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1

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

PubMed

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

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

2014-01-01

2

Abdominal Pain  

MedlinePLUS

... You could also try progressive relaxation or self-hypnosis . For more information about non-drug pain relief ... overall situation for the child. Teaching kids self-hypnosis [8] or guided imagery [8a] show great promise ...

3

Abdominal Pain Syndrome  

MedlinePLUS

... most helpful information that a doctor uses to determine the cause of abdominal pain. The characteristics of the pain (sharp, dull, cramping, burning, twisting, tearing, penetrating), its location and relation to eating or to having a bowel movement are important ...

4

Postpartum Lower Abdominal Pain  

Microsoft Academic Search

Pains after labor can be as severe as those experienced during labor, particularly the commonly occurring lower abdominal\\u000a “after-pains” that are associated with prolonged uterine contractions during breast feeding. Other causes of lower abdominal\\u000a pain may not be physiologically based but are either direct complications of parturition, such as genital infection, or fortuitous,\\u000a such as appendicitis. Although the focus of

Anita Holdcroft

1999-01-01

5

Functional Abdominal Pain  

Microsoft Academic Search

\\u000a Functional abdominal pain (FAP) is a frequent complaint seen in the pediatric primary care setting. Current diagnostic criteria\\u000a for functional gastrointestinal disorders (FGIDs) are defi ned in the Rome III criteria, which outline a positive symptom\\u000a profi le for diagnosis. In addition, clinicians should be aware of specifi c “red fl ag ” rule-out symptoms that may suggest\\u000a organic disease

Lisa Scharff; Laura E. Simons

6

Hypnosis for functional abdominal pain.  

PubMed

Chronic abdominal pain is a common pediatric condition affecting 20% of the pediatric population worldwide. Most children with this disorder are found to have no specific organic etiology and are given the diagnosis of functional abdominal pain. Well-designed clinical trials have found hypnotherapy and guided imagery to be the most efficacious treatments for this condition. Hypnotic techniques used for other somatic symptoms are easily adaptable for use with functional abdominal pain. The author discusses 2 contrasting hypnotic approaches to functional abdominal pain and provides implications for further research. These approaches may provide new insights into this common and complex disorder. PMID:21922712

Gottsegen, David

2011-07-01

7

Abdominal pain in pregnancy.  

PubMed

Abdominal pain in pregnancy is most commonly caused by complications of the pregnancy, e.g., abortion, ectopic pregnancy and abruptio placentae. A careful history and methodical physical examination and, if necessary, simple ultrasonographic investigations will reveal the cause in most of these conditions. In a few cases of abdominal pain in pregnancy a gynaecological condition, such as torsion of an ovarian cyst, or a nongynaecological (medical or surgical) one is the cause. Some of these conditions are serious, e.g., acute appendicitis, and unless the correct diagnosis is made and the appropriate management promptly instituted both the mother and her baby may suffer tragic consequences. Moreover, these conditions are more likely to be misdiagnosed during pregnancy. This is because the anatomical and physiological changes which occur in pregnancy tend to change and obtund the expected clinical features and laboratory data which are used to diagnose these conditions. Their early diagnosis therefore requires a high index of suspicion together with awareness of the ways in which they may present in pregnancy. PMID:7941766

Klufio, C A; Amoa, A B; Rageau, O

1993-12-01

8

Hypnosis for Functional Abdominal Pain  

Microsoft Academic Search

Chronic abdominal pain is a common pediatric condition affecting 20% of the pediatric population worldwide. Most children with this disorder are found to have no specific organic etiology and are given the diagnosis of functional abdominal pain. Well-designed clinical trials have found hypnotherapy and guided imagery to be the most efficacious treatments for this condition. Hypnotic techniques used for other

David Gottsegen

2011-01-01

9

Abdominal pain - children under age 12  

MedlinePLUS

Stomach pain in children; Pain - abdomen - children; Abdominal cramps in children; Belly ache in children ... When your child complains of abdominal pain, see if s/he can describe it to you. Here are different kinds of pain: ...

10

Recurrent abdominal pain in children.  

PubMed

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

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

2002-09-01

11

Pathology Case Study: Abdominal Pain  

NSDL National Science Digital Library

This is a case study presented by the University of Pittsburgh Department of Pathology in which a 65-year-old man is complaining of abdominal pain. Visitors are given the radiology, gross and microscopic descriptions, flow cytometry, and molecular diagnostics, 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 hematopathology.

Latulippe, Steven; Ohori, N. P.

2007-12-05

12

Pathology Case Study: Abdominal Pain  

NSDL National Science Digital Library

This is a case study presented by the University of Pittsburgh Department of Pathology in which a 72-year-old man has abdominal pain, anorexia, and weight loss but no significant past medical history. 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 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 autopsy pathology.

Nine, Jeff S.; Weir, Ed

2007-12-03

13

Mechanisms and management of functional abdominal pain.  

PubMed

Functional abdominal pain syndrome is characterised by frequent or continuous abdominal pain associated with a degree of loss of daily activity. It has a reported population prevalence of between 0.5% and 1.7%, with a female preponderance. The pathophysiology of functional abdominal pain is incompletely understood although it has been postulated that peripheral sensitisation of visceral afferents, central sensitisation of the spinal dorsal horn and aberrancies within descending modulatory systems may have an important role. The management of patients with functional abdominal pain requires a tailored multidisciplinary approach in a supportive and empathetic environment in order to develop an effective therapeutic relationship. Patient education directed towards an explanation of the pathophysiology of functional abdominal pain is in our opinion a prerequisite step and provides the rationale for the introduction of interventions. Interventions can usefully be categorised into general measures, pharmacotherapy, psychological interventions and 'step-up' treatments. Pharmacotherapeutic/step-up options include tricyclic antidepressants, serotonin noradrenergic reuptake inhibitors and the gabapentinoids. Psychological treatments include cognitive behavioural therapy and hypnotherapy. However, the objective evidence base for these interventions is largely derived from other chronic pain syndrome, and further research is warranted in adult patients with functional abdominal pain. PMID:25193056

Farmer, Adam D; Aziz, Qasim

2014-09-01

14

Abdominal Pain, Long-Term  

MedlinePLUS

... or do you alternate between loose and hard bowel movements? Yes Your pain may be from IRRITABLE BOWEL ... 6. Do you have soft or diarrhea-like bowel movements many times throughout the day and mucus or ...

15

Pathology Case Study: Progressive Abdominal / Pelvic Pain  

NSDL National Science Digital Library

This is a case study presented by the University of Pittsburgh Department of Pathology in which a woman presented with progressively worsening abdominal/pelvic pain over a period of 6 weeks. She experienced minor intermittent pain. Visitors can view both gross and microscopic descriptions, including images, and have 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 introduce or test students of pathology.

Mcfadden, Kathryn

2009-03-06

16

Pathology Case Study: Anemia and Abdominal Pain  

NSDL National Science Digital Library

This is a case study presented by the University of Pittsburgh Department of Pathology in which a woman found a large left adrenal mass after a history of abdominal pain. 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 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 hematopathology.

Horn, Kevin D.; Sholehvar, David

2009-09-29

17

Transverse abdominal plane neurostimulation for chronic abdominal pain: a novel technique.  

PubMed

Management of chronic abdominal pain can be challenging. Sometimes patients fail to get adequate response from multiple medications and nerve blocks. We present a patient case report of chronic abdominal pain with a history of multiple surgeries managed successfully by neuromodulation of the transverse abdominis plane (TAP). The TAP block is a procedure in which local anesthetic is injected into the abdominal fascial plane that carries sensory nerves to the abdominal wall in order to block pain sensation. It has been shown to reduce postoperative pain and analgesic dependence after abdominal and gynecological surgeries. A 60-year-old woman presented to us for chronic abdominal pain for which medications provided little relief. She had an extensive history of abdominal surgeries and was also treated for lower back pain with surgery and less invasive procedures in the past. Under our care, she underwent 2 TAP blocks with almost complete resolution of her abdominal pain. Her pain, however, came back within a few of weeks of the procedures. Since our patient found pain relief from the TAP blocks, we proceeded with neurostimulation of the TAP for long-term pain relief. We placed a dorsal column stimulator 16 contact lead for lower back and leg pain and 8 contact leads placed in the TAP under ultrasound guidance. She has had multiple follow-ups since her TAP lead placement procedure with continued and near complete resolution of her abdominal pain. The TAP lead stimulation was helping her abdominal pain and the dorsal column lead stimulation was helping her back and leg pain. PMID:25247911

Gupta, Mayank; Goodson, Robert

2014-01-01

18

The appendix as the cause of chronic lower abdominal pain  

Microsoft Academic Search

The records of 63 patients who had appendectomy for chronic lower abdominal pain were reviewed. Histologically 92% of the removed appendices revealed abnormality, and 95% of these patients were completely cured. It is concluded that appendicopathy does exist and could be the cause of chronic lower abdominal pain.

Jamil A. Fayez; Nancy J. Toy; Tiffany M. Flanagan

1995-01-01

19

An exceptional cause of left lower quadrant abdominal pain  

PubMed Central

Acute appendicitis is an exceptional cause of left lower quadrant abdominal pain. Computed tomography scan is the key to its diagnosis and helps to establish its early treatment. We present a case of a 35-year-old male patient who presented acute appendicitis with redundant and loosely attached cecum which was diagnosed based on his left lower quadrant abdominal pain. PMID:19610153

Abboud, Bassam; Daher, Ronald

2009-01-01

20

Treatment options for chronic abdominal pain in children and adolescents  

Microsoft Academic Search

Chronic abdominal pain is a common feature of most functional gastrointestinal disorders in children, including functional\\u000a abdominal pain (FAP) and irritable bowel syndrome (IBS). FAP can impair a child’s life and often leads to significant school\\u000a absences. Although the underlying mechanism is likely multifactorial, early pain experiences during a vulnerable period in\\u000a the developing nervous system can cause longterm changes

Adrian Miranda; Manu Sood

2006-01-01

21

Abdominal pain: an approach to a challenging diagnosis.  

