:22973418

  6. Abdominal pregnancy - Case presentation

    PubMed Central

    Bohiltea, R; Radoi, V; Tufan, C; Horhoianu, IA; Bohiltea, C

    2015-01-01

    Introduction. Abdominal pregnancy, a rare diagnosis, belongs to the ectopic pregnancy group, the leading cause of pregnancy related exitus. The positive diagnosis is very difficult to establish most often in an acute setting, leading to a staggering percent of feto-maternal morbidity and mortality. Case report. We present the case of 26-weeks-old abdominal pregnancy with partial feto-placental detachment in a patient, after hysteroscopy and in vitro fertilization, which until the acute symptoms that led to emergency laparotomy went unrecognized. The patient recovered completely and satisfactorily after surgery and, due to the high risk of uterine rupture with regard to a second pregnancy, opted for a surrogate mother. Conclusion. Abdominal pregnancy can be regarded as a difficult to establish diagnosis, with a greater chance in case of increased awareness. It is compulsory to be well informed in order not to be surprised by the diagnosis and to apply the correct treatment immediately as the morbidity and mortality rate is elevated. PMID:25914739

  7. Abdominal trauma by ostrich

    PubMed Central

    Usurelu, Sergiu; Bettencourt, Vanessa; Melo, Gina

    2015-01-01

    Introduction Ostriches typically avoid humans in the wild, since they correctly assess humans as potential predators, and, if approached, often run away. However, ostriches may turn aggressive rather than run when threatened, especially when cornered, and may also attack when they feel the need to defend their offspring or territories. Presentation of case A 71-year-old male patient presented with intra abdominal injury sustained from being kicked in the abdominal wall by an ostrich. During laparotomy, were found free peritoneal effusion and perforation of the small intestine. Discussion The clinical history and physical examination are extremely important for diagnostic and therapeutic decision making. CT-scan is the most accurate exam for making diagnosis. Surgery is the treatment of choice, and is always indicated when there is injury to the hollow viscera. In general it is possible to suture the defect. Conclusion In cases of blunt abdominal trauma by animals is necessary to have a low threshold of suspicion for acute abdomen. PMID:25685344

  8. Pain Assessment

    Microsoft Academic Search

    Frank Andrasik; Carla Rime

    In adults, pain is one of the most common physical complaints. For example, a comprehensive review of available epidemiological\\u000a studies yielded a median point prevalence of chronic benign pain of 15% in adults, with individual study values ranging from\\u000a 2–40% (Verhaak, Kerssens, Dekker, Sorbi, & Bensing, 1998). Unfortunately, pain is not limited to the adult years, as estimates\\u000a of pain

  9. Face pain

    MedlinePLUS

    Face pain may be dull and throbbing or an intense, stabbing discomfort in the face or forehead. It can occur in one or ... Pain that starts in the face may be caused by a nerve problem, ... Face pain may also begin other places in the body. Abscessed ...

  10. Acquired Abdominal Intercostal Hernia: A Case Report and Literature Review

    PubMed Central

    Tripodi, Giuseppe

    2014-01-01

    Acquired abdominal intercostal hernia (AAIH) is a rare disease phenomenon where intra-abdominal contents reach the intercostal space directly from the peritoneal cavity through an acquired defect in the abdominal wall musculature and fascia. We discuss a case of a 51-year-old obese female who arrived to the emergency room with a painful swelling between her left 10th rib and 11th rib. She gave a history of a stab wound to the area 15 years earlier. A CT scan revealed a fat containing intercostal hernia with no diaphragmatic defect. An open operative approach with a hernia patch was used to repair this hernia. These hernias are difficult to diagnose, so a high clinical suspicion and thorough history and physical exam are important. This review discusses pathogenesis, clinical presentation, complications, and appropriate treatment strategies of AAIH. PMID:25197605

  11. Complex abdominal wall repair using a porcine dermal matrix.

    PubMed

    Gentile, Pietro; Colicchia, Gianfranco Marcello; Nicoli, Fabio; Cervelli, Giulio; Curcio, Cristiano Beniamino; Brinci, Lorenzo; Cervelli, Valerio

    2013-12-01

    Management of complex abdominal defects remains a significant challenge for many surgeons, especially in contaminated fields. Currently, available biosynthetic grafts include human cadaveric dermis (AlloDerm), porcine dermal (Permacol and Strattice), and submucosal (Surgisis) sources. All these grafts are composed of an acellular collagen scaffold to provide a bridge for tissue incorporation and neovascularization. The authors describe a case report of a woman who required dual mesh explantation and successive reparative surgery using a porcine dermal matrix for a complex and infected abdominal wound. Twelve months postdischarge the patient remains well, she is pain free, and she returned home to full activities with complete wound closure and without any evidence of residual or recurrent hernia. The patient was satisfied with her cosmetic results. In conclusion, the authors' experience shows that the use of Permacol, a porcine dermal matrix, has been successful in treating an infected abdomen and a vast abdominal wall defect. PMID:22006210

  12. Clinical presentation of abdominal tuberculosis in HIV seronegative adults

    PubMed Central

    Bolukbas, Cengiz; Bolukbas, Fusun F; Kendir, Tulin; Dalay, Remzi A; Akbayir, Nihat; Sokmen, Mehmet H; Ince, Ali T; Guran, Mithat; Ceylan, Erkan; Kilic, Guray; Ovunc, Oya

    2005-01-01

    Background The accurate diagnosis of abdominal tuberculosis usually takes a long time and requires a high index of suspicion in clinic practice. Eighty-eight immune-competent patients with abdominal tuberculosis were grouped according to symptoms at presentation and followed prospectively in order to investigate the effect of symptomatic presentation on clinical diagnosis and prognosis. Methods Based upon the clinical presentation, the patients were divided into groups such as non-specific abdominal pain & less prominent in bowel habit, ascites, alteration in bowel habit, acute abdomen and others. Demographic, clinical and laboratory features, coexistence of pulmonary tuberculosis, diagnostic procedures, definitive diagnostic tests, need for surgical therapy, and response to treatment were assessed in each group. Results According to clinical presentation, five groups were constituted as non-specific abdominal pain (n = 24), ascites (n = 24), bowel habit alteration (n = 22), acute abdomen (n = 9) and others (n = 9). Patients presenting with acute abdomen had significantly higher white blood cell counts (p = 0.002) and abnormalities in abdominal plain radiographs (p = 0.014). Patients presenting with alteration in bowel habit were younger (p = 0.048). The frequency of colonoscopic abnormalities (7.5%), and need for therapeutic surgery (12.5%) were lower in patients with ascites, (p = 0.04) and (p = 0.001), respectively. There was no difference in gender, disease duration, diagnostic modalities, response to treatment, period to initial response, and mortality between groups (p > 0.05). Gastrointestinal tract alone was the most frequently involved part (38.5%), and this was associated with acid-fast bacteria in the sputum (p = 0.003). Conclusion Gastrointestinal tract involvement is frequent in patients with active pulmonary tuberculosis. Although different clinical presentations of patients with abdominal tuberculosis determine diagnostic work up and need for therapeutic surgery, evidence based diagnosis and consequences of the disease does not change. PMID:15969744

  13. Drug Management of Visceral Pain: Concepts from Basic Research

    PubMed Central

    Davis, Mellar P.

    2012-01-01

    Visceral pain is experienced by 40% of the population, and 28% of cancer patients suffer from pain arising from intra- abdominal metastasis or from treatment. Neuroanatomy of visceral nociception and neurotransmitters, receptors, and ion channels that modulate visceral pain are qualitatively or quantitatively different from those that modulate somatic and neuropathic pain. Visceral pain should be recognized as distinct pain phenotype. TRPV1, Na 1.8, and ASIC3 ion channels and peripheral kappa opioid receptors are important mediators of visceral pain. Mu agonists, gabapentinoids, and GABAB agonists reduce pain by binding to central receptors and channels. Combinations of analgesics and adjuvants in animal models have supra-additive antinociception and should be considered in clinical trials. This paper will discuss the neuroanatomy, receptors, ion channels, and neurotransmitters important to visceral pain and provide a basic science rationale for analgesic trials and management. PMID:22619712

  14. Daisaikoto for menstrual pain: a lesson from a case with menstrual pain successfully treated with daisaikoto.

    PubMed

    Horiba, Yuko; Yoshino, Tetsuhiro; Watanabe, Kenji

    2015-01-01

    Menstrual pain is one of the common symptoms among women. It is estimated that 5-14% of women are sometimes absent from school or work because of pain. Usually gynecologists prescribe analgesics and/or low-dose oral contraceptives. However, such treatment is not always effective and sometimes causes an adverse effect, such as stomach pain or low body temperature. Kampo medicine is one of the choices for the menstrual pain in Japan. Tokishakuyakusan, kamishoyosan, or keishibukuryogan is commonly used for the treatment of menstrual pain. Here we report a case of menstrual pain successfully treated with daisaikoto which is not commonly used for such a case. Twenty-five-year-old woman suffered from severe menstrual pain and stress at company. She also had constipation and abdominal distension. We prescribed daisaikoto extract 7.5?g per day. Not only menstrual pain but also constipation and abdominal distension improved within 6 months. Here we propose that daisaikoto is one of the choices for the treatment of menstrual pain with mental stress. PMID:25792985

  15. Abdominal Superficial Subcutaneous Fat

    PubMed Central

    Golan, Rachel; Shelef, Ilan; Rudich, Assaf; Gepner, Yftach; Shemesh, Elad; Chassidim, Yoash; Harman-Boehm, Ilana; Henkin, Yaakov; Schwarzfuchs, Dan; Ben Avraham, Sivan; Witkow, Shula; Liberty, Idit F.; Tangi-Rosental, Osnat; Sarusi, Benjamin; Stampfer, Meir J.; Shai, Iris

    2012-01-01

    OBJECTIVE Unlike visceral adipose tissue (VAT), the association between subcutaneous adipose tissue (SAT) and obesity-related morbidity is controversial. In patients with type 2 diabetes, we assessed whether this variability can be explained by a putative favorable, distinct association between abdominal superficial SAT (SSAT) (absolute amount or its proportion) and cardiometabolic parameters. RESEARCH DESIGN AND METHODS We performed abdominal magnetic resonance imaging (MRI) in 73 patients with diabetes (mean age 58 years, 83% were men) and cross-sectionally analyzed fat distribution at S1-L5, L5-L4, and L3-L2 levels. Patients completed food frequency questionnaires, and subgroups had 24-h ambulatory blood pressure monitoring and 24-h ambulatory electrocardiography. RESULTS Women had higher %SSAT (37 vs. 23% in men; P < 0.001) despite a similar mean waist circumference. Fasting plasma glucose (P = 0.046) and HbA1c (P = 0.006) were both lower with increased tertile of absolute SSAT. In regression models adjusted for age, waist circumference, and classes of medical treatments used in this patient population, increased %SSAT was significantly associated with decreased HbA1c (? = ?0.317; P = 0.013), decreased daytime ambulatory blood pressure (? = ?0.426; P = 0.008), and increased HDL cholesterol (? = 0.257; P = 0.042). In contrast, increased percent of deep SAT (DSAT) was associated with increased HbA1c (? = 0.266; P = 0.040) and poorer heart rate variability parameters (P = 0.030). Although total fat and energy intake were not correlated with fat tissue distribution, increased intake of trans fat tended to be associated with total SAT (r = 0.228; P = 0.05) and DSAT (r = 0.20; P = 0.093), but not with SSAT. CONCLUSIONS Abdominal SAT is composed of two subdepots that associate differently with cardiometabolic parameters. Higher absolute and relative distribution of fat in abdominal SSAT may signify beneficial cardiometabolic effects in patients with type 2 diabetes. PMID:22344612

  16. Intra-abdominal Infections.

    PubMed

    Shirah, Gina R; O'Neill, Patrick J

    2014-12-01

    Intra-abdominal infections are multifactorial, but all require prompt identification, diagnosis, and treatment. Resuscitation, early antibiotic administration, and source control are crucial. Antibiotic administration should initially be broad spectrum and target the most likely pathogens. When cultures are available, antibiotics should be narrowed and limited in duration. The method of source control depends on the anatomic site, site accessibility, and the patient's clinical condition. Patient-specific factors (advanced age and chronic medical conditions) as well as disease-specific factors (health care-associated infections and inability to obtain source control) combine to affect patient morbidity and mortality. PMID:25440126

  17. Rectus abdominal muscle endometriosis in a patient with cesarian scar: case report.

    PubMed

    Sahin, L; Dinçel, O; Türk, B Aydin

    2013-01-01

    Endometriosis is the existence of endometrial tissue out of the intrauterine cavity. Abdominal wall endometrioma is a well-defined mass composed of endometrial glands and stroma that may develop after gynecologic and obstetrical surgeries. A cyclic painful mass at the site of a cesarean section scar is most likely due to an endometrioma, and wide local excision is the advisable treatment. The authors present a case of endometrioma in the abdominal wall, which was treated with local excision. PMID:24597267

  18. Incidental Discovery of a Chronically Thrombosed Abdominal Aortic Aneurysm: Case Report and Literature Review.

    PubMed

    Wu, Chris Y; Rectenwald, John E

    2015-07-01

    Chronic spontaneously thrombosed abdominal aortic aneurysms (AAAs) are rare. We present a patient with a completely thrombosed abdominal aortic aneurysm found incidentally on imaging for evaluation of unrelated abdominal pain. The patient was asymptomatic with regards to the aneurysm due to extensive collateralization of the intercostal and lumbar arteries to the bilateral hypogastric and internal mammary arteries to the common femoral arteries bilaterally. Follow-up imaging after 10 months showed no aneurysmal change. Further study is needed regarding indications for elective repair, medical therapy, and surveillance modality and schedule for patients with chronically occluded AAAs as these patients are at risk for aneurysm rupture and thrombus propagation. PMID:25770381

  19. Neuropathic Pain

    PubMed Central

    Costigan, Michael; Scholz, Joachim; Woolf, Clifford J.

    2009-01-01

    Neuropathic pain is triggered by lesions to the somatosensory nervous system that alter its structure and function so that pain occurs spontaneously and responses to noxious and innocuous stimuli are pathologically amplified. The pain is an expression of maladaptive plasticity within the nociceptive system, a series of changes that constitute a neural disease state. Multiple alterations distributed widely across the nervous system contribute to complex pain phenotypes. These alterations include ectopic generation of action potentials, facilitation and disinhibition of synaptic transmission, loss of synaptic connectivity and formation of new synaptic circuits, and neuroimmune interactions. Although neural lesions are necessary, they are not sufficient to generate neuropathic pain; genetic polymorphisms, gender, and age all influence the risk of developing persistent pain. Treatment needs to move from merely suppressing symptoms to a disease-modifying strategy aimed at both preventing maladaptive plasticity and reducing intrinsic risk. PMID:19400724

  20. Traumatic appendicitis in minor blunt abdominal injury.

    PubMed

    Paschos, Konstantinos A; Boulas, Konstantinos; Liapis, Apostolos; Georgiou, Eleftheria; Vrakas, Xenos

    2012-06-01

    Trauma has been reported as a cause of appendicitis on several cases in the literature. The present study reports the relationship between blunt abdominal trauma (BAT) of injury severity score less than 4 and appendicitis. A 17-year-old girl developed appendicitis after a minor BAT. An ecchymosis at the right lower quadrant misled the diagnosis, which was made 1 day later. Laparotomy revealed an inflamed appendix, a few enlarged mesenteric lymph nodes, contusion, as well as punctuated bleeding sites of the caecum. Moreover, based on a brief literature review, the different pathophysiological mechanisms and the difficulties of diagnosis of this entity are discussed. It is suggested that appendicitis should be considered as a possibility in the setting of right lower quadrant pain following minor BAT, when there is clinical suspicion of an inflammatory process within the right iliac fossa. PMID:22672177

  1. Retained intra-abdominal artery forceps – An unusual cause of intestinal strangulation

    PubMed Central

    Ugochukwu, Anthony Ikemefuna; Edeh, Anthony Jude

    2011-01-01

    Context: Surgical instruments and materials continue to be retained in the peritoneal cavity despite precautionary measures. Even though uncommon it is also under-reported and carries serious medico-legal consequences. Gauzes and sponges (gossypiboma) are the most commonly retained materials and intra-abdominal retained artery forceps are much rarer but when they do occur lead to chronic abdominal pain and can be a rare cause of intestinal obstruction or strangulation with significant morbidity and mortality. Case Report: We present a case of intraabdominal retained artery forceps in a 70-years-old lady who underwent laparotomy with splenectomy for a large spleen in a peripheral hospital. Upon discharge she continued to complain of intermittent abdominal pain of increasing severity. 12 months later she presented to us with an acute (surgical) abdomen requiring another laparotomy. At laparotomy she had strangulated/gangrenous lower jejunual and upper ileal bowel loops, the small bowel mesentery of this area being tightly trapped between the jaws of the retained artery forceps. She had gut resection and enteroanastomosis. Unfortunately she died from continuing sepsis on the second post-operative day. Conclusion: Retained instruments in intra-abdominal surgery can cause serious complication and should be treated surgically. High index of suspicion and appropriate investigations like plain abdominal X-ray, abdominal ultrasound and CT and MRI scans should be instituted in patients who develop chronic abdominal symptoms following laparotomy. Preventive measures against retained instruments must follow strict laid down protocols for surgical instruments handling in theatre. PMID:22540110

  2. Penetrating abdominal injuries: management controversies

    Microsoft Academic Search

    Muhammad U Butt; Nikolaos Zacharias; George C Velmahos

    2009-01-01

    Penetrating abdominal injuries have been traditionally managed by routine laparotomy. New understanding of trajectories, potential for organ injury, and correlation with advanced radiographic imaging has allowed a shift towards non-operative management of appropriate cases. Although a selective approach has been established for stab wounds, the management of abdominal gunshot wounds remains a matter of controversy. In this chapter we describe

  3. [The abdominal drop flap].

    PubMed

    Bodin, F; Liverneaux, P; Seigle-Murandi, F; Facca, S; Bruant-Rodier, C; Dissaux, C; Chaput, B

    2015-08-01

    The skin between the mastectomy scar and the future infra-mammary fold may be managed in different ways in delayed breast reconstruction using a DIEP (deep inferior epigastric perforator). Conserving this skin and positioning the flap skin paddle in the middle of the breast usually highlights skin color disparity because of two visible transition zones. Resection of the entire skin under the scar may be more aesthetic but limits direct closure possibility in case of flap failure. In order to benefit from both aesthetic result and safe surgical method, we propose the abdominal drop flap. The inferior thoracic skin flap is detached from the thoracic wall beyond the future infra-mammary fold, preserved and pushed under the breast. PMID:25896871

  4. Pain and Anxiety Experienced by Patients Following Placement of a Percutaneous Endoscopic Gastrostomy.

    PubMed

    Oppong, Philip; Pitts, Narrie; Chudleigh, Vicky; Latchford, Andrew; Roy, Amy; Rocket, Mark; Lewis, Stephen

    2014-09-23

    Background: Abdominal pain following percutaneous endoscopic gastrostomy (PEG) placement is a recognized complication. However, the prevalence and degree of severity of pain are poorly characterized. We assessed abdominal pain and anxiety levels associated with PEG placement in communicative and noncommunicative patients. Methods: A prospective questionnaire assessed patients' anxiety and abdominal pain 1 hour before, 1 hour after, and 24 hours after PEG placement using 11-point Likert-type scales. Patients were followed up until pain had resolved. Procedural data, analgesia requirements, and complications were recorded. For analysis, patients were divided into 2 groups: communicative (able to self-assess) and noncommunicative (clinician assessed). Results: Seventy consecutive patients were assessed. Of the 49 self-assessed patients, 11 (22%) reported immediate pain, 32 (65%) reported pain at 1 hour (24 mild, 5 moderate, 3 severe), and 40 (82%) reported pain at 24 hours. Pain most commonly lasted between 24 and 48 hours (25 patients). Of the 21 clinician-assessed patients, only 1 was deemed to have pain, and this was at 24 hours. Four (6%) patients were admitted with pain. There was no relationship between preplacement anxiety scores and postplacement pain scores. Discussion: Abdominal pain after PEG placement pain is common but resolved by 48 hours in most patients. In patients able to communicate, clinicians scored pain lower compared with patients' scores. It is likely that pain is not identified in patients unable to communicate. Patients need to be better informed about the possibility of postprocedural pain and routinely offered access to appropriate analgesia. PMID:25249027

  5. LATERAL ABDOMINAL MUSCLE SYMMETRY IN COLLEGIATE SINGLE-SIDED ROWERS

    PubMed Central

    Gill, Norman W.; Mason, Beth E.; Gerber, J. Parry

    2012-01-01

    Purpose/Background: Although side to side symmetry of lateral abdominal muscle thickness has been established in healthy individuals, it is unknown whether abdominal muscle symmetry exists in athletes with asymmetrical physiological demands, such as those of single-sided rowers. The purpose of this study was to examine the oarside versus the non-oarside lateral abdominal musculature thickness in collegiate single-sided rowers, as measured by ultrasound imaging (USI). Methods: The study was a prospective, cross-sectional, observational design. Thirty collegiate crew team members (17 males, 13 females, age 19.8±1.2 years) characterized as single-sided rowers participated. Resting muscle thickness measurements of the transversus abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles were obtained via USI. Comparisons of absolute and relative muscle thickness between oarside and non-oarside were performed using paired t-tests. Potential differences based on gender, rowing experience, and history of low back pain were investigated using mixed model analysis of variance. Results: There were no clinically significant differences in absolute or relative thickness of the TrA, IO or EO on the oarside versus the non-oarside. There were no significant side to side differences in the relative muscle thickness of the TrA, IO or EO based on gender, rowing experience, or history of low back pain. Conclusions: In this sample of single-sided rowing athletes, no clinically significant side to side differences in lateral abdominal muscle thickness were observed. Despite the asymmetrical functional demands of single-sided rowers in this study, thickness of the lateral abdominal muscles was symmetric. Level of Evidence: 4 PMID:22319677

  6. Pain frequency moderates the relationship between pain catastrophizing and pain

    PubMed Central

    Kjøgx, Heidi; Zachariae, Robert; Pfeiffer-Jensen, Mogens; Kasch, Helge; Svensson, Peter; Jensen, Troels S.; Vase, Lene

    2014-01-01

    Background: Pain frequency has been shown to influence sensitization, psychological distress, and pain modulation. The present study examined if pain frequency moderates the relationship between pain catastrophizing and pain. Method: A non-clinical (247 students) and a clinical (223 pain patients) sample completed the Danish versions of the Pain Catastrophizing Scale (PCS), Beck Depression Inventory, and the State Trait Anxiety Inventory and rated pain intensity, unpleasantness and frequency. Results: In both samples, high pain frequency was found to moderate the association between pain catastrophizing and pain intensity, whereas low pain frequency did not. The psychometric properties and the factor structure of the Danish version of the PCS were confirmed. Conclusions: This is the first study to validate the Danish version of the PCS and to show that pain frequency moderates the relationship between pain catastrophizing and reported pain in both non-clinical and clinical populations. PMID:25646089

  7. Pain Genes

    Microsoft Academic Search

    Tom Foulkes; John N. Wood

    2008-01-01

    Pain, which afflicts up to 20% of the population at any time, provides both a massive therapeutic challenge and a route to understanding mechanisms in the nervous system. Specialised sensory neurons (nociceptors) signal the existence of tissue damage to the central nervous system (CNS), where pain is represented in a complex matrix involving many CNS structures. Genetic approaches to investigating

  8. Neck Pain

    PubMed Central

    Darracott, John

    1979-01-01

    Most neck pain is treated with a varying degree of confidence and success. A better understanding of what constitutes neck pain, a pertinent history and examination, critical interpretation of investigations and treatment modalities will provide family physicians, who treat the majority of these patients, with a confident disciplined approach which can reduce morbidity.

  9. Pain experience and satisfaction with postoperative pain control among surgical patients.

    PubMed

    Subramanian, Pathmawathi; Ramasamy, Suguna; Ng, Kwan Hoong; Chinna, Karuthan; Rosli, Roshaslina

    2014-10-30

    Alleviating acute pain and providing pain relief are central to caring for surgical patients as pain can lead to many adverse medical consequences. This study aimed to explore patients' experience of pain and satisfaction with postoperative pain control. A cross-sectional survey was carried out among 107 respondents who had undergone abdominal surgery in the surgical ward of an urban hospital using the Revised American Pain Society's Patient Outcome and Satisfaction Survey Questionnaires (APS-POQ-R). Data were analysed using descriptive statistics and chi-square test. Chi-square test showed significant association between race (P?=?0.038), education level (P???0.001), previous operation status (P?=?0.032) and operation status (P???0.001). Further analysis on nominal regression, association between dissatisfaction with factors of operation status (46.09 (95% CI 7.456, 284.947)) and previous operation status (13.38 (95% CI 1.39, 128.74)) was found to be significant. Moderate to high levels of pain intensity in the last 24?h after surgery, as well as moderate to high rates of pain-related interference with care activities were most reported. Pain still remains an issue among surgical patients, and effective pain management and health education are needed to manage pain more effectively after surgery. PMID:25355297

  10. Effect of drainage on postoperative pain after laparoscopic ovarian cystectomy.

    PubMed

    Kerimoglu, O S; Yilmaz, S A; Pekin, A; ?ncesu, F; Dogan, N U; ?lhan, T T; Celik, C

    2015-04-01

    The aim of this prospective study was to investigate the effect of drainage on postoperative shoulder and abdominal pain after uncomplicated laparoscopic ovarian cystectomy (LOC). Allocation to drain or not to drain was non-randomised. There were 55 patients with drainage and 56 patients without drainage. Postoperative shoulder and abdominal pain was assessed using a 10-point visual analogue scale. Postoperative hospital stay in the drainage group was longer than the non-drainage group (p = 0.040). Postoperative shoulder pain scores at 6 h and 24 h were similar between the drainage and non-drainage groups (p = 0.376 and p = 0.847, respectively). Postoperative abdominal pain was higher in the drainage group at 6 h (p = 0.009), but was similar at 24 h (p = 0.097) between the groups. These data suggest that for LOC, drainage may not be useful to prevent postoperative shoulder pain and also increases postoperative abdominal pain and length of hospital stay. PMID:25140836

  11. Acute incarcerated external abdominal hernia

    PubMed Central

    Yang, Xue-Fei

    2014-01-01

    External abdominal hernia occurs when abdominal organs or tissues leave their normal anatomic site and protrude outside the skin through the congenital or acquired weakness, defects or holes on the abdominal wall, including inguinal hernia, umbilical hernia, femoral hernia and so on. Acute incarcerated hernia is a common surgical emergency. With advances in minimally invasive devices and techniques, the diagnosis and treatment have witnessed major changes, such as the use of laparoscopic surgery in some cases to achieve minimally invasive treatment. However, strict adherence to the indications and contraindications is still required. PMID:25489584

  12. Acute incarcerated external abdominal hernia.

    PubMed

    Yang, Xue-Fei; Liu, Jia-Lin

    2014-11-01

    External abdominal hernia occurs when abdominal organs or tissues leave their normal anatomic site and protrude outside the skin through the congenital or acquired weakness, defects or holes on the abdominal wall, including inguinal hernia, umbilical hernia, femoral hernia and so on. Acute incarcerated hernia is a common surgical emergency. With advances in minimally invasive devices and techniques, the diagnosis and treatment have witnessed major changes, such as the use of laparoscopic surgery in some cases to achieve minimally invasive treatment. However, strict adherence to the indications and contraindications is still required. PMID:25489584

  13. Abdominal pain and collapse in the emergency department

    PubMed Central

    Green, Adam; Bowman-Burns, Carley; Cumberbatch, Gary

    2013-01-01

    Rupture of a splenic artery aneurysm is a rare but life-threatening presentation to the emergency department. This case demonstrates the importance of swift resuscitation and the benefit of bedside imaging in a highly unstable patient. The definitive management of this condition in patients who are refractory to resuscitative attempts is immediate surgery with the diagnosis often only confirmed at laparotomy. PMID:23761509

  14. Chronic diarrhea and abdominal pain: pin the pinworm.

    PubMed

    Rajamanickam, Anitha; Usmani, Ali; Suri, Sanjeev; Dimov, Vesselin

    2009-02-01

    Enterobius vermicularis is the most common helminthic infection in the US. It is usually considered an innocuous parasite that at the most causes perianal itching. We report a case of an 84-year-old female patient from an assisted living facility who presented with symptoms of colitis for 2 months. On detailed history and exam, she was found to have E. vermicularis infection. All her symptoms resolved dramatically within 2 days after a single dose of albendazole. We want to emphasize the importance of including parasitic infections such as E. vermicularis in the differential diagnoses of patients presenting with symptoms of colitis. PMID:19219921

  15. Chronic pain - resources

    MedlinePLUS

    Pain - resources; Resources - chronic pain ... The following organizations are good resources for information on chronic pain: American Chronic Pain Association - www.theacpa.org National Fibromyalgia and Chronic Pain Association - www.fmcpaware.org ...

  16. Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds

    Microsoft Academic Search

    Paul W. Hodges; Carolyn A. Richardson

    1999-01-01

    Objective: To compare trunk muscle coordination in people with and without low back pain with varying speeds of limb movement.Study Design: Abdominal and back extensor muscle activity in association with upper limb movement was compared among three speeds of movement and between people with and without low back pain.Participants: Fourteen subjects with a history of recurrent low back pain and

  17. Decreased pain inhibition in irritable bowel syndrome depends on altered descending modulation and higher-order brain processes

    Microsoft Academic Search

    M. Piché; M. Bouin; M. Arsenault; P. Poitras; P. Rainville

    2011-01-01

    Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder involving abdominal pain and bowel dysfunction. IBS pain symptoms have been hypothesized to depend on peripheral and central mechanisms, but the pathophysiology is still unclear. The aim of the present study was to assess the contribution of cerebral and cerebrospinal processes to pain inhibition deficits in IBS. Fourteen female patients with

  18. Acute pancreatitis presenting as back pain: a case report

    PubMed Central

    Decina, Philip A; Vallee, Dwight; Mierau, Dale

    1992-01-01

    A man with acute back pain presented to a chiropractic clinic with clinical symptoms and signs suggesting abdominal disease rather than mechanical spine pain. He was referred to a local hospital emergency where a diagnosis of acute pancreatitis secondary to chronic cholecystitis was made. The diagnostic images are compared to normal studies. The characteristic clinical examination findings found with back pain due to acute pancreatitis are compared to those typically seen with mechanical spine pain. ImagesFigure 1Figure 2aFigure 2bFigure 3Figure 4aFigure 4bFigure 5aFigure 5b

  19. Neuropathic Pain

    MedlinePLUS

    ... know that it can erode quality of life. Communication Tools View All Everyday Tools During Your Visit ... pain. Online Tool Printable Tool (PDF) Show More Communication Tools Where Does It Hurt? / Nerve Man With ...

  20. “Toxic Pancreatitis with an Intra-Abdominal Abscess which was Caused by Organophosphate Poisoning (OP)”

    PubMed Central

    L, Venugopal; Rao V, Dharma; Rao M, Srinivas; Y, Mallikarjuna

    2013-01-01

    Organophosphate insecticides are the potent inhibitors of the acetylcholinesterase enzyme which lead to an increased acetylcholine activity, which are responsible for symptoms such as abdominal pain, diarrhoea, vomiting and hypersalivation. We are reporting on a young male with acute organophosphate poisoning, who presented with unusual complications like toxic pancreatitis with an intraabdominal abscess. PMID:23543622

  1. Effect of cyclooxygenase-2-specific inhibitors on postoperative analgesia after major open abdominal surgery.

    PubMed

    Yang, Xiufang; Peng, Nanhai; Li, Ning; Li, Jieshou

    2015-06-01

    The aim of this study was to examine the effect of cyclooxygenase-2 (COX-2)-specific medications on postoperative analgesia after major open abdominal surgery. This is was a prospective, randomized controlled, double-blind study conducted on 90 patients who underwent major open abdominal surgery between September 2011 and June 2012, in the General Surgery Department, Jinling Hospital. After written informed consent, patients were prospectively and randomly assigned to one of three treatment groups before surgery, and were scheduled to receive different analgesic drugs according to randomization. We assessed the patients' pain levels using pain intensity score and adverse events during our study period. The group that received intravenous parecoxib for 3 days, and continued oral celecoxib for 4 days had better postoperative analgesia than other groups. COX-2-specific inhibitors are safe and effective in reducing postoperative pain in patients who have undergone major open abdominal surgery. Additionally, sufficient postoperative analgesia, lasting for 1 week, was necessary for patients to obtain satisfactory pain control after major open abdominal surgery. PMID:26025794

  2. Clinical Efficacy Comparison of Saccharomyces boulardii and Yogurt Fluid in Acute Non-Bloody Diarrhea in Children: A Randomized, Controlled, Open Label Study

    PubMed Central

    Eren, Makbule; Dinleyici, Ener C.; Vandenplas, Yvan

    2010-01-01

    The purpose of this trial is to evaluate the clinical efficacy and cost/effectiveness of Saccharomyces boulardii compared with yogurt fluid (YF) in acute non-bloody diarrhea in children. This randomized, prospective open-label clinical trial includes 55 children (36 boys, 19 girls; mean age 21.2 ± 28.2 months). Group A (N = 28) received lyophilized S. boulardii and group B (N = 27) received YF. The duration of diarrhea was shorter with S. boulardii but the hospital stay was reduced with YF, although these differences were not significant. However, diarrhea had resolved in significantly more children on day 3 in the S. boulardii group (48.5% versus 25.5%; P < 0.05). In outpatient cases, yogurt treatment was cheaper than S. boulardii whereas in hospitalized patients, treatment cost was similar. In conclusion, the effect of daily freshly prepared YF was comparable to S. boulardii in the treatment of acute non-bloody diarrhea in children. The duration of diarrhea was shorter in the S. boulardii group, expressed as a significantly higher number of patients with normal stools on day 3. PMID:20207879

  3. Iatrogenic uterine perforation with abdominal extrusion of fetal parts: A rare radiological diagnosis

    PubMed Central

    Chauhan, Narvir Singh; Gupta, Amit; Soni, Pawan Kumar; Surya, Mukesh; Mahajan, Som Raj

    2013-01-01

    Background Failure to detect uterine perforation during surgical abortion may result in adverse patient outcome besides having medicolegal implications. This rare case of uterine perforation was diagnosed seven days after abortion and underscores the importance of remaining vigilant for this complication during and after the procedure. Case A female underwent surgical abortion at sixteen weeks gestation and was discharged after the procedure, assuming no complication. She presented with abdominal pain seven days after the event. Ultrasound and CT revealed uterine perforation with abdominal expulsion of fetal parts. Conclusion A patient complaining of abdominal pain following recent abortion related instrumentation should alert the clinician regarding possibility of perforation. Secondary signs on ultrasound may reveal the diagnosis even if rent is not identified. CT is valuable in emergent situations. PMID:23372874

  4. Abdominal Radical Trachelectomy

    PubMed Central

    C?pîlna, Mihai Emil; Ioanid, Nicolae; Scripcariu, Viorel; Gavrilescu, Madalina Mihaela; Szabo, Bela

    2014-01-01

    Objective Abdominal radical trachelectomy (ART) is one of the fertility-sparing procedures in women with early-stage cervical cancer. The published results of ART, in comparison with vaginal radical trachelectomy, so far are limited. Materials and Methods This retrospective study comprises all cases of female patients referred to ART with early-stage cervical cancer from 2 gynecologic oncology centers in Romania. Results A total of 29 women were referred for ART, but subsequently, fertility could not be preserved in 3 of them. Eleven women had stage IA2 disease (42.3%), 14 (53.8%) women had stage IB1 disease, and 1 (3.8%) woman had stage IB2 disease. Histologic subtypes were 15 (57.6%) squamous, 8 (30.7%) adenocarcinoma, and 3 (11.5%) adenosquamous. There were no major intraoperative complications in both hospitals. Early postoperative complications were mainly related to the type C parametrectomy—bladder dysfunction for more than 7 days (8 [30.7%] women) and prolonged constipation (6 [23.0%] women). Other complications consisted in symptomatic lymphocele in 2 (7.6%) patients, which were drained. Median follow-up time was 20 months (range, 4–43 months). Up to the present time, there has been 1 (3.8%) recurrence in our series. Most patients did not experience late postoperative complications. Three (11.5%) women are amenorrheic, and 1 (3.8%) woman developed a cervical stenosis. Of the 23 women who have normal menstruation and maintained their fertility, a total of 7 (30.4%) women have attempted pregnancy, and 3 (42.8%) of them achieved pregnancy spontaneously. These pregnancies ended in 2 first trimester miscarriages and 1 live birth at term by cesarean delivery. Conclusions Our results demonstrate that ART preserves fertility and maintains excellent oncological outcomes with low complication rates. PMID:24445820

  5. Fingerprint enhancement revisited and the effects of blood enhancement chemicals on subsequent profiler Plus fluorescent short tandem repeat DNA analysis of fresh and aged bloody fingerprints.