PubMed

Acute abdominal pain represents the cardinal symptom of a large number of intra-abdominal pathologies. Because of multiple organ systems, varied pathology from life threatening to benign, and differences in presentation related to sex and age, identifying a final diagnosis is a challenge. The clinician's goal for patients with acute abdominal pain is to rapidly identify whether the underlying cause requires an urgent or immediate surgical intervention. By developing a systematic approach to evaluating patients with abdominal pain, clinicians can generate a differential diagnosis to ensure appropriate treatment and improved patient outcomes. The purpose of this article is to provide clinicians with a framework for evaluating the complaint of acute abdominal pain and recognizing patients who require expedited evaluation. PMID:25054532

Brown, Helen F; Kelso, Lynn

2014-01-01

22

If I Had - A Child with Abdominal Pain  

MedlinePLUS Videos and Cool Tools

... News For June 25, 2008 General Anesthetic Increases Post-Surgical Pain, Turmeric a Potential Diabetes Treatment, C- ... has abdominal surgery changed? What can patients expect post-operatively? I think that the biggest way that ...

23

Supraspinal TRPV1 modulates the emotional expression of abdominal pain.  

PubMed

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

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

2014-10-01

24

Support Vector Machine Diagnosis of Acute Abdominal Pain  

NASA Astrophysics Data System (ADS)

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.

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

25

Acute abdominal pain and constipation due to lead poisoning.  

PubMed

Although uncommon, lead poisoning should be considered as a differential diagnosis in cases of unexplained acute abdominal pain in both adults and children. We present the case of a 35-year-old Asian male who presented with abdominal pain and constipation secondary to lead poisoning. Initially, the source of lead exposure was not apparent; this was later found to be due to ingestion of an Ayurvedic herbal medicine for the treatment of infertility. Lead poisoning due to the ingestion of Ayurvedic remedies is well described. We discuss the diagnosis, pathophysiology and treatment of lead poisoning. This case illustrates one of the rarer medical causes of acute abdominal pain and emphasizes the need to take a thorough history (including specific questioning regarding the use of over-the-counter and traditional/ herbal remedies) in cases of suspected poisoning or drug toxicity. PMID:24364054

Mongolu, S; Sharp, P

2013-01-01

26

Pneumonia presenting with lower right abdominal pain and migratory polyarthritis  

PubMed Central

The clinical presentation of community acquired pneumonia (CAP) in adults includes mainly symptoms from the respiratory system, whereas CAP is considered as a main cause of abdominal pain in pediatric patients. We present the case of a patient, who was admitted to our hospital due to abdominal pain that deteriorated progressively and radiated to the lumbar region. The clinical examination revealed decreased breath sounds at the right lung base after 72 h, while the chest X-ray showed pneumonia of the right lung base. The blood culture isolated Streptococcus pneumoniae, and the patient received penicillin according to the results of the antibiogram. In addition, the patient developed symptoms of migratory arthritis, which resolved after 48 h. CAP should be included in the differential diagnosis of abdominal pain in adult patients. Furthermore, the hematogenous spread of S. pneumoniae may be associated with the development of migratory arthritis.

Armeni, Eleni; Mylona, Vasiliki; Karlis, George; Makrygiannis, Elias

2011-01-01

27

Celiac plexus block in the management of chronic abdominal pain.  

PubMed

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

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

2014-02-01

28

Treatment options for chronic abdominal pain in children and adolescents.  

PubMed

Chronic abdominal pain is a common feature of most functional gastrointestinal disorders in children, including functional abdominal pain (FAP) and irritable bowel syndrome (IBS). FAP can impair a child's life and often leads to significant school absences. Although the underlying mechanism is likely multifactorial, early pain experiences during a vulnerable period in the developing nervous system can cause long-term changes in the brain-gut axis and ultimately may result in altered pain pathways and visceral hyperalgesia. Care providers often feel uncomfortable managing patients with chronic abdominal pain, as the pathophysiology is poorly understood, and limited data exist regarding safety and efficacy of therapeutic options in children. The primary goal of therapy in FAP is to alleviate pain symptoms and to help the child return to normal daily activities. Treatment should be individualized and chosen based on the severity of symptoms, the existence of comorbid psychological disorders, and the impact the disorder has on the child's school attendance and normal functioning. Various psychological interventions, such as cognitive-behavioral therapy, hypnosis, and guided imagery, have been successfully used in children with chronic abdominal pain. Pharmacologic therapies such as H(2) blockers, proton-pump inhibitors, tricyclic antidepressants, and various serotonergic drugs have been used, but good controlled trials are lacking. More studies are clearly needed to investigate the benefits and safety of pharmacologic therapy in children. Newer pharmacologic agents that target specific receptors involved in nociception, stress, and neurogenic inflammation currently are being developed. Future targets for visceral hyperalgesia should not only be aimed at alleviating symptoms but also should include prevention, particularly in cases with a suspected sensitizing event such as neonatal pain and postinfectious IBS. PMID:16942666

Miranda, Adrian; Sood, Manu

2006-09-01

29

Dextromethorphan and pain after total abdominal hysterectomy  

Microsoft Academic Search

Summary Dextromethorphan is an N-methyl-D-aspartate (NMDA) receptor antagonist which has been shown to inhibit the development of cutaneous secondary hyperalgesia after tissue trauma. We studied 60 ASA I-II patients undergoing total abdominal hysterectomy in a randomized, double-blind, placebo-controlled study. Patients received either dextromethorphan 27 mg cap- sules, two doses before operation and three doses in the first 24 h after

P. M. MCCONAGHY; P. MCSORLEY; W. MCCAUGHEY; W. I. CAMPBELL

1998-01-01

30

Treatment of abdominal pain in irritable bowel syndrome.  

PubMed

Functional abdominal pain in the context of irritable bowel syndrome (IBS) is a challenging problem for primary care physicians, gastroenterologists and pain specialists. We review the evidence for the current and future non-pharmacological and pharmacological treatment options targeting the central nervous system and the gastrointestinal tract. Cognitive interventions such as cognitive behavioral therapy and hypnotherapy have demonstrated excellent results in IBS patients, but the limited availability and labor-intensive nature limit their routine use in daily practice. In patients who are refractory to first-line therapy, tricyclic antidepressants (TCA) and selective serotonin reuptake inhibitors are both effective to obtain symptomatic relief, but only TCAs have been shown to improve abdominal pain in meta-analyses. A diet low in fermentable carbohydrates and polyols (FODMAP) seems effective in subgroups of patients to reduce abdominal pain, bloating, and to improve the stool pattern. The evidence for fiber is limited and only isphagula may be somewhat beneficial. The efficacy of probiotics is difficult to interpret since several strains in different quantities have been used across studies. Antispasmodics, including peppermint oil, are still considered the first-line treatment for abdominal pain in IBS. Second-line therapies for diarrhea-predominant IBS include the non-absorbable antibiotic rifaximin and the 5HT3 antagonists alosetron and ramosetron, although the use of the former is restricted because of the rare risk of ischemic colitis. In laxative-resistant, constipation-predominant IBS, the chloride-secretion stimulating drugs lubiprostone and linaclotide, a guanylate cyclase C agonist that also has direct analgesic effects, reduce abdominal pain and improve the stool pattern. PMID:24845149

Vanuytsel, Tim; Tack, Jan F; Boeckxstaens, Guy E

2014-08-01

31

Empirically supported treatments in pediatric psychology: recurrent abdominal pain  

Microsoft Academic Search

Objective: To review the status of empirically supported treatments for recurrent abdominal pain (RAP). Methods: We identified studies based on literature search and contact with experts in the field and evalu- ated studies based on guidelines modified from the criteria established by the Task Force on Promotion and Dissemination of Psychological Procedures. Results: Nine published intervention studies were identified that

David M. Janicke; Jack W. Finney

1999-01-01

32

Ruptured abdominal aortic aneurysm presenting as buttock pain.  

PubMed

This is the first case report of a ruptured aortic aneurysm presenting with acute right buttock pain. The patient was an 80 year old man. A literature search revealed one report of ruptured internal iliac artery aneurysm presenting with acute hip pain and another of an unruptured aortic aneurysm presenting with chronic hip pain. Thus the present case is another unusual presentation of ruptured abdominal aortic aneurysm and highlights the importance of careful history taking and clinical examination. A high index of clinical suspicion of aneurysm rupture should be maintained in elderly patients presenting with a history of collapse. PMID:15911962

Mahmood, F; Ahsan, F; Hockey, M

2005-06-01

33

A typology of pain coping in pediatric patients with chronic abdominal pain  

PubMed Central

This study aimed to identify clinically meaningful profiles of pain coping strategies used by youth with chronic abdominal pain (CAP). Participants (n = 699) were pediatric patients (ages 8–18 years) and their parents. Patients completed the Pain Response Inventory (PRI) and measures of somatic and depressive symptoms, disability, pain severity and pain efficacy, and perceived competence. Parents rated their children’s pain severity and coping efficacy. Hierarchical cluster analysis based on the 13 PRI subscales identified pain coping profiles in Sample 1 (n = 311) that replicated in Sample 2 (n = 388). Evidence was found of external validity and distinctiveness of the profiles. The findings support a typology of pain coping that reflects the quality of patients’ pain mastery efforts and interpersonal relationships associated with pain coping. Results are discussed in relation to developmental processes, attachment styles, and treatment implications. PMID:17928144

Walker, Lynn S.; Baber, Kari Freeman; Garber, Judy; Smith, Craig A.

2009-01-01

34

Pathology Case Study: Severe Abdominal Pain  

NSDL National Science Digital Library

This is a case study presented by the University of Pittsburgh Department of Pathology in which a 16 year old boy returns after a diagnosis of presumptive gastroenteritis. During his return visit he complained of unremitting severe sharp, crampy pain in the lower abdomen, with occasional radiation in the back. Visitors are given admission data, surgical notes, gross and microscopic 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 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 gastrointestinal pathology.

Davie, James

2009-07-27

35

Plain abdominal radiography in acute abdominal pain-is it really necessary?  