    PubMed

    Frégeau, C J; Germain, O; Fourney, R M

    2000-03-01

    This study was aimed at determining the effect of seven blood enhancement reagents on the subsequent Profiler Plus fluorescent STR DNA analysis of fresh or aged bloody fingerprints deposited on various porous and nonporous surfaces. Amido Black, Crowle's Double Stain. 1,8-diazafluoren-9-one (DFO), Hungarian Red, leucomalachite green, luminol and ninhydrin were tested on linoleum, glass, metal, wood (pine, painted white), clothing (85% polyester/15% cotton, 65% polyester/35% cotton, and blue denim) and paper (Scott 2-ply and Xerox-grade). Preliminary experiments were designed to determine the optimal blood dilutions to use to ensure a DNA typing result following chemical enhancement. A 1:200 blood dilution deposited on linoleum and enhanced with Crowle's Double Stain generated enough DNA for one to two rounds of Profiler Plus PCR amplification. A comparative study of the DNA yields before and after treatment indicated that the quantity of DNA recovered from bloody fingerprints following enhancement was reduced by a factor of 2 to 12. Such a reduction in the DNA yields could potentially compromise DNA typing analysis in the case of small stains. The blood enhancement chemicals selected were also evaluated for their capability to reveal bloodmarks on the various porous and nonporous surfaces chosen in this study. Luminol. Amido Black and Crowle's Double Stain showed the highest sensitivity of all seven chemicals tested and revealed highly diluted (1:200) bloody fingerprints. Both luminol and Amido Black produced excellent results on both porous and nonporous surfaces, but Crowle's Double Stain failed to produce any results on porous substrates. Hungarian Red, DFO, leucomalachite green and ninhydrin showed lower sensitivities. Enhancement of bloodmarks using any of the chemicals selected, and short-term exposure to these same chemicals (i.e., less than 54 days), had no adverse effects on the PCR amplification of the nine STR systems surveyed (D3S 1358, HumvWA, HumFGA, D8S1179, D21S11, D18S51, D5S818, D13S317, D7S820) or of the gender determination marker Amelogenin. The intensity of the fluorescent signals was very similar and the allele size measurements remained constant and identical to those of untreated bloody fingerprints. No additional background fluorescence was noted. Continuous exposure (for 54 days) to two of the seven enhancement chemicals selected (i.e., Crowle's Double Stain and Hungarian Red) slightly reduced the amplification efficiency of the longer STR loci in profiles of fresh and 7 to 14-day-old bloodprints. This suggests that long-term exposure to these chemicals possibly affects the integrity of the DNA molecules. This study indicates that significant evidence can be obtained from fresh or aged bloody fingerprints applied to a variety of absorbent and nonabsorbent surfaces which are exposed to different enhancement chemicals for short or long periods of time. It also reaffirms that PCR STR DNA typing procedures are robust and provide excellent results when used in concert with fluorescence-based detection assays after fingerprint identification has taken place. PMID:10782955

  6. Pain and chronic pancreatitis: A complex interplay of multiple mechanisms

    PubMed Central

    Poulsen, Jakob Lykke; Olesen, Søren Schou; Malver, Lasse Paludan; Frøkjær, Jens Brøndum; Drewes, Asbjørn Mohr

    2013-01-01

    Despite multiple theories on the pathogenesis of pain in chronic pancreatitis, no uniform and consistently successful treatment strategy exists and abdominal pain still remains the dominating symptom for most patients and a major challenge for clinicians. Traditional theories focussed on a mechanical cause of pain related to anatomical changes and evidence of increased ductal and interstitial pressures. These observations form the basis for surgical and endoscopic drainage procedures, but the outcome is variable and often unsatisfactory. This underscores the fact that other factors must contribute to pathogenesis of pain, and has shifted the focus towards a more complex neurobiological understanding of pain generation. Amongst other explanations for pain, experimental and human studies have provided evidence that pain perception at the peripheral level and central pain processing of the nociceptive information is altered in patients with chronic pancreatitis, and resembles that seen in neuropathic and chronic pain disorders. However, pain due to e.g., complications to the disease and adverse effects to treatment must not be overlooked as an additional source of pain. This review outlines the current theories on pain generation in chronic pancreatitis which is crucial in order to understand the complexity and limitations of current therapeutic approaches. Furthermore, it may also serve as an inspiration for further research and development of methods that can evaluate the relative contribution and interplay of different pain mechanisms in the individual patients, before they are subjected to more or less empirical treatment. PMID:24259959

  7. Comparison of Abdominal Muscle Activity in Relation to Knee Angles during Abdominal Drawing-in Exercises Using Pressure Biofeedback

    PubMed Central

    Lee, Jun-Cheol; Lee, Su-Kyoung; Kim, Kyoung

    2013-01-01

    [Purpose] The leg angles that are the most effective for abdominal muscle activation were investigated by performing abdominal drawing-in exercises at different leg angles with a biofeedback pressure unit. [Methods] Subjects were asked to adopt a supine position, and the tip of the biofeedback pressure unit was placed under the posterior superior iliac spine. Then, the pressure was adjusted to 40 mmHg while referring to the pressure gauge connected to the biofeedback pressure unit. Subjects were instructed to increase the pressure by 10 mmHg using the drawing-in technique upon the oral instruction, “Start,” and to maintain the drawn-in state. The time during which the pressure was maintained within an error range of ±1–2mmHg was measured in seconds. [Result] During the abdominal drawing-in exercises, the activity of the rectus abdominis, the internal and external obliques, and the transverse abdominis increased as the knee joint flexion angle increased from 45° to 120°. [Conclusion] When trunk stabilization exercises are performed at the same pressure to reduce damage after the acute phase of low back pain, trunk muscle strength can be efficiently increased by increasing the knee joint angle gradually, while performing abdominal drawing-in exercises with a biofeedback pressure unit. PMID:24259770

  8. Clear Cell Adenocarcinoma Arising from Abdominal Wall Endometriosis

    PubMed Central

    Achach, Thouraya; Rammeh, Soumaya; Trabelsi, Amel; Ltaief, Rached; Ben Abdelkrim, Soumaya; Mokni, Moncef; Korbi, Sadok

    2008-01-01

    Endometriosis is a frequent benign disorder. Malignancy arising in extraovarian endometriosis is a rare event. A 49-year-old woman is presented with a large painful abdominal wall mass. She underwent a myomectomy, 20 years before, for uterus leiomyoma. Computed tomography suggested that this was a desmoid tumor and she underwent surgery. Histological examination showed a clear cell adenocarcinoma associated with endometriosis foci. Pelvic ultrasound, computed tomography, and endometrial curettage did not show any malignancy or endometriosis in the uterus and ovaries. Adjuvant chemotherapy was recommended, but the patient was lost to follow up. Six months later, she returned with a recurrence of the abdominal wall mass. She was given chemotherapy and then she was reoperated. PMID:19266089

  9. Pain sensation in pancreatic diseases is not uniform: The different facets of pancreatic pain

    PubMed Central

    D’Haese, Jan G; Hartel, Mark; Demir, Ihsan Ekin; Hinz, Ulf; Bergmann, Frank; Büchler, Markus W; Friess, Helmut; Ceyhan, Güralp O

    2014-01-01

    AIM: To systematically characterize specific pain patterns in the most frequent pancreatic diseases. METHODS: Pain in patients with chronic pancreatitis (n = 314), pancreatic cancer (n = 469), and other pancreatic tumors (n = 249) including mucinous (n = 20) and serous cystadenoma (n = 31), invasive (n = 37) and non-invasive intraductal papillary mucinous neoplasia (IPMN; n = 48), low stage (n = 18) and high stage neuroendocrine neoplasia (n = 44), and ampullary cancer (n = 51) was registered and correlated with clinicopathological data. Survival times were estimated by the Kaplan-Meier method. Patients alive at the follow-up time were censored. Survival curves were compared statistically using the log-rank test. RESULTS: Forty-nine point one percent of pancreatic cancer patients revealed no pain, whereas in chronic pancreatitis only 18.3% were pain free. In contrary, moderate/severe pain was registered in 15.1% in pancreatic cancer patients that was increased in chronic pancreatitis with up to 34.2%. Serous cystadenoma was asymptomatic in most cases (58.1%), whereas 78.9% of all mucinous cystadenoma patients suffered pain. In neuroendocrine neoplasia pain was not a key clinical symptom since 64% of low stage neuroendocrine neoplasia and 59% of high stage neuroendocrine neoplasia patients were pain free. Cancer localization in the pancreatic body and patients with malignant pancreatic neoplasms were associated with more severe pain. Tumor grading and stage did not show any impact on pain. Only in pancreatic cancer, pain was directly associated with impaired survival. CONCLUSION: Pancreatic pain depicts different patterns of abdominal pain sensation according to the respective pancreatic disorder and does not allow a unification of the term pancreatic pain. PMID:25083089

  10. Chronic pelvic pain in the adolescent.

    PubMed

    Hicks, Caitlin W; Rome, Ellen S

    2012-01-01

    Chronic pelvic pain occurs commonly in the adolescent and can be a diagnostic and therapeutic challenge for the clinician, the adolescent, and her family. Defined as lower quadrant or lower abdominal pain lasting 3-6 months or longer, chronic pelvic pain can lead to missed school and activities, decreased functioning, and decreased quality of life in the adolescent. Both the primary care clinician and the pediatric gynecologist need to be aware of the most common causes of chronic pelvic pain in the adolescent, including surgical and nonsurgical, gynecologic versus other pathology including the psychosomatic, and the role of the mind in control of somatic pain in the adolescent. Adding to this complexity is the standard adolescent sense of invulnerability; a knowledge of adolescent development remains essential to the delivery of appropriate gynecologic care for this age group. Education and communication with both the adolescent and her family requires sensitivity, especially in cultures where adolescent sexuality is taboo or discouraged. This chapter will discuss the developmental stages of adolescence and how that impacts care of the patient with chronic pelvic pain at the varying ages, the issue of confidentiality when obtaining a sexual history on the adolescent, and etiologies of chronic pelvic pain specific to the adolescent, including gynecologic and nongynecologic causes. Diagnostic and treatment considerations for chronic pelvic pain in the adolescent will also be addressed. PMID:22846533

  11. Rupture of an abdominal aortic aneurysm in a patient with a situs inversus totalis: Report of a case

    Microsoft Academic Search

    Naoyuki Kimura; Koji Kawahito; Satoshi Ito

    2008-01-01

    An 80-year-old woman was admitted to our hospital complaining of severe abdominal and back pain. Computed tomography (CT)\\u000a showed an 8.5 × 7.0-cm infrarenal abdominal aortic aneurysm (AAA) with a large contained retroperitoneal hematoma. Known situs\\u000a inversus totalis was reconfirmed by CT. Just after the CT examination, the patient collapsed and was immediately taken to\\u000a the operating room. Her hemodynamics

  12. Pain management.

    PubMed

    Ripamonti, C I

    2012-09-01

    Despite published guidelines and educational programs on the assessment and treatment of cancer-related pain, in any stage of oncological disease, unrelieved pain continues to be a substantial worldwide public health concern either in patients with solid and haematological malignancies. The proper and regular self-reporting assessment of pain is the first step for an effective and individualized treatment. Opioids are the mainstay of analgesic therapy and can be associated with non-opioids drugs such as paracetamol or non-steroidal anti-inflammatory drugs and to adjuvant drugs (for neuropathic pain and symptom control). The role and the utility of weak opioids (i.e. codeine, dihydrocodeine, tramadol) are a controversy point. Morphine has been placed by World Health Organization on its Essential Drug List. In the comparative study with other strong opioids (hydromorphone, oxycodone), there is no evidence to show superiority or inferiority with morphine as the first choice opioid. Oral methadone is a useful and safe alternative to morphine. Methadone presents the potential to control pain difficult to manage with other opioids. although the oral route of opioid administration is considered the one of choice, intravenous, subcutaneous, rectal, transdermal, sublingual, intranasal, and spinal routes must be used in particular situation. Transdermal opioids such as fentanyl and buprenorphine are best reserved for patients whose opioid requirements are stable. Switching from one opioid to another can improve analgesia and tolerability. PMID:22987980

  13. Abdominal muscle training in sport.

    PubMed Central

    Norris, C M

    1993-01-01

    This paper evaluates several abdominal exercises, and highlights factors which are important for their safe prescription and effective use. The function of the abdominal muscles and hip flexors is considered, and the importance of the infra-umbilical portion of the rectus abdominis is emphasized. The effects of flexion on the lumbar spine are outlined. The trunk curl, sit-up, and straight leg raise are analysed, together with modifications of these exercises. The effect of foot fixation and hip flexion during the performance of the sit-up is discussed. The sit-up performed with foot fixation, and the bilateral straight leg raise can compound hip muscle imbalance, and both hyperextend and hyperflex the lumbar spine and are therefore not recommended. The importance of muscular control of pelvic tilt is considered with reference to muscle imbalance around the pelvis. It is recommended that a musculoskeletal assessment should be performed before prescribing abdominal exercises. Exercise therapy to re-educate control of pelvic tilt is described. Intra-abdominal pressure, and the effects of abdominal exercise on this mechanism, and lumbar stabilization are examined. The importance of training specificity is stressed. PMID:8457806

  14. Jejunal diverticulum enterolith causing perforation and upper abdominal peritonitis.

    PubMed

    Hubbard, Thomas James Eliot; Balasubramanian, Rajesh; Smith, Jason J

    2015-01-01

    A patient presented with a 4?h history of acute onset, progressive upper abdominal pain. There was localised peritonitis, with raised inflammatory markers and lactate. CT scan showed a large calcified mass, with evidence of mesenteric twist/volvulus causing some degree of small bowel obstruction. At laparotomy, there were multiple jejunal diverticula, one of which had perforated due to a large enterolith. Resection of the affected jejunum and washout was performed and the patient recovered well. Complications of jejunal diverticula and enteroliths are reported and should be considered in patients with an acute abdomen. PMID:26174728

  15. Considerations in Abdominal Wall Reconstruction

    PubMed Central

    Sacks, Justin M.; Broyles, Justin M.; Baumann, Donald P.

    2012-01-01

    Reconstruction of complex defects of the central abdomen is both challenging and technically demanding for plastic surgeons. Advancements in the use of pedicle and free tissue transfer along with the use of bioprosthetic and synthetic meshes have provided for novel approaches to these complex defects. Accordingly, detailed knowledge of abdominal wall and lower extremity anatomy in combination with insight into the design, implementation, and limitations of various flaps is essential to solve these complex clinical problems. Although these defects can be attributed to a myriad of etiologic factors, the objectives in abdominal wall reconstruction are consistent and include the restoration of abdominal wall integrity, protection of intraabdominal viscera, and the prevention of herniation. In this article, it is our goal to review pertinent anatomy, pre- and postoperative care regimens, and the various local, regional, and distant flaps that can be utilized in the reconstruction of these complex clinical cases of the central abdomen. PMID:23372451

  16. Lap Pak for Abdominal Retraction

    PubMed Central

    Sivarajan, Ganesh; Chang, Sam S; Fergany, Amr; Malkowicz, S. Bruce; Steinberg, Gary D; Lepor, Herbert

    2012-01-01

    Retraction of the bowels during abdominal surgery is generally facilitated by the use of a combination of various retractors along with surgical towels or sponges. The use of surgical towels and sponges may lead to retained foreign bodies or adhesions. In addition, these towels and sponges often require manipulation during long surgical procedures. The ideal way to avoid these problems in abdominal surgery is to develop a technique for retraction of the abdominal contents that eliminates the requirement for these foreign bodies. This article presents the results of a small trial for Lap Pak (Seguro Surgical, Columbia, MD), a disposable radio-opaque device that is made of silicone and retracts the bowels in a cephalad orientation without the need for towels or sponges. PMID:23526186

  17. Transversus abdominis plane block following abdominally based breast reconstruction: study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Breast reconstruction using the free muscle-sparing transversus abdominus myocutaneous or deep inferior epigastric perforator flaps are common methods for restoring mastectomy defects for breast cancer patients. Despite its increasing popularity and safety, the abdominal donor site remains a major source of postoperative pain. Conventional postoperative pain relief protocol consists primarily of a patient-controlled anesthesia device delivering intravenous opioids. Opioids can cause numerous side effects such as sedation, headache, nausea, vomiting, breathing difficulties and bladder and bowel dysfunction. A promising approach to provide postoperative pain control of the abdominal incision is the newly developed transversus abdominis plane peripheral nerve block. Methods/Design This study is a double-blind, placebo-controlled, randomized controlled trial designed to rigorously test the effectiveness of a transversus abdominis plane catheter delivering intermittent local anesthetic in reducing postoperative abdominal pain following abdominal tissue breast reconstruction. The primary objective of this study is compare the mean total opioid consumption in the first postoperative 48 hours between the control and study groups including the patient-controlled anesthesia amounts and oral narcotic doses converted to intravenous morphine equivalent units. The secondary outcome measures include the following parameters: total in-hospital cumulative opioid consumption; daily patient-reported pain scores; total in-hospital cumulative anti-nausea consumption; nausea and sedation scores; and Quality of Recovery score; time to first bowel movement, ambulation, and duration of hospital stay. Discussion Autologous breast reconstruction using abdominal tissue is rapidly becoming the reconstructive option of choice for postmastectomy patients across North America. A substantial component of the pain experienced by patients after this abdominally based procedure is derived from the abdominal wall incision. By potentially decreasing the need for systemic opioids and their associated side effects, this transversus abdominis plane block study will utilize the most scientifically rigorous double-blind, placebo-controlled, randomized controlled trial methodology to potentially improve both clinical care and health outcomes in breast cancer surgery patients. Trial registration Clinicaltrials.gov NCT01398982 PMID:24325953

  18. Pericardiectomy causing abdominal hernia incarceration.

    PubMed

    Rajab, Taufiek Konrad; Maurice, Musoni; Munyana, Jackline; Robinson, Barbara

    2011-12-01

    A 26-year-old Rwandan male presented with constrictive pericarditis, massive ascites and a giant umbilical hernia that had been asymptomatic for over a decade. Successful pericardiectomy was complicated by prompt incarceration of the abdominal hernia. This unexpected complication was caused by rapid resolution of the ascites due to autodiuresis and subsequent collapse of the hernial orifice. Patients with constrictive pericarditis and massive ascites who are evaluated for pericardiectomy should be carefully examined for the presence of abdominal hernias. If any such hernias are found, perioperative hernia repair should be considered and postoperative diuresis should be undertaken under close observation. PMID:21930673

  19. Abdominal imaging in child abuse

    Microsoft Academic Search

    Maria Raissaki; Corinne Veyrac; Eleonore Blondiaux; Christiana Hadjigeorgi

    2011-01-01

    Introduction  Abdominal injuries in abused children are less common than musculoskeletal and craniocerebral injuries; however they carry\\u000a high mortality and morbidity rates. In every case of trauma, regardless of aetiology, radiologists are responsible for the\\u000a documentation and evaluation of injuries.\\u000a \\u000a \\u000a \\u000a \\u000a Injuries  Any abdominal injury pattern maybe observed following physical abuse and none is specific for abuse. However, a high index\\u000a of suspicion

  20. Pain Management Programs

    MedlinePLUS

    ... Pain Management Programs Pain Management Programs Assessment Communication Education Program Outcomes Conclusion Resource Guide to Chronic Pain Medications & Treatments The Art of Pain Management What We Have Learned Going ...

  1. Gabapentin: An Alternative to the Cyclooxygenase2 Inhibitors for Perioperative Pain Management

    Microsoft Academic Search

    CHRISTOPH STEIN

    The cyclooxygenase-2 inhibitor, rofecoxib, was a popu- lar analgesic adjuvant for improving perioperative pain management. We designed this placebo-controlled study to test the hypothesis that gabapentin could pro- duce similar reductions in postoperative pain and opi- oid analgesic usage, thereby improving the recovery process. One hundred patients undergoing abdominal hysterectomy procedures were randomly assigned to one of four treatment groups:

  2. Heel Pain

    MedlinePLUS

    ... pain is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury, or a bruise incurred while walking, running, or jumping on hard surfaces; wearing poorly ...

  3. Chest Pain

    MedlinePLUS

    Having a pain in your chest can be scary. It does not always mean that you are having a heart attack. There can be many other causes, ... embolism Costochondritis - an inflammation of joints in your chest Some of these problems can be serious. Get ...

  4. Clinical Issues in Pain Management Clinical Issues in Pain Management

    E-print Network

    Meagher, Mary

    Pain Clinical Issues in Pain Management #12;Clinical Issues in Pain Management: Acute Pain #12;Clinical Issues in Pain Management: Chronic Pain Chronic Pain Typically begins with an acute in Pain Management: Chronic Pain Chronic benign pain Persists more than 6 months Varies in severity

  5. Duloxetine 60 mg once-daily in the treatment of painful physical symptoms in patients with major depressive disorder

    Microsoft Academic Search

    Stephen K. Brannan; Craig H. Mallinckrodt; Eileen B. Brown; Madelaine M. Wohlreich; John G. Watkin; Alan F. Schatzberg

    2005-01-01

    Background: While emotional symptoms such as depressed mood and loss of interest have traditionally been considered to constitute the core symptoms of major depressive disorder (MDD), the prevalence and importance of painful physical symptoms such as back pain, abdominal pain, and musculoskeletal pain is becoming increasingly appreciated. Antidepressants possessing dual serotonin\\/norepinephrine (5-HT\\/NE) reuptake inhibition may demonstrate greater efficacy in the

  6. Abdominal obesity and metabolic syndrome

    Microsoft Academic Search

    Jean-Pierre Després; Isabelle Lemieux

    2006-01-01

    Metabolic syndrome is associated with abdominal obesity, blood lipid disorders, inflammation, insulin resistance or full-blown diabetes, and increased risk of developing cardiovascular disease. Proposed criteria for identifying patients with metabolic syndrome have contributed greatly to preventive medicine, but the value of metabolic syndrome as a scientific concept remains controversial. The presence of metabolic syndrome alone cannot predict global cardiovascular disease

  7. Abdominal pregnancy: Methods of hemorrhage control

    PubMed Central

    Kunwar, Shipra; Khan, Tamkin; Srivastava, Kumkumrani

    2015-01-01

    Summary Abdominal pregnancy is an extremely rare form of ectopic pregnancy, mostly occurring secondarily after tubal rupture or abortion with secondary implantation anywhere in the peritoneal cavity. Massive intra-abdominal hemorrhage is a life threatening complication associated with secondary abdominal pregnancy. Various methods and techniques have been reported in the literature for controlling hemorrhage. Here, we report a case of massive intraperitoneal haemorrhage following placental removal controlled by abdominal packing and review the literature for diagnostic and management challenges. PMID:25984430

  8. Efficacy of postoperative continuous wound infiltration with local anesthetic after major abdominal surgery.

    PubMed

    Abadir, Adel R; Nicolas, Fred; Gharabawy, Ramiz; Shah, Trusha; Michael, Rafik

    2009-01-01

    The aim of this study was to evaluate the analgesic efficacy, safety, opioid sparing effects and improvement of respiratory function when using 0.2% ropivacaine continuous wound infiltration after major intra-abdominal surgery. Forty patients undergoing major intra-abdominal surgery requiring a midline incision of > or = 20 cm were enrolled into this IRB-approved, randomized, prospective controlled study. Group 1: 20 patients, parenteral analgesia (control group). Group II: 20 patients, with local anesthetic wound infiltration (pain pump group). At the end of the procedure, in the pain pump group of patients, a multi hole, 20-gauge catheter was inserted percutaneously, above the fascia. An initial dose of 10 ml of 0.2% ropivacaine was injected in the wound through the catheter. A device provided continuous delivery of 0.2% ropivacaine; the infusion was initiated at 6 ml/h for the following two days. The total "rescue" morphine and oxycodone/acetaminophen tablets administered were significantly lower in the pain pump group. At all time intervals, resting pain scores were significantly lower in the pain pump group when compared with the control group. However, at the 4-48 and 12-48 hours pain scores generated after leg raise and coughing, respectively, were significantly lower in group II. The patient vital capacities were insignificantly higher in group II. We conclude that after major abdominal surgery, infiltration and continuous wound instillation with 0.2% ropivacaine decreases postoperative pain, opioid requirements and oral analgesia. Early patient rehabilitation, hastening convalescence, and preventing respiratory complications are expected outcomes of this approach. PMID:22128418

  9. Vaginal mesh erosion after abdominal sacral colpopexy

    Microsoft Academic Search

    Anthony G. Visco; Alison C. Weidner; Matthew D. Barber; Evan R. Myers; Geoffrey W. Cundiff; Richard C. Bump; W. Allen Addison

    2001-01-01

    Objective: Our goal was to compare the prevalence of vaginal mesh erosion between abdominal sacral colpopexy and various sacral colpoperineopexy procedures. Study Design: We undertook a retrospective analysis of all sacral colpopexies and colpoperineopexies performed between March 1, 1992, and February 28, 1999. The patients were divided into the following 4 groups: abdominal sacral colpopexy, abdominal sacral colpoperineopexy, and 2

  10. Referred pain.

    PubMed

    Markman, Stanley

    2014-01-01

    Comprehending orofacial referred pain requires an understanding of the neuroanatomy of the trigeminal nerve and associated cranial nerves. It also requires knowledge of the concept of neuronal convergence as well as the recognition that the caudalis is laminated and is therefore responsible for sensory receptive fields-that one interneuron may receive multiple sensory inputs and that structures within a lamina have sensory neurons which project into the caudalis and may share the same interneuron. PMID:25141487

  11. Interventional treatment of refractory cancer pain.

    PubMed

    Birthi, Pravardhan; Sloan, Paul

    2013-01-01

    Recent advances in medical science have prolonged the life expectancy for many cancer patients. However, many studies demonstrate that cancer pain is a symptom for two thirds of patients in the advanced stages of the disease and nearly universal in the last 48 hours of life. Whereas most cancer patients can be effectively treated with conventional analgesics, 10% to 15% of patients require additional, and sometimes invasive, therapy. The most commonly used procedures for the treatment of this refractory cancer pain is the topic of review in this paper. Neurolytic blocks, such as celiac plexus and ganglion of impar block, are still used in the management of pain related to abdominal and pelvic cancers. Nondestructive interventional techniques include the use of epidural and intrathecal spinal analgesics. The efficacy, recommended medications, and adverse effect profile of these therapies are reviewed. PMID:24051611

  12. Abdominal Compartment Syndrome: pathophysiology and definitions

    PubMed Central

    Cheatham, Michael L

    2009-01-01

    "Intra-abdominal hypertension", the presence of elevated intra-abdominal pressure, and "abdominal compartment syndrome", the development of pressure-induced organ-dysfunction and failure, have been increasingly recognized over the past decade as causes of significant morbidity and mortality among critically ill surgical and medical patients. Elevated intra-abdominal pressure can cause significant impairment of cardiac, pulmonary, renal, gastrointestinal, hepatic, and central nervous system function. The significant prognostic value of elevated intra-abdominal pressure has prompted many intensive care units to adopt measurement of this physiologic parameter as a routine vital sign in patients at risk. A thorough understanding of the pathophysiologic implications of elevated intra-abdominal pressure is fundamental to 1) recognizing the presence of intra-abdominal hypertension and abdominal compartment syndrome, 2) effectively resuscitating patients afflicted by these potentially life-threatening diseases, and 3) preventing the development of intra-abdominal pressure-induced end-organ dysfunction and failure. The currently accepted consensus definitions surrounding the diagnosis and treatment of intra-abdominal hypertension and abdominal compartment syndrome are presented. PMID:19254364

  13. Constitutive modelling of abdominal organs.

    PubMed

    Miller, K

    2000-03-01

    Abdominal organs are very susceptible to trauma. In order to protect them properly against car crash and other impact consequences, we need to be able to simulate the abdominal organ deformation. Such simulation should account for proper stress-strain relation as well as stress dependence on strain rate. As the step in this direction, this paper presents three-dimensional, non-linear, viscoelastic constitutive models for liver and kidney tissue. The models have been constructed basing on in vivo experiments conducted in Highway Safety Research Institute and the Medical Centre of The University of Michigan (Melvin et al., 1973). The proposed models are valid for compressive nominal strains up to 35% and fast (impact) strain rates between 0.2 and 22.5 s(-1). Similar models can find applications in computer and robot assisted surgery, e.g. the realistic simulation of surgical procedures (including virtual reality) and non-rigid registration. PMID:10673121

  14. Abdominal MR: liver and pancreas

    Microsoft Academic Search

    C. Bartolozzi; R. Lencioni; F. Donati; D. Cioni

    1999-01-01

    .   Following the introduction of rapid, high-quality scan techniques and the development of new, tissue-specific contrast agents,\\u000a the applications of MRI for abdominal imaging are experiencing unprecedented growth. This article examines the current status\\u000a of liver and pancreatic MRI, highlighting technical and methodological approach, use of contrast agents, and main clinical\\u000a applications. The MRI technique appears to be the ideal

  15. Laparoscopy in penetrating abdominal trauma.

    PubMed

    Uranues, Selman; Popa, Dorin Eugen; Diaconescu, Bogdan; Schrittwieser, Rudolph

    2015-06-01

    If morbidity and mortality are to be reduced in patients with penetrating abdominal trauma, first priority goes to prompt and accurate determination of peritoneal penetration and identification of the need for surgery. In this setting, laparoscopy may have an important impact on the rate of negative or non-therapeutic laparotomies. We analyzed indications and patient selection criteria for laparoscopy in penetrating trauma along with outcomes. The analysis focused on identification of peritoneal penetration and injuries to the diaphragm, small intestine, and mesentery. Results from the early phase of laparoscopy were compared with those from recent decades with more advanced laparoscopic equipment and instruments and more experienced surgeons. A systematic review of the role of laparoscopy in penetrating abdominal trauma shows a sensitivity ranging from 66.7 to 100 %, specificity from 33.3 to 100 % and accuracy from 50 to 100 %. Publications from the 1990s found trauma laparoscopy to be inadequate for detecting intestinal injuries and so to lead to missed injuries. Twenty-three of the 50 studies including the most recent ones report sensitivity, specificity, and accuracy of 100 %. Laparoscopy is more cost effective than negative laparotomy. Laparoscopy can be performed safely and effectively on stable patients with penetrating abdominal trauma. The most important advantages are reduction of morbidity, accuracy in detecting diaphragmatic and intestinal injuries, and elimination of prolonged hospitalization for observation, so reducing the length of stay and increasing cost effectiveness. PMID:25446491

  16. Abdominal symptoms among sewage workers.

    PubMed

    Friis, L; Agréus, L; Edling, C

    1998-05-01

    The objective of this cross-sectional study was to investigate the prevalence of abdominal symptoms and the abdominal medical history among sewage workers. 142 male sewage workers and 137 male referents in 11 Swedish municipalities were addressed with a questionnaire about abdominal symptoms, medical history, occupational history and life style factors. The sewage workers suffered less from nausea [adjusted odds ratio (adjOR) = 0.18, 95% confidence interval (Cl) 0.04-0.84] than the referents. There was no significant difference in the three months prevalence of diarrhoea (adjOR = 1.7, 95% Cl = 0.79-3.4), dyspepsia (adjOR = 0.85, 95% Cl = 0.49-1.5) or irritable bowel syndrome (adjOR = 1.4, 95% Cl = 0.53-3.5). The sewage workers were affected more often by peptic ulcers during their present jobs than the referents, although the increased risk was not significant (adjOR = 1.4, 95% Cl = 0.31-6.1). The odds ratios were adjusted for age, use of tobacco products and alcohol consumption. The conclusion of this study was that sewage workers are less affected by nausea than comparable referents. PMID:9800423

  17. Neuroanatomy of lower gastrointestinal pain disorders

    PubMed Central

    Vermeulen, Wim; De Man, Joris G; Pelckmans, Paul A; De Winter, Benedicte Y

    2014-01-01

    Chronic abdominal pain accompanying intestinal inflammation emerges from the hyperresponsiveness of neuronal, immune and endocrine signaling pathways within the intestines, the peripheral and the central nervous system. In this article we review how the sensory nerve information from the healthy and the hypersensitive bowel is encoded and conveyed to the brain. The gut milieu is continuously monitored by intrinsic enteric afferents, and an extrinsic nervous network comprising vagal, pelvic and splanchnic afferents. The extrinsic afferents convey gut stimuli to second order neurons within the superficial spinal cord layers. These neurons cross the white commissure and ascend in the anterolateral quadrant and in the ipsilateral dorsal column of the dorsal horn to higher brain centers, mostly subserving regulatory functions. Within the supraspinal regions and the brainstem, pathways descend to modulate the sensory input. Because of this multiple level control, only a small proportion of gut signals actually reaches the level of consciousness to induce sensation or pain. In inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) patients, however, long-term neuroplastic changes have occurred in the brain-gut axis which results in chronic abdominal pain. This sensitization may be driven on the one hand by peripheral mechanisms within the intestinal wall which encompasses an interplay between immunocytes, enterochromaffin cells, resident macrophages, neurons and smooth muscles. On the other hand, neuronal synaptic changes along with increased neurotransmitter release in the spinal cord and brain leads to a state of central wind-up. Also life factors such as but not limited to inflammation and stress contribute to hypersensitivity. All together, the degree to which each of these mechanisms contribute to hypersensitivity in IBD and IBS might be disease- and even patient-dependent. Mapping of sensitization throughout animal and human studies may significantly improve our understanding of sensitization in IBD and IBS. On the long run, this knowledge can be put forward in potential therapeutic targets for abdominal pain in these conditions. PMID:24574773

  18. Postoperative pain control.

    PubMed

    Lovich-Sapola, Jessica; Smith, Charles E; Brandt, Christopher P

    2015-04-01

    Prevention and control of postoperative pain are essential. Inadequate treatment of postoperative pain continues to be a major problem after many surgeries and leads to worse outcomes, including chronic postsurgical pain. Optimal management of postoperative pain requires an understanding of the pathophysiology of pain, methods available to reduce pain, invasiveness of the procedure, and patient factors associated with increased pain, such as anxiety, depression, catastrophizing, and neuroticism. Use of a procedure-specific, multimodal perioperative pain management provides a rational basis for enhanced postoperative pain control, optimization of analgesia, decrease in adverse effects, and improved patient satisfaction. PMID:25814108

  19. A Case of Pulmonary Paragonimiasis with Involvement of the Abdominal Muscle in a 9-Year-Old Girl

    PubMed Central

    Cho, Ah-Rum; Lee, Hae-Ran; Lee, Kwan-Sub; Lee, Sang-Eun

    2011-01-01

    In Korea, many people enjoy eating raw or underkooked freshwater crayfish and crabs which unfortunately may cause paragonimiasis. Here, we describe a case of pulmonary and abdominal paragonimiasis in a 9-year-old girl, who presented with a 1-month history of abdominal pain, especially in the right flank and the right inguinal area, with anorexia. A chest radiograph revealed pleural effusion in both lungs, and her abdominal sonography indicated an inflammatory lesion in the right psoas muscle. Peripheral blood analysis of the patient showed hypereosinophilia (66.0%) and an elevated total serum IgE level (>2,500 IU/ml). The pleural effusion tested by ELISA were also positive for antibodies against paragonimiasis. Her dietary history stated that she had ingested raw freshwater crab, 4 months previously. The diagnosis was pulmonary paragonimiasis accompanied by abdominal muscle involvement. She was improved after 5 cycles of praziquantel treatment and 2 times of pleural effusion drainage. In conclusion, herein, we report a case of pulmonary and abdominal paragonimiasis in a girl who presented with abdominal pain and tenderness in the inguinal area. PMID:22355209

  20. Inherited Pain

    PubMed Central

    Eberhardt, Mirjam; Nakajima, Julika; Klinger, Alexandra B.; Neacsu, Cristian; Hühne, Kathrin; O'Reilly, Andrias O.; Kist, Andreas M.; Lampe, Anne K.; Fischer, Kerstin; Gibson, Jane; Nau, Carla; Winterpacht, Andreas; Lampert, Angelika

    2014-01-01

    Inherited erythromelalgia (IEM) causes debilitating episodic neuropathic pain characterized by burning in the extremities. Inherited “paroxysmal extreme pain disorder” (PEPD) differs in its clinical picture and affects proximal body areas like the rectal, ocular, or jaw regions. Both pain syndromes have been linked to mutations in the voltage-gated sodium channel Nav1.7. Electrophysiological characterization shows that IEM-causing mutations generally enhance activation, whereas mutations leading to PEPD alter fast inactivation. Previously, an A1632E mutation of a patient with overlapping symptoms of IEM and PEPD was reported (Estacion, M., Dib-Hajj, S. D., Benke, P. J., Te Morsche, R. H., Eastman, E. M., Macala, L. J., Drenth, J. P., and Waxman, S. G. (2008) NaV1.7 Gain-of-function mutations as a continuum. A1632E displays physiological changes associated with erythromelalgia and paroxysmal extreme pain disorder mutations and produces symptoms of both disorders. J. Neurosci. 28, 11079–11088), displaying a shift of both activation and fast inactivation. Here, we characterize a new mutation of Nav1.7, A1632T, found in a patient suffering from IEM. Although transfection of A1632T in sensory neurons resulted in hyperexcitability and spontaneous firing of dorsal root ganglia (DRG) neurons, whole-cell patch clamp of transfected HEK cells revealed that Nav1.7 activation was unaltered by the A1632T mutation but that steady-state fast inactivation was shifted to more depolarized potentials. This is a characteristic normally attributed to PEPD-causing mutations. In contrast to the IEM/PEPD crossover mutation A1632E, A1632T failed to slow current decay (i.e. open-state inactivation) and did not increase resurgent currents, which have been suggested to contribute to high-frequency firing in physiological and pathological conditions. Reduced fast inactivation without increased resurgent currents induces symptoms of IEM, not PEPD, in the new Nav1.7 mutation, A1632T. Therefore, persistent and resurgent currents are likely to determine whether a mutation in Nav1.7 leads to IEM or PEPD. PMID:24311784

  1. Phantom Pain 

    E-print Network

    Valentine, A.

    as he tried to get me out from under the truck. I remember the anguish on his face when he saw that nothing was 195 "Phantom Pain" working. The wind and rain were lashing both of our faces and the water was getting higher and higher. The cell... phones wouldn't work and the wreck had totaled the truck's radio. Something was burning ... I'm not sure what... It made a surreal light around the place but all I remember was wondering how it could keep burning in ali that rain and wind and water...