PubMed

The aims of this study are to audit the ordering of abdominal radiographs (AXR) in the emergency department (ED) and evaluate the current practices, knowledge and attitudes of emergency physicians with regard to ordering AXRs in patients presenting with acute abdominal pain. A retrospective study was undertaken at an ED of a tertiary hospital in Tasmania using clinical notes on patient presenting with acute abdominal pain who underwent an AXR. The study also included a short questionnaire, which assessed emergency physicians' knowledge of current imaging guidelines and clinical practice when ordering an AXR. During the study period, 108 patients satisfied the selection criteria, and the AXR was reported as normal in 76 % (n?=?82; p value <0.05), non-specific in 12 % (n?=?13; p value <0.05) and abnormal in 12 % (n?=?13; p value <0.05) of patients. Of those patients, 25 % (n?=?27) of the AXRs did not meet indications listed in the Diagnostic Imaging Pathways published by the Western Australia Department of Health and were found not to benefit patient care. Of the 19 doctors who completed the survey, only 16 % (n?=?3) were aware of any clinical guidelines for imaging in this setting. Current guidelines should be followed when ordering imaging for patients with acute abdominal pain to minimise unnecessary patient radiation exposure, avoid delays in diagnosis and definitive patient management, reduce costs and therefore increase efficiency in ED. PMID:24880255

Sreedharan, Sadhishaan; Fiorentino, Mark; Sinha, Sankar

2014-12-01

36

Variations in Psychological Profile Among Children with Recurrent Abdominal Pain  

Microsoft Academic Search

This study was designed to determine whether distinct subgroups of children with recurrent abdominal pain (RAP) could be identified\\u000a based on patterns of psychological functioning. Two hundred and eighty-three children (ages 8–17 years), and a primary caretaker,\\u000a completed the Behavior Assessment System for Children (BASC) during the initial evaluation of RAP at a pediatric gastroenterology\\u000a clinic. Cluster analysis of BASC

Jennifer Verrill Schurman; Caroline Elder Danda; Craig A. Friesen; Paul E. Hyman; Stephen D. Simon; Jose T. Cocjin

2008-01-01

37

A differential diagnosis in chronic lower abdominal pain  

PubMed Central

INTRODUCTION Spigelian hernias represent 0.12–2.4% of all abdominal wall hernias. Its diagnosis is elusive and requires a high level of conjecture given the disease rarity, vague associated abdominal complaints and frequent lack of consistent physical findings. PRESENTATION OF CASE A 60-year-old woman presented with a history of chronic pain in the left lower side of the abdomen. The patient was treated for several diseases with no relief of symptoms. Abdominal ultrasound showed a Spigelian hernia in the lower left abdomen and surgery was scheduled for treatment. DISCUSSION A SH is generally an inter-parietal hernia, meaning that the pre-peritoneal fat and the hernia sac penetrate the trasnversus abdominis and internal oblique muscles but remain behind the external oblique aponeurosis. In most of the patients the lack of clinical signs demands radiological investigation. That's the importance of the high grade of suspicious of the disease during the physical exam. The surgical repair is necessary due to the high risk of incarceration-related complications which can occur in up to 21% of cases. CONCLUSION It's important to think in the Spigelian hernia as cause of lower abdominal pain to prompt indicate surgical repair and provide the patient's symptom relief. Also the type of repair is dependent on the surgeon's choice and also the means available in each center. PMID:22858791

Siosaki, Marcos Duarte; Costa, Márcia Maria Hagge Coelho; Figueiredo, Higino Felipe; da Silva Junior, Messias Froes; da Silva Junior, Rubem Alves

2012-01-01

38

Abdominal separation in an adult male patient with acute abdominal pain  

PubMed Central

We report a male patient with prolonged post-prandial abdominal distension and a sudden onset of epigastric pain initially diagnosed as acute abdomen. The patient had no history of surgery. Physical examination revealed peritonitis and abdominal computed tomography scan showed upper abdominal mesentery intorsion. The patient then underwent surgical intervention. It was found that the descending mesocolon dorsal root was connected to the ascending colon and formed a membrane encapsulating the small intestine. The membrane also formed an orifice in the ileal pars caeca, from which a 30 cm herniated ileum formed a “C”-shaped loop which was strangulated by the orifice. An abdominal separation was diagnosed after surgery. We liberated the membranous peritoneum which incarcerated the intestinal canal from the root of ileocecal junction to Treitz ligament, and reduced the small intestinal malrotation. The patient had an uneventful recovery after operation with his abdominal distention disappeared during the follow-up. Abdominal separation is a rare situation, which may be related with embryo development. Surgery is a choice of treatment for it. PMID:20614494

Liu, Bao-Lin; Chen, Yang; Liu, Shi-Qing; Zhang, Xiao-Bo; Cui, Dong-Xu; Dai, Xian-Wei

2010-01-01

39

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

PubMed

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

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

2014-08-01

40

The Brain-Gut Axis in Abdominal Pain Syndromes  

PubMed Central

The importance of bidirectional brain-gut interactions in gastrointestinal (GI) illness is increasingly recognized, most prominently in the area of functional GI syndromes such as irritable bowel syndrome (IBS), functional dyspepsia, and functional chest pain. The brain receives a constant stream of interoceptive input from the GI tract, integrates this information with other interoceptive information from the body and with contextual information from the environment, and sends an integrated response back to various target cells within the GI tract. This system is optimized to assure homeostasis of the GI tract during physiological perturbations and to adapt GI function to the overall state of the organism. In health, the great majority of interoceptive information reaching the brain is not consciously perceived but serves primarily as input to autonomic reflex pathways. In patients with functional abdominal pain syndromes, conscious perception of interoceptive information from the GI tract, or recall of interoceptive memories of such input, can occur in the form of constant or recurrent discomfort or pain. This is often associated with alterations in autonomic nervous system output and with emotional changes. A model is proposed that incorporates reported peripheral and central abnormalities in patients with IBS, extrapolates similar alterations in brain-gut interactions to patients with other chronic abdominal pain syndromes, and provides novel treatment targets. PMID:21090962

Mayer, Emeran A.; Tillisch, Kirsten

2013-01-01

41

An unusual cause of acute abdominal pain in dengue fever.  

PubMed

Dengue fever is an acute febrile viral disease caused by the bite of Aedes aegypti mosquito. It is a major health problem especially in tropical and subtropical areas including South East Asia and Pakistan. In the past few years, dengue fever has been endemic in Northern Punjab. Physicians managing dengue fever come across varied and uncommon complications of dengue fever. We report a case of dengue fever that developed severe right upper quadrant abdominal pain and induration after extreme retching and vomiting for 2 days. A rectus sheath hematoma was confirmed on noncontrast computed tomography (CT). Rectus sheath hematoma as a complication of dengue fever has rarely been reported before and never from this part of the world. Rectus sheath hematoma is an uncommon and often clinically misdiagnosed cause of abdominal pain. It is the result of bleeding into the rectus sheath from damage to the superior or inferior epigastric artery or their branches or from a direct tear of the rectus muscle. It can mimic almost any abdominal condition (See Fig.) (See Table). PMID:24560393

Waseem, Tariq; Latif, Hina; Shabbir, Bilquis

2014-07-01

42

Spinal cord stimulation for relief of abdominal pain in two patients with familial Mediterranean fever.  

PubMed

Familial Mediterranean fever is a hereditary disease characterized by recurrent attacks of fever and serosal inflammation that commonly presents as severe abdominal pain. Though colchicine remains the mainstay of treatment, a significant proportion of patients are partially responsive, unresponsive or intolerant to it. We present two such cases where spinal cord stimulation (SCS) was used to manage the paroxysmal abdominal pain associated with this disease. Abdominal visceral pain pathways and the application of SCS techniques in its management are discussed. PMID:17062615

Kapur, S; Mutagi, H; Raphael, J

2006-12-01

43

Fever with abdominal pain and diabetes - Is it Emphysematous Pyelonephritis?  

PubMed Central

Emphysematous pyelonephritis (EPN) is a rare, severe infection of renal parenchyma presenting commonly with fever and flank pain and presence of gas in the renal and/or peri-renal space. EPN can be life threatening if not diagnosed and treated promptly. Air shadows in the renal or peri-renal region on imaging studies of the abdomen are diagnostic features of EPN. However, computed tomography (CT) scan of the abdomen is better than ultrasound for diagnostic classification, prognosis, and treatment options. We treated a young female with uncontrolled type II diabetes mellitus who had severe abdominal and back pain with fever. The CT scan confirmed the diagnosis of EPN. The conservative treatment itself was effective in complete resolution of the disease even though patient had severe type of EPN.

BAMANIKAR, Arvind; DHOBALE, Swati

2014-01-01

44

Fever with abdominal pain and diabetes - Is it Emphysematous Pyelonephritis?  

PubMed

Emphysematous pyelonephritis (EPN) is a rare, severe infection of renal parenchyma presenting commonly with fever and flank pain and presence of gas in the renal and/or peri-renal space. EPN can be life threatening if not diagnosed and treated promptly. Air shadows in the renal or peri-renal region on imaging studies of the abdomen are diagnostic features of EPN. However, computed tomography (CT) scan of the abdomen is better than ultrasound for diagnostic classification, prognosis, and treatment options. We treated a young female with uncontrolled type II diabetes mellitus who had severe abdominal and back pain with fever. The CT scan confirmed the diagnosis of EPN. The conservative treatment itself was effective in complete resolution of the disease even though patient had severe type of EPN. PMID:25246841

Bamanikar, Arvind; Dhobale, Swati

2014-05-01

45

'Tell me about your pain': abdominal pain and a history of bullying  

PubMed Central

A 7-year-old girl was brought to our outpatient clinic to investigate recurrent abdominal pain. She was unwilling to attend the school. Her mother reported bullying at school and nosebleeds. The girl rated her pain 9 on a visual analogue score card ranging from 1 to 10. Physical examination disclosed painful bruising and haematomas. Emergency laboratory blood tests indicated by the history, physical examination and the pain intensity showed reduced numbers of white blood cells and platelets. A bone marrow smear on admission disclosed 100% blasts and suggested an initial diagnosis of leukaemia but also disclosed the pseudo-rosettes typically seen in neuro-ectodermic tumours. The diagnosis of stage IV primary neuroblastoma was confirmed by trephine biopsies and high urinary catecholamines. The girl died 10 months later. This unusual case underlines the need for outpatient paediatricians to involve children in their initial diagnostic work-up by asking them about their pain thus expediting the diagnosis. PMID:22699481

Rosati, Paola; Jenkner, Alessandro; De Vito, Rita; Boldrini, Renata; Chiodi, Patrizia; Celesti, Lucia; Giampaolo, Rosaria

2011-01-01

46

Acute abdominal and pelvic pain in pregnancy: ESUR recommendations.  

PubMed

Acute abdominal pain in pregnancy presents diagnostic and therapeutic challenges. Standard imaging techniques need to be adapted to reduce harm to the fetus from X-rays due to their teratogenic and carcinogenic potential. Ultrasound remains the primary imaging investigation of the pregnant abdomen. Magnetic resonance imaging (MRI) has been shown to be useful in the diagnosis of gynaecological and obstetric problems during pregnancy and in the setting of acute abdomen during pregnancy. MRI overcomes some of the limitations of ultrasound, mainly the size of the gravid uterus. MRI poses theoretical risks to the fetus and care must be taken to minimise these with the avoidance of contrast agents. This article reviews the evolving imaging and clinical literature on appropriate investigation of acute abdominal and pelvic pain during established intrauterine pregnancy, addressing its common causes. Guidelines based on the current literature and on the accumulated clinico-radiological experience of the European Society of Urogenital Radiology (ESUR) working group are proposed for imaging these suspected conditions. PMID:23990045

Masselli, Gabriele; Derchi, Lorenzo; McHugo, Josephine; Rockall, Andrea; Vock, Peter; Weston, Michael; Spencer, John

2013-12-01

47

Citalopram Treatment of Pediatric Recurrent Abdominal Pain and Comorbid Internalizing Disorders: An Exploratory Study  

ERIC Educational Resources Information Center

Objective: To assess the potential efficacy, tolerability, and safety of citalopram in the treatment of functional pediatric recurrent abdominal pain and comorbid internalizing disorders. Method: Twenty-five clinically referred children and adolescents with recurrent abdominal pain aged 7 to 18 years, inclusive, participated in a 12-week,…

Campo, John V.; Perel, James; Lucas, Amanda; Bridge, Jeff; Ehmann, Mary; Kalas, Catherine; Monk, Kelly; Axelson, David; Birmaher, Boris; Ryan, Neal; Di Lorenzo, Carlo; Brent, David A.

2004-01-01

48

Atypical abdominal pain: post-traumatic transverse colon stricture.  

PubMed

A driver presented to the emergency department 1 day after an accident driving his excavator with abdominal pain and vomiting. He was admitted to the surgical ward 2 days later, after reattending. A CT scan revealed wall thickening and oedema in the transverse colon. This was supported by a subsequent CT virtual colonoscopy which raised the suspicion of neoplasia. A follow-up colonoscopy was not carried further than the transverse colon due to an indurated, tight stricture. Biopsies from that area showed ulceration and inflammatory changes non-specific for ischaemia, drug-induced changes or inflammatory bowel disease. As a consequence of the subocclusive symptoms and the possibility of a neoplastic diagnosis, a laparoscopic-assisted transverse colectomy was performed. The histology of the resected segment revealed post-traumatic inflammation and fibrosis with no evidence of neoplasia. PMID:23975915

Rotar, Raluca; Uwechue, Raphael; Sasapu, Kishore Kumar

2013-01-01

49

New Bloody Sunday Inquiry  

NSDL National Science Digital Library

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.

De Nie, Michael W.

1998-01-01

50

Imperforate Hymen - a rare cause of acute abdominal pain and tenesmus: case report and review of the literature  

PubMed Central

Imperforate hymen is a rare condition that presents with amenorrhea, cyclical abdominal pains and urine retention among pubertal girls. A 14 year old girl with imperforate hymen underwent hymenotomy for hematocolpometra, having presented with abdominal pains and tenesmus. PMID:24009804

Mwenda, Aruyaru Stanley

2013-01-01

51

[UL-scanning of children with recurrent abdominal pain--a diagnostic gain?].  

PubMed

The medical records were reviewed for 109 children (0-15 years) who were investigated by abdominal ultrasonography as part of the evaluation of recurrent abdominal pain. We characterised this group of children in an attempt to localise the characteristics that would predict abnormal findings by abdominal ultrasonography. We conclude that neither location, frequency or duration of pain, nor sex nor age have any predictive value. All abnormal findings seen by abdominal ultrasonography could have been revealed by a carefully taken history, thorough clinical examination and commonly performed laboratory tests, such as urine analysis. We recommend that abdominal ultrasonography should only be used in the evaluation of recurrent abdominal pain in children if there are other characteristics, such as a history of cystitis. PMID:8607207

Dahl, M; Pedersen, L V

1996-01-15

52

Anaemia and abdominal pain due to occupational lead poisoning.  

PubMed

We describe a 47-year-old patient with chronic anaemia with basophilic stippling of erythrocytes, recurrent abdominal colics, discoloration of gums, sensitive polyneuropathy to the four limbs, hyperuricaemia, hepatosteatosis with raised transaminases, and a long ignored history of lead exposure in a battery recycling plant. The diagnosis of poisoning was confirmed by high lead levels in the blood and urine, decreased erythrocyte delta-aminolevulinic acid dehydratase (ALA-D), raised erythrocyte zinc protoporphyrin (ZP), and elevated urinary excretion of porphyrins. Chelation with EDTA resulted in increased urinary lead excretion, gradual improvement of the clinical picture, and progressive normalization of lead biomarkers. The case highlights the importance of occupational anamnesis for the diagnosis of lead poisoning, an uncommon condition which may mimic a variety of internal and surgical diseases. Since antiquity, lead has been extensively mined, produced, and utilized in a variety of industrial settings, such as metallurgy, construction, production of plastics, ceramics, paints and pigments. Lead and its compounds are systemic toxicants, and a wide range of adverse health effects (including haematological, gastrointestinal, neuropsychiatric, cardiovascular, renal, endocrine, and reproductive disorders) has been observed in exposed workers. The general population (particularly children) may also be exposed to toxic lead levels due to air, soil, food and water contamination. Thanks to the improvement of workplace hygienic conditions, the pathological picture of occupational lead poisoning (plumbism, saturnism) has gradually become less serious, at least in the most industrialized countries, and has progressively changed into aspecific, subclinical manifestations. We describe here an unusual case (nowadays) of anaemia and recurrent abdominal pain due to lead poisoning from battery recycling. PMID:17405745

Fonte, Rodolfo; Agosti, Antonio; Scafa, Fabrizio; Candura, Stefano M

2007-02-01

53

FACTORS RELATED TO ABDOMINAL PAIN IN GASTROPARESIS: CONTRAST TO PATIENTS WITH PREDOMINANT NAUSEA AND VOMITING  

PubMed Central

Background Factors associated with abdominal pain in gastroparesis are incompletely evaluated and comparisons of pain versus other symptoms are limited. This study related pain to clinical factors in gastroparesis and contrasted pain/discomfort- with nausea/vomiting-predominant disease. Methods Clinical and scintigraphy data were compared in 393 patients from 7 centers of the NIDDK Gastroparesis Clinical Research Consortium with moderate-severe (Patient Assessment of Upper Gastrointestinal Disorders Symptoms [PAGI-SYM] score ?3) vs. none-mild (PAGI-SYM <3) upper abdominal pain and predominant pain/discomfort vs. nausea/vomiting. Key Results Upper abdominal pain was moderate-severe in 261 (66%). Pain/discomfort was predominant in 81 (21%); nausea/vomiting was predominant in 172 (44%). Moderate-severe pain was more prevalent with idiopathic gastroparesis and with lack of infectious prodrome (P?0.05) and correlated with scores for nausea/vomiting, bloating, lower abdominal pain/discomfort, bowel disturbances, and opiate and antiemetic use (P<0.05) but not gastric emptying or diabetic neuropathy or control. Gastroparesis severity, quality of life, and depression and anxiety were worse with moderate-severe pain (P?0.008). Factors associated with moderate-severe pain were similar in diabetic and idiopathic gastroparesis. Compared to predominant nausea/vomiting, predominant pain/discomfort was associated with impaired quality of life, greater opiate, and less antiemetic use (P<0.01), but similar severity and gastric retention. Conclusions & Inferences Moderate-severe abdominal pain is prevalent in gastroparesis, impairs quality of life, and is associated with idiopathic etiology, lack of infectious prodrome, and opiate use. Pain is predominant in one fifth of gastroparetics. Predominant pain has at least as great an impact on disease severity and quality of life as predominant nausea/vomiting. PMID:23414452

2013-01-01

54

Evaluation and management of acute abdominal pain in the emergency department  

PubMed Central

Evaluation of the emergency department patient with acute abdominal pain is sometimes difficult. Various factors can obscure the presentation, delaying or preventing the correct diagnosis, with subsequent adverse patient outcomes. Clinicians must consider multiple diagnoses, especially those life-threatening conditions that require timely intervention to limit morbidity and mortality. This article will review general information on abdominal pain and discuss the clinical approach by review of the history and the physical examination. Additionally, this article will discuss the approach to unstable patients with abdominal pain. PMID:23055768

Macaluso, Christopher R; McNamara, Robert M

2012-01-01

55

Recurrent abdominal pain in young pre-menarchal female: clinical and surgical observations.  

PubMed

The purpose of this study is to determine the role of surgical intervention in pre-menarchal patients with recurrent abdominal pain. Seventy-six pre-menarchal females aged 9-12 were examined for recurrent abdominal pain; during clinical observation blood tests were within normal values and abdominal and pelvic US showed no surgical or gynaecological problems. After laparoscopic appendectomy the patients' clinical-surgical findings were related to their age, relief of symptoms and histopathological findings. A total of 71% of patients showed positive surgical findings; 55.5% of these showed variations in the position of the appendix with mild inflammation and reactive pericaecal lymph nodes, 7.5% had a macroscopic inflammation with adhesions and 37% had a mild inflammation. Twenty-nine percent of patients had a normal appendix without adhesions, inflammations or infections. Histopathological examination showed a pathologic appendix in 60 cases (79%). Six months after surgery abdominal pain persisted in 18 patients out of 76 (23%). There is a statistically significant relationship between recurrent abdominal pain, surgical observation and relief of symptoms (P < 0.05). We believe that patients affected by recurrent abdominal pain need to be closely and simultaneously monitored. For this reason, laparoscopy should be considered and used with those patients suffering from frequent abdominal pain and discomfort. PMID:18026737

Zampieri, Nicola; Zamboni, Carla; Corroppolo, Michele; Pietrobelli, Angelo; Camoglio, Francesco Saverio

2008-03-01

56

Abdominal pain in sickle cell disease: the role of CT.  