  2. Descending pain modulation and chronification of pain

    PubMed Central

    Ossipov, Michael H.; Morimura, Kozo; Porreca, Frank

    2015-01-01

    Purpose of review Chronic pain is an important public health problem that negatively impacts quality of life of affected individuals and exacts an enormous socio-economic cost. Currently available therapeutics provide inadequate management of pain in many patients. Acute pain states generally resolve in most patients. However, for reasons that are poorly understood, in some individuals, acute pain can transform to a chronic state. Our understanding of the risk factors that underlie the development of chronic pain is limited. Recent studies have suggested an important contribution of dysfunction in descending pain modulatory circuits to pain ‘chronification’. Human studies provide insights into possible endogenous and exogenous factors that may promote the conversion of pain into a chronic condition. Recent findings Descending pain modulatory systems have been studied and characterized in animal models. Human brain imaging techniques, deep brain stimulation and the mechanisms of action of drugs that are effective in the treatment of pain confirm the clinical relevance of top-down pain modulatory circuits. Growing evidence supports the concept that chronic pain is associated with a dysregulation in descending pain modulation. Disruption of the balance of descending modulatory circuits to favour facilitation may promote and maintain chronic pain. Recent findings suggest that diminished descending inhibition is likely to be an important element in determining whether pain may become chronic. This view is consistent with the clinical success of drugs that enhance spinal noradrenergic activity, such as serotonin/norepinephrine reuptake inhibitors (SNRIs), in the treatment of chronic pain states. Consistent with this concept, a robust descending inhibitory system may be normally engaged to protect against the development of chronic pain. Imaging studies show that higher cortical and subcortical centres that govern emotional, motivational and cognitive processes communicate directly with descending pain modulatory circuits providing a mechanistic basis to explain how exogenous factors can influence the expression of chronic pain in a susceptible individual. Summary Preclinical studies coupled with clinical pharmacologic and neuroimaging investigations have advanced our understanding of brain circuits that modulate pain. Descending pain facilitatory and inhibitory circuits arising ultimately in the brainstem provide mechanisms that can be engaged to promote or protect against pain ‘chronification’. These systems interact with higher centres, thus providing a means through which exogenous factors can influence the risk of pain chronification. A greater understanding of the role of descending pain modulation can lead to novel therapeutic directions aimed at normalizing aberrant processes that can lead to chronic pain. PMID:24752199

  3. When Sex Is Painful

    MedlinePLUS

    How common is painful sex? Pain during intercourse is very common—nearly 3 out of 4 women have pain during intercourse at some time during ... a long-term problem. What causes pain during sex? Pain during sex may be a sign of ...

  4. Gabapentin in Pain Management

    Microsoft Academic Search

    Jianren Mao; Lucy L. Chen

    2000-01-01

    role of gabapentin in pain treatment will be discussed with an attempt to identify pain symptoms that are likely to be responsive to gabapentin; 2) animal stud- ies of gabapentin on neuropathic pain and other pain behaviors will be evaluated; and 3) possible mecha- nisms of gabapentin actions will be considered in re- lation to mechanisms of neuropathic pain in

  5. Musculoskeletal pain, fear avoidance behaviors, and functional decline in obesity: potential interventions to manage pain and maintain function.

    PubMed

    Vincent, Heather K; Adams, Meredith C B; Vincent, Kevin R; Hurley, Robert W

    2013-01-01

    Individuals with musculoskeletal pain exhibit abnormal movement patterns, including antalgic gait, postural dysfunction, increased thoracolumbar stiffness, decreased proprioception, and altered activation of abdominal and extensor muscles. Additionally, aberrant or increased biomechanical forces over time produce joint or structural damage that results in pain. A large body habitus resulting from excessive weight can accelerate these musculoskeletal complaints. Irrespective of age, obesity contributes to chronic musculoskeletal pain, impairment of mobility, and eventual physical disability. Potential mechanisms that may mediate the relationships between obesity-related pain and functional decline include skeletal muscle strength deterioration, systemic inflammation, and psychosocial characteristics (eg, pain catastrophizing, kinesiophobia, and depression). Treatment considerations for obese patients with musculoskeletal pain include assessment of kinesiophobia levels, biomechanical analysis, and pain medication use. Ideally, a multidisciplinary team of physicians, psychologists, and physical therapists should optimize the design of interventions specific to the patient. In some cases, the use of appropriate pain medications or intra-articular injectable agents may help control pain, fostering sustained activity, caloric expenditure, and weight loss. Morbid obesity is a medical condition that alters biomechanical forces on the tissues of the body. This condition provides the opportunity to examine accelerated development of musculoskeletal pain syndromes and etiology. The proposed therapeutic interventions can have multiple benefits in the obese population including weight loss, improved psychological outlook and self-efficacy, reduced kinesiophobia levels, reduced risk of functional dependence, and improved quality of life. PMID:24141874

  6. What Is Chronic Pain?

    MedlinePLUS Videos and Cool Tools

    ... Pain Management Programs Videos Resources Glossary FAQs Surveys September is Pain Awareness Month Partners for Understanding Pain ... range of individual contributors. Last Updated: 6/26/2015 We comply with the HONcode standard for trustworthy ...

  7. Pain medications - narcotics

    MedlinePLUS

    Narcotics (also called opioid pain relievers) are used only for pain that is severe and is not ... these drugs can be effective at reducing pain. Narcotics work by binding to receptors in the brain, ...

  8. American Chronic Pain Association

    MedlinePLUS

    ... to Chronic Pain Medications & Treatments The Art of Pain Management What We Have Learned Going to the ER Communication Tools Pain Management Programs Videos Resources Glossary FAQs Surveys September is ...

  9. Palliative care - managing pain

    MedlinePLUS

    End of life - pain management; Hospice - pain management ... or if you have side effects from your pain treatments. ... Bookbinder M, McHugh ME. Symptom management in palliative care and ... Medicine . 1st ed. Philadelphia, PA: Elsevier Saunders; 2008:chap ...

  10. Chronic Pelvic Pain

    MedlinePLUS

    ... in relieving pelvic pain, especially dysmenorrhea . • Physical therapy—Acupuncture, acupressure, and nerve stimulation therapies may be useful in treating pain caused by dysmenorrhea. Physical therapy that eases trigger points may give relief of muscular pain. Some types ...

  11. What Is Back Pain?

    MedlinePLUS

    ... some types of treatments for chronic back pain. Hot or Cold Packs (or Both) Hot or cold packs can soothe sore, stiff backs. ... helps reduce swelling and numbs deep pain. Using hot or cold packs may relieve pain, but this ...

  12. Endometriosis of abdominal and pelvic wall scars: multimodality imaging findings, pathologic correlation, and radiologic mimics.

    PubMed

    Gidwaney, Rita; Badler, Ruth L; Yam, Benjamin L; Hines, John J; Alexeeva, Vlada; Donovan, Virginia; Katz, Douglas S

    2012-01-01

    Implantation of an endometriotic lesion within a pelvic or abdominal wall scar is an uncommon but well-described condition that may be the underlying cause of acute or chronic recurrent abdominal or pelvic pain, especially after cesarean section. Radiologists may not consider scar endometriosis when it is encountered at cross-sectional imaging. Cesarean section scars are the most common site of extraovarian or extrauterine endometriosis. The condition also has been identified in other uterine surgery-related scars and in the skin, subcutaneous tissues, and abdominal and pelvic wall musculature adjacent to these scars. The most plausible cause of scar endometriosis is implantation of endometrial stem cells at the surgical site at the time of uterine surgery. Patients with scar endometriosis may be asymptomatic or present with cyclical pain corresponding to the menstrual cycle. Cross-sectional imaging findings vary from the nonspecific to those suggestive of the diagnosis when combined with clinical history. In particular, the presence of blood products in an anterior abdominal wall mass at magnetic resonance (MR) imaging with no other explanation is strongly suggestive of scar endometriosis. Ultrasonography, computed tomography, and MR imaging may be used to depict an endometriotic lesion, exclude endometriosis, or provide evidence for an alternative diagnosis. PMID:23150856

  13. Pain and Alzheimer's disease.

    PubMed

    Pickering, G; Eschalier, A; Dubray, C

    2000-01-01

    Literature on pain management in Alzheimer's disease is slowly emerging and this review deals with different aspects of pain in this growing population. Clinical pain, experimental pain and assessment of pain in cognitively impaired patients are presented. Treatment of pain is also discussed. This review calls for more studies and clinical trials with a view to improve the comfort and quality of life of patients suffering from Alzheimer's disease. PMID:10965178

  14. High post surgical opioid requirements in Crohn’s disease are not due to a general change in pain sensitivity

    Microsoft Academic Search

    Kathrin Huehne; Stefan Leis; Tino Muenster; Andreas Wehrfritz; Stefanie Winter; Christian Maihöfner; Thomas Foertsch; Roland Croner; André Reis; Andreas Winterpacht; Bernd Rautenstrauss

    2009-01-01

    Crohn’s disease (CD) is a painful inflammatory bowel disease with complex multigenic inheritance. Suggested on the basis of a few isolated reports CD patients require significantly higher post operative opioid doses than patients undergoing comparable severe abdominal surgery. Crohn’s disease therefore may be a suitable model for the identification of novel pain susceptibility genes. In order to confirm this observation

  15. A focus on intra-abdominal infections

    Microsoft Academic Search

    Massimo Sartelli

    2010-01-01

    Complicated intra-abdominal infections are an important cause of morbidity and are frequently associated with poor prognosis, particularly in higher risk patients. Well defined evidence-based recommendations for intra-abdominal infections treatment are partially lacking because of the limited number of randomized-controlled trials. Factors consistently associated with poor outcomes in patients with intra-abdominal infections include increased illness severity, failed source control, inadequate empiric

  16. Abdominal Aortic Aneurysm Complicated by Intestinal Malrotation

    PubMed Central

    Okazaki, Jin; Ishida, Masaru; Kodama, Akio; Mii, Shinsuke

    2015-01-01

    Intestinal malrotation (IM) is an anomaly of fetal intestinal rotation that usually presents in the first month of life; it is rare for malrotaion to present in adulthood. Furthermore, the presentation of IM in conjunction with Abdominal aortic aneurysm is extremely rare and may require consideration with respect to the surgical approach and exposure of the abdominal aorta. We herein report a case of an abdominal aortic aneurysm complicated by intestinal malrotation. PMID:25848429

  17. [Dirofilaria in the abdominal cavity].

    PubMed

    Révész, Erzsébet; Markovics, Gabriella; Darabos, Zoltán; Tóth, Ildikó; Fok, Eva

    2008-10-01

    Number of cases of filariasis have been recently reported in the Hungarian medical literature, most of them caused by Dirofilaria repens . Dirofilaria repens is a mosquito-transmitted filarioid worm in the subcutaneous tissue of dogs and cats. Human infection manifests as either subcutaneous nodules or lung parenchymal disease, which may even be asymptomatic. The authors report a human Dirofilaria repens infection of the abdominal cavity in a 61-year-old man,who underwent laparotomy for acute abdomen. Intraoperatively, local peritonitis was detected caused by a white nemathhelminth, measured 8 cm in size. Histocytology confirmed that the infection was caused by Dirofilaria repens. PMID:19028661

  18. BIOMECHANICS OF ABDOMINAL AORTIC ANEURYSM

    PubMed Central

    Vorp, David A.

    2009-01-01

    Abdominal aortic aneurysm (AAA) is a condition whereby the terminal aorta permanently dilates to dangerous proportions, risking rupture. The biomechanics of AAA has been studied with great interest since aneurysm rupture is a mechanical failure of the degenerated aortic wall and is a significant cause of death in developed countries. In this review article, the importance of considering the biomechanics of AAA is discussed, and then the history and the state-of-the-art of this field is reviewed - including investigations into the biomechanical behavior of AAA tissues, modeling AAA wall stress and factors which influence it, and the potential clinical utility of these estimates in predicting AAA rupture. PMID:17254589

  19. Endovascular abdominal aortic aneurysm repair

    PubMed Central

    Norwood, M G A; Lloyd, G M; Bown, M J; Fishwick, G; London, N J; Sayers, R D

    2007-01-01

    The operative mortality following conventional abdominal aortic aneurysm (AAA) repair has not fallen significantly over the past two decades. Since its inception in 1991, endovascular aneurysm repair (EVAR) has provided an alternative to open AAA repair and perhaps an opportunity to improve operative mortality. Two recent large randomised trials have demonstrated the short and medium term benefit of EVAR over open AAA repair, although data on the long term efficacy of the technique are still lacking. This review aimed at providing an overview of EVAR and a discussion of the potential benefits and current limitations of the technique. PMID:17267674

  20. Abdominal Wall Abscess due to Acute Perforated Sigmoid Diverticulitis: A Case Report with MDCT and US Findings

    PubMed Central

    Vasileios, Rafailidis; Anna, Gavriilidou; Christos, Liouliakis; Asimina, Tsimitri; Sofia, Paschaloudi; Vasiliki, Karadimou

    2013-01-01

    Perforation of the inflamed diverticula is a common diverticulitis complication. It usually leads to the formation of a local abscess. In some rare cases, the inflammatory process may spread towards extra-abdominal sites like the anterior or posterior abdominal wall or the thigh and form an abscess in these sites. We present the case of a 73-year-old man with a history of pain at the lower left quadrant of the abdomen for 20 days and a visible mass in this site. Ultrasonography and computed tomography revealed this mass to be an abscess of the abdominal wall which had been formed by the spread of ruptured sigmoid diverticulitis by continuity of tissue through the lower left abdominal wall. Local drainage of the abscess was performed and the patient was discharged after alleviation of symptoms and an uneventful course. We also discuss causes of abdominal wall abscesses along with the possible pathways by which an intra-abdominal abscess could spread outside the abdominal cavity. PMID:24386584

  1. Abdominal Wall Abscess due to Acute Perforated Sigmoid Diverticulitis: A Case Report with MDCT and US Findings.

    PubMed

    Rafailidis, Vasileios; Vasileios, Rafailidis; Gavriilidou, Anna; Anna, Gavriilidou; Liouliakis, Christos; Christos, Liouliakis; Tsimitri, Asimina; Asimina, Tsimitri; Paschaloudi, Sofia; Sofia, Paschaloudi; Karadimou, Vasiliki; Vasiliki, Karadimou

    2013-01-01

    Perforation of the inflamed diverticula is a common diverticulitis complication. It usually leads to the formation of a local abscess. In some rare cases, the inflammatory process may spread towards extra-abdominal sites like the anterior or posterior abdominal wall or the thigh and form an abscess in these sites. We present the case of a 73-year-old man with a history of pain at the lower left quadrant of the abdomen for 20 days and a visible mass in this site. Ultrasonography and computed tomography revealed this mass to be an abscess of the abdominal wall which had been formed by the spread of ruptured sigmoid diverticulitis by continuity of tissue through the lower left abdominal wall. Local drainage of the abscess was performed and the patient was discharged after alleviation of symptoms and an uneventful course. We also discuss causes of abdominal wall abscesses along with the possible pathways by which an intra-abdominal abscess could spread outside the abdominal cavity. PMID:24386584

  2. Abdominal atlas mapping in CT and MR volume images using a normalized abdominal coordinate system

    Microsoft Academic Search

    Hongkai Wang; Jing Bai; Yongxin Zhou; Yonghong Zhang

    2008-01-01

    In this paper, a normalized abdominal coordinate system is defined for abdominal atlas mapping in CT and MR volume images. This coordinate system is independent of both the abdomen size and the respiratory motion. A real-time atlas mapping algorithm based on this coordinate system is also proposed. The purpose of this algorithm is to provide initial positions for abdominal organ

  3. Temporary abdominal closure followed by definitive abdominal wall reconstruction of the open abdomen

    Microsoft Academic Search

    Thomas R. Howdieshell; Charles D. Proctor; Erez Sternberg; Jorge I. Cué; J. Sheppard Mondy; Michael L. Hawkins

    2004-01-01

    BackgroundInability to close the abdominal wall after laparotomy for trauma may occur as a result of visceral edema, retroperitoneal hematoma, use of packing, and traumatic loss of tissue. Often life-saving, decompressive laparotomy and temporary abdominal closure require later restoration of anatomic continuity of the abdominal wall.

  4. Pain from a Bullet Lingers on: An Uncommon Case of Lead Toxicity

    PubMed Central

    Abraham, Albin; Singh, Jaspreet; Mustacchia, Paul; Rizvon, Kaleem

    2012-01-01

    Lead toxicity from a retained bullet as a cause for abdominal pain is rarely considered. Given its unpredictable latent period and nonspecific clinical symptoms, such cases are difficult to diagnose but may be fatal if unrecognized. We present the case of a 48-year-old man who presented with complaints of abdominal pain, weight loss and constipation. His past history was significant for a gunshot wound to the left hip about 20 years before. Radiographic studies confirmed the same with the presence of numerous intra-articular bullet fragments and a calcified hemarthrosis surrounding the left femoral head. Blood lead levels were elevated following which the patient was started on chelation therapy with succimer which resulted in symptomatic improvement. The aim of this paper is to highlight the importance of considering lead toxicity from a retained bullet as a cause of abdominal pain and to review the relevant literature. PMID:22679412

  5. Abdominal migraine reviewed from both central and peripheral aspects

    PubMed Central

    Kakisaka, Yosuke; Uematsu, Mitsugu; Wang, Zhong I; Haginoya, Kazuhiro

    2012-01-01

    Despite the 2%-5% prevalence of abdominal migraine (AM) during childhood, the precise mechanism remains unknown. In this review, we present recent studies on AM and speculate its mechanism from both peripheral and central nervous system aspects. Although the main symptoms of AM exist at the peripheral level, previous studies have reported possible dysfunction of central nervous system, including photophobia, phonophobia and abnormal visual evoked responses. Recently, a case has been reported with AM combined with “Alice in Wonderland” syndrome with visual and/or bodily distortions, which serves as another piece of evidence of central dysfunction. Another case reported an AM patient having peculiar stereotypical ecchymosis in the legs and buttocks associated with pain attack, which implied possible involvement of peripheral nervous system. Although further investigations and accumulation of AM cases are still needed, we believe that the schema hypothesized here is helpful to plan further experimental approach to clarify the mechanism of this peculiar disease. PMID:24520537

  6. CT features of abdominal plasma cell neoplasms

    Microsoft Academic Search

    J. Monill; J. Pernas; E. Montserrat; C. Pérez; J. Clavero; A. Martinez-Noguera; R. Guerrero; S. Torrubia

    2005-01-01

    The aim of this study was to describe the CT features of abdominal plasma cell neoplasms. We reviewed CT imaging findings in 11 patients (seven men, four women; mean age 62 years) with plasma cell neoplasms and abdominal involvement. Helical CT of the entire abdomen and pelvis was performed following intravenous administration of contrast material. Images were analyzed in consensus

  7. The Brain in Pain

    PubMed Central

    AHMAD, Asma Hayati; ABDUL AZIZ, Che Badariah

    2014-01-01

    Pain, while salient, is highly subjective. A sensation perceived as painful by one person may be perceived as uncomfortable, not painful or even pleasant to others. Within the same person, pain may also be modulated according to its threat value and the context in which it is presented. Imaging techniques, such as functional magnetic resonance imaging and positron emission tomography, have identified a distributed network in the brain, the pain-relevant brain regions, that encode the sensory-discriminative aspect of pain, as well as its cognitive and affective/emotional factors. Current knowledge also implicates the prefrontal cortex as the modulatory area for pain, with its subdivisions forming the cortico-cortical pathway, an alternative pain modulatory pathway distinct from the descending modulatory pathway of pain. These findings from neuroimaging in human subjects have paved the way for the molecular mechanisms of pain modulation to be explored in animal studies. PMID:25941463

  8. [Gasless laparoscopic cholecystectomy using retractor of the abdominal wall].

    PubMed

    D'Urbano, C; Fuertes Guiro, F; Sampietro, R

    1996-03-01

    The Authors present a new gasless laparoscopic cholecystectomy method using an abdominal wall elevator with subcutaneous traction ("laparotenser"). Fifty patients between May 1994 and March 1995 were operated by videolaparoscopy using this new gasless method. Twenty of them were operated with Nagai's method while the laparotenser was used in the remaining thirty. The results obtained are similar to those using pneumoperitoneum. It has been observed a global reduction of costs, less postoperative pain, no influence in cardiovascular and metabolic indexes. No complications were reported during the postoperative period but two cases of conversion to laparotomy not related to the method used were needed. Laparoscopic cholecystectomy without pneumoperitoneum using the subcutaneous elevator of the abdominal wall ("laparotenser") has demonstrated that it's possible to operate in a working space similar to that created by the pneumoperitoneum. After an initial period of distrust towards the laparoscopic methods without pneumoperitoneum it has been accepted that gasless methods multiply the indications to minimally invasive surgery in patients with cardiorespiratory problems considered no ideal candidates to laparoscopic cholecystectomy with pneumoperitoneum. PMID:8679422

  9. Diagnosis of abdominal tuberculosis: the importance of laparoscopy.

    PubMed

    Rai, S; Thomas, W M

    2003-12-01

    Abdominal tuberculosis (TB) tends to present with non-specific features and can be hard to diagnose. In the University Hospitals of Leicester, which serve a large immigrant population, 36 patients had this diagnosis between 1995 and 2001. We examined their records to identify features, including history, clinical presentation, investigations and diagnostic procedures, that might help with diagnosis of future cases. 32 of the patients were of Asian origin, predominantly from the Indian subcontinent. The most common presenting complaints were abdominal pain and weight loss. On clinical examination the findings were non-specific. Only 2 patients were found to have concurrent pulmonary TB. The most consistent laboratory finding (>90%) was a low haemoglobin with a raised C-reactive protein. The tuberculin test (Mantoux) was positive in only 7 patients (22%), and Ziehl-Neelsen staining of ascitic fluid was negative in all 11 patients in whom it was examined. An ultrasound scan of the abdomen revealed findings consistent with TB in 9/28 patients and a CT scan was helpful in 6/11. Laparoscopy, although usually performed as a last resort, proved the most effective investigation, yielding the diagnosis in 23 (92%) of the 25 patients in whom it was performed. In patients with the relevant background and clinical history, laparoscopy is the investigation of choice. PMID:14645607

  10. Rare cause of abdominal incidentaloma: Hepatoduodenal ligament teratoma

    PubMed Central

    Jeismann, Vagner Birk; Dumarco, Rodrigo Blanco; Loreto, Celso di; Barbuti, Ricardo Correa; Jukemura, José

    2014-01-01

    The occurrence of a hepatoduodenal ligament teratoma is extremely rare, with only a few cases reported in the literature. This case report describes the discovery of a hepatoduodenal ligament lesion revealed during abdominal ultrasonography for cholelithiasis-related abdominal pain in a 27-year-old female. Cross-sectional imaging identified a 5 cm × 4 cm heterogeneous mass of fat tissue with irregular calcification located in the posterior-superior aspect of the head of the pancreas. An encapsulated lesion showing no invasion to the common bile duct or adjacent organs and vessels was exposed during laparotomy and resected. Intraoperative cholangiography during the cholecystectomy showed no abnormalities. The postoperative course was uneventful. Pathological analysis of the resected mass indicated hepatoduodenal ligament teratoma. This case report demonstrates that cross-sectional imaging, such as computed tomography, can reveal suspected incidences of this rare type of teratoma, which can then be confirmed after pathologic analysis of the specimen. The prognosis after complete surgical resection of lesions presenting with benign pathological features is excellent. PMID:24868330

  11. Pulmonary complications of abdominal wall defects.

    PubMed

    Panitch, Howard B

    2015-01-01

    The abdominal wall is an integral component of the chest wall. Defects in the ventral abdominal wall alter respiratory mechanics and can impair diaphragm function. Congenital abdominal wall defects also are associated with abnormalities in lung growth and development that lead to pulmonary hypoplasia, pulmonary hypertension, and alterations in thoracic cage formation. Although infants with ventral abdominal wall defects can experience life-threatening pulmonary complications, older children typically experience a more benign respiratory course. Studies of lung and chest wall function in older children and adolescents with congenital abdominal wall defects are few; such investigations could provide strategies for improved respiratory performance, avoidance of respiratory morbidity, and enhanced exercise ability for these children. PMID:25458796

  12. Recognising and assessing blunt abdominal trauma.

    PubMed

    McGrath, Anthony; Whiting, Dean

    2015-03-01

    Blunt abdominal trauma is common following major traumatic injury but may not be recognised quickly enough and is therefore a cause of preventable death in trauma patients. Emergency department nurses have a major role to play in reducing the incidence of unrecognised abdominal trauma by enhancing their knowledge and skills. They can do this by attending trauma-related courses, taking on more expanded roles, carrying out full and comprehensive physical assessments, and ensuring that members of the multidisciplinary team use the wide range of diagnostic adjuncts available to them. This article reviews the anatomy and physiology of the abdominal cavity, explains abdominal trauma, gives an overview of advanced abdominal assessment techniques and diagnostic adjuncts, and reviews some management strategies for uncontrolled haemorrhage that have been adopted in the UK. PMID:25746888

  13. [Renal angiomyolipoma rupture as a cause of lumbar pain: report of one case].

    PubMed

    Cifuentes, Melissa; Calleja, Félix; Hola, José; Daviú, Antonio; Jara, Danilo; Vallejos, Humberto

    2008-08-01

    Renal angiomyolipoma is a benign tumor formed by smooth muscle, adipose tissue and blood vessels. It is commonly found incidentally and its clinical manifestations are pain and abdominal mass or spontaneous tumor rupture with retroperitoneal bleeding. The clinical presentation of a hemorrhagic shock secondary to a retroperitoneal hematoma is uncommon. We report a 40 year-old male who presented to the emergency room with lumbar pain and deterioration of hemodynamic parameters. The CT scan showed a left renal injury associated to an expansive retroperitoneal process. The abdominal exploration, vascular control of the renal pedicle and nephrectomy allowed a successful outcome. PMID:18949188

  14. Prophylactic cholecystectomy during abdominal surgery.

    PubMed

    Cabarrou, P; Portier, G; Chalret Du Rieu, M

    2013-09-01

    The presence of asymptomatic gallstones is no longer an indication for elective prophylactic cholecystectomy (PC) according to the recommendations of the 1991 French Consensus Conference on cholelithiasis. However, there may be potential benefits of performing prophylactic cholecystectomy during certain abdominal procedures for non-biliary disease; this remains a subject of debate. This debate has become livelier with the recent increase in bariatric surgery. Gastrectomy for cancer, small bowel resection, colonic resection, and splenectomy for hereditary spherocytosis as well as all bariatric surgical interventions can all alter the physiology of gallstone disease raising the question of the value of PC, but the specific morbidity of cholecystectomy must be kept in mind. The purpose of this study was to report epidemiological and pathophysiological data and the results from literature reports in order to assess the value of concomitant prophylactic cholecystectomy during various common surgical situations. PMID:23916848

  15. Pathology Case Study: Abdominal Distention

    NSDL National Science Digital Library

    Rao, Uma N. M.

    This is a case study presented by the University of Pittsburgh Department of Pathology, which describes a 60-year-old woman who presented with a history of marked abdominal distention lasted for several months with associated progressive fatigue, progressive weight loss and fever. Visitors are given patient history along with gross and microscopic descriptions, including images, and are given the opportunity to diagnose the patient. A "Final Diagnosis" section provides a discussion of the findings as well as references. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in soft tissue pathology.

  16. [A case of fulminant amoebic colitis with an abscess in the abdominal cavity rescued by conservative management].

    PubMed

    Matsui, Akira; Nomura, Kousuke; Odagiri, Hiroyuki; Yamada, Akihiro; Domon, Kaoru; Yamashita, Satoshi; Furuhata, Tsukasa; Kikuchi, Daisuke; Nakamura, Masanori; Mitani, Toshifumi; Ogawa, Osamu; Iizuka, Toshiro; Hoteya, Shu; Kaise, Mitsuru; Matoba, Shuichirou; Fujii, Takeshi

    2012-05-01

    A 75-year-old man was admitted because of watery diarrhea, hematochezia and right lower abdominal pain. Many deep undermining colonic ulcers were found by colonoscopy, and we detected trophozoite amoeba pathologically. Metronidazole was administered orally from 3 days after admission. However, since CT demonstrated a huge abscess in the abdominal cavity, we performed percutaneous drainage from 17 days after admission. On day 157, the patient was discharged, because the colonic ulcers had almost healed, and trophozoite amoebas were not recognized pathologically. PMID:22688105

  17. Pain and the ethics of pain management.

    PubMed

    Edwards, R B

    1984-01-01

    In this article I clarify the concepts of 'pain', 'suffering', 'pains of body', 'pains of soul'. I explore the relevance of an ethic to the clinical setting which gives patients a strong prima facie right to freedom from unnecessary and unwanted pain and which places upon medical professionals two concomitant moral obligations to patients. First, there is the duty not to inflict pain and suffering beyond what is necessary for effective diagnosis, treatment and research. Next, there is the duty to do all that can be done to relieve all the pain and suffering which can be alleviated. I develop in some detail that individuality of pain sensitivity must be taken into account in fulfilling these obligations. I explore the issue of the relevance of informed consent and the right to refuse treatment to the matter of pain relief. And I raise the question of what conditions, if any, should override the right to refuse treatment where pain relief is of paramount concern. PMID:6710192

  18. Management of intra-abdominal hypertension and abdominal compartment syndrome: a review

    PubMed Central

    2014-01-01

    Patients in the intensive care unit (ICU) are at risk of developing of intra abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Aim: This review seeks to define IAH and ACS, identify the aetiology and presentation of IAH and ACS, identify IAP measurement techniques, identify current management and discuss the implications of IAH and ACS for nursing practice. A search of the electronic databases was supervised by a health librarian. The electronic data bases Cumulative Index of Nursing and Allied Health Literature (CINAHL); Medline, EMBASE, and the World Wide Web was undertaken from 1996- January 2011 using MeSH and key words which included but not limited to: abdominal compartment syndrome, intra -abdominal hypertension, intra-abdominal pressure in adult populations met the search criteria and were reviewed by three authors using a critical appraisal tool. Data derived from the retrieved material are discussed under the following themes: (1) etiology of intra-abdominal hypertension; (2) strategies for measuring intra-abdominal pressure (3) the manifestation of abdominal compartment syndrome; and (4) the importance of nursing assessment, observation and interventions. Intra-abdominal pressure (IAP) and abdominal compartment syndrome (ACS) have the potential to alter organ perfusion and compromise organ function. PMID:24499574

  19. Chiropractic care for back pain

    MedlinePLUS

    ... Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. ...

  20. Managing your chronic back pain

    MedlinePLUS

    ... Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. ...

  1. Epidural injections for back pain

    MedlinePLUS

    ... Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. ...

  2. Pediatric pain management.

    PubMed

    Lederhaas, G

    1997-01-01

    It is now recognized that from the newborn period onwards, children are capable of experiencing pain. This includes the premature infant. The challenge for healthcare providers is to incorporate methods of pain assessment and treatment into their daily practices. The child's understanding of pain closely follows the cognitive and behavioral model developed by Jean Piaget. Based on these developmental stages, pain assessment measures have been developed. Pharmacologic advances have accompanied this improved understanding of infant, child, and adolescent psychology. While acute pain accounts for the majority of children's experiences, recurrent/chronic pain states do occur (e.g. sickle cell related and neuropathic) and can be effectively treated. PMID:9037997

  3. [Internationalization and innovation of abdominal acupuncture].

    PubMed

    Wang, Yong-Zhou

    2013-09-01

    Characteristics of abdominal acupuncture are analyzed through three aspects of inheriting and innovation, collaborated research as well as international visual field. It is pointed that abdominal acupuncture is based on clinical practice, focuses on enhancing the therapeutic effect and expending the clinical application. It also promots the thinking on how to recall the tradition and how to inherit tradition availably. The modern medical problems should be studied and innovation resolutions should be searched, which can help the internationalization and modernization of abdominal acupuncture. PMID:24298780

  4. Teaching Cost-Conscious Medicine: Impact of a Simple Educational Intervention on Appropriate Abdominal Imaging at a Community-Based Teaching Hospital

    PubMed Central

    Covington, Matthew F.; Agan, Donna L.; Liu, Yang; Johnson, John O.; Shaw, David J.

    2013-01-01

    Background Rising costs pose a major threat to US health care. Residency programs are being asked to teach residents how to provide cost-conscious medical care. Methods An educational intervention incorporating the American College of Radiology appropriateness criteria with lectures on cost-consciousness and on the actual hospital charges for abdominal imaging was implemented for residents at Scripps Mercy Hospital in San Diego, CA. We hypothesized that residents would order fewer abdominal imaging examinations for patients with complaints of abdominal pain after the intervention. We analyzed the type and number of abdominal imaging studies completed for patients admitted to the inpatient teaching service with primary abdominal complaints for 18 months before (738 patients) and 12 months following the intervention (632 patients). Results There was a significant reduction in mean abdominal computed tomography (CT) scans per patient (1.7–1.4 studies per patient, P < .001) and total abdominal radiology studies per patient (3.1–2.7 studies per patient, P ?=? .02) following the intervention. The avoidance of charges solely due to the reduction in abdominal CT scans following the intervention was $129 per patient or $81,528 in total. Conclusions A simple educational intervention appeared to change the radiologic test-ordering behavior of internal medicine residents. Widespread adoption of similar interventions by residency programs could result in significant savings for the health care system. PMID:24404274

  5. Amoebic Dysentery and Fetal Death: A Case Report

    Microsoft Academic Search

    Calle A; Armijos RX; Vega IP

    Rectocolitis related to Entamoeba histolytica is a widespread disease through the world and, it can result with mortality in some instances. A 33 year-old patient who was at the second trimester of her gestation admitted to the hospital with the complaints of abdominal pain, bloody diarrhea and lack of fetal movement for 3 days. Microscopic examination of gaita revealed Entamoeba

  6. Campylobacter enteritis

    Microsoft Academic Search

    J. P. Butzler

    1982-01-01

    Summary Campylobacter jejuni (previously called “related vibrio”) has recently become recognized as an important cause of acute diarrhoeal disease in many countries. As with other intestinal pathogens, the clinical picture ofC. jejuni infection varies from symptomless excretion to severe disease. The incubation period averages two to five days. Fever, abdominal pain and bloody diarrhoea are the usual symptoms of campylobacter

  7. The Tribolium homeotic gene Abdominal is homologous to abdominal-A of the Drosophila bithorax complex

    NASA Technical Reports Server (NTRS)

    Stuart, J. J.; Brown, S. J.; Beeman, R. W.; Denell, R. E.; Spooner, B. S. (Principal Investigator)

    1993-01-01

    The Abdominal gene is a member of the single homeotic complex of the beetle, Tribolium castaneum. An integrated developmental genetic and molecular analysis shows that Abdominal is homologous to the abdominal-A gene of the bithorax complex of Drosophila. abdominal-A mutant embryos display strong homeotic transformations of the anterior abdomen (parasegments 7-9) to PS6, whereas developmental commitments in the posterior abdomen depend primarily on Abdominal-B. In beetle embryos lacking Abdominal function, parasegments throughout the abdomen are transformed to PS6. This observation demonstrates the general functional significance of parasegmental expression among insects and shows that the control of determinative decisions in the posterior abdomen by homeotic selector genes has undergone considerable evolutionary modification.

  8. Endoluminal Abdominal Aortic Aneurysm Repair

    PubMed Central

    Ghouri, Maaz; Krajcer, Zvonimir

    2010-01-01

    Endovascular abdominal aortic aneurysm repair (EVAR) is an attractive alternative to open surgical repair. Distal endograft migration and type 1 endoleak are recognized to be the 2 main complications of EVAR. First-generation endografts had a stronger propensity for distal migration, modular component separation, thrombosis, and loss of structural integrity. Substantial progress has been made in recent years with 2nd- and 3rd-generation devices to prevent these complications. Some of the most common predictors of endograft failure are angulated and short infrarenal necks, large-diameter necks, and thrombus in the aneurysmal sac. The purpose of this study is to describe and review our experience in using innovative techniques and a newer generation of endografts to prevent distal migration and type 1 endoleak in patients with challenging infrarenal neck anatomy. The use of these innovative EVAR techniques and the new generation of endografts in patients with challenging infrarenal neck anatomy has yielded encouraging procedural and intermediate-term results. PMID:20200623

  9. Painful Intercourse Is Significantly Associated with Evoked Pain Perception and Cognitive Aspects of Pain in Women with Pelvic Pain

    PubMed Central

    Alappattu, Meryl J; George, Steven Z; Robinson, Michael E; Fillingim, Roger B; Moawad, Nashat; LeBrun, Emily Weber; Bishop, Mark D

    2015-01-01

    Introduction Evidence suggests that painful intercourse, pain-related psychosocial factors, and altered pain processing magnify the pain experience, but it is not clear how these factors are related to each other. Aim The aims were to (i) characterize differences between women with pelvic pain and pain-free women using a battery of pain-related psychosocial measures, clinical pain ratings, and evoked local and remote pain sensitivity; and (ii) examine the relationship between intercourse pain, clinical pain, and local and remote evoked pain sensitivity. Methods Women with pelvic pain lasting at least 3 months and pain-free women completed questionnaires and underwent pain sensitivity testing. Self-report measures included clinical pain intensity, pain catastrophizing, pain-related fear, pain anxiety, depression, sexual function, and self-efficacy. Pain sensitivity measures included threshold and tolerance and temporal summation of pain. Separate analyses of variance (anova) were used to test group differences in self-report and pain sensitivity measures. Correlations were calculated among dyspareunia, psychosocial factors, and evoked pain. Main Outcome Measures Self-reported pain and pain sensitivity measures. Results Twenty-eight pain-free women and 14 women with pelvic pain participated in this study. Women with pelvic pain reported greater pain intensity and greater psychosocial involvement compared with pain-free women. No differences existed between groups for thermal or pressure measures, but women with pelvic pain rated their pain with pain testing significantly higher than pain-free women. Intercourse pain was significantly associated with affective and sensory pain and pressure pain ratings at the puborectalis, vulvar vestibule, adductor longus tendons, and tibialis anterior muscle. Conclusions Differences in local pain ratings suggest that women with pelvic pain perceive stimuli in this region as more painful than pain-free women although the magnitude of stimuli does not differ. Alappattu MJ, George SZ, Robinson ME, Fillingim RB, Moawad N, LeBrun EW, and Bishop MD. Painful intercourse is significantly associated with evoked pain perception and cognitive aspects of pain in women with pelvic pain. Sex Med 2015;3:14–23. PMID:25844171

  10. Patient Education on Pain

    MedlinePLUS Videos and Cool Tools

    ... People with Pain Press Room Position Statements Patient Education on Pain AAPM Past President, Perry G. Fine, ... Member Center Patient Center Research Advocacy Practice Management Education Annual Meeting Contact Us Privacy Policy Sitemap Close ...

  11. The dynamic pain connectome.

    PubMed

    Kucyi, Aaron; Davis, Karen D

    2015-02-01

    Traditionally, studies of how pain and attention modulate one another involved explicit cognitive-state manipulations. However, emerging evidence suggests that spontaneous brain-wide network communication is intrinsically dynamic on multiple timescales, and attentional states are in constant fluctuation. Here, in light of studies on neural mechanisms of spontaneous attentional fluctuations and pain variability, we introduce the concept of a dynamic 'pain connectome' in the brain. We describe how recent progress in our understanding of individual differences in intrinsic attention to pain and neural network dynamics in chronic pain can facilitate development of personalized pain therapies. Furthermore, we emphasize that the dynamics of pain-attention interactions must be accounted for in the contemporary search for a 'neural signature' of the pain connectome. PMID:25541287

  12. Sickle Cell Pain

    MedlinePLUS

    ... manage pain. Distraction – engaging activities (such as hobbies, video games and movies) that change the patient's focus can help relieve stress and pain. Psychotherapy – speaking with a mental health professional about the stress and frustration of sickle ...

  13. Eldercare at Home: Pain

    MedlinePLUS

    ... or "heaviness" or “misery.” Look for behavior or body language that looks like a response to pain. An ... to communicate about pain in words. Behaviors or body language to look for include facial expressions such as ...

  14. ABDOMINAL INCISIONS IN GENERAL SURGERY: A REVIEW

    PubMed Central

    2007-01-01

    There is this wrong notion that the only standard abdominal incision is the midline incision. Cases have been seen in which an abdominal incision extends from the xyphoid process to the symphysis pubis just to remove a perforated appendix! It is also not unusual to see a groin incision together with a lower abdominal incision for an obstructed inguinal hernia repair that “slipped” back into the abdominal cavity during preparation for surgery. Even though the trend nowadays in surgery is to opt for laparoscopic and mini-incision surgery, the basic rule in surgery is to have an incision that will be comfortable for the surgeon and provide adequate access to the area of pathology. PMID:25161434

  15. Pain Characteristics of Painful Ophthalmoplegia (The Tolosa-Hunt Syndrome)

    Microsoft Academic Search

    Jan Hannerz

    1985-01-01

    Pain characteristics of the Tolosa-Hunt syndrome were abstracted from the observations of five patients with repeated incidents of painful ophthalmoplegia. The pain was experienced either as pressure behind the ophthalmoplegic eye or as boring pain in one orbital region, fluctuating in intensity, sometimes worsening to knife stab-like pain in the eye. The unilateral pain did not shift side during a

  16. Integrating the Concept of Pain Interference into Pain Management

    Microsoft Academic Search

    Marian Wilson

    Undertreatment of pain is a significant problem. Nursing pain assessments have been identified as an area for improvement. This concept analysis sought to examine the use of pain interference as a measurement to assist pain management practices. Existing literature including the term pain interference was reviewed for the years 2000-2010. Pain interference is a common outcome measurement in clinical research.

  17. Managing Chemotherapy Side Effects: Pain

    MedlinePLUS

    ... anD human services national institutes of health Managing Chemotherapy Side Effects Pain “I was worried about getting ... need help to pay for pain medicine. Managing Chemotherapy Side Effects: Pain Keep track of the pain. ...

  18. Definitions and Types of Pain

    MedlinePLUS

    ... Types of Pain Defining Pain Pain is a perception that signals the individual that tissue damage has ... in the body that are involved in the perception of pain are called "nociception." Basic and clinical ...

  19. JAMA Patient Page: Chest Pain

    MedlinePLUS

    ... of the American Medical Association JAMA PATIENT PAGE Chest Pain C hest pain can have many causes. ... about cardiac causes of chest pain. CAUSES OF CHEST PAIN FOR MORE INFORMATION • National Heart, Lung, and ...

  20. The reliability and validity of the COMFORT scale as a postoperative pain instrument in 0 to 3-year-old infants

    Microsoft Academic Search

    Monique van Dijk; Josien B de Boer; Hans M Koot; Dick Tibboel; Jan Passchier; Hugo J Duivenvoorden

    2000-01-01

    The aim of this study was to test the reliability and validity of the COMFORT scale as a postoperative pain instrument for children aged 0–3 years. Subjects were 158 neonates and toddlers after major abdominal or thoracic surgery. Trained nurses rated the children's pain at 3, 6 and 9 h postoperative on the Pediatric Surgical Intensive Care Unit using the

  1. Cancer pain and anxiety

    Microsoft Academic Search

    Paul D. Thielking

    2003-01-01

    Anxiety and pain can be understood with a multidimensional framework that accounts for somatic, emotional, cognitive, and\\u000a behavioral aspects of these conditions. Patients who have cancer or treatment-related pain are more likely to be anxious than\\u000a cancer patients without pain. Patients with cancer pain and anxiety cause difficult diagnostic dilemmas because some degree\\u000a of anxiety is a normal response to

  2. Posttonsillectomy pain in children.

    PubMed

    Sutters, Kimberly A; Isaacson, Glenn

    2014-02-01

    Tonsillectomy, used to treat a variety of pediatric disorders, including obstructive sleep apnea, peritonsillar cellulitis or abscesses, and very frequent throat infection, is known to produce nausea, vomiting, and prolonged, moderate-to-severe pain. The authors review the causes of posttonsillectomy pain, current findings on the efficacy of various pharmacologic and nonpharmacologic interventions in pain management, recommendations for patient and family teaching regarding pain management, and best practices for improving medication adherence. PMID:24445532

  3. Technology for chronic pain.

    PubMed

    Zhang, Suyi; Seymour, Ben

    2014-09-22

    Technology developed for chronic pain management has been fast evolving and offers new stand-alone prospects for the diagnosis and treatment of pain, rather than simply addressing the limitations of pharmacology-based approaches. There are two central challenges to be tackled: developing objective measures that capture the subjectivity of pain experience, and providing technology-based interventions that offer new approaches for pain management. Here we highlight recent developments that hold promise in addressing both of these challenges. PMID:25247372

  4. Chronic Pain Explained

    Microsoft Academic Search

    KENNETH J. SUFKA

    2000-01-01

    Pains that persist long after damaged tissue hasrecovered remain a perplexing phenomenon. Theseso-called chronic pains serve no useful function foran organism and, given its disabling effects, mighteven be considered maladaptive. However, a remarkablesimilarity exists between the neural bases thatunderlie the hallmark symptoms of chronic pain andthose that subserve learning and memory. Bothphenomena, wind-up in the pain literature andlong-term potentiation (LTP)

  5. Abdominal Hernias Complicating Continuous Ambulatory Peritoneal Dialysis

    Microsoft Academic Search

    John P. O’Connor; Russell J. Rigby; Ian R. Hardie; Darryl R. Wall; Russell W. Strong; Peter W. H. Woodruff; James J. B. Petrie

    1986-01-01

    Twenty-five percent of all CAPD patients reviewed in this study developed abdominal hernias. Eleven hernias (32.4%) occurred at the catheter insertion site, 17.6% were inguinal, 26.5% were epigastric and umbilical and 23.5 % occurred at the site of previous abdominal incisions. The risk of developing a hernia was significantly greater in patients over 40 years of age, women of parity

  6. A focus on intra-abdominal infections

    PubMed Central

    2010-01-01

    Complicated intra-abdominal infections are an important cause of morbidity and are frequently associated with poor prognosis, particularly in higher risk patients. Well defined evidence-based recommendations for intra-abdominal infections treatment are partially lacking because of the limited number of randomized-controlled trials. Factors consistently associated with poor outcomes in patients with intra-abdominal infections include increased illness severity, failed source control, inadequate empiric antimicrobial therapy and healthcare-acquired infection. Early prognostic evaluation of complicated intra-abdominal infections is important to select high-risk patients for more aggressive therapeutic procedures. The cornerstones in the management of complicated intra-abdominal infections are both source control and antibiotic therapy. The timing and the adequacy of source control are the most important issues in the management of intra-abdominal infections, because inadequate and late control of septic source may have a negative effect on the outcomes. Recent advances in interventional and more aggressive techniques could significantly decrease the morbidity and mortality of physiologically severe complicated intra-abdominal infections, even if these are still being debated and are yet not validated by limited prospective trials. Empiric antimicrobial therapy is nevertheless important in the overall management of intra-abdominal infections. Inappropriate antibiotic therapy may result in poor patient outcomes and in the appearance of bacterial resistance. Antimicrobial management is generally standardised and many regimens, either with monotherapy or combination therapy, have proven their efficacy. Routine coverage especially against Enterococci and candida spp is not always recommended, but can be useful in particular clinical conditions. A de escalation approach may be recommended in patients with specific risk factors for multidrug resistant infections such as immunodeficiency and prolonged antibacterial exposure. Therapy should focus on the obtainment of adequate source control and adequate use of antimicrobial therapy dictated by individual patient risk factors. Other critical issues remain debated and more controversies are still open mainly because of the limited number of randomized controlled trials. PMID:20302628

  7. The Effects of Deep Abdominal Muscle Strengthening Exercises on Respiratory Function and Lumbar Stability

    PubMed Central

    Kim, Eunyoung; Lee, Hanyong

    2013-01-01

    [Purpose] The purpose of this study was to examine the effects of deep abdominal muscle strengthening exercises on respiratory function and lumbar stability. [Subjects] From among 120 male and female students, 22 whose thoraxes opened no more than 5 cm during inspiration and expiration and whose forced expiratory flow rates were around 300 m/L were recruited. The subjects were randomly divided into an experimental group of eleven, who performed deep abdominal muscle strengthening exercises, and a control group of eleven, who received no particular intervention. [Methods] The subjects were instructed to perform normal breathing in the hook-lying position. They were then directed to hold their breath for ten seconds at the end of inspiration. Ten repetitions of this breathing comprised a set of respiratory training, and a total of five sets were performed by the subjects. [Results] Deep abdominal muscle training was effective at enhancing respiratory function and lumbar stabilization. [Conclusion] The clinical application of deep abdominal muscle strengthening exercises along with lumbar stabilization exercises should be effective for lower back pain patients in need of lumbar stabilization. PMID:24259823

  8. Reliability of ultrasound thickness measurement of the abdominal muscles during clinical isometric endurance tests.

    PubMed

    ShahAli, Shabnam; Arab, Amir Massoud; Talebian, Saeed; Ebrahimi, Esmaeil; Bahmani, Andia; Karimi, Noureddin; Nabavi, Hoda

    2015-07-01

    The study was designed to evaluate the intra-examiner reliability of ultrasound (US) thickness measurement of abdominal muscles activity when supine lying and during two isometric endurance tests in subjects with and without Low back pain (LBP). A total of 19 women (9 with LBP, 10 without LBP) participated in the study. Within-day reliability of the US thickness measurements at supine lying and the two isometric endurance tests were assessed in all subjects. The intra-class correlation coefficient (ICC) was used to assess the relative reliability of thickness measurement. The standard error of measurement (SEM), minimal detectable change (MDC) and the coefficient of variation (CV) were used to evaluate the absolute reliability. Results indicated high ICC scores (0.73-0.99) and also small SEM and MDC scores for within-day reliability assessment. The Bland-Altman plots of agreement in US measurement of the abdominal muscles during the two isometric endurance tests demonstrated that 95% of the observations fall between the limits of agreement for test and retest measurements. Together the results indicate high intra-tester reliability for the US measurement of the thickness of abdominal muscles in all the positions tested. According to the study's findings, US imaging can be used as a reliable method for assessment of abdominal muscles activity in supine lying and the two isometric endurance tests employed, in participants with and without LBP. PMID:26118508

  9. American Pain Society

    MedlinePLUS

    ... on Complex Regional Pain Syndrome (CRPS), August 31-September 1, 2015. The conference aims to provide a summary of ... presents Integrative Pain Care for the 21st Century, September 25-27, in Orlando, FL. Read More » Posted June 16, 2015 Pain Interprofessional Curriculum Design (PICD) Workshop PICD invites ...

  10. Sleep and chronic pain

    Microsoft Academic Search

    Jeanetta C Rains; Donald B Penzien

    2003-01-01

    Objective: The ?-EEG sleep anomaly has been associated with chronic benign pain syndromes. Although controversial, the anomaly is believed by some to be an important biologic correlate of certain otherwise poorly explained painful conditions (e.g., fibromyalgia and chronic fatigue syndrome). To shed further light on this phenomenon, this study compared the sleep and psychological characteristics of chronic pain patients who

  11. Central pain control

    Microsoft Academic Search

    Bernard Calvino; Rose Marie Grilo

    2006-01-01

    We describe the anatomic and physiological components involved in pain physiology, with the goal of providing readers with the background information needed to understand central pain control mechanisms. These include spinal segmental controls, supraspinal excitatory and inhibitory controls, and diffuse noxious inhibitory controls (DNICs). Pain is a subjective sensation produced by an emotionally unpleasant experience considered to originate in adaptive

  12. Pediatric Procedural Pain

    ERIC Educational Resources Information Center

    Blount, Ronald L.; Piira, Tiina; Cohen, Lindsey L.; Cheng, Patricia S.

    2006-01-01

    This article reviews the various settings in which infants, children, and adolescents experience pain during acute medical procedures and issues related to referral of children to pain management teams. In addition, self-report, reports by others, physiological monitoring, and direct observation methods of assessment of pain and related constructs…

  13. TRPV1 sensitization mediates postinflammatory visceral pain following acute colitis.

    PubMed

    Lapointe, Tamia K; Basso, Lilian; Iftinca, Mircea C; Flynn, Robyn; Chapman, Kevin; Dietrich, Gilles; Vergnolle, Nathalie; Altier, Christophe

    2015-07-15

    Quiescent phases of inflammatory bowel disease (IBD) are often accompanied by chronic abdominal pain. Although the transient receptor potential vanilloid 1 (TRPV1) ion channel has been postulated as an important mediator of visceral hypersensitivity, its functional role in postinflammatory pain remains elusive. This study aimed at establishing the role of TRPV1 in the peripheral sensitization underlying chronic visceral pain in the context of colitis. Wild-type and TRPV1-deficient mice were separated into three groups (control, acute colitis, and recovery), and experimental colitis was induced by oral administration of dextran sulfate sodium (DSS). Recovery mice showed increased chemically and mechanically evoked visceral hypersensitivity 5 wk post-DSS discontinuation, at which point inflammation had completely resolved. Significant changes in nonevoked pain-related behaviors could also be observed in these animals, indicative of persistent discomfort. These behavioral changes correlated with elevated colonic levels of substance P (SP) and TRPV1 in recovery mice, thus leading to the hypothesis that SP could sensitize TRPV1 function. In vitro experiments revealed that prolonged exposure to SP could indeed sensitize capsaicin-evoked currents in both cultured neurons and TRPV1-transfected human embryonic kidney (HEK) cells, a mechanism that involved TRPV1 ubiquitination and subsequent accumulation at the plasma membrane. Importantly, although TRPV1-deficient animals experienced similar disease severity and pain as wild-type mice in the acute phase of colitis, TRPV1 deletion prevented the development of postinflammatory visceral hypersensitivity and pain-associated behaviors. Collectively, our results suggest that chronic exposure of colon-innervating primary afferents to SP could sensitize TRPV1 and thus participate in the establishment of persistent abdominal pain following acute inflammation. PMID:26021808

  14. The misdiagnosis of ruptured abdominal aortic aneurysm: an ancient problem always present. Report of an atypical case.

    PubMed

    Ciardo, L F; Agresta, F; Bedin, N

    2007-05-01

    The rupture of an abdominal aortic aneurysm is one of the most dramatic event in the daily clinical practice. It is often easily suspected when the classical signs of hemorrhagic shock are associated with an anterior (mesogastric) abdominal pain and an expanding mass, especially in the non-obese patients. Sometimes many of these signs can lack and, as a consequence, the diagnosis might be very difficult. This may cause a fatal delay for the patients. We describe a singular case in which the rupture of an abdominal aortic aneurysm was simulating an acute cholecystitis: the presented symptoms, together with a negative personal medical history, were so atypical that even four experienced practitioners misdiagnosed the vascular lesion and the diagnosis was possible only at autopsy. PMID:17547788

  15. Ultrasound measurement of abdominal muscles activity during abdominal hollowing and bracing in women with and without stress urinary incontinence

    Microsoft Academic Search

    Amir Massoud Arab; Mahshid Chehrehrazi

    2011-01-01

    Synergistic co-activation of the abdominal and pelvic floor muscles (PFM) has been reported in the literature. Considering that PFM dysfunction is present in women with stress urinary incontinence (SUI), altered abdominal muscle activation may also occur in incontinent women. The purpose of this study was to investigate the abdominal muscle activity during abdominal hollowing and bracing maneuver in women with

  16. A prospective randomized controlled comparison of immediate versus late removal of urinary catheter after abdominal hysterectomy

    PubMed Central

    Joshi, Bharti; Aggarwal, Neelam; Chopra, Seema; Taneja, Neelam

    2014-01-01

    Objective: Indwelling transurethral catheter is frequently used after gynecological surgeries in order to prevent urinary retention. There is controversy about the ideal time to remove the catheter after surgery. This randomized controlled study was undertaken to determine whether the immediate removal of urinary catheter after abdominal hysterectomy affects the rate of symptomatic urinary tract infection (UTI), recatheterization, subjective pain perception and febrile morbidity. Study Design: This prospective randomized controlled trial included 70 women undergoing abdominal hysterectomy with or without salpingoophrectomy for benign diseases. Patients were divided into two equal groups on the basis of timing of removal of urinary catheter (Group I — Immediate removal after surgery, Group II — Removal after 24 h and evaluated for benefits versus risks of immediate catheter removal. The results were compared by the Chi-square test. Results: Recatheterization was required in three patients of immediate removal group and none in late removal group (P = 0.07). Higher incidence of positive urine cultures (25.9%) and febrile morbidity (10%) was found in Group II when compared to immediate removal group (8%). Pain perception was not statistically different in both groups (P = 0.567). Conclusions: The early removal of an indwelling catheter after surgery was not associated with an increased rate of febrile events, UTI. Pain perception was also lower in early removal group. Although need of recatheterization was higher in early removal group, but not statistically significant. PMID:24970984

  17. Symptomatic schwannoma of the abdominal wall: A case report and review of the literature

    PubMed Central

    BALZAROTTI, RUBEN; RONDELLI, FABIO; BARIZZI, JESSICA; CARTOLARI, ROBERTO

    2015-01-01

    Schwannoma is a rare, benign tumor that arises from the nerve sheath. This tumor usually involves the extremities, but can also be found in the head and neck, trunk, pelvis, retroperitoneum, mediastinum and gastrointestinal tract. In numerous cases, the tumors are asymptomatic and are identified incidentally on physical examination or imaging. Occasionally, schwannoma is symptomatic due to compression of surrounding large nerves. In the present study, a 57-year-old female presented to the surgical outpatient’s department due to a well-localized parietal pain in the left lower quadrant. The onset of the pain occurred three years prior to presentation, without apparent cause and in the absence of other symptoms. Ultrasound and a computed tomography scan revealed a small solid tumor in the anterior abdominal wall, which was dimensionally stable over time, but was not noted in a preliminary analysis by a radiologist. The lesion was surgically removed using an anterior surgical approach. Histopathology revealed the tumor to be benign schwannoma. The painful symptoms completely disappeared. To the best of our knowledge, this is the third case of an abdominal wall benign schwannoma in the medical literature, and the first symptomatic case. PMID:25663862

  18. [Abdominal tuberculous abscesses in patients with acquired immunodeficiency syndrome: description of 5 cases].

    PubMed

    Bascuñana, A; Torres Tortosa, M; Pérez Pérez, M; López Cano, A; Rendón, P; Pérez Millán, E

    1990-09-01

    Five cases of tuberculous abdominal abscesses in patients with acquired immunodeficiency syndrome (AIDS) are reported. They were localized in pelvic retroperitoneum (2 cases), peripancreatic area, abdominal rectus anterior muscle, and were multiple in the remaining patient. All patients had presented with sustained fever and dull pain in the abscess area. In four patients this was the disease that led to the diagnosis of AIDS. The cultures from several sources (sputum, urine, cerebrospinal fluid, lymphadenopathy) revealed that the tuberculous abscess was a part of disseminated tuberculosis. Two patients were treated with surgical drainage and the other three with percutaneous drainage under echographic control. Two patients died from disseminated tuberculosis. It is pointed out that this form of tuberculosis in AIDS patients may be more common than previously reported. PMID:2283899

  19. Laparoscopic drainage of abdominal wall abscess from spilled stones post-cholecystectomy

    PubMed Central

    Chong, Vincent; Ram, Rishi

    2015-01-01

    We present a case on abdominal wall abscess from spilled stones post-cholecystectomy and describe laparoscopic drainage as our choice of management. Mr M is a 75-year-old male who presented on multiple occasions to the hospital with right upper quadrant pain and fever post-laparoscopic cholecystectomy. He also required multiple courses of antibiotics. Subsequent computed tomography and magnetic resonance imaging scan confirmed a number of retained stone with signs of chronic inflammation. Hence, 6 months after his initial laparoscopic cholecystectomy, he proceeded to an exploratory laparoscopy. We found an abscess cavity measuring 3 × 4 cm over the anterior abdominal wall. The cavity was de-roofed, drained and washed out. The tissue culture grew Klebsiella pneumoniae. Laparoscopic approach is optimal as the abscess cavity can be clearly identified, stones visualized and removed under direct vision. Patient does not require a laparotomy. PMID:26183574

  20. Psychologic Influence on Experimental Pain Sensitivity and Clinical Pain Intensity for Patients with Shoulder Pain

    Microsoft Academic Search

    Steven Z. George; Adam T. Hirsh

    2009-01-01

    Pain-related fear and pain catastrophizing are 2 central psychologic factors in fear-avoidance models. Our previous studies in healthy subjects indicated that pain-related fear, but not pain catastrophizing, was associated with cold pressor pain outcomes. The current study extends previous work by investigating pain-related fear and pain catastrophizing in a group of subjects with shoulder pain, and included concurrent measures of

  1. Myofascial low back pain.

    PubMed

    Ramsook, Ryan R; Malanga, Gerard A

    2012-10-01

    Low back pain is a common condition that is encountered by both primary care physicians as well as various specialists, which include: orthopedic surgeons, physical medicine and rehabilitation specialists, neurologists, rheumatologists, and pain management specialists. Associated muscular pain is very common and often a reactive response from nociception from other structures. Myofascial pain may arise, which is characterized by the presence of myofascial trigger points (MTrPs) that are located in fascia, tendons, and/or muscle. This article reviews the current evidence regarding the pathophysiology, assessment, and recommended treatment options for myofascial low back pain. PMID:22945480

  2. Minute Sphere Acupressure Does Not Reduce Postoperative Pain or Morphine Consumption

    Microsoft Academic Search

    Masatomo Sakurai; Muhammad-Irfan Suleman; Nobutada Morioka; Daniel I. Sessler

    2003-01-01

    Minute sphere acupressure has been used for more than 2000 yr and remains popular in Japan. The points most relevant to abdominal surgery are those associated with meridian flows crossing or originating in the abdomen. We tested the hypothesis that minute sphere therapy re- duces pain and analgesic requirements after open abdom- inal surgery. Participating patients were given standard- ized

  3. Pain in pressure ulcers.

    PubMed

    Reddy, Madhuri; Keast, David; Fowler, Evonne; Sibbald, R Gary

    2003-04-01

    Integrating pain management into a treatment paradigm for pressure ulcers can lead to improved outcomes. An approach to wound bed preparation that addresses the cause and patient-centered concerns--as well as local wound care factors of moisture balance, debridement, and bacterial balance--can be integrated with the Krasner model of chronic wound pain. The risk factors for pressure ulcers are well known, but pain may be an important contributor to immobility and the development of pressure ulcers. Pain is also an important signal of wound-related infections. Strategies must be developed to control the cyclic acute pain of dressing changes and the noncyclic acute pain of wound debridement. Spinal cord injured and elderly, cognitively impaired patients with pressure ulcers present special challenges in pain management. PMID:12856291

  4. [Growing pains in children].

    PubMed

    Uziel, Yosef; Hashkes, Philip J

    2008-10-01

    Growing pains are the most common form of recurrent musculoskeletal pains in childhood and are present in 10-20% of children, mainly between the ages of 3-12 years. The diagnosis is based on typical historical clinical characteristics with a normal physical examination. The etiology is still unknown but current theories include low pain thresholds, as in fibromyalgia and local overuse pain that is supported by the finding of low bone strength in painful regions by ultrasound and hypermobility in many children with growing pains. There is also an associated familial and patient behavioral element. Treatment is conservative with patient and parental education on the benign outcome of these pains the most important element, in order to decrease anxiety. PMID:19039913

  5. Relation of the factor to menstrual pain and musculoskeletal pain.

    PubMed

    Lee, Jang-Won; Park, Hye-Sang

    2015-04-01

    The purpose of the present study is to investigate the relationship between the regions of menstrual pain and of myofascial pain syndrome, which is the main cause of musculoskeletal pain, as well as to examine the changes and relationships among the menstrual pain-related factors, which are pain level, pain area, activity, appetite, mood, and sleeping pattern. The subjects were 13 sufferers of musculoskeletal pain and 17 non-sufferers. Pain diary and pain chart systems were used for the measurement of menstrual pain-related factors and musculoskeletal pain. Data were analyzed using repeated ANOVA. The results show that there are significant differences between the two groups in pain level, activity, and mood during menstruation periods (P< 0.05). The area of musculoskeletal pain and menstrual pain were found to be the same. PMID:25960984

  6. Relation of the factor to menstrual pain and musculoskeletal pain

    PubMed Central

    Lee, Jang-Won; Park, Hye-Sang

    2015-01-01

    The purpose of the present study is to investigate the relationship between the regions of menstrual pain and of myofascial pain syndrome, which is the main cause of musculoskeletal pain, as well as to examine the changes and relationships among the menstrual pain-related factors, which are pain level, pain area, activity, appetite, mood, and sleeping pattern. The subjects were 13 sufferers of musculoskeletal pain and 17 non-sufferers. Pain diary and pain chart systems were used for the measurement of menstrual pain-related factors and musculoskeletal pain. Data were analyzed using repeated ANOVA. The results show that there are significant differences between the two groups in pain level, activity, and mood during menstruation periods (P< 0.05). The area of musculoskeletal pain and menstrual pain were found to be the same. PMID:25960984

  7. Pain in older adults.

    PubMed

    Miller, Lois L; Talerico, Karen Amann

    2002-01-01

    This chapter reviews 80 published research reports of pain and pain problems in older adults by nurse researchers and researchers from other disciplines. Reports were identified through searches of MEDLINE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) using the search terms pain, older adult, aged and pain, and dementia. Reports were included if published between 1985 to 2001, if conducted on samples age 60 or older, if conducted by nurses or relevant to nursing research, and if published in English. Descriptive, qualitative, correlational, longitudinal, and intervention studies were included. Key findings include the following: pain is widely prevalent in older adult populations; few studies have included minority groups; under-identification and undertreatment of pain in older adults is a consistent interpretation of research findings; pain intensity rating scales are as valid and reliable in older populations as in younger populations; current observational methods of assessing pain in cognitively impaired older adults must be used with caution; nursing intervention studies demonstrate the beneficial effects of education and interventions aimed at improved pain assessment. The main recommendations are: careful attention should be given to the conceptualization and definition of pain; examination of pain should include physiological, motivational, cognitive, and affective factors; studies evaluating undertreatment of pain should include measures of pain self-report; standardized pain measures should be used; studies of persons over the age of 85 and studies of ethnic minorities are needed; more attention should be given to nursing intervention studies and should include both pharmacological and nonpharmacological, psychosocial interventions. PMID:12092519

  8. A multicenter randomized comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy in abdominal hysterectomy candidates

    Microsoft Academic Search

    Robert L Summitt; Thomas G Stovall; John F Steege; Gary H Lipscomb

    1998-01-01

    Objective: To compare intraoperative and postoperative outcomes between laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy among patients who are not eligible for vaginal hysterectomy.Methods: Study subjects were randomly assigned to undergo laparoscopically assisted vaginal hysterectomy or standard abdominal hysterectomy. Intraoperative and postoperative management was similar for each group. Surgical characteristics, complications, length of hospital stay, charges, and convalescence were analyzed.Results:

  9. Pain management in the elderly.

    PubMed

    Malec, Monica; Shega, Joseph W

    2015-03-01

    Persistent pain in older adults is common, and associated with substantial morbidity. Optimal management starts with assessment, including pain presence, intensity, characteristics, and interference; painful conditions; pain behaviors; pain-related morbidity; pain treatments; and coping style. Treatment incorporates analgesics demonstrated to decrease pain and improve a patient's sense of well-being. The World Health Organization's 3-step pain ladder is widely accepted and adopted for selecting analgesics among patients with non-cancer pain. Shared decision making is essential to balance the benefits and burdens of analgesics. This article reviews pain assessment/management for older adults, focusing on commonly used analgesics. PMID:25700587

  10. Chronic pain management: pharmacotherapy for chronic pain.

    PubMed

    Chang, Ku-Lang; Fillingim, Roger; Hurley, Robert W; Schmidt, Siegfried

    2015-05-01

    Clinicians should combine nonpharmacologic therapies and pharmacotherapy for management of chronic pain. Safety and effectiveness determine the choice of therapy. Typically, nonopioid analgesics are first-line treatment, including acetaminophen, nonsteroidal anti-inflammatory drugs, and topical drugs. A trial of an opioid, in combination with other modalities, should be considered if pain persists. Because of the potential for serious adverse effects, opioids should be prescribed only if the clinician is familiar with their use and associated risks. If pain is not controlled, consider pharmacogenetic effects or the addition of adjuvant therapy. In states with prescription drug monitoring programs, clinicians must access these programs regularly when prescribing a controlled substance. Consider performing pill counts and random urine drug screening for monitoring drug use. Adjuvant drugs to be considered include antidepressants, buspirone, anticonvulsants, muscle relaxants, onabotulinumtoxinA, clonidine, and corticosteroids, depending on type of pain and individual characteristics. PMID:25970870

  11. [Latest pain management for painful bony metastases].