PubMed

Patients with either homozygous or heterozygous sickle cell disease may have frequent episodes of abdominal pain and/or fever of uncertain cause. While many of these episodes represent a so-called sterile crisis, the possibility of gross organ infarction and rupture, infection, or other complication cannot be ignored. Computed tomography (CT) was used to evaluate 30 such patients. Virtually all patients had splenic abnormalities, which could be considered clinically significant (rupture, hemorrhage) or insignificant (calcified spleen). In four patients hepatic abnormalities were found, including one case of multiple liver infarction, one of hepatic abscess, and two of retained intrahepatic gallstones after cholecystectomy. Two patients had significant acute renal abnormalities, including one case of interstitial nephritis and one of renal vein thrombosis. One patient had a ruptured periappendiceal abscess and one a pericolonic abscess. One patient had an abscess around a total hip replacement. CT was found to be an excellent and relatively noninvasive means of both initial investigation and subsequent follow-up. PMID:3562812

Magid, D; Fishman, E K; Charache, S; Siegelman, S S

1987-05-01

57

Ultrasonography aids decision-making in children with abdominal pain  

PubMed Central

INTRODUCTION Although regular clinical assessment of the acute abdomen is considered best practice, ultrasonography confirming the presence of appendicitis will add to the decision-making process. The aim of this study was to assess the accuracy of ultrasonography and its usefulness in diagnosing acute appendicitis in a regional paediatric surgical institution. METHODS Retrospectively and in this order, radiology, theatre and histopathology databases were searched for patients who had presented with acute abdominal pain, patients who had undergone an appendicectomy and all appendix specimens over a two-year period. The databases were cross-referenced against each other. RESULTS A total of 273 non-incidental appendicectomies were performed over the study period. The negative appendicectomy rate was 16.5% and the perforation rate 23.7%. Thirty-nine per cent of children undergoing an appendicectomy had at least one pre-operative ultrasound scan. Ultrasonography as a diagnostic tool for acute appendicitis in children had a sensitivity of 83.3%, a specificity of 97.4 %, a positive predictive value of 92.1% and a negative predictive value of 94.0%. CONCLUSIONS Ultrasonography is used liberally to aid in the decision making process of equivocal and complicated cases of acute appendicitis and it achieves good measures of accuracy. As a diagnostic tool it is unique in its ability to positively predict as well as exclude. A high negative predictive value suggests that more patients could be managed on an outpatient basis following a negative scan. PMID:21943467

Scammell, S; Lansdale, N; Sprigg, A; Campbell, D; Marven, S

2011-01-01

58

Hypokinetic gallbladder disease: A cause of chronic abdominal pain in children and adolescents  

Microsoft Academic Search

Background\\/Purpose: Impaired gallbladder emptying has been identified as a cause of chronic abdominal pain in adults. This study aims to define a pediatric population with functional abnormalities of gallbladder contractility and to assess clinical outcome after cholecystectomy.Methods: Children and adolescents (n = 42) with abdominal complaints underwent gallbladder emptying studies, measured by either ultrasonography or scintigraphy with intravenous cholecystokinin (CCK).

R. Charles Dumont; Donna A Caniano

1999-01-01

59

Depression is Associated with Repeat Emergency Department Visits in Patients with Non-specific Abdominal Pain  

PubMed Central

Introduction: Patients with abdominal pain often return multiple times despite no definitive diagnosis. Our objective was to determine if repeat emergency department (ED) use among patients with non-specific abdominal pain might be associated with a diagnosis of moderate to severe depressive disorder. Methods: We screened 987 ED patients for major depression during weekday daytime hours from June 2011 through November 2011 using a validated depression screening tool, the PHQ-9. Each subject was classified as either no depression, mild depression or moderate/severe depression based on the screening tool. Within this group, we identified 83 patients with non-specific abdominal pain by either primary or secondary diagnosis. Comparing depressed patients versus non-depressed patients, we analyzed demographic characteristics and number of prior ED visits in the past year. Results: In patients with non-specific abdominal pain, 61.9% of patients with moderate or severe depression (PHQ9?10) had at least one visit to our ED for the same complaint within a 365-day period, as compared to 29.2% of patients with no depression (PHQ9<5), (p=0.013). Conclusion: Repeat ED use among patients with non-specific abdominal pain is associated with moderate to severe depressive disorder. Patients with multiple visits for abdominal pain may benefit from targeted ED screening for depression. [West J Emerg Med. 2014;15(3):325–328.] PMID:24868312

Meltzer, Andrew Charles; Bregman, Benjamin; Blanchard, Janice

2014-01-01

60

A case report from Nepalese community pharmacy on levofloxacin induced severe abdominal pain  

PubMed Central

A 46-year-old female patient developed severe abdominal pain shortly after taking levofloxacin, 1000 mg for acute bacterial sinusitis. The pain started after taking the first dose of levofloxacin and became worse after the second dose. The patient was unable to do daily physical activities. The pain resolved upon discontinuation of levofloxacin and symptomatic therapy. Other factors that may cause abdominal pain were ruled out. This case is of interest as it documents severe abdominal pain due to levofloxacin requiring discontinuation of therapy and describes its appropriate management. In addition, it highlights the vital role that community pharmacists could play in managing adverse drug reactions (ADRs) and preventing potential Drug Related Problems (DRPs). PMID:23960849

Bhuvan, K.C.; ALrasheedy, Alian A.; Ibrahim, Mohamed Izham Mohamed

2013-01-01

61

Activated Mast Cells in Proximity to Colonic Nerves Correlate With Abdominal Pain in Irritable Bowel Syndrome  

Microsoft Academic Search

Background & Aims: The mechanisms underlying ab- dominal pain perception in irritable bowel syndrome (IBS) are poorly understood. Intestinal mast cell infiltra- tion may perturb nerve function leading to symptom perception. We assessed colonic mast cell infiltration, mediator release, and spatial interactions with mucosal innervation and their correlation with abdominal pain in IBS patients. Methods: IBS patients were diagnosed ac-

GIOVANNI BARBARA; VINCENZO STANGHELLINI; ROBERTO DE GIORGIO; CESARE CREMON; GRAEME S. COTTRELL; DONATELLA SANTINI; GIANANDREA PASQUINELLI; ANTONIO M. MORSELLI-LABATE; EILEEN F. GRADY; NIGEL W. BUNNETT; STEPHEN M. COLLINS; ROBERTO CORINALDESI

2004-01-01

62

Can lab data be used to reduce abdominal computed tomography (CT) usage in young adults presenting to the emergency department with nontraumatic abdominal pain?  

Microsoft Academic Search

We sought to determine whether laboratory parameters could be found, predictive of a negative abdominal CT scan in young adults\\u000a with nontraumatic abdominal pain. Following institutional review board approval, we evaluated CT reports of 522 patients,\\u000a aged 21–35 years old, who presented to the Emergency Department with nontraumatic abdominal pain. Bivariate analyses relating\\u000a ten laboratory parameters to whether the CT detected

Meir H. Scheinfeld; Soham Mahadevia; Evan G. Stein; Katherine Freeman; Alla M. Rozenblit

2010-01-01

63

Ruptured abdominal aortic aneurysm presenting as buttock pain  

Microsoft Academic Search

This is the first case report of a ruptured aortic aneurysm presenting with acute right buttock pain. The patient was an 80 year old man. A literature search revealed one report of ruptured internal iliac artery aneurysm presenting with acute hip pain and another of an unruptured aortic aneurysm presenting with chronic hip pain. Thus the present case is another

F Mahmood; F Ahsan; M Hockey

2005-01-01

64

Pain reported during prolonged standing is associated with reduced anticipatory postural adjustments of the deep abdominals.  

PubMed

Within the context of low back pain, the measurement of deep abdominal anticipatory postural adjustments (APAs) during rapid limb movement has received much interest. There is dispute about the association between APAs and back pain. Moreover, there is limited evidence examining compensatory postural adjustments (CPAs) in back pain. This study examined the relationship between APAs and CPAs with pain reported in the low back during 2 h of prolonged standing. Twenty-six participants with no history of severe back pain performed 2-h prolonged standing. APAs and CPAs of the deep abdominal muscles (transverse abdominis/internal obliques) were measured by surface electromyography during rapid shoulder flexion and extension. APAs and CPAs measured pre-standing revealed symmetrical anticipatory activity, but an asymmetry between the different sides of the abdominal wall for CPAs. APAs and CPAs measured pre-standing were not associated with pain reported during standing. For the whole group, APA amplitudes were reduced post-standing during shoulder flexion (p = 0.005). Pain reported during standing was associated with the changes in APA amplitudes post-standing (rs = 0.43, p = 0.002). These findings support previous research using hypertonic saline injections to induce back pain that showed reduced APA amplitudes, and extends findings to suggest pain does not effect compensatory postural adjustments. PMID:25059911

Marshall, Paul W M; Romero, Rick; Brooks, Cristy

2014-11-01

65

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

PubMed Central

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

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

2014-01-01

66

Influence of Hamstring and Abdominal Muscle Activation on a Positive Ober's Test in People with Lumbopelvic Pain  

PubMed Central

ABSTRACT Purpose: To assess the immediate effect of hamstring and abdominal activation on pain levels as measured by the Numeric Pain Scale (NPS) and hip range of motion as measured by Ober's Test in people with lumbopelvic pain. Methods: Thirteen participants with lumbopelvic pain and positive Ober's Tests completed an exercise developed by the Postural Restoration Institute™ to recruit hamstrings and abdominal muscles. Results: There was a significant increase in passive hip-adduction angles (p<0.01) and decrease in pain (p<0.01) immediately after the intervention. Conclusion: Specific exercises that activate hamstrings and abdominal muscles appear to immediately improve Ober's Test measurements and reduce pain as measured by the NPS in people with lumbo-pelvic pain. Hamstring/abdominal activation, rather than iliotibial band stretching, may be an effective intervention for addressing lumbopelvic pain and a positive Ober's Test. PMID:24381375

Tenney, H. Rich; DeBord, Aaron

2013-01-01

67

Lower abdominal wall pain and contusion in single-incision laparoscopic cholecystectomy.  