    PubMed

    Ikenaga, Masayuki

    2006-04-01

    Pain management for painful bony metastases is the most important problem for symptom relief of terminally-ill cancer patients. Pathological fractures often decrease the activity of daily life (ADL) of patients, and cause deterioration of the quality of life (QOL) and prognosis. Basically pharmacological therapies of the World Health Organization (WHO) method are essential for symptom relief from cancer pain. This article provides the latest pain managements (palliative irradiation, bisphosphonate, orthopedic surgery, percutaneous vertebroplasty and radiopharmaceutical therapy) of bony metastases, and mentions the indications and the problems of these interventions. In consideration to prognosis, the QOL and patient's needs, medical staffs have to perform multidisciplinary approach for providing suitable palliative care. PMID:16582515

  12. Abdominal sarcoidosis: cross-sectional imaging findings

    PubMed Central

    Gezer, Naciye Sinem; Ba?ara, I??l; Altay, Canan; Harman, Mustafa; Rocher, Laurence; Karabulut, Nevzat; Seçil, Mustafa

    2015-01-01

    Sarcoidosis is a multisystem inflammatory disease of unknown etiology. The lungs and the lymphoid system are the most commonly involved organs. Extrapulmonary involvement is reported in 30% of patients, and the abdomen is the most common extrapulmonary site with a frequency of 50%–70%. Although intra-abdominal sarcoidosis is usually asymptomatic, its presence may affect the prognosis and treatment options. The lesions are less characteristic and may mimick neoplastic or infectious diseases such as lymphoma, diffuse metastasis, and granulomatous inflammation. The liver and spleen are the most common abdominal sites of involvement. Sarcoidosis of the gastrointestinal system, pancreas, and kidneys are extremely rare. Adenopathy which is most commonly found in the porta hepatis, exudative ascites, and multiple granulomatous nodules studding the peritoneum are the reported manifestations of abdominal sarcoidosis. Since abdominal sarcoidosis is less common and long-standing, unrecognized disease can result in significant morbidity and mortality. Imaging contributes to diagnosis and management of intra-abdominal sarcoidosis. In this report we reviewed the cross-sectional imaging findings of hepatobiliary, gastrointestinal, and genitourinary sarcoidosis. PMID:25512071

  13. Abdominal sarcoidosis: cross-sectional imaging findings.

    PubMed

    Gezer, Naciye Sinem; Ba?ara, I??l; Altay, Canan; Harman, Mustafa; Rocher, Laurence; Karabulut, Nevzat; Seçil, Mustafa

    2015-01-01

    Sarcoidosis is a multisystem inflammatory disease of unknown etiology. The lungs and the lymphoid system are the most commonly involved organs. Extrapulmonary involvement is reported in 30% of patients, and the abdomen is the most common extrapulmonary site with a frequency of 50%-70%. Although intra-abdominal sarcoidosis is usually asymptomatic, its presence may affect the prognosis and treatment options. The lesions are less characteristic and may mimick neoplastic or infectious diseases such as lymphoma, diffuse metastasis, and granulomatous inflammation. The liver and spleen are the most common abdominal sites of involvement. Sarcoidosis of the gastrointestinal system, pancreas, and kidneys are extremely rare. Adenopathy which is most commonly found in the porta hepatis, exudative ascites, and multiple granulomatous nodules studding the peritoneum are the reported manifestations of abdominal sarcoidosis. Since abdominal sarcoidosis is less common and long-standing, unrecognized disease can result in significant morbidity and mortality. Imaging contributes to diagnosis and management of intra-abdominal sarcoidosis. In this report we reviewed the cross-sectional imaging findings of hepatobiliary, gastrointestinal, and genitourinary sarcoidosis. PMID:25512071

  14. Actinomyces infection causing acute right iliac fossa pain.

    PubMed

    Govindarajah, Narendranath; Hameed, Waseem; Middleton, Simon; Booth, Michael

    2014-01-01

    This is a case of a 75-year-old man being admitted to the on-call surgical department with acute abdominal pain. On arrival he was clinically dehydrated and shocked with localised pain over McBurney's point and examination findings were suggestive of appendiceal or other colonic pathology. Full blood testing revealed a white cell count of 38×10(9)/L and a C reactive protein (CRP) of 278?mg/L. A CT scan revealed a gallbladder empyema that extended into the right iliac fossa. This case highlights the potential for a hyperdistended gallbladder empyema to present as acute right iliac fossa pain with blood tests suggestive of complicated disease. Further analysis confirmed Actinomyces infection as the underlying aetiology prior to a laparoscopic subtotal cholecystectomy. This case serves to remind clinicians of this as a rare potential cause of atypical gallbladder pathology. PMID:24872493

  15. Necrotizing soft tissue infection of the right anterolateral abdominal wall caused by a ruptured gangrenous appendix in an elderly diabetic patient.

    PubMed

    Marinis, Athanasios; Voultsos, Mavroudis; Foteinos, Argyrios; Tselioti, Paraskevi; Avraamidou, Alexandra; Paschalidis, Nikolaos; Rizos, Spyros

    2015-06-01

    Necrotizing soft tissue infections (NSTIs) of the abdominal wall usually occur when either a common superficial soft tissue infection progresses down to, or an injury (e.g. knife stab) penetrates, the investing muscle fascia, or an intra-abdominal infection spreads directly to the muscle layers of the abdominal wall. These infections are severe and associated with significant morbidity and mortality. We present an 83-year-old female diabetic patient who was admitted to the surgical emergency department complaining of right abdominal pain after a fall to the floor. She had previously received oral antibiotics for a minor superficial skin infection attributed to her subcutaneous use of insulin. On admission she exhibited signs of agitation and dyspnoea with hypotension and tachycardia (systolic arterial pressure 90mmHg, heart rate >110 bpm, oxygen saturation 88%). Furthermore, she had a tender right abdomen but without any demonstrable pathology on her skin or crepitus. Arterial blood gases revealed metabolic acidosis and hypoxaemia. An abdominal computed tomography (CT) scan demonstrated signs of infection of the entire right anterior abdominal wall and the LRINEC score was calculated to be 13. Subsequent operative aggressive necrosectomy of all the involved layers of the right anterolateral abdominal wall sparing the peritoneum was undertaken. Unfortunately, the patient died the next day due to multiple organ failure. PMID:26110301

  16. Pain in cancer survivors.

    PubMed

    Glare, Paul A; Davies, Pamela S; Finlay, Esmé; Gulati, Amitabh; Lemanne, Dawn; Moryl, Natalie; Oeffinger, Kevin C; Paice, Judith A; Stubblefield, Michael D; Syrjala, Karen L

    2014-06-01

    Pain is a common problem in cancer survivors, especially in the first few years after treatment. In the longer term, approximately 5% to 10% of survivors have chronic severe pain that interferes with functioning. The prevalence is much higher in certain subpopulations, such as breast cancer survivors. All cancer treatment modalities have the potential to cause pain. Currently, the approach to managing pain in cancer survivors is similar to that for chronic cancer-related pain, pharmacotherapy being the principal treatment modality. Although it may be appropriate to continue strong opioids in survivors with moderate to severe pain, most pain problems in cancer survivors will not require them. Moreover, because more than 40% of cancer survivors now live longer than 10 years, there is growing concern about the long-term adverse effects of opioids and the risks of misuse, abuse, and overdose in the nonpatient population. As with chronic nonmalignant pain, multimodal interventions that incorporate nonpharmacologic therapies should be part of the treatment strategy for pain in cancer survivors, prescribed with the aim of restoring functionality, not just providing comfort. For patients with complex pain issues, multidisciplinary programs should be used, if available. New or worsening pain in a cancer survivor must be evaluated to determine whether the cause is recurrent disease or a second malignancy. This article focuses on patients with a history of cancer who are beyond the acute diagnosis and treatment phase and on common treatment-related pain etiologies. The benefits and harms of the various pharmacologic and nonpharmacologic options for pain management in this setting are reviewed. PMID:24799477

  17. Pain in Cancer Survivors

    PubMed Central

    Glare, Paul A.; Davies, Pamela S.; Finlay, Esmé; Gulati, Amitabh; Lemanne, Dawn; Moryl, Natalie; Oeffinger, Kevin C.; Paice, Judith A.; Stubblefield, Michael D.; Syrjala, Karen L.

    2014-01-01

    Pain is a common problem in cancer survivors, especially in the first few years after treatment. In the longer term, approximately 5% to 10% of survivors have chronic severe pain that interferes with functioning. The prevalence is much higher in certain subpopulations, such as breast cancer survivors. All cancer treatment modalities have the potential to cause pain. Currently, the approach to managing pain in cancer survivors is similar to that for chronic cancer-related pain, pharmacotherapy being the principal treatment modality. Although it may be appropriate to continue strong opioids in survivors with moderate to severe pain, most pain problems in cancer survivors will not require them. Moreover, because more than 40% of cancer survivors now live longer than 10 years, there is growing concern about the long-term adverse effects of opioids and the risks of misuse, abuse, and overdose in the nonpatient population. As with chronic nonmalignant pain, multimodal interventions that incorporate nonpharmacologic therapies should be part of the treatment strategy for pain in cancer survivors, prescribed with the aim of restoring functionality, not just providing comfort. For patients with complex pain issues, multidisciplinary programs should be used, if available. New or worsening pain in a cancer survivor must be evaluated to determine whether the cause is recurrent disease or a second malignancy. This article focuses on patients with a history of cancer who are beyond the acute diagnosis and treatment phase and on common treatment-related pain etiologies. The benefits and harms of the various pharmacologic and nonpharmacologic options for pain management in this setting are reviewed. PMID:24799477

  18. Neurological diseases and pain

    PubMed Central

    2012-01-01

    Chronic pain is a frequent component of many neurological disorders, affecting 20–40% of patients for many primary neurological diseases. These diseases result from a wide range of pathophysiologies including traumatic injury to the central nervous system, neurodegeneration and neuroinflammation, and exploring the aetiology of pain in these disorders is an opportunity to achieve new insight into pain processing. Whether pain originates in the central or peripheral nervous system, it frequently becomes centralized through maladaptive responses within the central nervous system that can profoundly alter brain systems and thereby behaviour (e.g. depression). Chronic pain should thus be considered a brain disease in which alterations in neural networks affect multiple aspects of brain function, structure and chemistry. The study and treatment of this disease is greatly complicated by the lack of objective measures for either the symptoms or the underlying mechanisms of chronic pain. In pain associated with neurological disease, it is sometimes difficult to obtain even a subjective evaluation of pain, as is the case for patients in a vegetative state or end-stage Alzheimer's disease. It is critical that neurologists become more involved in chronic pain treatment and research (already significant in the fields of migraine and peripheral neuropathies). To achieve this goal, greater efforts are needed to enhance training for neurologists in pain treatment and promote greater interest in the field. This review describes examples of pain in different neurological diseases including primary neurological pain conditions, discusses the therapeutic potential of brain-targeted therapies and highlights the need for objective measures of pain. PMID:22067541

  19. Acute Appendagitis Presenting with Features of Appendicitis: Value of Abdominal CT Evaluation

    PubMed Central

    Dubb, Sukhpreet; Arnold, Ahran; Banavali, Shekar; Arnold, Jayantha

    2008-01-01

    We report a case of acute appendagitis in a patient who presented initially with typical features of acute appendicitis. The diagnosis of acute appendagitis was made on pathognomonic signs on computed tomography (CT) scan. Abdominal pain is a common surgical emergency. CT is not always done if there are clear features of acute appendicitis. The rare but important differential diagnosis of acute appendagitis must be borne in mind when dealing with patients with suspected acute appendicitis. A CT scan of the abdomen may avoid unnecessary surgery in these patients. PMID:21505556

  20. Chronic Contained Abdominal Aortic Aneurysm Rupture Mimicking Vertebral Spondylodiscitis: A Case Report

    PubMed Central

    Kamal, Dhafer

    2015-01-01

    A 63-year-old Caucasian male presented with a 4-month history of low back pain associated with bilateral intermittent claudication. A contrast enhanced CT scan demonstrated a 4 cm abdominal aortic aneurysm (AAA), along with severe bilateral aorto-iliac disease, a right psoas collection, and extensive vertebral erosion. An MRI of the lumbar spine suggested spondylodiscitis at L4–L5. After an unsuccessful and prolonged course of antibiotics, a decision was ultimately made to repair the aneurysm and bypass the aorto-iliac disease. Intra-operatively, a chronic contained rupture (CCR) involving the posterior aortic wall was encountered and repaired with an aorto-bifemoral bypass graft.

  1. Disengagement from pain: the role of catastrophic thinking about pain.

    PubMed

    Van Damme, Stefaan; Crombez, Geert; Eccleston, Christopher

    2004-01-01

    This paper reports an experimental investigation of attentional engagement to and disengagement from pain. Thirty-seven pain-free volunteers performed a cueing task in which they were instructed to respond to visual target stimuli, i.e. the words 'pain' and 'tone'. Targets were preceded by pain stimuli or tone stimuli as cues. Participants were characterized as high or low pain catastrophizers, using self-reports. We found that the effect of cueing upon target detection was differential for high and low pain catastrophizers. Analyses revealed a similar amount of attentional engagement to pain in both groups. However, we also found that participants high in pain catastrophizing had difficulty disengaging from pain, whereas participants low in pain catastrophizing showed no retarded disengagement from pain. Our results provide further evidence that catastrophic thinking enhances the attentional demand of pain, particularly resulting in difficulty disengaging from pain. The clinical implications of these findings are discussed. PMID:14715391

  2. Pain perception and assessment.

    PubMed

    Chapman, C R

    2005-01-01

    Our inability to measure pain effectively is a major barrier to progress in pain research and advancement in clinical interventions for pain. Historically, the mind-body dichotomy has constrained our thinking about pain and its quantification. One line of work has pursued pain as the sensory end product of nociception: pain is the realization of signals of tissue injury arriving at the cortex. At the other extreme, some clinicians contend that pain is ''what the patient says it is''. In other words, it is a purely mental and entirely subjective phenomenon. Research on functional brain imaging, psychophysiological research and recent neurophysiological research on animal models provide confluent evidence that both of these positions are misleading oversimplifications. Pain is the emergent product of massive, parallel, distributed processing in the brain that engages structures involved in emotion and cognition as well as in sensation. To advance pain measurement, our research team has examined Sokolov's defense response in human subjects experiencing repeated, brief painful electrical shocks delivered to a fingertip through a tiny electrode. Sokolov proposed that threatening events elicit a hypothalamically-orchestrated pattern of arousal that prepares the organism to cope with threat. Measures of sympathetic nervous system arousal and brain evoked potentials in our subjects reveal a stable pattern of this sort when we subject the data to structural equation modeling. When subjects undergo equally intense shocks delivered through a large electrode, they experience a strong vibration-like, unpleasant sensation that causes discomfort but not nociception. The non-painful shock elicits broad levels of arousal equal to those obtained with painful shocks in subjects, but structural equation modeling demonstrates that such arousal does not conform to the defense response pattern. Moreover, multivariate measures of sympathetic arousal and evoked potentials can discriminate painful from non-painful stimuli more accurately than can subjective pain reports. These observations suggest that pain may have a unique psychophysiological signature. More importantly, perhaps, this approach suggests that the combination of psychophysiological research and multivariate statistics provides an avenue for advancing pain research outside of the mind-body dichotomy. PMID:16012413

  3. Loin pain hematuria syndrome: Pain relief with intrathecal morphine

    Microsoft Academic Search

    Joshua P. Prager; Antonio DeSalles; Alan Wilkinson; Marilyn Jacobs; Marie Csete

    1995-01-01

    Loin pain hematuria syndrome (LPHS) is characterized by hematuria and incapacitating loin pain. The pain experienced with LPHS is, in general, extremely difficult to treat. Many surgical and pharmacologic therapies have been directed at LPHS pain without success. This report documents successful pain control in a patient with LPHS using long-term intrathecal morphine delivered via an implantable pump. Intrathecal narcotic

  4. Bioprosthetic Mesh in Abdominal Wall Reconstruction

    PubMed Central

    Baumann, Donald P.; Butler, Charles E.

    2012-01-01

    Mesh materials have undergone a considerable evolution over the last several decades. There has been enhancement of biomechanical properties, improvement in manufacturing processes, and development of antiadhesive laminate synthetic meshes. The evolution of bioprosthetic mesh materials has markedly changed our indications and methods for complex abdominal wall reconstruction. The authors review the optimal properties of bioprosthetic mesh materials, their evolution over time, and their indications for use. The techniques to optimize outcomes are described using bioprosthetic mesh for complex abdominal wall reconstruction. Bioprosthetic mesh materials clearly have certain advantages over other implantable mesh materials in select indications. Appropriate patient selection and surgical technique are critical to the successful use of bioprosthetic materials for abdominal wall repair. PMID:23372454

  5. Flap Coverage of Anterior Abdominal Wall Defects

    PubMed Central

    Sacks, Justin M.; Broyles, Justin M.; Baumann, Donald P.

    2012-01-01

    Reconstruction of complex defects of the anterior abdomen is both challenging and technically demanding for reconstructive surgeons. Advancements in the use of pedicle and free tissue transfer along with the use of bioprosthetic and synthetic meshes have provided for novel approaches to these complex defects. Accordingly, detailed knowledge of abdominal wall and lower extremity anatomy in combination with insight into the design, implementation, and limitations of various flaps is essential to solve these complex clinical problems. Although these defects can be attributed to a myriad of etiologic factors, the objectives in abdominal wall reconstruction are consistent and include the restoration of abdominal wall integrity, protection of intraabdominal viscera, and the prevention of herniation. In this article, the authors review pertinent anatomy and the various local, regional, and distant flaps that can be utilized in the reconstruction of these complex clinical cases of the anterior abdomen. PMID:23372457

  6. Amphibian pain and analgesia.

    PubMed

    Machin, K L

    1999-03-01

    Analgesics are often not provided to amphibians because the presence and severity of pain may not be recognized in these animals. In addition, there is little information on the mechanism of action of analgesic agents in amphibians. However, amphibians possess appropriate neurologic components for transmitting pain from peripheral receptors to the central nervous system and antinociceptive mechanisms to modulate pain. They are capable of displaying behavioral and physiologic modification of pain systems in response to analgesic pharmacologic agents. Therefore, pain perception in amphibians is likely analogous to that in mammals and invasive, potentially painful procedures should be accompanied by appropriate analgesia and anesthesia. Although specific doses have not been established in clinical trials, basic research into the mechanisms and regulation of endogenous opioid systems demonstrates the potential clinical benefit for the use of opioids in these animals. Other analgesics such as alpha2-agonists, ketamine, and tricaine methanesulfonate have also demonstrated analgesic potential. PMID:10367638

  7. Pain management in newborns.

    PubMed

    Hall, Richard W; Anand, Kanwaljeet J S

    2014-12-01

    As a standard of care for preterm/term newborns effective pain management may improve their clinical and neurodevelopmental outcomes. Neonatal pain is assessed using context-specific, validated, and objective pain methods, despite the limitations of currently available tools. Therapeutic approaches reducing invasive procedures and using pharmacologic, behavioral, or environmental measures are used to manage neonatal pain. Nonpharmacologic approaches like kangaroo care, facilitated tucking, non-nutritive sucking, sucrose, and others can be used for procedural pain or adjunctive therapy. Local/topical anesthetics, opioids, NSAIDs/acetaminophen and other sedative/anesthetic agents can be incorporated into NICU protocols for managing moderate/severe pain or distress in all newborns. PMID:25459780

  8. Neonatal pain management

    PubMed Central

    Bhalla, Tarun; Shepherd, Ed; Tobias, Joseph D.

    2014-01-01

    The past 2-3 decades have seen dramatic changes in the approach to pain management in the neonate. These practices started with refuting previously held misconceptions regarding nociception in preterm infants. Although neonates were initially thought to have limited response to painful stimuli, it was demonstrated that the developmental immaturity of the central nervous system makes the neonate more likely to feel pain. It was further demonstrated that untreated pain can have long-lasting physiologic and neurodevelopmental consequences. These concerns have resulted in a significant emphasis on improving and optimizing the techniques of analgesia for neonates and infants. The following article will review techniques for pain assessment, prevention, and treatment in this population with a specific focus on acute pain related to medical and surgical conditions. PMID:25538531

  9. Combined myocardial revascularization and abdominal aortic aneurysm repair.

    PubMed

    Hinkamp, T J; Pifarre, R; Bakhos, M; Blakeman, B

    1991-03-01

    Myocardial infarction remains the leading cause of early and late deaths after abdominal aortic reconstruction in patients with abdominal aortic aneurysm. Our approach for the past 4 years has been combined myocardial revascularization with abdominal aortic aneurysm repair in patients with good left ventricle performance. From July 1984 through June 1989, 128 patients underwent abdominal aortic aneurysm repair. Seventeen patients underwent combined abdominal aortic reconstruction with coronary artery bypass grafting. One patient died (5.9%). The remaining patients are all well at current follow-up. Our experience shows that patients with coronary artery disease and abdominal aortic aneurysm may have both lesions safely repaired as a single operative procedure. PMID:1998428

  10. Treatment of painful polyneuropathies

    Microsoft Academic Search

    Bruce Nicholson

    2005-01-01

    The treatment of painful polpyneuropathies has begun to improve over the past several years. This is based on an evolving\\u000a understanding of the pathogenesis related to the development of diabetic neuropathy and other diseases that may lead to peripheral\\u000a nerve injury. Consensus on evaluation strategies for patients presenting with pain has furthered our ability to define neuropathic\\u000a pain and accompanying

  11. Pain management and yoga.

    PubMed

    Nespor, K

    1991-01-01

    The use of yoga and yoga related techniques in pain management is reviewed and discussed. Self-awareness, relaxation, approaches which use respiration, increased self-understanding and self-acceptance, changed context of pain, increased control, life style improvements, group and social support proved beneficial. The use of yoga in pain management has its transpersonal and philosophical dimensions. Independence and self-confidence of suffering people may be protected in this way. PMID:1723397

  12. Giant cystic abdominal masses in children.

    PubMed

    Wootton-Gorges, Sandra L; Thomas, Kristen B; Harned, Roger K; Wu, Sarah R; Stein-Wexler, Rebecca; Strain, John D

    2005-12-01

    In this pictorial essay the common and uncommon causes of large cystic and cyst-like abdominal masses in children are reviewed. We discuss and illustrate the following: mesenchymal hamartoma, choledochal cyst, hydrops of the gallbladder, congenital splenic cyst, pancreatic pseudocyst, pancreatic cystadenoma, hydronephrosis, multicystic dysplastic kidney, multilocular cystic nephroma, adrenal hemorrhage, mesenteric and omental cysts, gastrointestinal duplication cyst, meconium pseudocyst, ovarian cysts and cystic neoplasms, hematocolpos, urachal cysts, appendiceal abscess, abdominal and sacrococcygeal teratoma, and CSF pseudocyst. We also describe imaging features and clues to the diagnosis. PMID:16151789

  13. Painful Boney Metastases

    PubMed Central

    Smith, Howard S.

    2013-01-01

    Boney metastasis may lead to terrible suffering from debilitating pain. The most likely malignancies that spread to bone are prostate, breast, and lung. Painful osseous metastases are typically associated with multiple episodes of breakthrough pain which may occur with activities of daily living, weight bearing, lifting, coughing, and sneezing. Almost half of these breakthrough pain episodes are rapid in onset and short in duration and 44% of episodes are unpredictable. Treatment strategies include: analgesic approaches with "triple opioid therapy", bisphosphonates, chemotherapeutic agents, hormonal therapy, interventional and surgical approaches, steroids, radiation (external beam radiation, radiopharmaceuticals), ablative techniques (radiofrequency ablation, cryoablation), and intrathecal analgesics. PMID:23861996

  14. Pain: You Can Get Help

    MedlinePLUS

    ... where you hurt and exactly how it feels. Acute Pain and Chronic Pain There are two kinds of pain. Acute ... rheumatoid arthritis (RA) and sciatica. In some cases, chronic pain follows after acute pain from an injury or other health issue ...

  15. Effect of abdominal and pelvic floor tasks on muscle activity, abdominal pressure and bladder neck

    Microsoft Academic Search

    Baerbel Junginger; Kaven Baessler; Ruth Sapsford; Paul W. Hodges

    2010-01-01

    Introduction and hypothesis  Although the bladder neck is elevated during a pelvic floor muscle (PFM) contraction, it descends during straining. This study\\u000a aimed to investigate the relationship between bladder neck displacement, electromyography (EMG) activity of the pelvic floor\\u000a and abdominal muscles and intra-abdominal pressure (IAP) during different pelvic floor and abdominal contractions.\\u000a \\u000a \\u000a \\u000a Methods  Nine women without PFM dysfunction performed maximal, gentle and

  16. First year's experience with an acute pain service--University Hospital Kuala Lumpur.

    PubMed

    Vijayan, R; Delilkan, A E

    1994-12-01

    An Acute Pain Service (APS) was started in University Hospital, Kuala Lumpur by the Department of Anaesthesiology in October 1992 for more effective control of postoperative pain. The main modalities of treatment included patient controlled analgesia (PCA) using morphine or pethidine with PCA devises, epidural opiate analgesia (EOA) using tramadol or fentanyl/bupivacaine mixture and subcutaneous administration of morphine or pethidine. Five hundred and fifty-one patients were managed in the first year, with an overall patient satisfaction score of 83%. The majority (98.5%) of them were after abdominal or major orthopaedic surgery. Eighty per cent of patients scored < 3 on the verbal numeric pain scale, where 0 is no pain and 10 is the worst imaginable pain, on the first postoperative day. Nausea and vomiting was an unpleasant side effect in 20% of patients. PMID:7545779

  17. Formation of a chronic pain syndrome due to mesh shrinkage after laparoscopic intraperitoneal onlay mesh (IPOM).

    PubMed

    Klein, Fritz; Ospina, Carlos; Rudolph, Birgit; Wüstefeld, Joost; Denecke, Timm; Neuhaus, Peter; Schmidt, Sven-Christian

    2012-10-01

    The case of a 58-year-old male patient who developed a chronic pain syndrome after laparoscopic intraperitoneal onlay mesh for treatment of a large symptomatic umbilical hernia combined with rectus diastasis is reported. Twelve months after an uncomplicated initial surgery, the patient presented with progressive signs of a foreign body sensation and pain in the anterior abdominal wall. Computed tomography examination revealed no pathologic findings but a marked shrinkage of the mesh implant. Because of further progressive symptoms, explorative laparotomy was performed. Mesh shrinkage and adhesions with a surrounding chronic tissue reaction were found as the cause of the pain syndrome. This case demonstrates a case of a chronic pain syndrome due to mesh shrinkage 12 months after initial ventral hernia repair. Mesh shrinkage should therefore be taken into consideration in patients with progressive pain chronic syndromes after laparoscopic ventral hernia repair. PMID:23047409

  18. TelePain: A Community of Practice for Pain Management

    PubMed Central

    Meins, Alexa R.; Doorenbos, Ardith Z.; Eaton, Linda; Gordon, Debra; Theodore, Brian; Tauben, David

    2015-01-01

    Introduction Comprehensive pain management services are primarily located in urban areas, limiting specialist consultation opportunities for community healthcare providers. A community of practice (CoP) for pain management could create opportunities for consultation by establishing professional relationships between community healthcare providers and pain management specialists. A CoP is a group of people with a common concern, set of problems, or a passion for something they do. Members of a CoP for pain management increase their knowledge of evidence-based pain management strategies in a way that is meaningful and relevant. In this article, we provide evidence that TelePain, an interdisciplinary, case-based pain management teleconference consultation program through the University of Washington, qualifies as a CoP and present preliminary evidence of TelePain's effectiveness as a CoP for pain management. Methods Specific behaviors and conversations gathered through participant observation during TelePain sessions were analyzed based on the 14 indicators Wegner developed to evaluate the presence of a CoP. To demonstrate preliminary effectiveness of TelePain as a CoP for pain management, descriptive statistics were used to summarize TelePain evaluation forms. Results TelePain is an example of a successful CoP for pain management as demonstrated by the presence of Wegner's 14 indicators. Additionally, evaluation forms showed that TelePain enhanced community healthcare providers' knowledge of pain management strategies and that continued participation in TelePain lead to community healthcare providers' increased confidence in their ability to provide pain management. Conclusion TelePain, a CoP for pain management, facilitates multidisciplinary collaboration and allows members to develop interdisciplinary care plans for complex pain patients through case study discussions. Evidence-based pain management strategies gained through CoP membership could be disseminated to other healthcare providers in members' clinics, which has the potential of improving the care of chronic pain patients. PMID:25964869

  19. ABDOMINAL OBESITY, MUSCLE COMPOSITION, AND INSULIN RESISTANCE IN PREMENOPAUSAL WOMEN

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The independent relationships between visceral and abdominal subcutaneous adipose tissue (AT) depots, muscle composition, and insulin sensitivity were examined in 40 abdominally obese, premenopausal women. Measurements included glucose disposal by euglycemic clamp, muscle composition by computed to...

  20. Giant cystic abdominal masses in children

    Microsoft Academic Search

    Sandra L. Wootton-Gorges; Kristen B. Thomas; Roger K. Harned; Sarah R. Wu; Rebecca Stein-Wexler; John D. Strain

    2005-01-01

    In this pictorial essay the common and uncommon causes of large cystic and cyst-like abdominal masses in children are reviewed. We discuss and illustrate the following: mesenchymal hamartoma, choledochal cyst, hydrops of the gallbladder, congenital splenic cyst, pancreatic pseudocyst, pancreatic cystadenoma, hydronephrosis, multicystic dysplastic kidney, multilocular cystic nephroma, adrenal hemorrhage, mesenteric and omental cysts, gastrointestinal duplication cyst, meconium pseudocyst, ovarian

  1. Intra-abdominal extralobar pulmonary sequestration

    Microsoft Academic Search

    J. Antón-Pacheco; J. Cuadros; I. Cano; A. Gomez; F. Echavarri

    1995-01-01

    A left-upper-quadrant abdominal mass was identified in a routine ultrasound (US) examination in the 16th week of gestation. The sonographic features were those of a homogeneous, hyperechogenic lesion situated between the diaphragm and the left kidney. Other radiologic examinations (CT, MRI) confirmed the mass, but a presumptive diagnosis could not be made. The lesion was excised and histologic examination demonstrated

  2. Abdominoplasty repair for abdominal wall hernias.

    PubMed

    Robertson, J Douglas; de la Torre, Jorge I; Gardner, Paul M; Grant, John H; Fix, R Jobe; Vásconez, Luis O

    2003-07-01

    The objectives of abdominal hernial repair are to reconstruct the structural integrity of the abdominal wall while minimizing morbidity. Current techniques include primary closure, staged repair, and the use of prosthetic materials. Techniques for abdominoplasty include the use of the transverse lower abdominal incision and the resection of excess skin. By incorporating these aspects into hernial repairs, the procedures are made safer and the results are improved. The medical records were reviewed of 123 consecutive patients who underwent hernial repair. Seventy-six of these patients underwent a total of 82 herniorrhaphies using an abdominoplasty approach. This included using a transverse lower abdominal incision with or without extending it into an inverted-T incision. The hernial defect was then identified and isolated. Repair was obtained with primary fascial closure and plication, primary fascial approximation and reinforcement with absorbable Vicryl mesh, or placement of permanent mesh with or without fascial approximation. Overall, 8 of 82 hernias recurred. Most complications were minor and could be managed with local wound care only. Major complications included one enterocutaneous fistula, one occurrence of skin flap necrosis requiring operative debridement and skin grafting, and one delayed permanent mesh extrusion 2 years after repair. The abdominoplasty approach isolates the incision from the hernial defect and repair. This technique is safe with a low risk of complications and a low rate of recurrence. It is particularly helpful in obese patients, in patients with multiple hernias, and in those patients with recurrent hernias. PMID:12838119

  3. Segmentation of male abdominal fat using MRI

    E-print Network

    for the automatic and robust segmentation of adipose tissue in the abdominal region of human men. The segmentation is done into 3 classes: subcutaneous adipose tissue, visceral adipose tissue and other tissue. The MRI of adipose tissue into the subcutaneous adipose tissue and visceral adipose tissue classes is done using

  4. Damage control in trauma and abdominal sepsis.

    PubMed

    Waibel, Brett H; Rotondo, Michael F

    2010-09-01

    Damage control surgery, initially formalized <20 yrs ago, was developed to overcome the poor outcomes in exsanguinating abdominal trauma with traditional surgical approaches. The core concepts for damage control of hemorrhage and contamination control with abbreviated laparotomy followed by resuscitation before definitive repair, although simple in nature, have led to an alteration in which emergent surgery is handled among a multitude of problems, including abdominal sepsis and battlefield surgery. With the aggressive resuscitation associated with damage control surgery, understanding of abdominal compartment syndrome has expanded. It is probably through avoiding this clinical entity that the greatest improvement in surgical outcomes for various emergent surgical problems has occurred in the past two decades. However, with its success, new problems have emerged, including increases in enterocutaneous fistulas and open abdomens. But as with any crisis, innovative strategies are being developed. New approaches to control of the open abdomen and reconstruction of the abdominal wall are being developed from negative pressure dressing therapies to acellular allograft meshes. With further understanding of new resuscitative strategies, the need for damage control surgery may decline, along with its concomitant complications, at the same time retaining the success that damage control surgery has brought to the critically ill trauma and general surgery patient in the past few years. PMID:20724875

  5. [Ultrasonic aspects of abdominal abscesses and hematomas].

    PubMed

    Weill, F; Eisenscher, A; Bourgoin, A; Aucant, D; Camelot, G

    1976-12-01

    Abdominal ultrasonography often enables to display the fluid collection of an abcess or haematoma. This type of diagnostic procedure is most useful in a post-operative period. The intestinal gases which stop the ultrasonic beam may be responsible for diagnostic failures. Positive results, which are the most frequent, are never the less precious to assess and decide a treatment policy. PMID:1026726

  6. Duplex surveillance of abdominal aortic stent grafts

    Microsoft Academic Search

    Bonnie L. Johnson; Ronald L. Dalman

    2001-01-01

    Aortic stent grafting is gaining acceptance rapidly as a durable and effective alternative to open surgery for abdominal aortic aneurysms (AAA). Unlike follow-up after open surgical procedures, postplacement surveillance protocols are necessary to ensure long-term freedom from device failure or aneurysm rupture. Surveillance protocols incorporating duplex scanning are effective and may reduce overall postplacement expenses. Specific device or patient anatomic

  7. Medical Management of Small Abdominal Aortic Aneurysms

    Microsoft Academic Search

    B. Timothy Baxter; Michael C. Terrin; Ronald L. Dalman

    2010-01-01

    Abdominal aortic aneurysm is a common condition that may be lethal when it is unrecognized. Current guidelines suggest repair as the aneurysm diameter reaches 5.0 to 5.5 cm. Most aortic aneurysms are detected incidentally when imaging is done for other purposes or through screening programs. Ninety percent of these aneurysms are below the threshold for intervention at the time of

  8. Early Feeding After a Total Abdominal Hysterectomy

    Microsoft Academic Search

    Mary Flesher; Brenda Wagner; Lyn Jones

    Background: Oral fluids and food are traditionally introduced slowly after total abdominal hysterectomy (TAH). This descriptive study examined the effect and tolerance of early oral intake following this surgery. Methods: A retrospective chart review was conducted on 164 patients who had been on a clinical pathway following TAH. Comparisons in initiation of fluids and foods, and gastrointestinal effects were made

  9. Altered Pain Sensitivity in Elderly Women with Chronic Neck Pain

    PubMed Central

    Uthaikhup, Sureeporn; Prasert, Romchat; Paungmali, Aatit; Boontha, Kritsana

    2015-01-01

    Background Age-related changes occur in both the peripheral and central nervous system, yet little is known about the influence of chronic pain on pain sensitivity in older persons. The aim of this study was to investigate pain sensitivity in elders with chronic neck pain compared to healthy elders. Methods Thirty elderly women with chronic neck pain and 30 controls were recruited. Measures of pain sensitivity included pressure pain thresholds, heat/cold pain thresholds and suprathreshold heat pain responses. The pain measures were assessed over the cervical spine and at a remote site, the tibialis anterior muscle. Results Elders with chronic neck pain had lower pressure pain threshold over the articular pillar of C5-C6 and decreased cold pain thresholds over the cervical spine and tibialis anterior muscle when compared with controls (p < 0.05). There were no between group differences in heat pain thresholds and suprathreshold heat pain responses (p > 0.05). Conclusion The presence of pain hypersensitivity in elderly women with chronic neck pain appears to be dependent on types of painful stimuli. This may reflect changes in the peripheral and central nervous system with age. PMID:26039149

  10. Textiloma formation post endovascular repair of abdominal aortic aneurysm.

    PubMed

    Hatzidakis, Adam; Vassalou, Evangelia; Touloupakis, Emanuel; Krokidis, Miltiadis E

    2015-03-01

    We report a case of an 80-year-old man, who underwent an endovascular repair of an abdominal aortic aneurysm. Surgical access was obtained from both common femoral arteries, and the procedure was uneventful. One month computed tomography (CT) follow-up was without findings. Two months after endovascular aortic aneurysm repair (EVAR), the patient complained of claudication on the left side associated with persistent pain, rigid swelling on the left groin area, and occasional febrile episodes within the last month. Ultrasonography showed fluid collection, and needle aspiration gained pus. It was thought to be local postsurgical infection, and the patient got antibiotics, but he did worse. One month later, computed tomography revealed focal left common femoral artery (CFA) stenosis, edematous appearance of subcutaneous soft tissue in the left groin area, and anterior displacement of the ipsilateral CFA in relation to the right side. Surgical exploration of the region revealed retained, uncapsuled, and partially destroyed surgical gauze, lying just behind the left CFA, which was removed. PMID:25838925

  11. Textiloma formation post endovascular repair of abdominal aortic aneurysm

    PubMed Central

    Hatzidakis, Adam; Vassalou, Evangelia; Touloupakis, Emanuel

    2015-01-01

    We report a case of an 80-year-old man, who underwent an endovascular repair of an abdominal aortic aneurysm. Surgical access was obtained from both common femoral arteries, and the procedure was uneventful. One month computed tomography (CT) follow-up was without findings. Two months after endovascular aortic aneurysm repair (EVAR), the patient complained of claudication on the left side associated with persistent pain, rigid swelling on the left groin area, and occasional febrile episodes within the last month. Ultrasonography showed fluid collection, and needle aspiration gained pus. It was thought to be local postsurgical infection, and the patient got antibiotics, but he did worse. One month later, computed tomography revealed focal left common femoral artery (CFA) stenosis, edematous appearance of subcutaneous soft tissue in the left groin area, and anterior displacement of the ipsilateral CFA in relation to the right side. Surgical exploration of the region revealed retained, uncapsuled, and partially destroyed surgical gauze, lying just behind the left CFA, which was removed. PMID:25838925

  12. INTERVENTIONAL PAIN FOR MORE INFORMATION

    E-print Network

    Haykin, Simon

    experience in interventional pain management. The diagnostic and therapeutic approach to the patient. TARGET AUDIENCE Physicians from across Canada with experience in Pain Management and Physicians with experience in Pain Management pertaining to Anesthesia, Physical Medicine, Psychiatry, and Palliative Care

  13. Chemical Interventions for Pain.

    ERIC Educational Resources Information Center

    Aronoff, Gerald M.; And Others

    1986-01-01

    Reviews properties and pharmacological effects of medications for pain, including peripherally acting analgesics, centrally acting narcotics, and adjuvant analgesics including antidepressants. Discusses the role of the endogenous opioid system in pain and depression. Explores clinical management issues in both inpatient and outpatient settings,…

  14. Chronic pain in adults.

    PubMed

    Ostler, Anneli

    2015-06-10

    Reading the CPD article helped improve my understanding of the importance of identifying chronic pain. Chronic pain may occur on its own or as a feature of other chronic conditions, and it may be nociceptive or neuropathic, or a combination of the two. PMID:26058654

  15. Painful and painless channelopathies.

    PubMed

    Bennett, David L H; Woods, C Geoffrey

    2014-06-01

    The discovery of genetic variants that substantially alter an individual's perception of pain has led to a step-change in our understanding of molecular events underlying the detection and transmission of noxious stimuli by the peripheral nervous system. For example, the voltage-gated sodium ion channel Nav1.7 is expressed selectively in sensory and autonomic neurons; inactivating mutations in SCN9A, which encodes Nav1.7, result in congenital insensitivity to pain, whereas gain-of-function mutations in this gene produce distinct pain syndromes such as inherited erythromelalgia, paroxysmal extreme pain disorder, and small-fibre neuropathy. Heterozygous mutations in TRPA1, which encodes the transient receptor potential cation channel, can cause familial episodic pain syndromes, and variants of genes coding for the voltage-gated sodium channels Nav1.8 (SCN10A) and Nav1.9 (SCN11A) lead to small-fibre neuropathy and congenital insensitivity to pain, respectively. Furthermore, other genetic polymorphisms have been identified that contribute to risk or severity of more complex pain phenotypes. Novel models of sensory disorders are in development-eg, using human sensory neurons differentiated from human induced pluripotent stem cells. Understanding rare heritable pain disorders not only improves diagnosis and treatment of patients but may also reveal new targets for analgesic drug development. PMID:24813307

  16. Hypnosis and Clinical Pain

    Microsoft Academic Search

    David R. Patterson; Mark P. Jensen

    2003-01-01

    Hypnosis has been demonstrated to reduce analogue pain, and studies on the mechanisms of laboratory pain reduction have provided useful applications to clinical populations. Studies showing central nervous system activity during hypnotic procedures offer preliminary information concerning possible physiological mechanisms of hypnotic analgesia. Randomized controlled studies with clinical populations indicate that hypnosis has a reliable and significant impact on acute

  17. PAIN SCALES (ATTACHMENT A)

    E-print Network

    Oliver, Douglas L.

    back and forth, tense Arched, rigid or jerking CRY No cry (awake or asleep) Moans or whimpers; occasional complaint Crying steadily, screams or sobs, frequent complaints CONSOLABILITY Content, relaxed for Scoring Post-operative Pain in Young Children (1997) Pediatric Nursing. 23(3): 293-297. #12;PAIN SCALES

  18. Opioids in pain management

    Microsoft Academic Search

    Henry McQuay

    1999-01-01

    Dose titration and differences between clinical and laboratory pharmacology The clinical use of opioids shows a difference between their clinical pharmacology and their laboratory pharmacology. What happens when opioids are given to someone in pain is different from what happens when they are given to someone not in pain. The respiratory depression that results from the acute use of opioids

  19. Pain: Hope through Research

    MedlinePLUS

    ... without affecting other nervous system functions. As we learn more about the specific roles of GABA receptors, drug development may be accelerated. ... reverse and makes pain persist beyond its protective role. ... imaging technology, to locate pain precisely, and to assess the ...