PubMed

There is a surge in interest in single-incision laparoscopic surgery in the recent years. Due to entry of all the ports and instruments from the same incision and obliquity of the instruments, the lowermost port exerts repeated pressure on the infraumbilical abdominal wall. We are reporting 2 cases of single-incision laparoscopic surgery cholecystectomy who presented with lower abdominal pain and contusion in the post operative period. PMID:20874236

Garg, Pankaj; Thakur, Jai Deep; Singh, Iqbal

2010-10-01

68

An oblique muscle hematoma as a rare cause of severe abdominal pain: a case report  

PubMed Central

Background Abdominal wall hematomas are an uncommon cause of acute abdominal pain and are often misdiagnosed. They are more common in elderly individuals, particularly in those under anticoagulant therapy. Most abdominal wall hematomas occur in the rectus sheath, and hematomas within the oblique muscle are very rare and are poorly described in the literature. Here we report the case of an oblique muscle hematoma in a middle-aged patient who was not under anticoagulant therapy. Case presentation A 42-year-old Japanese man presented with a painful, enlarging, lateral abdominal wall mass, which appeared after playing baseball. Abdominal computed tomography and ultrasonography showed a large soft tissue mass located in the patient’s left internal oblique muscle. A diagnosis of a lateral oblique muscle hematoma was made and the patient was treated conservatively. Conclusion Physicians should consider an oblique muscle hematoma during the initial differential diagnosis of pain in the lateral abdominal wall even in the absence of anticoagulant therapy or trauma. PMID:23327472

2013-01-01

69

Hereditary angioneurotic oedema: an unusual case of recurring abdominal pain 1  

PubMed Central

Two patients with hereditary angioneurotic oedema, a condition characterized by repeated episodes of abdominal pain and oedema, and by an absence of complement-1 esterase inhibitor activity in the plasma are presented in detail. Both underwent multiple surgical procedures before the diagnosis was established. Abdominal pain is often the presenting complaint, and although a complete history will usually lead to the proper diagnosis, cases in which the family history is not clear can present a diagnostic dilemma. Characteristic radiological demonstration of localized intestinal oedema will only be obtained if studies are performed early during the acute attack. ImagesFig. 1Fig. 2Fig. 4 PMID:5511819

Feller, Edward J.; Spiro, Howard M.; Katz, Leonard A.

1970-01-01

70

[Two cases of C1INH deficiency with paroxysmal abdominal pain].  

PubMed

We encountered two cases of C1 inhibitor deficiency (26-year-old man and 29-year-old woman). They had been suffering from paroxysmal abdominal pain for many years. Imaging studies showed wall thickening of the intestine and ascites and diagnosis was difficult. Decreased serum levels of C4 and C1INH activity indicated a diagnosis of C1INH deficiency. Although C1INH deficiency is rare, it should be considered as a differential diagnosis in young patients with paroxysmal abdominal pain. PMID:17548946

Takamura, Kazuto; Arai, Keiko; Otsu, Naoya

2007-06-01

71

Parent attention versus distraction: Impact on symptom complaints by children with and without chronic functional abdominal pain  

Microsoft Academic Search

The objective of this study was to assess the impact of parent attention and distraction on symptom complaints by children with and without chronic functional abdominal pain. The water load symptom provocation task was used to induce visceral discomfort in pediatric patients with abdominal pain (N=104) and well children (N=119), ages 8–16 years. Parents were randomly assigned and trained to

Lynn S. Walker; Sara E. Williams; Craig A. Smith; Judy Garber; Deborah A. Van Slyke; Tricia A. Lipani

2006-01-01

72

Computed tomography in patients with abdominal pain and diarrhoea: does the benefit outweigh the drawbacks?  

PubMed

The role of computed tomography (CT) in the evaluation of abdominal pain is well established. However, concern exists in regard to procedure-related radiation levels, contrast-medium toxicity and costs. We sought to determine whether the use of abdominal CT caused major changes in the management of patients who had abdominal pain and diarrhoea. We reviewed all abdominal CT examinations that were performed at our hospital from October through December 2010. We selected 574 scans that had been performed in patients who presented with or without diarrhoea. We examined the selected medical records to determine whether the CT scan changed patients' management. A scan was considered to be management changing if a decisive intervention occurred on the basis of the scan results. Among 124 scans in patients with diarrhoea and 450 scans in patients without diarrhoea, the scan results changed management in 13 of the patients with diarrhoea (11%) and in 233 of those without diarrhoea (52%) (P < 0.001). When management changed, the changes resulted from findings unrelated to diarrhoea. Despite its defined role in the assessment of abdominal pain, CT of patients that also had diarrhoea seldom caused a major change in management. The probability of CT causing such a change does not outweigh the cost, radiation risk or potential for contrast-induced nephropathy. PMID:24134171

Aisenberg, G M; Grimes, R M

2013-10-01

73

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

Microsoft Academic Search

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

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

2009-01-01

74

Efficacy of a Brief Relaxation Training Intervention for Pediatric Recurrent Abdominal Pain  

ERIC Educational Resources Information Center

This study is a preliminary investigation of the efficacy of a brief intervention for recurrent abdominal pain (RAP) via a multiple baseline across subjects design. The intervention consisted of a single 1-hour session including psychoeducation and coaching of breathing retraining; the length, duration, and content of the intervention were…

Bell, Katrina M.; Meadows, Elizabeth A.

2013-01-01

75

Increased Diagnostic Yield of Capsule Endoscopy in Patients with Chronic Abdominal Pain  

PubMed Central

Background and Study Aims Chronic abdominal pain is one of the most common chief complaints, but the underlying pathophysiology often remains unknown after routine clinical evaluation. Capsule endoscopy (CE) is a new technique for the visualization of the entire small bowel. The aim of this study was to evaluate the diagnostic efficacy of CE in patients with chronic abdominal pain of obscure origin. Patients and Methods Two hundred forty three patients with chronic abdominal pain with no significant lesions were enrolled in this study. CE was performed in all patients. Results A diagnosis was made in 23.0% of patients screened with CE. Of the 243 patients, 19 (7.8%) were diagnosed with Crohn's disease, 15 (6.2%) with enteritis, 11 (4.5%) with idiopathic intestinal lymphangiectasia, 5 (2.1%) with uncinariasis, and a number of other diagnoses including small bowel tumor, ascariasis, and anaphylactoid purpura. Five patients had abnormal transit time, and capsule retention occurred in two patients. Conclusions In contrast to other previous studies, we found that CE is an effective diagnostic tool for patients with abdominal pain. PMID:24498097

Yang, Liping; Chen, Yu; Zhang, Bingling; Chen, Chunxiao; Yue, Min; Du, Juan; Yu, Chaohui; Li, Youming

2014-01-01

76

Teaching Critical Decision-Making Skills to Students Concerning Patients with Acute Abdominal Pain.  

ERIC Educational Resources Information Center

The clinical performance of junior hospital staff concerning the management of patients with acute abdominal pain may be enhanced by placing greater emphasis on teaching clinical decision-making skills during the preintern year. Final year medical students took part in a teaching session in which groups of six to eight rotated through six stations…

Hill, David; And Others

1994-01-01

77

Hypnotherapy for Children With Functional Abdominal Pain or Irritable Bowel Syndrome: A Randomized Controlled Trial  

Microsoft Academic Search

Background & Aims: Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are highly prevalent in childhood. A substantial proportion of patients continues to experience long-lasting symptoms. Gut-directed hypnotherapy (HT) has been shown to be highly effective in the treatment of adult IBS patients. We undertook a randomized controlled trial and com- pared clinical effectiveness of HT with standard medical

ARINE M. VLIEGER; CARLA MENKO-FRANKENHUIS; SIMONE C. S. WOLFKAMP; ELLEN TROMP; MARC A. BENNINGA

2007-01-01

78

The role of emergency MRI in the setting of acute abdominal pain.  

PubMed

Abdominal pain is one of the most common reasons for patients to present to the emergency department (ED) in the USA, with an estimated seven million visits in 2007-2008, a figure which represents 8 % (±0.2 %) [2] of all ED visits and a 31.8 % increase from 1999-2000. Abdominal pain has a broad differential diagnosis that encompasses multiple organ systems and can provide a significant diagnostic challenge to the ED physician. Although magnetic resonance imaging (MRI) currently plays a limited role in the assessment of abdominal pain presenting to the ED in the nongravid population, its utility in the pregnant and pediatric population has already been proven. A proven diagnostic track record, lack of ionizing radiation and the ability to provide excellent tissue contrast without the use of nephrotoxic iodinated contrast, makes MRI an attractive imaging modality. As physicians and patients become more aware of the potential risks associated with exposure to ionizing radiation, ED MRI utilization is likely to increase. In this article, we discuss the MRI appearance of some of the most common diagnoses, which present as abdominal pain to the ED. PMID:24828243

Ditkofsky, Noah G; Singh, Ajay; Avery, Laura; Novelline, Robert A

2014-12-01

79

An epidemiological survey of recurrent abdominal pain in a rural Malay school  

Microsoft Academic Search

Objective: To study the prevalence of complaints of recurrent abdominal pain (RAP) among school children aged 11-12 years in a rural setting in Malaysia. Methodology: Questionnaires were distributed to all parents and teachers of children aged 11-12 years who attended a small rural school in which all the children were Malays. Complaints of RAP were defined as at least three

C. C. M. Boey; S. B. Yap

1999-01-01

80

Abdominal pain and irritable bowel syndrome in adolescents: A community-based study  

Microsoft Academic Search

OBJECTIVES: This study was undertaken to determine (1) the prevalence of gastrointestinal symptoms including abdominal pain in a community-based population of adolescents, (2) whether a subgroup of these subjects have symptoms resembling irritable bowel syndrome (IBS), and (3) whether anxiety and depression are more commonly found in adolescents with IBS-type symptoms compared with unaffected adolescents. METHODS: We collected data by

Jeffrey S. Hyams; Georgine Burke; Patricia M. Davis; Barbara Rzepski; Paul A. Andrulonis

1996-01-01

81

Contrast-enhanced ultrasound detects gallbladder perforation in a patient with acute abdominal pain.  

PubMed

We present the case of a patient with abdominal pain, in which gallbladder perforation was detected by contrast-enhanced ultrasound. A 90-year-old patient presented to the emergency department with a complaint of acute abdominal pain and vomiting. An abdominal ultrasound revealed a thickened gallbladder wall and small amounts of perihepatic fluid. Because these findings were suspicious for gallbladder perforation and contrast-enhanced computed tomography could not be performed because of a history of monoclonal gammopathy, a contrast-enhanced ultrasound scan was performed. After the administration of 2.5 mL of SonoVue (Bracco, Milan, Italy), a defect of the gallbladder wall was detected. The patient underwent laparotomy, on which the diagnosis of gallbladder perforation was confirmed. PMID:21447432

Zechner, Peter Michael; Rienmüller, Susanne; Dorr, Katrin; Genger, Christina; Wurzer, Herbert

2012-03-01

82

[Evaluation of bloody nipple discharge].  

PubMed

A 64-year old woman was referred for radiological evaluation of right sided bloody nipple discharge lasting for five months. Finally galactography supposed the diagnosis of an intraductal papilloma which was confirmed by surgery. Histopathologically an eight millimeter measuring intraductal papilloma with atypical ductal hyperplasia with signs of a carcinoma in situ was seen. PMID:15795963

Tschirch, F T C; Kubik-Huch, R A; Knüsel, P R; Komminoth, P; Hohl, M K; Otto, R C

2005-03-01

83

Management of bloody nipple discharge.  