  20. The pain of altruism.

    PubMed

    Finlay, Barbara L; Syal, Supriya

    2014-12-01

    Sociality and cooperation are benefits to human cultures but may carry unexpected costs. We suggest that both the human experience of pain and the expression of distress may result from many causes not experienced as painful in our close primate relatives, because human ancestors motivated to ask for help survived in greater numbers than either the thick-skinned or the stoic. PMID:25200380

  1. Previous Multiple Abdominal Surgeries: A Valid Contraindication to Abdominal Free Flap Breast Reconstruction?

    PubMed Central

    Di Candia, Michele; Asfoor, Ahmed Al; Jessop, Zita M.; Kumiponjera, Devor; Hsieh, Frank; Malata, Charles M.

    2012-01-01

    Presented in part at the following Academic Meetings: 57th Meeting of the Italian Society of Plastic, Reconstructive and Aesthetic Surgery, September 24-27, 2008, Naples, Italy.45th Congress of the European Society for Surgical Research (ESSR), June 9-12, 2010, Geneva, Switzerland.British Association of Plastic Reconstructive and Aesthetic Surgeons Summer Scientific Meeting, June 30-July 2, 2010, Sheffield Hallam University, Sheffield, UK. Background: Patients with previous multiple abdominal surgeries are often denied abdominal free flap breast reconstruction because of concerns about flap viability and abdominal wall integrity. We therefore studied their flap and donor site outcomes and compared them to patients with no previous abdominal surgery to find out whether this is a valid contraindication to the use of abdominal tissue. Patients and Methods: Twenty patients with multiple previous abdominal operations who underwent abdominal free flap breast reconstruction by a single surgeon (C.M.M., 2000-2009) were identified and retrospectively compared with a cohort of similar patients without previous abdominal surgery (sequential allocation control group, n = 20). Results: The index and control groups were comparable in age, body mass index, comorbidities, previous chemotherapy, and RT exposure. The index patients had a mean age of 54 years (r, 42-63) and an average body mass index of 27.5 kg/m2 (r, 22-38). The main previous surgeries were Caesarean sections (19), hysterectomies (8), and cholecystectomies (6). They underwent immediate (n = 9) or delayed (n = 11) reconstructions either unilaterally (n = 18) or bilaterally (n = 2) and comprising 9 muscle-sparing free transverse rectus abdominis muscle and 13 deep inferior epigastric perforator flaps. All flaps were successful, and there were no significant differences in flap and donor site outcomes between the 2 groups after an average follow up of 26 months (r, 10-36). Conclusion: Multiple previous abdominal surgeries did not predispose to increased flap or donor site morbidity. On the basis of our experience, we have proposed some recommendations for successful abdominal free flap breast reconstruction in patients with previous multiple scars. Careful preoperative planning and the use of some intraoperative adaptations can allow abdominal free flap breast reconstruction to be reliably undertaken in such patients. PMID:22848775

  2. Lateral abdominal muscle size at rest and during abdominal drawing-in manoeuvre in healthy adolescents.

    PubMed

    Linek, Pawel; Saulicz, Edward; Wolny, Tomasz; My?liwiec, Andrzej; Kokosz, Miros?aw

    2015-02-01

    Lateral abdominal wall muscles in children and adolescents have not been characterised to date. In the present report, we examined the reliability of the ultrasound measurement and thickness of the oblique external muscle (OE), oblique internal muscle (OI) and transverse abdominal muscle (TrA) at rest and during abdominal drawing-in manoeuvre (ADIM) on both sides of the body in healthy adolescents. We also determined possible differences between boys and girls and defined any factors-such as body mass, height and BMI-that may affect the thickness of the abdominal muscles. B-mode ultrasound was used to assess OE, OI and TrA on both sides of the body in the supine position. Ultrasound measurements at rest and during ADIM were reliable in this age group (ICC3,3 > 0.92). OI was always the thickest and TrA the thinnest muscle on both sides of the body. In this group, an identical pattern of the contribution of the individual muscles to the structure of the lateral abdominal wall (OI > OE > TrA) was observed. At rest and during ADIM, no statistically significant side-to-side differences were demonstrated in either gender. The body mass constitutes between 30% and <50% of the thickness differences in all muscles under examination at rest and during ADIM. The structure of lateral abdominal wall in adolescents is similar to that of adults. During ADIM, the abdominal muscles in adolescents react similarly to those in adults. This study provided extensive information regarding the structure of the lateral abdominal wall in healthy adolescents. PMID:25088309

  3. Responses of intra-abdominal pressure and abdominal muscle activity during dynamic trunk loading in man

    Microsoft Academic Search

    A. G. Cresswell

    1993-01-01

    Summary  The purpose of this study was to determine and compare interactions between the abdominal musculature and intea-abdominal pressure (IAP) during controlled dynamic and static trunk muscle loading. Myoelectric activity was recorded in six subjects from the rectus abdominis, obliquus externus, obliquus internus, transversus abdominis and erector spinae muscles using surface and intea-muscular fine-wire electrodes. The IAP was recorded intea-gastrically. Trunk

  4. Cancer and Referred Facial Pain.

    PubMed

    Romero-Reyes, Marcela; Teruel, Antonia; Ye, Yi

    2015-08-01

    Orofacial pain may be a symptom of diverse types of cancers as a result of local or distant tumor effects. The pain can be presented with the same characteristics as any other orofacial pain disorder, and this should be recognized by the clinician. Orofacial pain also can arise as a consequence of cancer therapy. In the present article, we review the mechanisms of cancer-associated facial pain, its clinical presentation, and cancer therapy associated with orofacial pain. PMID:26088459

  5. An archaeology of pain

    NASA Astrophysics Data System (ADS)

    Gruber, Dennis Michael

    Pain is a discursive construct of science and medicine. Through the discourses of biopower and technoscience pain is used to construct and maintain the social body. Biopower and technoscience are discursive practices that are enveloped within the disciplines of Western society. Specifically, the disciplines of education, science, and medicine use biopower and technoscience to normalize the body and construct binaries which create the abnormal. The cyborg is a discursive practice used to implode the binaries of the disciplines which maintain the social body. Through the implosion of binaries, the binary of mind/body is no longer plausible in the explanation of pain. Neuropathic chronic pain and phantom limb pain become cyborg discourses which operate to deconstruct the pedagogies of science and medicine.

  6. Musculoskeletal chest wall pain

    PubMed Central

    Fam, Adel G.; Smythe, Hugh A.

    1985-01-01

    The musculoskeletal structures of the thoracic wall and the neck are a relatively common source of chest pain. Pain arising from these structures is often mistaken for angina pectoris, pleurisy or other serious disorders. In this article the clinical features, pathogenesis and management of the various musculoskeletal chest wall disorders are discussed. The more common causes are costochondritis, traumatic muscle pain, trauma to the chest wall, “fibrositis” syndrome, referred pain, psychogenic regional pain syndrome, and arthritis involving articulations of the sternum, ribs and thoracic spine. Careful analysis of the history, physical findings and results of investigation is essential for precise diagnosis and effective treatment. ImagesFig. 3Fig. 4Fig. 5 PMID:4027804

  7. Pitfalls in prenatal diagnosis of unusual congenital abdominal wall defects.

    PubMed

    Schnur, Jessica; Dolgin, Stephen; Vohra, Nidhi; Soffer, Samuel; Glick, Richard

    2008-02-01

    We report three cases of unusual skin covered abdominal wall defects not accurately diagnosed by prenatal sonography. An associated omphalocele was recognized in two but misinterpreted as a giant omphalocele in one. Suspicious sonographic features--an enlarged abdominal circumference, irregular laxity of the abdominal--may be clarified by MRI. PMID:18240083

  8. 2013 WSES guidelines for management of intra-abdominal infections

    PubMed Central

    2013-01-01

    Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high. The 2013 update of the World Society of Emergency Surgery (WSES) guidelines for the management of intra-abdominal infections contains evidence-based recommendations for management of patients with intra-abdominal infections. PMID:23294512

  9. Abdominal Ultrasonography as Related to Problems of the Chest

    Microsoft Academic Search

    S. Beckh; K. Kirchpfening

    2009-01-01

    Abdominal sonography represents one of the basic imaging procedures in diagnosing internal diseases. Thanks to bedside equipment examinations can be done in critically ill patients easily and quickly. Abdominal organs such as liver or spleen serve as acoustic windows for imaging of chest diseases. The diaphragm, the pleura and the lower parts of the lung are visible from the abdominal

  10. Ultrasound in abdominal trauma John S. Rose, MD

    E-print Network

    Ultrasound in abdominal trauma John S. Rose, MD Department of Emergency Medicine, University of California Davis Medical Center, 2315 Stockton Blvd., PSSB 2100, Sacramento, CA 95817, USA Ultrasound in the evaluation of abdominal trauma has evolved over the past 30 years. The use of ultrasound for abdominal trauma

  11. Intra-Abdominal Hypertension and Abdominal Compartment Syndrome in Association with Ruptured Abdominal Aortic Aneurysm in the Endovascular Era: Vigilance Remains Critical

    PubMed Central

    Bozeman, Matthew C.; Ross, Charles B.

    2012-01-01

    Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are common complications of ruptured abdominal aortoiliac aneurysms (rAAAs) and other abdominal vascular catastrophes even in the age of endovascular therapy. Morbidity and mortality due to systemic inflammatory response syndrome (SIRS) and multiple organ failure (MOF) are significant. Recognition and management of IAH are key critical care measures which may decrease morbidity and improve survival in these vascular patients. Two strategies have been utilized: expectant management with prompt decompressive laparotomy upon diagnosis of threshold levels of IAH versus prophylactic, delayed abdominal closure based upon clinical parameters at the time of initial repair. Competent management of the abdominal wound with preservation of abdominal domain is also an important component of the care of these patients. In this review, we describe published experience with IAH and ACS complicating abdominal vascular catastrophes, experience with ACS complicating endovascular repair of rAAAs, and techniques for management of the abdominal wound. Vigilance and appropriate management of IAH and ACS remains critically important in decreasing morbidity and optimizing survival following catastrophic intra-abdominal vascular events. PMID:22454763

  12. A rare case of early onset type of abdominal trocar site hernia (TSH) with atypical externalizing in two-step: multidetector row CT diagnosis.

    PubMed

    Coulier, B; Ramboux, A; Pierard, F

    2014-01-01

    We report a rare case of early onset type Trocar Site Hernia (TSH) producing in the right lower abdominal quadrant of a 64-year old obese woman. The patient was admitted in the emergency room for abdominal pain producing four days after laparoscopic adnexectomy. The hernia atypically externalized in two-steps creating two superposed concentric small bowel strangulating hernias producing through two distinctive superposed orifices. A precise and complete anatomic diagnosis was made by contrast enhanced 64-row multidetector computed tomography (MDCT). The imaging features are presented with a short review of the literature. The case emphasizes the high performances of MDCT for the early diagnosis of Trocar Site Hernias. PMID:25597215

  13. The comparative study of epidural levobupivacaine and bupivacaine in major abdominal surgeries

    PubMed Central

    Uzuner, Ali; Saracoglu, Kemal Tolga; Saracoglu, Ayten; Erdemli, Ozcan

    2011-01-01

    BACKGROUND: Opioid and local anesthetic infusion by an epidural catheter is widely used as a postoperative pain management method after major abdominal surgeries. There are several agents nowadays to provide sufficient analgesia. The agents which cause less side effects but better quality of analgesia are more valuable. We aimed to postoperatively compare the analgesic, hemodynamic and arrhythmogenic effects of epidural levobupivacaine-fentanyl and bupivacaine-fentanyl solutions. METHODS: Fifty patients were scheduled to undergo major abdominal surgery in this clinical trial. The parameters were recorded pre- and post-operatively. In Group I (n=25), bupivacaine with fentanyl solution and in Group II (n=25), levobupivacaine with fentanyl solution was infused via epidural patient-controlled analgesia (PCA). According to the preoperative and postoperative holter recording reports, the arrhythmogenic effects were examined in four catagories: ventricular arrhythmia (VA), supraventricular arrhythmia (SVA), atrioventricular conduction abnormalities and pauses longer than two seconds. RESULTS: Mean visual analog scale (VAS) values of groups did not differ at all time. They were 6 at the end of the surgery (0. Min, p = 0.622). The scores were 5 in Group I and 4 in Group II in 30. min (p = 0.301). The frequency of SVA was higher in bupivacaine group. CONCLUSIONS: The results of our study suggest that same concentration of epidural levobupivacaine and bupivacaine with fentanyl provide stable postoperative analgesia and both were found safe for the patients undergoing major abdominal surgery. PMID:22973384

  14. Value-based Clinical Quality Improvement (CQI) for Patients Undergoing Abdominal Wall Reconstruction.

    PubMed

    Stephan, Bradley; Ramshaw, Bruce; Forman, Brandie

    2015-05-01

    Patients with complex ventral/incisional hernias often undergo an abdominal wall reconstruction (AWR). These operations have a high cost of care and often result in a long hospital stay and high complication rates. Using the principles of clinical quality improvement (CQI), several attempts at process improvement were implemented in one hernia program over a 3-year period. For consecutive cases of patients undergoing abdominal wall reconstruction, process improvement attempts included the use of a long-term resorbable synthetic mesh (TIGR® Resorbable Matrix, Novus Scientific, Uppsala, Sweden) in place of a biologic mesh, the use of the transversus abdominis release approach in place of an open or endoscopic component separation (external oblique release) technique, and the use of a preoperative transversus abdominis plane (TAP) block using a long-acting local anesthetic (Exparel®, Pacira Pharmaceutical, Parsippany, NJ) as a part of perioperative multi-modal pain management and an enhanced recovery program. After over 60 cases, improvement in materials costs and postoperative outcomes were documented. No mesh-related complications occurred and no mesh removal was required. In this real-world, value-based application of CQI, several attempts at process improvement led to decreased costs and improved outcomes for patients who underwent abdominal wall reconstruction for complex ventral/incisional hernias. Value-based CQI could be a tool for improved health care value globally. PMID:26055001

  15. Chronic Contained Rupture of an Abdominal Aortic Aneurysm: From Diagnosis to Endovascular Resolution

    SciTech Connect

    Gandini, Roberto, E-mail: marcello.chiocchi@fastwebnet.it; Chiocchi, Marcello; Maresca, Luciano; Pipitone, Vincenzo; Messina, Massimo; Simonetti, Giovanni [University of Rome 'Tor Vergata, Department of Diagnostic and Molecular Imaging, Interventional Radiology, Nuclear Medicine and Radiation Therapy (Italy)

    2008-07-15

    A male patient, 69 years old, presented with fever, leucocytosis, and persistent low back pain; he also had an abdominal aortic aneurysm (AAA), as previously diagnosed by Doppler UltraSound (US), and was admitted to our hospital. On multislice computed tomography (msCT), a large abdominal mass having no definite border and involving the aorta and both of the psoas muscles was seen. This mass involved the forth-lumbar vertebra with lysis, thus simulating AAA rupture into a paraspinal collection; it was initially considered a paraspinal abscess. After magnetic resonance imaging examination and culture of the fluid aspirated from the mass, no infective organisms were found; therefore, a diagnosisof chronically contained AAA rupture was made, and an aortic endoprosthesis was subsequently implanted. The patient was discharged with decreased lumbar pain. At 12-month follow-up, no evidence of leakage was observed. To our knowledge, this is the first case of endoprosthesis implantation in a patient, who was a poor candidate for surgical intervention due to renal failure, leucocytosis and high fever, having a chronically contained AAA ruptured simulatingspodilodiscitis abscess. Appropriate diagnosis and therapy resolved potentially crippling pathology and avoided surgical graft-related complications.

  16. Pain Catastrophising Affects Cortical Responses to Viewing Pain in Others

    PubMed Central

    Fallon, Nicholas

    2015-01-01

    Pain catastrophising is an exaggerated cognitive attitude implemented during pain or when thinking about pain. Catastrophising was previously associated with increased pain severity, emotional distress and disability in chronic pain patients, and is also a contributing factor in the development of neuropathic pain. To investigate the neural basis of how pain catastrophising affects pain observed in others, we acquired EEG data in groups of participants with high (High-Cat) or low (Low-Cat) pain catastrophising scores during viewing of pain scenes and graphically matched pictures not depicting imminent pain. The High-Cat group attributed greater pain to both pain and non-pain pictures. Source dipole analysis of event-related potentials during picture viewing revealed activations in the left (PHGL) and right (PHGR) paraphippocampal gyri, rostral anterior (rACC) and posterior cingulate (PCC) cortices. The late source activity (600–1100 ms) in PHGL and PCC was augmented in High-Cat, relative to Low-Cat, participants. Conversely, greater source activity was observed in the Low-Cat group during the mid-latency window (280–450 ms) in the rACC and PCC. Low-Cat subjects demonstrated a significantly stronger correlation between source activity in PCC and pain and arousal ratings in the long latency window, relative to high pain catastrophisers. Results suggest augmented activation of limbic cortex and higher order pain processing cortical regions during the late processing period in high pain catastrophisers viewing both types of pictures. This pattern of cortical activations is consistent with the distorted and magnified cognitive appraisal of pain threats in high pain catastrophisers. In contrast, high pain catastrophising individuals exhibit a diminished response during the mid-latency period when attentional and top-down resources are ascribed to observed pain. PMID:26186545

  17. Free fluid on abdominal computed tomography without solid organ injury after blunt abdominal injury does not mandate celiotomy

    Microsoft Academic Search

    David H Livingston; Robert F Lavery; Marian R Passannante; Joan H Skurnick; Stephen Baker; Timothy C Fabian; Donald E Fry; Mark A Malangoni

    2001-01-01

    Background: Mandatory celiotomy has been proposed for all patients with unexplained free fluid on abdominal computed tomography (CT) scanning after blunt abdominal injury. This recommendation has been based upon retrospective data and concerns over the potential morbidity from the late diagnosis of blunt intestinal injury. This study examined the rate of intestinal injury in patients with free fluid on abdominal

  18. Neuropathic pain in cancer.

    PubMed

    Goyal, Alka; Bhatnagar, Sushma

    2014-01-01

    Unrelieved neuropathic pain continues to be a substantial health problem in a cancer patient arises either due to disease itself or its treatment. Review of literature showed that neuropathic pain has high prevalence rate, greater severity and analgesic requirement with worse quality of life. Underreporting by patient and under treatment by physician is an important causative factor of indefinite persistence of neuropathic pain. Careful history taking, elaborated physical examination, patient's self report and diagnostic tools with high sensitivity and specificity are needed for accurate assessment of neuropathic pain. Neuropathic cancer pain is difficult to treat and also shows poor response to opioids so in this situation alternate a treatment strategy that also includes psycosocial and spiritual counseling with yoga and meditation exercises under the palliative care framework should be practiced. To find out the burden and estimation of resource generation of this widely recognized problem, accurate establishment of incidence, prevalence, severity, and effectiveness of treatment is quite mandatory. Complex phenomenon of neuropathic pain abolishes establishment of early diagnosis and accurate etiology of this symptom, emphasizes the need of sensitive and reliable clinical grading scale, international classification system and validated diagnostic tools that correspond with clinical assessment. Multiple studies towards this direction has been culminated and some are still going on, though the data and literature is very scant and require further research for the complete evaluation of neuropathic pain. PMID:25841479

  19. Pain and natural disaster.

    PubMed

    Guetti, Cristiana; Angeletti, Chiara; Paladini, Antonella; Varrassi, Giustino; Marinangeli, Franco

    2013-09-01

    The treatment for pain in emergency medicine is a matter of increasing interest. Available data indicate that in both normal conditions and during major-emergencies, the majority of healthcare providers are culturally and professionally unprepared to adequately treat acute pain conditions. In case of natural disasters, opioid drugs are often unavailable. Moreover, no guidelines or validated protocols provide adequate indications for the treatment for pain in case of massive emergencies. Training of the medical and nursing staff, in both formal and continuing, or on-the-job education is needed to adequately face a devastating emergency. Unfortunately, there is an inadequate level of training among healthcare professionals, even in highly seismic areas, and the source of aid is frequently limited, especially in the immediate aftermath of a disaster to those already present at the scene. Pain inadequately treated may modify the characteristics of the pain itself. Pain is no longer considered just a symptom, but itself becomes an autonomous pathology heavily influencing the social life and psycho-social aspects of a person. In the disastrous situation following an earthquake, an inadequate treatment of pain was the major violation of the psycho-physical integrity of individuals and a severe violation of their rights, as human beings and patients. PMID:23241164

  20. Low back pain.

    PubMed Central

    Ehrlich, George E.

    2003-01-01

    Low back pain is a leading cause of disability. It occurs in similar proportions in all cultures, interferes with quality of life and work performance, and is the most common reason for medical consultations. Few cases of back pain are due to specific causes; most cases are non-specific. Acute back pain is the most common presentation and is usually self-limiting, lasting less than three months regardless of treatment. Chronic back pain is a more difficult problem, which often has strong psychological overlay: work dissatisfaction, boredom, and a generous compensation system contribute to it. Among the diagnoses offered for chronic pain is fibromyalgia, an urban condition (the diagnosis is not made in rural settings) that does not differ materially from other instances of widespread chronic pain. Although disc protrusions detected on X-ray are often blamed, they rarely are responsible for the pain, and surgery is seldom successful at alleviating it. No single treatment is superior to others; patients prefer manipulative therapy, but studies have not demonstrated that it has any superiority over others. A WHO Advisory Panel has defined common outcome measures to be used to judge the efficacy of treatments for studies. PMID:14710509

  1. Macrophage Migration Inhibitory Factor Mediates PAR-Induced Bladder Pain

    PubMed Central

    Kouzoukas, Dimitrios E.; Meyer-Siegler, Katherine L.; Ma, Fei; Westlund, Karin N.; Hunt, David E.; Vera, Pedro L.

    2015-01-01

    Introduction Macrophage migration inhibitory factor (MIF), a pro-inflammatory cytokine, is constitutively expressed in urothelial cells that also express protease-activated receptors (PAR). Urothelial PAR1 receptors were shown to mediate bladder inflammation. We showed that PAR1 and PAR4 activator, thrombin, also mediates urothelial MIF release. We hypothesized that stimulation of urothelial PAR1 or PAR4 receptors elicits release of urothelial MIF that acts on MIF receptors in the urothelium to mediate bladder inflammation and pain. Thus, we examined the effect of activation of specific bladder PAR receptors on MIF release, bladder pain, micturition and histological changes. Methods MIF release was measured in vitro after exposing immortalized human urothelial cells (UROtsa) to PAR1 or PAR4 activating peptides (AP). Female C57BL/6 mice received intravesical PAR1- or PAR4-AP for one hour to determine: 1) bladder MIF release in vivo within one hour; 2) abdominal hypersensitivity (allodynia) to von Frey filament stimulation 24 hours after treatment; 3) micturition parameters 24 hours after treatment; 4) histological changes in the bladder as a result of treatment; 5) changes in expression of bladder MIF and MIF receptors using real-time RT-PCR; 6) changes in urothelial MIF and MIF receptor, CXCR4, protein levels using quantitative immunofluorescence; 7) effect of MIF or CXCR4 antagonism. Results PAR1- or PAR4-AP triggered MIF release from both human urothelial cells in vitro and mouse urothelium in vivo. Twenty-four hours after intravesical PAR1- or PAR4-AP, we observed abdominal hypersensitivity in mice without changes in micturition or bladder histology. PAR4-AP was more effective and also increased expression of bladder MIF and urothelium MIF receptor, CXCR4. Bladder CXCR4 localized to the urothelium. Antagonizing MIF with ISO-1 eliminated PAR4- and reduced PAR1-induced hypersensitivity, while antagonizing CXCR4 with AMD3100 only partially prevented PAR4-induced hypersensitivity. Conclusions Bladder PAR activation elicits urothelial MIF release and urothelial MIF receptor signaling at least partly through CXCR4 to result in abdominal hypersensitivity without overt bladder inflammation. PAR-induced bladder pain may represent an interesting pre-clinical model of Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS) where pain occurs without apparent bladder injury or pathology. MIF is potentially a novel therapeutic target for bladder pain in IC/PBS patients. PMID:26020638

  2. The water method is effective in difficult colonoscopy - it enhances cecal intubation in unsedated patients with a history of abdominal surgery

    PubMed Central

    Mann, Surinder K; Leung, Joseph W; Siao-Salera, Rodelei M; Guy, Jackson

    2011-01-01

    Background Colonoscopy in unsedated patients in the US is considered to be difficult. Success rate of cecal intubation is limited by discomfort. Colonoscopy in patients with a history of abdominal surgery is also considered to be difficult due to adhesion-related bowel angulations. The water method has been shown to significantly reduce pain during colonoscopy. Objective To test the hypothesis that the water method enhances the completion of colonoscopy in unsedated patients with a history of abdominal surgery. Design The data bases of two parallel RCT were combined and analyzed. Setting Two Veterans Affairs endoscopy units. Patient and Methods The water and air methods were compared in these two parallel RCT examining unsedated patients. Those with a history of abdominal surgery were selected for evaluation. Main Outcome Measurements Completion of unsedated colonoscopy. Results Among patients with a history of abdominal surgery, the proportion completing unsedated colonoscopy in the water group (19 of 22) was significantly higher than that (11 of 22) in the air group (p=0.0217, Fisher's exact test). Limitations Small number of predominantly male veterans, unblinded colonoscopists, not all types of abdominal surgery (e.g. hysterectomy, gastrectomy) predisposing to difficult colonoscopy were represented. Conclusion This proof-of-principle assessment confirms that in patients with a history of abdominal surgery the water method significantly increases the proportion able to complete unsedated colonoscopy. The water method deserves to be evaluated in patients with other factors associated with difficult colonoscopy. PMID:22586531

  3. Pain intensity, pain interference and characteristics of spinal cord injury

    PubMed Central

    Ullrich, PM; Jensen, MP; Loeser, JD; Cardenas, DD

    2009-01-01

    Study Design Postal survey. Objectives To examine if the intensity of pain in persons with spinal cord injury (SCI) varied as a function of pain site, and to identify the patient and SCI characteristics associated with pain location, pain intensity and pain interference in a sample of persons with SCI. Setting Community sample, United States. Methods A postal survey including measures of pain intensity, pain interference, other pain, demographic and medical characteristics was completed by 238 adults with SCI. Results Average pain intensity was moderate and pain was common across the body. Demographic and medical variables, including SCI level, were generally not associated with pain prevalence, intensity and interference. However, persons with higher level injuries were more likely to report upper extremity pain than persons with paraplegic injuries. The lower body was the location of the highest pain ratings. Conclusion Persons with SCI tend to experience high pain intensity over multiple body locations. Lower body pain was as common as upper extremity pain, but tended to be more intense. PMID:18283293

  4. Examining the Pain Stages of Change Questionnaire in Chronic Pain

    Microsoft Academic Search

    Renee M. Williams; Eleni G. Hapidou; Chia-Yu A. Lin; Hira Abbasi

    2007-01-01

    Purpose: This study examined the relationships of a readiness to adopt a self-management approach to chronic pain, measured by the Pain Stages of Change Questionnaire (PSOCQ), with other pain-related scales in patients attending a chronic pain management program and determined if these measures changed from admission to discharge. The PSOCQ consists of four stages: Pre- contemplation, Contemplation, Action and Maintenance.

  5. Over-the-counter pain relievers

    MedlinePLUS

    ... Analgesics; Acetaminophen; NSAID; Nonsteroidal anti-inflammatory drug; Pain medicine - over-the-counter; Pain medicine - OTC ... Pain medicines are also called analgesics. Each kind of pain medicine has benefits and risks. Some types of pain ...

  6. Nonspecific Arm Pain

    PubMed Central

    Moradi, Ali; Ebrahimzadeh, Mohammad H; Ring, David

    2013-01-01

    Nonspecific activity-related arm pain is characterized by an absence of objective physical findings and symptoms that do not correspond with objective pathophysiology. Arm pain without strict diagnosis is often related to activity, work-related activity in particular, and is often seen in patients with physically demanding work. Psychological factors such as catastrophic thinking, symptoms of depression, and heightened illness concern determine a substantial percentage of the disability associated with puzzling hand and arm pains. Ergonomic modifications can help to control symptoms, but optimal health may require collaborative management incorporating psychosocial and psychological elements of illness. PMID:25207288

  7. Reconstruction option of abdominal wounds with large tissue defects

    PubMed Central

    2014-01-01

    Background Abdominal wall defects result from trauma, abdominal wall tumors, necrotizing infections or complications of previous abdominal surgeries. Apart from cosmetics, abdominal wall defects have strong negative functional impact on the patients. Many different techniques exist for abdominal wall repair. Most problematic and troublesome are defects, where major part of abdominal wall had to be resected and tissue for transfer or reconstruction is absent. Case presentation Authors of the article present operative technique, in which reconstruction of abdominal wall was managed by composite polypropylene mesh with absorbable collagen film, creation of granulation tissue with use of NPWT (negative pressure wound therapy), and subsequent split skin grafting. Three patients with massive abdominal wall defect were successfully managed and abdominal wall reconstruction was performed by mentioned technique. Functional and cosmetic effect is acceptable and patients have good postoperative quality of life. Conclusions Patients with giant abdominal defects can benefit from described technique. It serves as the only option, with which abdominal wall is fully reconstructed without need for the secondary intervention. PMID:25103782

  8. [Six-month follow-up of the effect of neomenor in patients with painful menstruation].