PubMed

Bloody nipple discharge causes a high degree of anxiety in women because of fear of breast cancer. Commonly, the absence of palpable or mammographic abnormalities gives a false sense of security, causing delays in diagnosis. Initial evaluation with physical examination and mammography is useful in detecting high-risk cases. Bloody nipple discharge is most frequently benign. It is caused by intraductal papilloma, duct ectasia, and less frequently by breast cancer. Several diagnostic tests have been proposed to establish the cause of bloody nipple discharge. Galactography, ultrasound, and exfoliative cytology are useful only when positive, but have a high rate of false-negative results and do not preclude histologic diagnosis. More recently, ductal lavages in combination with cytology have provided promising results, but experience and long-term follow-up are limited. Traditional treatment is surgical excision of the involved ductal system from which the discharge emanates. Ductal excision has been the only reliable procedure in establishing a certain diagnosis and in controlling the bloody discharge. The early success reported with image-guided excision of papilloma and duct endoscopy promises a significant improvement in our diagnostic accuracy from minimally invasive emerging technology. PMID:12057078

Vargas, Hernan I; Romero, Lina; Chlebowski, Rowan T

2002-04-01

84

Bloody Sunday: Error or Design?  

Microsoft Academic Search

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

Niall Ó Dochartaigh

2010-01-01

85

Primary Cardiac Burkitt Lymphoma Presenting with Abdominal Pain  

PubMed Central

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.

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

2014-01-01

86

Functional abdominal pain in children: new understanding, diagnostic criteria, and treatment approaches.  

PubMed

From the array of articles, one can readily see the clinical and scientific progress made in symptom-based diagnosis and management of functional abdominal pain disorders over the past 5 years. We have provided a series of useful tools to approach these patients. We have provided the symptom-based diagnostic criteria plus the red flags to help you avoid missing an organic diagnosis. We have placed these disorders squarely within the complex biopsychosocial framework by identifying early life stress and many environmental factors that are key factors in the development of pain. We have identified the role of psychological comorbidities of anxiety and depression and the need to address them directly in order to rehabilitate a disabled child. Finally, pharmacologic, psychological, dietary, and complementary approaches are reviewed and recommended as empiric therapy in functional abdominal pain, functional dyspepsia, and irritable bowel syndrome. Use these new tools well. PMID:19476294

Li, B U K

2009-05-01

87

Pancreato-biliary Endoscopic Ultrasound in Opium Addicts Presenting with Abdominal Pain  

PubMed Central

Objective: Asymptomatic dilatation of bile duct and symptomatic sphincter of Oddi dysfunction have been reported in opium addicts. Except one case report, there is no report in the literature on endoscopic ultrasound (EUS) study of pancreato-biliary system in opium addicts. The aim of the present study was to report the EUS features of pancreato-biliary system in opium addicts presenting with abdominal pain. Patients and Methods: A total of 15 opium addicts presenting with upper abdominal pain and dilated common bile duct (CBD) and or pancreatic duct (PD) on abdominal ultrasound were included in this study. EUS findings of pancreato-biliary system were analyzed in these patients. Results: All the 15 patients were males (mean age 53.3 years) presented with upper abdominal pain. Mean duration of opium addiction was 20.1 years. On EUS CBD was dilated in all the patients while PD was dilated in six patients. Gall bladder, liver and pancreatic parenchyma was normal in all these patients. Surface area of papilla of Vater (SPV) was increased in 12 patients. Conclusion: Opium addiction causes obstruction at ampulla and produces dilatation of bile duct and PD. Bile duct dilatation was seen in all the patients while PD dilatation was seen in few patients. Increase in SPV was a peculiar finding and appears to be as a result of direct effect of opium on ampulla. PMID:24949397

Sharma, Shyam Sundar; Ram, Seva; Maharshi, Sudhir; Shankar, Vijay; Katiyar, Prashant; Jhajharia, Ashok; Sardava, Vimal; Bhardwaj, Hemendra

2013-01-01

88

Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study  

PubMed Central

Objective To identify an optimal imaging strategy for the accurate detection of urgent conditions in patients with acute abdominal pain. Design Fully paired multicentre diagnostic accuracy study with prospective data collection. Setting Emergency departments of two university hospitals and four large teaching hospitals in the Netherlands. Participants 1021 patients with non-traumatic abdominal pain of >2 hours’ and <5 days’ duration. Exclusion criteria were discharge from the emergency department with no imaging considered warranted by the treating physician, pregnancy, and haemorrhagic shock. Intervention All patients had plain radiographs (upright chest and supine abdominal), ultrasonography, and computed tomography (CT) after clinical and laboratory examination. A panel of experienced physicians assigned a final diagnosis after six months and classified the condition as urgent or non-urgent. Main outcome measures Sensitivity and specificity for urgent conditions, percentage of missed cases and false positives, and exposure to radiation for single imaging strategies, conditional imaging strategies (CT after initial ultrasonography), and strategies driven by body mass index and age or by location of pain. Results 661 (65%) patients had a final diagnosis classified as urgent. The initial clinical diagnosis resulted in many false positive urgent diagnoses, which were significantly reduced after ultrasonography or CT. CT detected more urgent diagnoses than did ultrasonography: sensitivity was 89% (95% confidence interval 87% to 92%) for CT and 70% (67% to 74%) for ultrasonography (P<0.001). A conditional strategy with CT only after negative or inconclusive ultrasonography yielded the highest sensitivity, missing only 6% of urgent cases. With this strategy, only 49% (46% to 52%) of patients would have CT. Alternative strategies guided by body mass index, age, or location of the pain would all result in a loss of sensitivity. Conclusion Although CT is the most sensitive imaging investigation for detecting urgent conditions in patients with abdominal pain, using ultrasonography first and CT only in those with negative or inconclusive ultrasonography results in the best sensitivity and lowers exposure to radiation. PMID:19561056

2009-01-01

89

Recurrent abdominal pain in child patients seen at a pediatric gastroenterology clinic. Observations of 50 children and their families.  

PubMed

Recurrent abdominal pain is a common patient complaint in general pediatric and gastroenterology clinics. Various psychiatric problems have been noted in the children, adolescents, and parents of children who present with nonorganic recurrent abdominal pain. This article reviews the stressors, psychopathology, and biopsychosocial treatment of 50 patients with recurrent abdominal pain who were referred from a pediatric gastroenterology clinic to their psychiatric consultant over a 3-year period (1987-1990). The salient literature is also reviewed and thoughts for future research are outlined. PMID:8284338

Woodbury, M M

1993-01-01

90

Functional abdominal pain and irritable bowel syndrome in children and adolescents  

PubMed Central

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

Chiou, Eric; Nurko, Samuel

2011-01-01

91

Sustained, progressive, nonresolving abdominal pain: a previously undescribed clinical presentation of familial Mediterranean fever.  

PubMed

Familial Mediterranean fever (FMF) is a genetic disorder characterized by sporadic, acute attacks of fever and serosal inflammation. Typical manifestations are recurrent febrile episodes of acute instauration for brief duration (1 to 4 days) that is associated with severe pain due to serositis at one or more sites. Abdominal crisis occurs in 95% of the patients. Treatment with colchicine is highly effective as preventive treatment, but it is considered to be ineffective for the treatment of established acute attacks. As mentioned, untreated crisis resolves spontaneously in 1 to 4 days. Prolonged, nonresolving crisis of abdominal pain refractory to nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids, with fever and elevation of acute phase reactants that resolves after the administration of colchicine, is a clinical presentation undescribed hitherto. The aim of this paper is to report a patient with this distinctively unusual clinical presentation of FMF. PMID:16328089

Radisic, Marcelo; Santamarina, Joaquin; Froment, Roberto

2006-11-01

92

The Epidemiology of Childhood Recurrent Abdominal Pain in Western Countries: A Systematic Review  

Microsoft Academic Search

OBJECTIVE:Recurrent abdominal pain (RAP) of childhood is a common problem encountered by clinicians. The aim of this study was to systematically review published literature about the prevalence, incidence, natural history, and co-morbid conditions of childhood RAP in western countries.METHODS:A computer-assisted search of MEDLINE, EMBASE, and Current Contents\\/Science Edition databases was performed. Study selection criteria included: (1) United States and European

Denesh K. Chitkara; David J. Rawat; Nicholas J. Talley

2005-01-01

93

Solitary eosinophilic granuloma causing spinal cord compression in a child presenting with abdominal pain  

Microsoft Academic Search

This report describes a case of an eosinophilic granuloma of T7 causing spinal cord compression in an 8-year-old boy who presented with abdominal pain. The purpose of this report was to illustrate both the variable clinical presentation and the rare incidence of cord compression due to an eosinophilic granuloma. Eosinophilic granuloma is a benign tumour-like condition that produces focal bone

Michael Leonard; Damian McCormack

2006-01-01

94

Evaluation of guided imagery as treatment for recurrent abdominal pain in children: a randomized controlled trial  

Microsoft Academic Search

BACKGROUND: Because of the paucity of effective evidence-based therapies for children with recurrent abdominal pain, we evaluated the therapeutic effect of guided imagery, a well-studied self-regulation technique. METHODS: 22 children, aged 5 – 18 years, were randomized to learn either breathing exercises alone or guided imagery with progressive muscle relaxation. Both groups had 4-weekly sessions with a therapist. Children reported

Joy A Weydert; Daniel E Shapiro; Sari A Acra; Cynthia J Monheim; Andrea S Chambers; Thomas M Ball

2006-01-01

95

Expression of the TRPV1 receptor differs in quiescent inflammatory bowel disease with or without abdominal pain  

Microsoft Academic Search

ObjectiveTransient receptor potential vanilloid type 1 (TRPV1) has been shown to play an important role in visceral hypersensitivity. A significant proportion of patients with inflammatory bowel disease (IBD) continue to complain of abdominal pain despite their disease being otherwise quiescent. We investigated TRPV1-immunoreactive fibres in rectosigmoid biopsies taken from such patients with correlation to abdominal pain severity.MethodsRectosigmoid biopsies were collected

Ayesha Akbar; Yiangos Yiangou; Paul Facer; W. G. Brydon; Julian R F Walters; Praveen Anand; Subrata Ghosh

2010-01-01

96

Acute abdominal pain in patients with lassa fever: Radiological assessment and diagnostic challenges  