    PubMed

    Sirakov, M; Karamisheva, V; Ivanov, St

    2011-01-01

    Neomenor is herbal medication especially created to permanently relieve painful menstruation symptoms in girls and women with primary dysmenorrhea. It supplies the organism with substances essential for the metabolic processes that guarantee normal menstrual cycles. In some women these substances are out of balance, there is an excess of prostaglandins, which leads to painful periods, menstrual cramps and even migraine. Each NEOMENOR tablet contains 400 mg of standardized extracts from stalks of: Astragalus glycypyhyllos (Wild liquorice), Erodium cicutarium (Redstem Stork's Bill) and Geranium sanguineum (Bloody Cranesbill). Their biologically active substances inhibit the synthesis of prostaglandins and their secretion into the uterus, hence strong muscle contractions are reduced and menstrual cramps disappear. The aim of this short study is to gain personal impressions about the action of the preparation. We have tested 35 girls and women with middle-age--18.74 on (14-28 years) with menarche--average at 12.8, suffering of primary dysmenorrhea. We have watched following factors: degree of dysmenorrhea, duration of complaints, habitus, gynecological and mental status, used painkillers. As a result of three months treatment 63% of the patients with III-d and 37% with II-nd grade of dysmenorrhea transformed in 42% with II-nd and 45% with I-st grade of dysmenorrhea. Only in 4 patients (11%) therapy was without success. The monitoring continues. PMID:21695945

  9. Abdominal tuberculosis mimicking Crohn’s disease’s exacerbation: A clinical, diagnostic and surgical dilemma. A case report

    PubMed Central

    Papis, Davide; Branchi, Vittorio; Gomez, Luis; Herrerias, Fernando; Vilardell, Felip; Gonzalez, Marta; Olsina, Jorge J

    2014-01-01

    Introduction Tuberculosis in Europe is a health public problem, which has increased constantly over the last few decades. The most common clinical manifestation of tuberculosis is pulmonary. The diagnosis of extrapulmonary tuberculosis can be challenging and clinical manifestations of gastrointestinal tuberculosis are unspecific and can mimic other pathologies. Presentation of case A young Chinese man, who had recently been diagnosed with Crohn’s disease, was admitted to the emergency room of our hospital with a one-month history of diffuse abdominal pain and weight loss. The patient initially presented with epigastric pain, which had been constantly increasing over the last 48 h. Other symptoms included diarrhea, nausea, and fever. The patient was then admitted with the diagnosis of Crohn’s disease exacerbation, and a treatment with corticosteroids, azathioprine, mesalazine, adalimumab, and antibiotic therapy was started. The symptoms were due to an initially misdiagnosed case of abdominal tuberculosis. Discussion Intestinal tuberculosis is mainly localized at the ileocecal level in 85% of patients. Medical therapy is the treatment of choice and surgery is not required if it is diagnosed at an early stage.? Conclusion The diagnosis of abdominal tuberculosis still remains a challenge for both internists and surgeons. Before starting a therapy with adalimumab, every patient should be tested for latent tuberculosis infection. PMID:25528041

  10. Transient receptor potential ankyrin 1 mediates chronic pancreatitis pain in mice

    PubMed Central

    Cattaruzza, Fiore; Johnson, Cali; Leggit, Alan; Grady, Eileen; Schenk, A. Katrin; Cevikbas, Ferda; Cedron, Wendy; Bondada, Sandhya; Kirkwood, Rebekah; Malone, Brian; Steinhoff, Martin; Bunnett, Nigel

    2013-01-01

    Chronic pancreatitis (CP) is a devastating disease characterized by persistent and uncontrolled abdominal pain. Our lack of understanding is partially due to the lack of experimental models that mimic the human disease and also to the lack of validated behavioral measures of visceral pain. The ligand-gated cation channel transient receptor potential ankyrin 1 (TRPA1) mediates inflammation and pain in early experimental pancreatitis. It is unknown if TRPA1 causes fibrosis and sustained pancreatic pain. We induced CP by injecting the chemical agent trinitrobenzene sulfonic acid (TNBS), which causes severe acute pancreatitis, into the pancreatic duct of C57BL/6 trpa1+/+ and trpa1-/- mice. Chronic inflammatory changes and pain behaviors were assessed after 2–3 wk. TNBS injection caused marked pancreatic fibrosis with increased collagen-staining intensity, atrophy, fatty replacement, monocyte infiltration, and pancreatic stellate cell activation, and these changes were reflected by increased histological damage scores. TNBS-injected animals showed mechanical hypersensitivity during von Frey filament probing of the abdomen, decreased daily voluntary wheel-running activity, and increased immobility scores during open-field testing. Pancreatic TNBS also reduced the threshold to hindpaw withdrawal to von Frey filament probing, suggesting central sensitization. Inflammatory changes and pain indexes were significantly reduced in trpa1-/- mice. In conclusion, we have characterized in mice a model of CP that resembles the human condition, with marked histological changes and behavioral measures of pain. We have demonstrated, using novel and objective pain measurements, that TRPA1 mediates inflammation and visceral hypersensitivity in CP and could be a therapeutic target for the treatment of sustained inflammatory abdominal pain. PMID:23558009

  11. Anterior Abdominal Wall Haemangioma with Inguinal Extension

    PubMed Central

    Dubhashi, Siddharth P; Choudhary, Kaushal

    2014-01-01

    Haemangioma are common benign vascular tumour but Intramuscular haemangiomas are rare tumours comprising less than 1% of all. The most frequent sites are extremities, head and neck whereas abdominal wall is a quiet rare location. Ultrasonography is an appropriate initial diagnostic modality and MRI is the investigation of choice. A rare case presented to us as Intramuscular haemangioma of anterior abdominal wall with inguinal extension. Ultrasonography with Doppler study and MRI was suggestive of same finding. Intraoperatively patient had huge haemangioma involving external oblique, internal oblique and transverse abdominus muscle. Wide local excision with meshplasty was done as part of muscle had to be removed. Histology confirmed the diagnosis of Intramuscular Haemangioma. PMID:25584266

  12. A rare nonincisional lateral abdominal wall hernia

    PubMed Central

    Kim, Dong-Ju

    2015-01-01

    A 68-year-old woman presented a rare lateral abdominal wall hernia. Three month before admission to Chungbuk National University Hospital, she found a large protruding mass measuring 8 cm in diameter in the midaxillary line just below the costal margin upon heavy coughing. She had no history of abdominal trauma, infection, or operation previously. The mass was easily reduced manually or by position change to left lateral decubitus. CT scan showed a defect of the right transversus abdominis muscle and internal oblique muscle at the right flank with omental herniation. Its location is different from that of spigelian hernia or lumbar hernia. The peritoneal lining of the hernia sac was smooth and there was no evidence of inflammation or adhesion. The hernia was successfully repaired laparoscopically using Parietex composite mesh with an intraperitoneal onlay mesh technique. The patient was discharged uneventfully and did not show any evidence of recurrence at follow-up visits. PMID:25692123

  13. Blunt trauma to the abdominal aorta.

    PubMed

    Lock, J S; Huffman, A D; Johnson, R C

    1987-06-01

    This review of blunt trauma to the abdominal aorta is based on one case summary and 32 cases from the literature. Motor vehicle accidents caused about half of the reported cases. In 69% of the cases the diagnosis was made in the immediate or early period. Associated injuries were present in 71% of the cases. Most injuries occurred at the inferior mesenteric artery (33%) or the renal arteries (24%). Overall mortality was 27%. Lower extremity ischemia evident on physical examination may suggest the diagnosis. When blunt abdominal aortic injury is suspected without distal ischemia, aortography may be used to define or exclude the injury and further therapy. Only minimal intimal disruptions should be managed nonoperatively. PMID:3298665

  14. [Normal abdominal ultrasound anatomy. Examination procedure].

    PubMed

    Salcedo Joven, I; Segura Grau, A; Rodríguez Lorenzo, A; Segura Cabral, J M

    2014-01-01

    To carry out an abdominal ultrasound examination with the highest degree of accuracy and thoroughness, it is essential to have a good knowledge of the anatomy and the normal measurements of the different organs. In this way, we can determine their normal condition and identify the pathology and its location more easily. It is very important to adopt a correct examination procedure, systematically sweeping the scan in the same direction and not leaving any organ unexamined. We suggest a procedure consisting of longitudinal, cross-sectional and oblique scans to view all the abdominal organs, starting the examination in the epigastric region, scanning first the right upper quadrant, then the left upper quadrant, both iliac fossa, and lastly the hypogastric region. PMID:24746380

  15. [Septic shock following abdominal operations (author's transl)].

    PubMed

    Krieg, H; Grönniger, J; Loth, R

    1977-02-25

    Septic or toxic shock is a life threatening complication after abdominal operations. The etiologic analysis of our 102 patients showed the following conditions: 1. diseases, which have already preoperatively a high incidence of septic complications, 2. sepsis developing after primary aseptic diseases, 3. septis without any etiologic connection to the primary disease or operation. An initial standarised intensive therapy must start before any irreversible organ damage may occur. First aim of all surgical measures is the eradication of the source of infection. Early relaparotomy is the only possibility for correction of intraoperativ technical defects. Only by longstanding combination of intensive personal and technical support prognosis of septic shock after abdominal operations can be improved. PMID:836527

  16. Postamputation pain: studies on mechanisms.

    PubMed

    Nikolajsen, Lone

    2012-10-01

    Amputation is followed by both painful and non-painful phantom phenomena in a large number of amputees. Non-painful phantom sensations rarely pose any clinical problem, but 60-80% of all amputees also experience painful sensations (i.e. phantom pain) located to the missing limb. The severity of phantom pain usually decreases with time, but severe pain persists in 5-10% of patients. Pain in the residual limb (i.e. stump pain) is another consequence of amputation. Both stump and phantom pain can be very difficult to treat. Treatment guidelines used for other neuropathic pain conditions are probably the best approximation, especially for the treatment of stump pain. The aim of the present doctoral thesis was to explore some of the mechanisms underlying pain after amputation. Ten studies were carried out (I-X). My PhD thesis from 1998 dealt with pain before the amputation and showed that preamputation pain increases the risk of phantom pain after amputation (I). A perioperative epidural blockade, however, did not reduce the incidence of pain or abnormal sensory phenomena after amputation (II, III). The importance of sensitization before amputation for the subsequent development of pain is supported by study IV, in which pressure pain thresholds obtained at the limb before amputation were inversely related to stump and phantom pain after 1 week. Afferent input from the periphery is likely to contribute to postamputation pain as sodium channels were upregulated in human neuromas (VI), although neuroma removal did not always alleviate phantom pain (V). Sensitization of neurons in the spinal cord also seems to be involved in pain after amputation as phantom pain was reduced by ketamine, an NMDA-receptor antagonist. Another NMDA-receptor antagonist, memantine, and gabapentin, a drug working by binding to the ?2?-subunit of voltage-gated calcium channels, had no effect on phantom pain (VII-IX). Supraspinal factors are also important for pain after amputation as catastrophizing was associated with phantom pain (X). In conclusion, the present doctoral thesis confirmed and expanded the findings by others that several mechanisms are involved in the development and maintenance of phantom pain. A better understanding of the underlying mechanisms will hopefully lead to improved treatment of pain after amputation in the future. PMID:23158899

  17. Laparoscopy in Non-Trauma Abdominal Emergencies

    Microsoft Academic Search

    Joshua R. Karas; Roberto Bergamaschi

    2010-01-01

    \\u000a Abstract\\u000a   The role for laparoscopy has evolved throughout the years and more evidence has become available to support its use in abdominal\\u000a emergencies. Although the literature has expanded and more randomized controlled trials are available, skepticism persists\\u000a concerning the use of laparoscopy in emergency situations. We attempt to provide the readers with a concise review and highlight\\u000a the most relevant

  18. Abdominal Aortic Aneurysm in Situs Inversus Totalis

    Microsoft Academic Search

    Takayoshi Kato; Hisato Takagi; Seishiro Sekino; Hideaki Manabe; Yukihiro Matsuno; Takuya Umemoto

    2006-01-01

    Situs inversus totalis refers to a mirror-image reversal of the normal position of the internal organs. The recognition of\\u000a concomitant anomalies, such as in the cardiac, venous, gastrointestinal, and urinary systems, is extremely important because\\u000a these anomalies may disturb the surgical procedure for the concurrent disease in situs inversus totalis. The authors describe\\u000a a case of successfully repaired abdominal aortic

  19. Cameraless Peritoneal Entry in Abdominal Laparoscopy

    PubMed Central

    Carlson, William H.; Tully, Griffeth; Rajguru, Amit; Burnett, Dan R.

    2012-01-01

    Background and Objectives: Despite significant advances in laparoscopic instrumentation and techniques, injury to intraabdominal structures remains a potentially serious complication of peritoneal access. Consensus on the best method to obtain peritoneal access is lacking. A safe technique that does not rely on direct visualization of the abdominal layers could shorten the learning curve for surgeons and potentially be adopted by other physicians for a variety of nonsurgical indications for peritoneal entry. Methods: A prospective series of 99 consecutive patients who underwent upper-abdominal laparoscopic surgery performed by a single surgeon between January 2009 and June 2010 was reviewed. The method used to obtain peritoneal access was the fluid-based peritoneal entry indication technique (C-PET) with the EndoTIP trocar. Results: Successful abdominal entry using C-PET was achieved in 90 (90.9%) of the patients; no trocar-related injuries or other injuries associated with peritoneal access occurred. The mean time from incision to confirmed peritoneal access was 21.4 s (range, 12 to 65). Of the 9 cases in which C-PET did not successfully gain entry, 6 occurred during the first 20 surgeries and only 3 in the final 79. Conclusions: C-PET is simple, safe, timely, and effective for gaining peritoneal access during laparoscopic abdominal surgeries. In this series, C-PET produced no complications and proved effective across a wide variety of patients, including the obese and those who had had previous surgery. Furthermore, C-PET does not require visual recognition of anatomic layers and potentially could easily be taught to nonsurgeon physicians who perform peritoneal access. PMID:23484564

  20. Data and image processing for abdominal imaging

    Microsoft Academic Search

    L. Bidaut

    2000-01-01

    Modern imaging techniques allow information from within the human body to be obtained by using noninvasive or minimally invasive\\u000a means. This article is intended as a summary of the tools used for processing and displaying such datasets, with a focus on\\u000a abdominal imaging. Although these tools and their applications are permanently evolving, their use for clinic and research\\u000a is already

  1. Malignant peritoneal mesothelioma after remote abdominal radiation

    SciTech Connect

    Gilks, B.; Hegedus, C.; Freeman, H.; Fratkin, L.; Churg, A.

    1988-05-15

    Peritoneal mesothelioma in a 61-year-old man, occurred 26 years after abdominal radiotherapy for a testicular seminoma. The patient had no history of asbestos exposure. After asbestos, radiation is the second most frequent defined cause of mesothelioma in North America, but the number of well-documented cases is small; this case represents only the fifth example of peritoneal mesothelioma after therapeutic irradiation of the abdomen. 16 references.

  2. Elective abdominal hysterectomy in Nigerian Jehovah's Witnesses.

    PubMed

    Oladapo, O T

    2004-09-01

    In a retrospective study at a university hospital, the perioperative morbidity associated with elective total abdominal hysterectomy in 23 Jehovah's Witnesses was compared with that of 46 non-Witness controls. The mean operative blood loss was significantly less, the procedure was lengthier and the average postoperative hospital stay was longer in the study than in the control group. Febrile morbidity was insignificantly more frequent among the study group (OR: 2.05, CI: 0.61-6.88) and there was no significant difference between the overall morbidity experienced by patients in both groups (study: 43.5% versus control: 39.1%; P = 0.73). The perioperative morbidity associated with elective abdominal hysterectomy in patients unwilling to accept blood transfusion does not justify the denial of this important gynaecological surgery when indicated. Gynaecologists in poor resource settings should consciously aim at providing 'bloodless' care for all their patients undergoing abdominal hysterectomy as this may translate to reduced blood loss and decreased need for blood transfusion. PMID:16147614

  3. Abdominal tuberculosis--a disease revived.

    PubMed Central

    Addison, N. V.

    1983-01-01

    Abdominal tuberculosis was common in the United Kingdom in the 18th and 19th centuries and in the first half of the 20th century. During the 1950's the recognition of Crohn's disease, the use of streptomycin and other drugs, and the pasteurisation of milk led to the virtual disappearance of abdominal tuberculosis in the western world. During the last two decades a new type, mycobacterium tuberculosis hominis, has appeared mainly in the immigrant population, especially in those from the Indian subcontinent. A retrospective review of 68 patients with abdominal tuberculosis is presented. The pathology, diagnosis and management of these cases is discussed, together with the differential diagnosis of Crohn's disease. It is suggested that the immigrant brings the disease into the United Kingdom in his mesenteric glands and that the disease is reactivated or 'revived' at some later date due to some modification of the immune process. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 PMID:6338801

  4. [Surgical management of blunt abdominal trauma].

    PubMed

    Wu, C L; Chou, M C

    1993-09-01

    From 1986 to 1990, 175 patients with blunt abdominal trauma were hospitalized and operated on in Kuang Tien General Hospital. Included were 140 males and 35 females with a mean age of 33 years (range: 2 to 82). The mean duration of the follow-up was 42 months. We classified the severity of the injured organs with the organ injury scale which was published by the Organ Injury Scaling (O.I.S.) Committee of the American Association for the Surgery of Trauma (A. A. S. T.) in 1989 and 1990. Among the patients, 12 cases were treated with splenorrhaphy. Eighty-two cases underwent splenectomy. Four cases underwent partial resection of the liver. Three cases required repair of the inferior vena cava. Seventeen cases were treated with partial resection of the small intestine and anastomosis. Seven cases underwent colostomy. Three cases were treated with distal pancreatectomy. Nineteen cases underwent nephrectomy. One case was treated with partial nephrectomy. The mortality rate was 6.3%, and the morbidity rate 20.6%. The most frequent postoperative complications related to blunt abdominal trauma in the patients who survived the initial operation were wound infection (8.0%), small bowel obstruction (4.0%), pulmonary infection (2.3%), intra-abdominal abscesses (2.3%), pancreatitis (1.7%), pancreatic fistula (1.7%), and pseudocyst (0.6%). PMID:8271328

  5. Pain Assessment for Older Adults

    Microsoft Academic Search

    Ellen Flaherty

    WHY: Studies on pain in older adults (persons 65 years of age and older) have demonstrated that 25%-50% of community dwelling older people have persistent pain. Additionally, 45-80% of nursing home residents report pain that is often left untreated. Pain is strongly associated with depression and can result in decreased socialization, impaired ambulation and increased healthcare utilization and costs. Older

  6. Chronic Pain in College Students

    PubMed Central

    Thomas, Michael; Roy, Ranjan; Cook, Andrew; Marykuca, Steve

    1992-01-01

    A survey of university students confirms earlier studies that found chronic pain fairly common among young adults. Students with chronic pain were similar demographically and psychologically to students with pain of less than 3 months' duration, but were much more likely to use analgesics and alcohol and to report that pain interfered with school work. Treatment implications are discussed. PMID:21221345

  7. Chronic pain in elderly people

    Microsoft Academic Search

    Lucy Gagliese; Ronald Melzack

    1997-01-01

    Chronic pain in elderly people has only recently begun to receive serious empirical consideration. There is compelling evidence that a significant majority of the elderly experience pain which may interfere with normal functioning. Nonetheless, a significant proportion of these individuals do not receive adequate pain management. Three significant factors which may contribute to this are (1) lack of proper pain

  8. Complex Regional Pain Syndrome

    MedlinePLUS

    ... injury. Your doctor may also call this condition reflex sympathetic dystrophy or causalgia. The cause of the ... specifically at dealing with chronic pain. Other Organizations Reflex Sympathetic Dystrophy Syndrome Association of America Questions to ...

  9. Complex regional pain syndrome

    MedlinePLUS

    ... plays an important role in the pain. Another theory is that CRPS is caused by a triggering ... early as possible. Starting an exercise program and learning to keep joints and muscles moving may prevent ...

  10. Anterior knee pain

    MedlinePLUS

    ... as running, jumping or twisting, skiing, or playing soccer) You have flat feet Anterior knee pain is ... to the kneecap Runners, jumpers, skiers, bicyclists, and soccer players who exercise often Teenagers and healthy young ...

  11. Point-of-care musculoskeletal ultrasound is critical for the diagnosis of hemarthroses, inflammation and soft tissue abnormalities in adult patients with painful haemophilic arthropathy.

    PubMed

    Kidder, W; Nguyen, S; Larios, J; Bergstrom, J; Ceponis, A; von Drygalski, A

    2015-07-01

    We previously demonstrated in adult patients with haemophilia (PWH) that hemarthrosis is present in only ~1/3rd of acutely painful joints by using point-of-care-musculoskeletal ultrasound (MSKUS). Therefore, other unrecognized tissue abnormalities must contribute to pain. Using high resolution MSKUS, employing grey scale and power Doppler, we sought to retrospectively (i) investigate soft tissue abnormalities in painful haemophilic joints and (ii) to determine to what extent MSKUS findings, functional or radiographic joint scores correlate with biomarkers of inflammation in PWH. Findings were correlated with Hemophilia Joint Health Scores (HJHS), Pettersson scores, high sensitivity C-reactive protein and von Willebrand factor activity and antigen levels. A total of 65 MSKUS examinations for acute and chronic joint pains were performed for 34 adult haemophilia patients, mostly for chronic joint pains (72.3%). The most prominent findings (66.5%) pertained to inflammatory soft tissue changes including synovitis, tendinitis, enthesitis, bursitis and fat pad inflammation. Effusions were present in 55.5% and 46.8% of MSKUS performed for acute and chronic pain, respectively. Of those, 90.0% were bloody during acute and 47.6% during persistent pains. While inflammatory biomarkers correlated well with overall HJHS and total Pettersson scores (P < 0.05), they did not differ between those patients with synovitis and those without. MSKUS is emerging as an important modality to diagnose treatable musculoskeletal abnormalities contributing to pain in haemophilic arthropathy, and therefore seems critical for a personalized approach to haemophilia care. The role of biomarkers in this setting remains less clear and requires further investigation. PMID:25623830

  12. Peripheral kappa-opioid agonists for visceral pain.

    PubMed

    Rivière, Pierre J-M

    2004-04-01

    Kappa (kappa)-opioid receptor agonists are particularly effective analgesics in experimental models of visceral pain. Their analgesic effects are mediated in the periphery. The molecular targets involved include peripherally located kappa-receptors and possibly, at least for some nonpeptidic kappa-agonists, additional nonopioid molecular targets such as sodium channels located on primary sensory afferents. Overall, these properties are expected to be of therapeutic interest in various visceral pain conditions, including abdominal surgery associated with postoperative pain and ileus, pancreatitis pain, dysmenorrhea, labor pain and functional disorders such as irritable bowel syndrome or dyspepsia. The first kappa-agonists to be developed were brain-penetrating organic small molecules. Their development was eventually discontinued due to central side effects such as sedation and dysphoria attributed to kappa-receptors located behind the blood-brain barrier. New drug discovery programs are now geared towards the design of peripherally-selective kappa-agonists. So far, most of the organic molecule-based peripheral kappa-agonists have achieved limited peripheral selectivity and a practically insufficient therapeutic window to justify full development. These compounds have been used in a small number of clinical pilot studies involving visceral pain. Although encouraging, the clinical data available so far with this class of compounds are too limited and fragmented to fully validate the therapeutic utility of kappa-agonists in visceral pain. Additional clinical studies with safer kappa-agonists (i.e. with higher peripheral selectivity) are still required. The most suitable tools to address this question in the future appear to be the newly discovered class of tetrapeptide-based kappa-agonists, which have shown unprecedented levels of peripheral selectivity. PMID:15051626

  13. Sodium channelopathies and pain

    Microsoft Academic Search

    Angelika Lampert; Andrias O. O’Reilly; Peter Reeh; Andreas Leffler

    2010-01-01

    Chronic pain often represents a severe, debilitating condition. Up to 10% of the worldwide population are affected, and many\\u000a patients are poorly responsive to current treatment strategies. Nociceptors detect noxious conditions to produce the sensation\\u000a of pain, and this signal is conveyed to the CNS by means of action potentials. The fast upstroke of action potentials is mediated\\u000a by voltage-gated

  14. Low Back Pain

    PubMed Central

    Reuler, James B.

    1985-01-01

    Low back pain is one of the most common and costly afflictions of our Society. The majority of adults will have at least one episode of acute low back pain that will likely resolve regardless of treatment. Lumbar spine radiographs are overused and there is little scientific support for many of the therapeutic interventions advocated. Even for those patients with symptomatic herniated disc, only a small fraction will ultimately require surgical intervention. PMID:2930949

  15. Myofascial Head Pain.

    PubMed

    Fernández-de-Las-Peñas, César

    2015-07-01

    Muscle nociception is mainly characterized by local tenderness and referred pain. The neurophysiological basis of muscle pain supports a role of sensitization mechanisms. From a clinical viewpoint, muscle pain is represented by the presence of myofascial trigger points (TrPs). Evidence suggests that TrPs are able to start a peripheral nociceptive mechanism and hence contributing to changes in the central nervous system. Several studies demonstrated that the referred pain elicited by TrPs reproduces the headache pattern in patients with tension-type headache (TTH), migraine, cervicogenic headache and, in some individuals, with cluster headache. In fact, sensitization of nociceptive pain pathways in the central nervous system due to prolonged nociceptive stimuli from TrPs seems to be responsible for the conversion of episodic to chronic TTH. In other headaches, TrPs may be able to stimulate the trigeminal nucleus caudalis and hence triggering a migraine or cluster headache attack. Proper treatment directed towards TrP inactivation has documented positive effects in individuals with these headaches; however, longitudinal studies are needed to further determine the role of TrPs in head pain. PMID:26049772

  16. Factors contributing to pain chronicity

    Microsoft Academic Search

    Charlie K. Wang; Jennifer Myunghae Hah; Ian Carroll

    2009-01-01

    The chronicity of pain is the feature of pain that is least understood and most directly linked with our inability to effectively\\u000a manage pain. Acute pain is relatively responsive to our current pharmacologic and interventional armamentarium. However, as\\u000a pain persists, our ability to treat effectively diminishes and the patient’s frustration and resource utilization increases.\\u000a This article explores our current understanding

  17. Multiple pain complaints in amputees.

    PubMed Central

    Lindesay, J E

    1985-01-01

    A group of amputees complaining of longstanding phantom pain was compared with another comparable group of non-complainers. It was found that those with phantom pain made significantly more complaints of other painful conditions, both related and unrelated to the amputation; they were also more depressed. It is suggested that this association is due to a lowered pain tolerance in the group with phantom pain complaints, and that depression is one factor contributing to this lowered tolerance. PMID:3999080

  18. Endovascular Repair of Abdominal Aortic Aneurysm

    PubMed Central

    2002-01-01

    EXECUTIVE SUMMARY The Medical Advisory Secretariat conducted a systematic review of the evidence on the effectiveness and cost-effectiveness of endovascular repair of abdominal aortic aneurysm in comparison to open surgical repair. An abdominal aortic aneurysm [AAA] is the enlargement and weakening of the aorta (major blood artery) that may rupture and result in stroke and death. Endovascular abdominal aortic aneurysm repair [EVAR] is a procedure for repairing abdominal aortic aneurysms from within the blood vessel without open surgery. In this procedure, an aneurysm is excluded from blood circulation by an endograft (a device) delivered to the site of the aneurysm via a catheter inserted into an artery in the groin. The Medical Advisory Secretariat conducted a review of the evidence on the effectiveness and cost-effectiveness of this technology. The review included 44 eligible articles out of 489 citations identified through a systematic literature search. Most of the research evidence is based on non-randomized comparative studies and case series. In the short-term, EVAR appears to be safe and comparable to open surgical repair in terms of survival. It is associated with less severe hemodynamic changes, less blood transfusion and shorter stay in the intensive care and hospital. However, there is concern about a high incidence of endoleak, requiring secondary interventions, and in some cases, conversion to open surgical repair. Current evidence does not support the use of EVAR in all patients. EVAR might benefit individuals who are not fit for surgical repair of abdominal aortic aneurysm and whose risk of rupture of the aneurysm outweighs the risk of death from EVAR. The long-term effectiveness and cost-effectiveness of EVAR cannot be determined at this time. Further evaluation of this technology is required. OBJECTIVE The objective of this health technology policy assessment was to determine the effectiveness and cost-effectiveness of endovascular repair of abdominal aortic aneurysms (EVAR) in comparison to open surgical repair (OSR). BACKGROUND Clinical Need An abdominal aortic aneurysm (AAA) is a localized, abnormal dilatation of the aorta greater than 3 cm or 50% of the aortic diameter at the diaphragm. (1) A true AAA involves all 3 layers of the vessel wall. If left untreated, the continuing extension and thinning of the vessel wall may eventually result in rupture of the AAA. The risk of death from ruptured AAA is 80% to 90%. (61) Heller et al. (44) analyzed information from a national hospital database in the United States. They found no significant change in the incidence rate of elective AAA repair or ruptured AAA presented to the nation’s hospitals. The investigators concluded that technologic and treatment advances over the past 19 years have not affected the outcomes of patients with AAAs, and the ability to identify and to treat patients with AAAs has not improved. Classification of Abdominal Aortic Aneurysms At least 90% of the AAAs are affected by atherosclerosis, and most of these aneurysms are below the level of the renal arteries.(1) An abdominal aortic aneurysm may be symptomatic or asymptomatic. An AAA may be classified according to their sizes:(7) Small aneurysms: less than 5 cm in diameter. Medium aneurysms: 5-7cm. Large aneurysms: more than 7 cm in diameter. Small aneurysms account for approximately 50% of all clinically recognized aneurysms.(7) Aortic aneurysms may be classified according to their gross appearance as follows (1): Fusiform aneurysms affect the entire circumference of a vessel, resulting in a diffusely dilated lesion Saccular aneurysms involve only a portion of the circumference, resulting in an outpouching (protrusion) in the vessel wall. Prevalence of Abdominal Aortic Aneurysms In community surveys, the prevalence of AAA is reported to be between 1% and 5.4%. (61) The prevalence is related to age and vascular risk factors. It is more common in men and in those with a positive family history. In Canada, Abdominal aortic aneurysms are the 10th leading cause of death in men 6

  19. Neural mechanisms mediating positive and negative treatment expectations in visceral pain: a functional magnetic resonance imaging study on placebo and nocebo effects in healthy volunteers.

    PubMed

    Schmid, Julia; Theysohn, Nina; Gaß, Florian; Benson, Sven; Gramsch, Carolin; Forsting, Michael; Gizewski, Elke R; Elsenbruch, Sigrid

    2013-11-01

    To elucidate placebo and nocebo effects in visceral pain, we conducted a functional magnetic resonance imaging (fMRI) study to analyze effects of positive and negative treatment expectations in a rectal pain model. In 36 healthy volunteers, painful rectal distensions were delivered after intravenous application of an inert substance combined with either positive instructions of pain relief (placebo group) or negative instructions of pain increase (nocebo group), each compared to neutral instructions. Neural activation during cued-pain anticipation and pain was analyzed along with expected and perceived pain intensity. Expected and perceived pain intensity were significantly increased in the nocebo group and significantly decreased in the placebo group. In the placebo group, positive expectations significantly reduced activation of the somatosensory cortex during anticipation and of the insula, somatosensory cortex, and amygdala during pain delivery when compared to neutral expectations. Within the nocebo group, negative expectations led to significantly increased insula activation during painful stimulation. Direct group contrasts during expectation modulation revealed significantly increased distension-induced activation within the somatosensory cortex in the nocebo group. In conclusion, the experience and neural processing of visceral pain can be increased or decreased by drug-specific expectations. This first brain imaging study on nocebo effects in visceral pain has implications for the pathophysiology and treatment of patients with chronic abdominal complaints such as irritable bowel syndrome. PMID:23867733

  20. Managing a Female Patient with Left Low Back Pain and Sacroiliac Joint Pain with Therapeutic Exercise: A Case Report

    PubMed Central

    2011-01-01

    ABSTRACT Purpose: The purpose of this case study is to describe the management of a female patient with chronic left low back pain and sacroiliac joint pain (LBP/SIJP) using unique unilateral exercises developed by the Postural Restoration Institute (PRI) to address pelvic asymmetry and left hip capsule restriction, which is consistent with a Right Handed and Left Anterior Interior Chain pattern of postural asymmetry. Client Description: The client was 65-year-old woman with a 10-month history of constant left LBP/SIJP and leg pain. Intervention: The patient was seen six times to correct pelvic position/posture and left hip posterior capsule restriction via (1) muscle activation (left hamstrings, adductor magnus, and anterior gluteus medius) and (2) left hip adduction to lengthen the left posterior capsule/ischiofemoral ligament. Stabilization exercises included bilateral hamstrings, gluteus maximus, adductors, and abdominals to maintain pelvic position/posture. Measures and Outcome: Left Ober's test (initially positive) was negative at discharge. Pain as measured on the Numeric Pain Rating Scale (initially 1/10 at best and 8/10 at worst) was 0/10–0/10 at discharge. Oswestry Disability Index score (initially 20%) was 0% at discharge. The patient no longer had numbness in her left leg, and sexual intercourse had become pain free. Implications: Interventions to restore and maintain the optimal position of pelvis and hip (femoral head in the acetabulum) may be beneficial for treating patients with chronic LBP/SIJP. The patient's pain was eliminated 13 days after she first performed three exercises to reposition the pelvis and restore left posterior hip capsule extensibility and internal rotation. PMID:22379254

  1. Pain as social glue: shared pain increases cooperation.

    PubMed

    Bastian, Brock; Jetten, Jolanda; Ferris, Laura J

    2014-11-01

    Even though painful experiences are employed within social rituals across the world, little is known about the social effects of pain. We examined the possibility that painful experiences can promote cooperation within social groups. In Experiments 1 and 2, we induced pain by asking some participants to insert their hands in ice water and to perform leg squats. In Experiment 3, we induced pain by asking some participants to eat a hot chili pepper. Participants performed these tasks in small groups. We found evidence for a causal link: Sharing painful experiences with other people, compared with a no-pain control treatment, promoted trusting interpersonal relationships by increasing perceived bonding among strangers (Experiment 1) and increased cooperation in an economic game (Experiments 2 and 3). Our findings shed light on the social effects of pain, demonstrating that shared pain may be an important trigger for group formation. PMID:25193943

  2. Measurement properties of painDETECT by average pain severity

    PubMed Central

    Cappelleri, Joseph C; Bienen, E Jay; Koduru, Vijaya; Sadosky, Alesia

    2014-01-01

    Background Since the burden of neuropathic pain (NeP) increases with pain severity, it is important to characterize and quantify pain severity when identifying NeP patients. This study evaluated whether painDETECT, a screening questionnaire to identify patients with NeP, can distinguish pain severity. Materials and methods Subjects (n=614, 55.4% male, 71.8% white, mean age 55.5 years) with confirmed NeP were identified during office visits to US community-based physicians. The Brief Pain Inventory – Short Form stratified subjects by mild (score 0–3, n=110), moderate (score 4–6, n=297), and severe (score 7–10, n=207) average pain. Scores on the nine-item painDETECT (seven pain-symptom items, one pain-course item, one pain-irradiation item) range from ?1 to 38 (worst NeP); the seven-item painDETECT scores (only pain symptoms) range from 0 to 35. The ability of painDETECT to discriminate average pain-severity levels, based on the average pain item from the Brief Pain Inventory – Short Form (0–10 scale), was evaluated using analysis of variance or covariance models to obtain unadjusted and adjusted (age, sex, race, ethnicity, time since NeP diagnosis, number of comorbidities) mean painDETECT scores. Cumulative distribution functions on painDETECT scores by average pain severity were compared (Kolmogorov–Smirnov test). Cronbach’s alpha assessed internal consistency reliability. Results Unadjusted mean scores were 15.2 for mild, 19.8 for moderate, and 24.0 for severe pain for the nine items, and 14.3, 18.6, and 22.7, respectively, for the seven items. Adjusted nine-item mean scores for mild, moderate, and severe pain were 17.3, 21.3, and 25.3, respectively; adjusted seven-item mean scores were 16.4, 20.1, and 24.0, respectively. All pair-wise comparisons of scores between pain-severity groups showed sizable and statistically significant differences (P<0.0001). Cumulative distribution functions showed distinct separation between severity (P<0.0001). Cronbach’s alphas were 0.76 and 0.80 for the nine- and seven-item scales, respectively. Conclusion This study provides strong psychometric evidence on the validity and reliability of painDETECT for distinguishing average pain severity in patients with NeP. PMID:25395867

  3. Phytotherapy in functional upper abdominal complaints Results of a clinical study with a preparation of several plants.

    PubMed

    Westphal, J; Hörning, M; Leonhardt, K

    1996-03-01

    Efficacy and tolerance of Lomatol® drops (a preparation with extracts of the fruits of Carum carvi [caraway], fruits of Foeniculum vulgare [fennel], leaves of Menta piperita [peppermint] and the herb of Artemisia absinthium [wormwood] in the treatment of upper abdominal complaints was compared with the efficacy and tolerance of metoclopramide drops in a controlled, randomized, double-blind study. Their impact on the symptoms of pain, nausea, heartburn, retching and gastrospasms were assessed on a 5-point rating scale. During the two weeks of treatment and observation the phytodrug demonstrated statistically significant better results than the synthetic preparation in relieving all the symptoms. These findings were confirmed by subjective assessment of the general condition by the patient. Moreover, Lomatol® caused significantly fewer adverse drug reactions than metoclopramide and was statistically significantly better tolerated. Thus, this plant combination can be recommended for upper abdominal complaints without any restrictions. The same is also true for similarly composed Lomatol® coated tablets. PMID:23194763

  4. Evaluation of a Porcine Dermal Collagen (Permacol) Implant for Abdominal Wall Reconstruction in a Pediatric Multitrauma Patient

    PubMed Central

    Mnouskin, Youri; Verdiger Kurzbart, Edna; Yoffe, Boris

    2014-01-01

    The presence of a contaminated surgical field in abdominal wall defects caused by trauma presents a challenge for surgeons. Both primary suture and synthetic meshes are strongly discouraged as surgical treatments in such cases. We describe the use of a porcine dermal collagen (Permacol) implant in an eight-year-old patient with multiple injuries. Three months after discharge, the child remains well with good cosmetic results. He is free of pain and has returned to full activity levels with complete wound closure and without any evidence of residual hernia. In conclusion, our experience indicates that the use of Permacol can be considered an efficient technique for reconstructing an infected abdominal wall defect of a pediatric multitrauma patient. PMID:24839568

  5. Evaluation of a porcine dermal collagen (permacol) implant for abdominal wall reconstruction in a pediatric multitrauma patient.

    PubMed

    Melnik, Idit; Mnouskin, Youri; Verdiger Kurzbart, Edna; Yoffe, Boris

    2014-01-01

    The presence of a contaminated surgical field in abdominal wall defects caused by trauma presents a challenge for surgeons. Both primary suture and synthetic meshes are strongly discouraged as surgical treatments in such cases. We describe the use of a porcine dermal collagen (Permacol) implant in an eight-year-old patient with multiple injuries. Three months after discharge, the child remains well with good cosmetic results. He is free of pain and has returned to full activity levels with complete wound closure and without any evidence of residual hernia. In conclusion, our experience indicates that the use of Permacol can be considered an efficient technique for reconstructing an infected abdominal wall defect of a pediatric multitrauma patient. PMID:24839568

  6. [A case of recurrent colon cancer with improvement in prognosis and cancer pain after surgical intervention].

    PubMed

    Fujisaki, Shigeru; Takashina, Motoi; Tomita, Ryouichi; Sakurai, Kenichi; Takayama, Tadatoshi

    2014-11-01

    We report a case of recurrent colon cancer with improvement in prognosis and cancer pain after surgical intervention. A 47-year-old man underwent an emergency Hartmann procedure for colon obstruction from descending colon cancer. Histopathological findings confirmed adenocarcinoma (moderate to poor), pT4apN0cM0, pStage II, and Cur A. In October 2009, abdominal computed tomography examination detected a solitary intraperitoneal recurrent lesion. Multi-agent chemotherapy ( mFOLFOX6)was administered. A fentanyl patch was also placed for relieving cancer pain, but was removed 4 months later because the pain disappeared. From June 2010, multi-agent chemotherapy with FOLFIRI was replaced with bevacizumab because of the increase in recurrent lesion size. In August 2011, the recurrent lesion involving the abdominal wall, left side of the colon, iliopsoas muscle, and left side of the ureter was resected and the left ureter was reconstructed. No fentanyl patch was prescribed at this time. In October 2012, tumor relapse was detected along with lung metastasis, and multi-agent chemotherapy ( FOLFIRI+bevacizumab) was resumed. In January 2013, the cancer pain recurred, and a fentanyl patch was placed again. Since then, the fentanyl dosage has been gradually increased. In August 2013, the tumor in the abdominal wall was resected to manage the patients' pain in the left lower side of the abdomen. Histopathology revealed a tumor in the lymph nodes. In November 2013, multi-agent chemotherapy with FOLFIRI+cetuximab was initiated, but was ineffective. In January 2014, regorafenib was prescribed. The patient has survived for more than 6 years after the primary surgery. We conclude that a therapeutic strategy that combines surgical interventions and multi-agent chemotherapy needs to be considered for improving prognosis and cancer pain in recurrent colon cancer. PMID:25731330

  7. The cancer pain experience of Israeli adults 65 years and older: the influence of pain interference, symptom severity, and knowledge and attitudes on pain and pain control

    Microsoft Academic Search

    Marlene Z. Cohen; Catherine F. Musgrave; Deborah B. McGuire; Neville E. Strumpf; Mark F. Munsell; Tito R. Mendoza; Maya Gips

    2005-01-01

    Goals: Little is known about Israeli elders' cancer pain ex- perience. The purpose of this study was to explore the cancer pain expe- rience, including pain intensity, pain management index, pain interference, symptom severity, and knowledge and attitudes toward pain and pain control. Patients and methods: Descriptive cross-sectional methods were used to obtain data with four instruments. The patients were

  8. Spinal Cord Stimulation for Intractable Visceral Pain Due to Sphincter of Oddi Dysfunction

    PubMed Central

    Lee, Kang Hun; Lee, Sang Eun; Jung, Jae Wook

    2015-01-01

    Sphincter of Oddi dysfunction (SOD) is a syndrome of chronic biliary pain or recurrent pancreatitis due to the functional obstruction of the pancreaticobiliary flow. We report a case of spinal cord stimulation (SCS) for chronic abdominal pain due to SOD. The patient had a history of cholecystectomy and had suffered from chronic right upper quadrant abdominal pain. The patient had been diagnosed as having SOD. The patient was treated with opioid analgesics and nerve blocks, including a splanchnic nerve block. However, two years later, the pain became intractable. We implanted percutaneous SCS at the T5-7 level for this patient. Visual analog scale (VAS) scores for pain and the amount of opioid intake decreased. The patient was tracked for more than six months without significant complications. From our clinical case, SCS is an effective and alternative treatment option for SOD. Further studies and long-term follow-up are necessary to understand the effectiveness and the limitations of SCS on SOD. PMID:25589948

  9. An open comparison between routine and self-administered postoperative pain relief.

    PubMed

    Slattery, P J; Harmer, M; Rosen, M; Vickers, M D

    1983-01-01

    Patients receiving staff-administered analgesics after upper abdominal surgery had higher pain scores than similar patients having self-administered analgesics, but this was associated with a considerably smaller average amount of analgesic given. This survey was subject to observer and patient bias and it was necessary to use 'pethidine equivalents' to enable comparisons to be made between drugs with effects of different duration; thus the striking differences in pain scores and grades can be considered indicative only. They nevertheless support the continued investigation of on-demand systems and make a strong case for a double-blind controlled trial. PMID:6824294

  10. Positive Traits Linked to Less Pain through Lower Pain Catastrophizing

    PubMed Central

    Hood, Anna; Pulvers, Kim; Carrillo, Janet; Merchant, Gina; Thomas, Marie

    2011-01-01

    The present study examined the association between positive traits, pain catastrophizing, and pain perceptions. We hypothesized that pain catastrophizing would mediate the relationship between positive traits and pain. First, participants (n = 114) completed the Trait Hope Scale, the Life Orientation Test- Revised, and the Pain Catastrophizing Scale. Participants then completed the experimental pain stimulus, a cold pressor task, by submerging their hand in a circulating water bath (0º Celsius) for as long as tolerable. Immediately following the task, participants completed the Short-Form McGill Pain Questionnaire (MPQ-SF). Pearson correlation found associations between hope and pain catastrophizing (r = ?.41, p < .01) and MPQ-SF scores (r = ?.20, p < .05). Optimism was significantly associated with pain catastrophizing (r = ?.44, p < .01) and MPQ-SF scores (r = ?.19, p < .05). Bootstrapping, a non-parametric resampling procedure, tested for mediation and supported our hypothesis that pain catastrophizing mediated the relationship between positive traits and MPQ-SF pain report. To our knowledge, this investigation is the first to establish that the protective link between positive traits and experimental pain operates through lower pain catastrophizing. PMID:22199416

  11. [Continuous peridural anesthesia in abdominal surgery. An alternative for elderly patients].

    PubMed

    Fuchs, C

    1992-10-01

    Being advanced in years is not in itself a high risk in anaesthesia; however, altered pharmacokinetics and pharmacodynamics, mental dysfunction and the administration of anaesthetics complicate the postoperative period. In order to examine the problem of sedation in elderly patients, we studied the effects and side effects of continuous peridural anaesthesia for abdominal surgery. METHODS. On the day before surgery we inserted a peridural catheter (Perifix 400, Braun, Melsungen, FRG) between T-12 and L-4 in 52 patients in a sitting position (mean age 69.3 +/- 10.9 years) using the loss-of-resistance technique. If no signs of spinal anaesthesia became apparent, the exact position of the catheter was determined using 9 or 10 ml bupivacaine 0.5%. Next day, after premedication with atropine, pethidine or midazolam, 20-25 ml bupivacaine 0.5% was instilled through the peridural catheter. During surgery patients were sedated using a small dose of propofol. We also insufflated oxygen (2 l/min). Blood pressure, heart rate, and blood gases were monitored and electrocardiography and pulse oximetry performed. As postoperative pain therapy, we administered morphine through the peridural catheter at intervals of 8 h. For statistical evaluation we used Wilcoxon's test. RESULTS. An adequate degree of analgesia was found between T-4 and T-7 and abdominal muscle relaxation was satisfactory. Heart rate decreased by 10.3% after the administration of local anaesthetics. After surgery had begun, blood pressure decreased over a period of 30 min (systolic by 20.5% and diastolic by 14.2%) but it remained constant at this level during the rest of the operation (see Fig. 1). Neither of these side effects was significant. Oxygen saturation and blood gases were normal. During the operation, a mean dose of 325 mg propofol/h was necessary to maintain sedation. After surgery all patients were awake, suffered no pain and had complete amnesia with regard to the operation. The postoperative peridural dosage of 5 mg morphine (three times in 24 h) was very effective. Because some patients vomited we used between 50 and 100 mg tramadol (four times in 24 h) instead of morphine. Early mobilization of patients was possible and there were no pulmonary complications such as pneumonia. CONCLUSIONS. If carried out by an experienced physician, continuous peridural anaesthesia can be an alternative method in abdominal surgery for elderly patients. We see advantages in the minimal disturbance of pulmonary and mental function, in the minimal amount of sedation required and in the successful postoperative pain therapy. PMID:1443512

  12. Early reconstruction of the abdominal wall in giant omphalocele.

    PubMed

    Zama, Mario; Gallo, Simona; Santecchia, Luigino; Bertozzi, Ettore; Zaccara, Antonio; Trucchi, Alessandro; Nahom, Antonella; Bagolan, Pietro; De Stefano, Cosmoferruccio

    2004-12-01

    Omphalocele is the most common congenital defect of the abdominal wall. Mortality rate is between 20 and 70% and early closure of the abdominal wall, within 10 days of life, is vital to the successful outcome of the surgical treatment. The authors describe the use of two bipedicled flaps of abdominal skin to correct the defect of the midline as soon as the reduction of all viscera has been accomplished. PMID:15544772

  13. Abdominal Wall Schwannoma: Case Report and Review of the Literature

    PubMed Central

    Mishra, A.; Hamadto, M.; Azzabi, M.; Elfagieh, M.

    2013-01-01

    A 29-year-old female had presented to surgical outpatient's department complaining of lump in the anterior abdominal wall. Ultrasound and magnetic resonance imaging revealed a solid degenerated tumor in the anterior abdominal wall. It was surgically excised, and histopathology confirmed it to be “ancient” schwannoma. To our knowledge, this is the second reported case of an abdominal wall ancient schwannoma in the medical literature. PMID:23841008

  14. Abdominal wall schwannoma: case report and review of the literature.

    PubMed

    Mishra, A; Hamadto, M; Azzabi, M; Elfagieh, M

    2013-01-01

    A 29-year-old female had presented to surgical outpatient's department complaining of lump in the anterior abdominal wall. Ultrasound and magnetic resonance imaging revealed a solid degenerated tumor in the anterior abdominal wall. It was surgically excised, and histopathology confirmed it to be "ancient" schwannoma. To our knowledge, this is the second reported case of an abdominal wall ancient schwannoma in the medical literature. PMID:23841008

  15. Pathology Case Study: Postoperative Abdominal Discomfort

    NSDL National Science Digital Library

    Kulich, Scott

    This is a clinical microbiology case study presented by the University of Pittsburgh Department of Pathology in which a 22 year old male is experiencing postoperative abdominal discomfort. Visitors are given both the microscopic and gross descriptions, including images, and are given the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using laboratory results to diagnose. It is also a helpful site for educators to use to introduce or test student learning in clinical microbiology and related medicine.

  16. [Nursing aspects in pain treatment].

    PubMed

    Sundqvist, A

    1994-01-01

    Pain, the concept of pain and how pain is connected with culture are discussed in this article. The experience of pain in individual. It can not be questioned. The primary task of nursing is to help and support a patient to cope with pain in spite of the fact whether there is a cause for pain or not. Besides pharmacotherapy there are other possibilities to help a patient, e.g. by taking care of the surroundings, offering interesting subjects to think about, using imagination, relaxation, cognitive behavioral therapy, massage, therapeutic touch and thermat and cryotherapy. PMID:8054647

  17. Acute postoperative pain management: focus on iontophoretic transdermal fentanyl

    PubMed Central

    Mattia, Consalvo; Coluzzi, Flaminia

    2007-01-01

    Despite progress in the management of chronic pain, acute pain remains an issue for many postoperative patients. Although patient-controlled analgesia (PCA) has demonstrated efficacy and patient satisfaction, current techniques using intravenous (IV) administration present limitations, including the risk of programming errors and the potential to limit patient mobility due to pumps, lines, and tubing. The patient-controlled fentanyl hydrochloride (HCl) iontophoretic transdermal system (fentanyl ITS) was designed to address these concerns. Fentanyl ITS is an innovative, needle-free, self-contained drug-delivery system that uses iontophoretic technology to deliver fentanyl through the skin by application of a low-intensity electrical field. The results of several clinical studies are presented in this review. In three phase 3 placebo-controlled trials, fentanyl ITS was shown to be superior to placebo for the treatment of postoperative pain following major abdominal, orthopedic, and thoracic surgery. The results of one active-comparator phase 3 trial demonstrated comparable safety and efficacy with a standard morphine IV PCA dosing regimen, without significant difference in the side effect profile. Fentanyl ITS represents a safe, easy to use, non-invasive, and convenient alternative to current acute postoperative pain management modalities. PMID:18360612

  18. Bromfenac sodium, acetaminophen\\/oxycodone, ibuprofen, and placebo for relief postoperative pain

    Microsoft Academic Search

    Gary H. Johnson; J. Dallas Van Wagoner; Jean Brown; Stephen A. Cooper

    1997-01-01

    The objective of this double-masked, parallel-group, multicenter, inpatient study was to compare bromfenac with an acetaminophen\\/oxycodone combination and ibuprofen in patients who had pain due to abdominal gynecologic surgery. In the 8-hour, single-dose phase, 238 patients received single oral doses of bromfenac (50 or 100 mg), acetaminophen 650 mg\\/oxycodone 10 mg, ibuprofen 400 mg, or placebo. In the multiple-dose phase,

  19. Management of separation pain after single-dose methotrexate therapy for ectopic pregnancy

    Microsoft Academic Search

    Gary H. Lipscomb; Karen J. Puckett; Derita Bran; Frank W. Ling

    1998-01-01

    Objective: To review the success of conservative management of moderate to severe abdominal\\/pelvic pain occurring after treatment of ectopic pregnancy with systemic methotrexate, to evaluate prognostic factors for success, and to determine if the overall resolution time was shorter in such patients.Methods: A retrospective chart review of all single-dose methotrexate patients treated from January 1, 1992 to January 1, 1997

  20. Cost and Reimbursement for Three Fibroid Treatments: Abdominal Hysterectomy, Abdominal Myomectomy, and Uterine Fibroid Embolization

    SciTech Connect

    Goldberg, Jay, E-mail: jaygoldbergmd@yahoo.com; Bussard, Anne [Jefferson Medical College, Department of Obstetrics and Gynecology (United States); McNeil, Jean [Jefferson Medical College, Department of Finance (United States); Diamond, James [Jefferson Medical College, Department of Family Medicine (United States)

    2007-02-15

    Purpose. To compare costs and reimbursements for three different treatments for uterine fibroids. Methods. Costs and reimbursements were collected and analyzed from the Thomas Jefferson University Hospital decision support database from 540 women who underwent abdominal hysterectomy (n 299), abdominal myomectomy (n = 105), or uterine fibroid embolization (UFE) (n = 136) for uterine fibroids during 2000-2002. We used the chi-square test and ANOVA, followed by Fisher's Least Significant Difference test, for statistical analysis. Results. The mean total hospital cost (US$) for UFE was $2,707, which was significantly less than for hysterectomy ($5,707) or myomectomy ($5,676) (p < 0.05). The mean hospital net income (hospital net reimbursement minus total hospital cost) for UFE was $57, which was significantly greater than for hysterectomy (-$572) or myomectomy (-$715) (p < 0.05). The mean professional (physician) reimbursements for UFE, hysterectomy, and myomectomy were $1,306, $979, and $1,078, respectively. Conclusion. UFE has lower hospital costs and greater hospital net income than abdominal hysterectomy or abdominal myomectomy for treating uterine fibroids. UFE may be more financially advantageous than hysterectomy or myomectomy for the insurer, hospital, and health care system. Costs and reimbursements may vary amongst different hospitals and regions.

  1. Abdominal alterations in disseminated paracoccidioidomycosis: computed tomography findings*

    PubMed Central

    Vermelho, Marli Batista Fernandes; Correia, Ademir Silva; Michailowsky, Tânia Cibele de Almeida; Suzart, Elizete Kazumi Kuniyoshi; Ibanês, Aline Santos; Almeida, Lanamar Aparecida; Khoury, Zarifa; Barba, Mário Flores

    2015-01-01

    Objective To evaluate the incidence and spectrum of abdominal computed tomography imaging findings in patients with paracoccidioidomycosis. Materials and Methods Retrospective analysis of abdominal computed tomography images of 26 patients with disseminated paracoccidioidomycosis. Results Abnormal abdominal tomographic findings were observed in 18 patients (69.2%), while no significant finding was observed in the other 8 (30.8%) patients. Conclusion Computed tomography has demonstrated to play a relevant role in the screening and detection of abdominal abnormalities in patients with disseminated paracoccidioidomycosis. PMID:25987748

  2. Low back pain.

    PubMed Central

    Frank, A

    1993-01-01

    The studies reviewed here show that the duration and severity of individual episodes of back pain can be lessened, reducing recurrences and their cost in terms of suffering and lost work. Frank examines differential diagnosis; acute, chronic, and intractable pain; and service implications. Modern management emphasises self care, and bed rest should usually not be longer than 48 hours. A return to physical fitness and other activities, including employment, is actively encouraged. Medication has a role in facilitating these objectives. Two points are especially emphasised: strategies to manage low back pain must be long term and preventive; and the responsibility to keep fit, maintain an exercise programme, and remain relaxed so as to avoid physically stressing the spine is that of the individual, not of the professionals. Images FIG 2 PMID:8347190

  3. In search of risk factors for chronic pain in adolescents: a case–control study of childhood and parental associations

    PubMed Central

    Coenders, Alies; Chapman, Cindy; Hannaford, Patricia; Jaaniste, Tiina; Qiu, Wen; Anderson, David; Glogauer, Maline; Goodison-Farnsworth, Evelyn; McCormick, Marianne; Champion, David

    2014-01-01

    Objectives This study was designed to investigate whether an individual and parental history of functional pain syndromes (FPS) is found more often in adolescents suffering from chronic pain than in their pain-free peers. Methods Our case–control study involved 101 adolescents aged 10–18 years. Cases were 45 patients of the Chronic Pain Clinic at Sydney Children’s Hospital with diverse chronic pain disorders. Controls consisted of 56 adolescent volunteers who did not have chronic pain. Adolescents and their parents filled out questionnaires assessing demographic data as well as known and potential risk factors for chronic pain. A history of FPS was assessed by questionnaire, including restless legs syndrome (RLS). Chi-squared tests and t-tests were used to investigate univariate associations between chronic pain in adolescents and lifetime prevalence of FPS. Logistic regression was used to test multivariate associations, while controlling for possible confounders. Results Migraine, non-migraine headaches, recurrent abdominal pain (RAP), and RLS were reported significantly more frequently in cases than controls (P-values of 0.01, <0.001, 0.01, and 0.03, respectively). Parental migraine, RAP, and RLS were also significantly associated with adolescent chronic pain in the multivariate analyses. Individual history of migraine, non-migraine headaches, and RAP, along with parental history of RAP and depression significantly accounted for 36%–49% of variance in chronic pain. Other associations with chronic pain were generally in accordance with previous reports. Discussion It may be helpful when assessing a child who has chronic pain or is at risk of chronic pain, to enquire about these associations. Based on the current findings, an individual history of migraine, non-migraine headaches, and RAP, as well as parental migraine, RAP, and RLS are symptoms that are of particular relevance to assess. PMID:24707186

  4. [Pain and Christianity. A symbol for overcoming pain?].

    PubMed

    Markschies, C

    2007-08-01

    Pain and Christianity appear to belong together: Christ's pain stands at the centre of God's healing; his pain leads to the salvation of mankind. We can learn from Jesus' example how to bear suffering and pain. In early Christian times, the belief that Jesus Christ suffered pain on the cross was usually not accepted. In line with the "apathy axiom", freedom from emotion was something to strive for at that time. Only after the acceptance of Christianity as the state religion of the Roman Empire in 380 AD did the pain of Christ again stand in the centre of the Christian doctrine of salvation. The memory of the fact that Jesus himself had to undergo the worst pain can still help people to overcome their pain and comfort them. PMID:17674055

  5. Accepting pain management or seeking pain cure: an exploration of patients' attitudes to chronic pain.

    PubMed

    Clarke, Kathryn A; Iphofen, Ron

    2007-06-01

    This article explores the differing attitudes of patients toward chronic pain. Because pain is a subjective experience, individuals react to living with chronic pain in varying ways. Some patients successfully manage their chronic pain, whereas others continue to seek a pain cure. A convenience sample (n = 8) was generated from a district general hospital's nurse-led pain clinic. The sample was subdivided by an expert panel rating procedure into two groups: those accepting pain management and those seeking a pain cure. The study used a multimethod approach comprising extended, highly focused interviews coupled with patients' diaries and drawing on a phenomenologic theoretical framework. Initial hermeneutic data analysis provided emerging themes: "rules for living," "pain = life," and "acceptance" for the pain management group, and "pillar to post," "self-fulfilling prophecy," and "mood" for those seeking a cure. Thematic content common to both groups were "family" and "coping strategies." These themes illustrate some differences and similarities between those who manage pain compared with those who seek a pain cure. Phenomenologically based research findings can rarely be generalized, but they enlighten and highlight the need for further research to generate detailed understanding of why some patients with chronic pain can accept pain management and others relentlessly seek a cure that is frequently not possible. PMID:17544130

  6. [Efficacy of emoxipine and mexidol in patients with chronic disorders of the digestive system and atherosclerosis of the abdominal aorta].

    PubMed

    Dolgushina, A I

    2011-01-01

    The influence of emoxipine (2-ethyl-6-methyl-3-hydroxypyridine hydrochloride) and mexidol (2-ethyl-6-methyl-3-hydroxypyridine succinate) on the content of lipid peroxidation products in peripheral blood and the dynamics of clinical symptoms of gastrointestinal tract pathology has been studied in patients of middle and senile age with atherosclerosis in the abdominal aorta. It is established that a two-week 3-hydroxypyridine derivatives leads to a decrease in the level of lipid peroxidation products. The administration of emoxipine led to the most pronounced control of pain. PMID:22379875

  7. Randomized controlled trial of an Internet-delivered family cognitive–behavioral therapy intervention for children and adolescents with chronic pain

    Microsoft Academic Search

    Tonya M. Palermo; Anna C. Wilson; Meaghan Peters; Amy Lewandowski; Hannah Somhegyi

    2009-01-01

    Cognitive–behavioral therapy (CBT) interventions show promise for decreasing chronic pain in youth. However, the availability of CBT is limited by many factors including distance to major treatment centers and expense. This study evaluates a more accessible treatment approach for chronic pediatric pain using an Internet-delivered family CBT intervention. Participants included 48 children, aged 11–17years, with chronic headache, abdominal, or musculoskeletal

  8. Benign mesenteric lipodystrophy presenting as low abdominal pain: a case report

    Microsoft Academic Search

    Jonathan Richard Rees; Phillip Burgess

    2010-01-01

    INTRODUCTION: Benign mesenteric lipodystrophy is rare and often presents in a non-specific fashion. Imaging findings may mimic a range of malignant conditions, particularly malignant ovarian disease in women. CASE PRESENTATION: We present the case of a 61-year-old Caucasian woman who was referred to the gynaecology service at our institution and was thought to have ovarian malignancy, and required a laparotomy.

  9. Benign mesenteric lipodystrophy presenting as low abdominal pain: a case report

    PubMed Central

    2010-01-01

    Introduction Benign mesenteric lipodystrophy is rare and often presents in a non-specific fashion. Imaging findings may mimic a range of malignant conditions, particularly malignant ovarian disease in women. Case presentation We present the case of a 61-year-old Caucasian woman who was referred to the gynaecology service at our institution and was thought to have ovarian malignancy, and required a laparotomy. However, histopathological analysis unexpectedly revealed benign mesenteric lipodystrophy. Conclusion Benign mesenteric lipodystrophy may mimic a range of conditions, particularly malignancy. PMID:20423496

  10. Chronic noncancer pain

    PubMed Central

    Mailis-Gagnon, Angela; Lakha, S. Fatima; Ou, Ting; Louffat, Ada; Yegneswaran, Balaji; Umana, Margarita; Cohodarevic, Tea; Nicholson, Keith; Deshpande, Amol

    2011-01-01

    Abstract Objective To describe the characteristics of patients with chronic noncancer pain (CNCP) prescribed opioids by community physicians and referred to a tertiary pain clinic. Design Cross-sectional, descriptive study. Setting A tertiary care, hospital-based pain clinic in Toronto, Ont. Participants A total of 455 consecutive patients newly referred to the pain clinic by community physicians. Main outcome measures Data on demographic characteristics, pain ratings, and medication intake were obtained using standardized collection forms and retrospective chart review. Patients were classified by diagnosis: group 1 patients had biomedical disorders only, group 2 patients had biomedical disorders and psychological factors, and group 3 patients had psychological factors only. Patients were also categorized based on opioid use: no opioid use (NOU); low opioid use (LOU), with a daily morphine-equivalent dosage (MED) of 200 mg or less; or high opioid use (HOU), with a daily MED of more than 200 mg. Results In the general study population, 63% of patients were taking opioids, with 1 in 5 exceeding an MED of 200 mg daily. In group 1, 59% of patients used opioids and 10% had HOU; 66% of patients in groups 2 and 3 were taking opioids, with 21% and 26% classified as having HOU. The mean (SD) daily MED for groups 2 and 3 HOU patients combined was significantly higher than that of group 1 HOU patients: 575.7 (472.9) mg/d versus 284.9 (74.6) mg/d, respectively. Men were twice as likely as women to have HOU; Canadian-born patients were 3 times as likely as foreign-born patients to have HOU. Psychoactive drugs were coprescribed in 61% of LOU patients and 76% of HOU patients. Greater opioid use was associated with group 2 and 3 diagnoses, male sex, Canadian-born origin, and high pain scores. Conclusion Our results indicate that male, Canadian-born CNCP patients presenting with psychological morbidity or comorbidity and reporting higher pain severity ratings were more likely to receive opioids. Additionally, many CNCP patients referred to our tertiary care pain clinic were receiving opioids in excess of a 200-mg/d MED. More studies are needed to determine which factors lead to high-dose opioid prescribing in a subset of this CNCP population. PMID:21402957

  11. [Greater trochanteric pain syndrome].

    PubMed

    Nissen, M J; Genevay, S

    2015-03-11

    Trochanteric bursitis, also known as "greater trochanter pain syndrome", is a frequent and often under-diagnosed cause of pain in the lateral hip region. The diagnosis is essentially based on the clinical examination; however various forms of imaging may be useful to confirm the diagnosis and particularly to ex- clude other aetiologies. The different therapeutic options include non-steroidal anti-inflammatories, physiotherapy, local injections of cortisone and local anaesthetic, and extra-corporeal shock wave therapy. Surgical intervention is only indicated in rare cases. PMID:25946869

  12. Discogenic pain in acute nonspecific low-back pain

    Microsoft Academic Search

    Hironori Hyodo; Tetsuro Sato; Hirotoshi Sasaki; Yasuhisa Tanaka

    2005-01-01

    Acute nonspecific low-back pain is characterized by the sudden onset and severe unendurable low-back pain without radicular pain or neurological deficit in the lower extremities. The study was carried out using 55 patients who visited our hospital for acute nonspecific low-back pain, who exhibited degeneration on T2-weighted MR images, and underwent intradiscal injection of local anesthetics,steroid and contrast medium. Intervertebral

  13. Low Back Pain: Where Does the Pain Come From?

    Microsoft Academic Search

    Helena Brisby

    \\u000a The pain mechanisms in patients with low back pain are unclear. Different theories exist about the mechanisms behind the experienced\\u000a pain, and different originating tissues are suggested to be of importance. The mechanisms in acute low back pain with recovery\\u000a within a few days are believed to be totally different compared to those in more long-standing (usually referred to as

  14. New advances in musculoskeletal pain

    PubMed Central

    Bove, Susan E.; Flatters, Sarah J.L.; Inglis, Julia J.; Mantyh, Patrick W.

    2015-01-01

    Non-malignant musculoskeletal pain is the most common clinical symptom that causes patients to seek medical attention and is a major cause of disability in the world. Musculoskeletal pain can arise from a variety of common conditions including osteoarthritis, rheumatoid arthritis, osteoporosis, surgery, low back pain and bone fracture. A major problem in designing new therapies to treat musculoskeletal pain is that the underlying mechanisms driving musculoskeletal pain are not well understood. This lack of knowledge is largely due to the scarcity of animal models that closely mirror the human condition which would allow the development of a mechanistic understanding and novel therapies to treat this pain. To begin to develop a mechanism-based understanding of the factors involved in generating musculoskeletal pain, in this review we present recent advances in preclinical models of osteoarthritis, post-surgical pain and bone fracture pain. The models discussed appear to offer an attractive platform for understanding the factors that drive this pain and the preclinical screening of novel therapies to treat musculoskeletal pain. Developing both an understanding of the mechanisms that drive persistent musculoskeletal pain and novel mechanism-based therapies to treat these unique pain states would address a major unmet clinical need and have significant clinical, economic and societal benefits. PMID:19166876

  15. Abdominal Drainage Following Appendectomy and Cholecystectomy

    PubMed Central

    Stone, H. Harlan; Hooper, C. Ann; Millikan, William J.

    1978-01-01

    Consecutive patients undergoing emergency appendectomy (283) or urgent cholecystectomy (51) were prospectively studied for the development of post-operative incisional or peritoneal sepsis. Severity of the original peritoneal infection was carefully recorded, while use of a Penrose dam to drain the peritoneum was randomized according to pre-assigned hospital number. Both aerobic and anaerobic cultures were taken from the abdomen at the time of operation as well as from all postoperative infectious foci. Results demonstrated no essential differences in incidence of wound and peritoneal infection following appendectomy for simple or suppurative appendicitis (187) or following cholecystectomy for acute cholecystitis (51). However, with gangrenous or perforative appendicitis (94), incisional and intra-abdominal infection rates were 43% and 45%, respectively, when a drain was used; yet only 29 and 13%, respectively, without a drain. These latter differences were significant (p < 0.001). In addition, intra-abdominal abscesses were three times as likely to drain through the incision than along any tract provided by the rubber conduit. Cultures revealed that hospital pathogens accounted for a greater proportion of wound and peritoneal sepsis after cholecystectomy and appendectomy for simple or suppurative appendicitis if a drain had been inserted than if managed otherwise. By contrast, a mixed bacterial flora was responsible for most infections following appendectomy for gangrenous or perforated appendicitis, irrespective as to use of a drain. PMID:646499

  16. Extensive Abdominal Surgery After Caustic Ingestion

    PubMed Central

    Cattan, Pierre; Munoz-Bongrand, Nicolas; Berney, Thierry; Halimi, Bruno; Sarfati, Emile; Celerier, Michel

    2000-01-01

    Objective To report the authors’ experience in extensive abdominal surgery after caustic ingestion, and to clarify its indications. Summary Background Data After caustic ingestion, extension of corrosive injuries beyond the esophagus and stomach to the duodenum, jejunum, or adjacent abdominal organs is an uncommon but severe complication. The limit to which resection of the damaged organs can be reasonably performed is not clearly defined. Methods From 1988 to 1997, nine patients underwent esophagogastrectomy extended to the colon (n = 2), the small bowel (n = 2), the duodenopancreas (n = 4), the tail of the pancreas (n = 1), or the spleen (n = 1). Outcome was evaluated in terms of complications, death, and function after esophageal reconstruction. Results Five patients required reintervention in the postoperative period for extension of the caustic lesions. There were two postoperative deaths. Seven patients had secondary esophageal reconstruction 4 to 8 months (median 6 months) after initial resection. Three additional patients died 8, 24, and 32 months after the initial resection. Three survivors eat normally, and one has unexplained dysphagia. Conclusions An aggressive surgical approach allows successful initial treatment of extended caustic injuries. Early surgical treatment is essential to improve the prognosis in these patients. PMID:10749612

  17. Lymphangiogenesis and Angiogenesis in Abdominal Aortic Aneurysm

    PubMed Central

    Sano, Masaki; Sasaki, Takeshi; Hirakawa, Satoshi; Sakabe, Junichi; Ogawa, Mikako; Baba, Satoshi; Zaima, Nobuhiro; Tanaka, Hiroki; Inuzuka, Kazunori; Yamamoto, Naoto; Setou, Mitsutoshi; Sato, Kohji; Konno, Hiroyuki; Unno, Naoki

    2014-01-01

    The pathogenesis of abdominal aortic aneurysm (AAA) is characterized to be inflammation-associated degeneration of vascular wall. Neovascularization is regularly found in human AAA and considered to play critical roles in the development and rupture of AAA. However, little is known about lymphangiogenesis in AAA. The purpose of this study was to demonstrate both angiogenesis and lymphangiogenesis in AAA. Abdominal aortic tissue was harvested either from autopsy (control group) and during open-repair surgery for AAA (AAA group). Adventitial lymphatic vasa vasorum was observed in both groups, but seemed to be no significant morphological changes in AAA. Immunohistochemical studies identified infiltration of lymphatic vessel endothelial hyaluronan receptor (LYVE) ?1, vascular endothelial growth factor (VEGF)-C, and matrix metalloproteinase (MMP)-9-positive macrophages and podoplanin and Prox-1-positive microvessels in the intima/media in AAA wall, where hypoxia-inducible factors (HIF)-1? was expressed. VEGF-C and MMP-9 were not expressed in macrophages infiltrating in the adventitia. Intraoperative indocyanine green fluorescence lymphography revealed lymph stasis in intima/medial in AAA. Fluorescence microscopy of the collected samples also confirmed the accumulation of lymph in the intima/media but not in adventitia. These results demonstrate that infiltration of macrophages in intima/media is associated with lymphangiogenesis and angiogenesis in AAA. Lymph-drainage appeared to be insufficient in the AAA wall. PMID:24651519

  18. Atlas based automatic identification of abdominal organs

    NASA Astrophysics Data System (ADS)

    Zhou, Yongxin; Bai, Jing

    2005-04-01

    Due to intensity inhomogeneities, partial volume effects, as well as organ shape variations, automatic segmentation of abdominal organs has always been a high challenging task. To conquer these difficulties, we employ a pre-labeled atlas (VIP-Man) to supplement anatomical knowledge to the segmentation process. First, an atlas-subject registration is carried out to establish the proper correspondence between the atlas and the subject. The registration consists of two steps. In the global registration step, a similarity transformation is found to eliminate the stature differences. In the organ registration step, organs of interest are registered respectively to achieve better alignments. Second, we utilize the fuzzy connectedness framework to segment abdominal organs of interest from the subject image. Under the guidance of the registered atlas, the seeds and intensity parameters of organs are specified in an auto-adaptive way. Further more, the anatomical knowledge contained in the atlas is blended into the frame work, to make the segmentation result more reliable. To remove possible jags on boundary, a level set smooth method which implements fuzzy connectedness as external speed forces, is utilized on the segmentation result. Our purpose is to accomplish the segmentation task like how anatomy experts do. So far, this approach has been applied to segment organs, including liver, spleen and kidneys, in the female MRI T1 data set from the VHP. All organs of interest are identified correctly, and delineated with considerable precision.

  19. [Surgical treatment of patients for abdominal sepsis].

    PubMed

    2014-08-01

    Results of surgical treatment of 201 patients, suffering abdominal sepsis (AS), which have occurred after operations on abdominal organs, were analyzed. Expediency of application of modern scales for the patients state severity estimation, prognostic sign-posts and dynamic of the pathological process course in every patient was substantiated. Existing systems of prognostication (APACHE II, SOFA, MODS) are applied restrictedly for diagnosis of infection in patients, what demands relaparotomy performance in presence of clinical signs of intraabdominal infection, which persists. For prognostication of the treatment result and determination of indications for relaparotomy conduction in patients, suffering severe AS and infectious-toxic shock (ITSH), the most informative is application of the Manheim's index of peritonitis together with analysis of clinico-laboratory indices for formation of groups of patients in risk, to whom reoperation is indicated. Advantages of relaparotomy "on demand" conduction were proved in comparison with "programmed" relaparotomy during the staged surgical treatment of patients, suffering severe AS and ITSH. Complex surgical treatment with substantiation of indications and choice of adequate method of intervention secures improvement of the treatment results in these severely ill patients. PMID:25507013

  20. [Surgical treatment of patients for abdominal sepsis].

    PubMed

    Kryvoruchko, I A; Usenko, O Iu; Andreieshchev, S A

    2014-08-01

    Results of surgical treatment of 201 patients, suffering abdominal sepsis (AS), which have occurred after operations on abdominal organs, were analyzed. Expediency of application of modern scales for the patients state severity estimation, prognostic sign-posts and dynamic of the pathological process course in every patient was substantiated. Existing systems of prognostication (APACHE II, SOFA, MODS) are applied restrictedly for diagnosis of infection in patients, what demands relaparotomy performance in presence of clinical signs of intraabdominal infection, which persists. For prognostication of the treatment result and determination of indications for relaparotomy conduction in patients, suffering severe AS and infectious-toxic shock (ITSH), the most informative is application of the Manheim's index of peritonitis together with analysis of clinico-laboratory indices for formation of groups of patients in risk, to whom reoperation is indicated. Advantages of relaparotomy "on demand" conduction were proved in comparison with "programmed" relaparotomy during the staged surgical treatment of patients, suffering severe AS and ITSH. Complex surgical treatment with substantiation of indications and choice of adequate method of intervention secures improvement of the treatment results in these severely ill patients. PMID:25417285