PubMed Central

Background: To highlight the problems of diagnosis and management of acute abdomen in patients with lassa fever. And to also highlight the need for high index of suspicion of lassa fever in patients presenting with acute abdominal pain in order to avoid surgical intervention with unfavourable prognosis and nosocomial transmission of infections, especially in Lassa fever-endemic regions. Materials and Methods: A review of experiences of the authors in the management of lassa fever over a 4-year period (2004-2008). Literature on lassa fever, available in the internet and other local sources, was studied in November 2010 and reviewed. Results: Normal plain chest radiographic picture can change rapidly due to pulmonary oedema, pulmonary haemorrhage and acute respiratory distress syndrome. Plain abdominal radiograph may show dilated bowels with signs of paralytic ileus or dynamic intestinal obstruction due to bowel wall haemorrhage or inflamed and enlarged Peyer's patches. Ultrasound may show free intra-peritoneal fluid due to peritonitis and intra-peritoneal haemorrhage. Bleeding into the gall bladder wall may erroneously suggest infective cholecystitis. Pericardial effusion with or without pericarditis causing abdominal pain may be seen using echocardiography. High index of suspicion, antibody testing for lassa fever and viral isolation in a reference laboratory are critical for accurate diagnosis. Conclusion: Patients from lassa fever-endemic regions may present with features that suggest acute abdomen. Radiological studies may show findings that suggest acute abdomen but these should be interpreted in the light of the general clinical condition of the patient. It is necessary to know that acute abdominal pain and vomiting in lassa fever-endemic areas could be caused by lassa fever, which is a medical condition. Surgical option should be undertaken with restraint as it increases the morbidity, may worsen the prognosis and increase the risk of nosocomial transmission. PMID:25013248

Eze, Kenneth C.; Salami, Taofeek A.; Kpolugbo, James U.

2014-01-01

97

Effects of stress on pain threshold and tolerance in children with recurrent abdominal pain  

Microsoft Academic Search

Models of stress-induced hyperalgesia state that exposure to stress can exaggerate subsequent pain experiences. Studies using both animal and human subjects have shown evidence for hyperalgesia as a function of stress [e.g., Jorum E. Analgesia or hyperalgesia following stress correlates with emotional behavior in rats. Pain 1988;32:341–48; Peckerman A, Hurwitz BE, Saab PG, Llabre MM, McCabe PM, Schneiderman N. Stimulus

Lynette M. Dufton; Brian Konik; Richard Colletti; Catherine Stanger; Margaret Boyer; Sara Morrow; Bruce E. Compas

2008-01-01

98

Antinociceptive effects of novel melatonin receptor agonists in mouse models of abdominal pain  

PubMed Central

AIM: To characterize the antinociceptive action of the novel melatonin receptor (MT) agonists, Neu-P11 and Neu-P12 in animal models of visceral pain. METHODS: Visceral pain was induced by intracolonic (ic) application of mustard oil or capsaicin solution or by intraperitoneal (ip) administration of acetic acid. Neu-P11, Neu-P12, or melatonin were given ip or orally and their effects on pain-induced behavioral responses were evaluated. To identify the receptors involved, the non-selective MT1/MT2 receptor antagonist luzindole, the MT2 receptor antagonist 4-P-PDOT, or the ?-opioid receptor antagonist naloxone were injected ip or intracerebroventricularly (icv) prior to the induction of pain. RESULTS: Orally and ip administered melatonin, Neu-P11, and Neu-P12 reduced pain responses in a dose-dependent manner. Neu-P12 was more effective and displayed longer duration of action compared to melatonin. The antinociceptive effects of Neu-P11 or Neu-P12 were antagonized by ip or icv. administered naloxone. Intracerebroventricularly, but not ip administration of luzindole or 4-P-PDOT blocked the antinociceptive actions of Neu-P11 or Neu-P12. CONCLUSION: Neu-P12 produced the most potent and long-lasting antinociceptive effect. Further development of Neu-P12 for future treatment of abdominal pain seems promising. PMID:24574803

Chen, Chunqiu; Fichna, Jakub; Laudon, Moshe; Storr, Martin

2014-01-01

99

Association of Race and Ethnicity With Management of Abdominal Pain in the Emergency Department  

PubMed Central

OBJECTIVE: To determine if race/ethnicity-based differences exist in the management of pediatric abdominal pain in emergency departments (EDs). METHODS: Secondary analysis of data from the 2006–2009 National Hospital Ambulatory Medical Care Survey regarding 2298 visits by patients ?21 years old who presented to EDs with abdominal pain. Main outcomes were documentation of pain score and receipt of any analgesics, analgesics for severe pain (defined as ?7 on a 10-point scale), and narcotic analgesics. Secondary outcomes included diagnostic tests obtained, length of stay (LOS), 72-hour return visits, and admission. RESULTS: Of patient visits, 70.1% were female, 52.6% were from non-Hispanic white, 23.5% were from non-Hispanic black, 20.6% were from Hispanic, and 3.3% were from “other” racial/ethnic groups; patients’ mean age was 14.5 years. Multivariate logistic regression models adjusting for confounders revealed that non-Hispanic black patients were less likely to receive any analgesic (odds ratio [OR]: 0.61; 95% confidence interval [CI]: 0.43–0.87) or a narcotic analgesic (OR: 0.38; 95% CI: 0.18–0.81) than non-Hispanic white patients (referent group). This finding was also true for non-Hispanic black and “other” race/ethnicity patients with severe pain (ORs [95% CI]: 0.43 [0.22–0.87] and 0.02 [0.00–0.19], respectively). Non-Hispanic black and Hispanic patients were more likely to have a prolonged LOS than non-Hispanic white patients (ORs [95% CI]: 1.68 [1.13–2.51] and 1.64 [1.09–2.47], respectively). No significant race/ethnicity-based disparities were identified in documentation of pain score, use of diagnostic procedures, 72-hour return visits, or hospital admissions. CONCLUSIONS: Race/ethnicity-based disparities exist in ED analgesic use and LOS for pediatric abdominal pain. Recognizing these disparities may help investigators eliminate inequalities in care. PMID:24062370

Weaver, Matthew D.; Borrero, Sonya; Davis, Esa M.; Myaskovsky, Larissa; Zuckerbraun, Noel S.; Kraemer, Kevin L.

2013-01-01

100

Pulmonary Embolism with Abdominal Pain and ST Elevation: A Case Report  

PubMed Central

Pulmonary embolism is considered as a great masquerader due to its frequent nonspecific signs and symptoms. Typically pulmonary embolism is under-diagnosed or over-diagnosed. In this study a patient with pulmonary embolism is reported in which the patient exhibited two unusual manifestations namely; right upper quadrant abdominal pain and ST-T elevation in anterior precordial leads. Due to the fact that the patient did not display typical pulmonary embolism symptoms and its major risk factors, extensive workup to discern the cause was carried out. The examination included abdominal sonography, kidney ureter and bladder Computed Tomography scan (CT-scan) and coronary angiography. Eventually after a six-day delay, pulmonary embolism was diagnosed by spiral chest CT scan. This case and several other similar reports underlines the fact that while various other common causes may exist for right upper abdominal pain, one should always consider pulmonary embolism as a possible cause especially when backed up with ECG finding. PMID:25031494

Fallahi, Mohammad Javad; Masoompour, Seyed Masoom; Mirzaee, Mehdi

2014-01-01

101

Abdominal Pain  

MedlinePLUS

... Schueler, MD How it Works Testimonials FAQ for Consumers FAQ for Physicians News Advertising Terms of Use Contact Us Site Map How ... yourself? About Stephen J. Schueler, M.D News Advertising How It Works FAQ for Consumers FAQ for Physicians Testimonials Site Map Terms of ...

102

Abdominal pain  

MedlinePLUS

... up in your abdomen and occurs after meals, antacids may help, especially if you feel heartburn or ... milk, having a bowel movement, or taking an antacid? What medications are you taking? OTHER MEDICAL HISTORY ...

103

A complex case of abdominal pain in a patient with pelviureteric junction obstruction  

PubMed Central

Pelviureteric junction (PUJ) obstruction is a condition frequently encountered in both adult and pediatric patients. Congenital abnormalities and crossing lower-pole renal vessels are the most common underlying pathologies in both men and women. This report presents a case of a young woman who was complaining of intermittent abdominal pain in whom right-sided hydronephrosis was diagnosed. The patient was scheduled for a laparoscopic right-sided Anderson-Hynes pyeloplasty. During the procedure a partly extraperitoneal appendix, with extensive adhesions to the posterior abdominal wall abutting on the ureter just below the obstructed PUJ, was identified. The patient underwent dismembered laparoscopic Anderson-Hynes pyeloplasty with concurrent appendectomy for likely dual pathologies being responsible for her symptoms. PMID:25097699

Wolak, Przemyslaw; Obarzanowski, Mateusz; Chlosta, Piotr

2014-01-01

104

Integrative treatment approaches: family satisfaction with a multidisciplinary paediatric Abdominal Pain Clinic  

PubMed Central

Objectives To assess patient and family satisfaction with evaluation received through a multidisciplinary paediatric Abdominal Pain Clinic (APC) staffed by a paediatric gastroenterologist and a paediatric psychologist as compared to a traditional gastroenterology clinic (GI) staffed by a paediatric gastroenterologist only. Methods Two hundred and ninety-eight families (145 APC, 153 GI) with a child or adolescent aged 8–17 years seen for initial evaluation of a chronic abdominal pain completed an anonymous survey to assess understanding of the treatment recommendations made, intent to follow through with various treatment recommendations, and the overall level of satisfaction with the evaluation service provided. Family perceptions of strengths and challenges of the APC evaluation process also were explored. Results APC families reported being prescribed adjunctive mental health and other therapies at significantly higher rates than GI families, while the rates of medication were comparable. APC families also reported significantly greater receptivity to beginning the treatments prescribed and higher levels of overall satisfaction with the evaluation process. The contribution of integrated medical and psychological perspectives frequently was identified as a strength of the APC evaluation process. Challenges identified for the APC evaluation were few and focused on issues related to paperwork and scheduling issues. Conclusions Integrative care approaches to the evaluation of paediatric abdominal pain appear well accepted by families, yielding high levels of satisfaction, and enhance receptivity to treatment recommendations. Integrative care starting at the time of first evaluation may be particularly well-tailored to enhance outcomes, reduce health care utilization, and yield financial savings within this population. PMID:20922066

Schurman, Jennifer Verrill; Friesen, Craig A

2010-01-01

105

Multicystic benign mesothelioma of the pelvic peritoneum presenting as acute abdominal pain in a young woman  

PubMed Central

Multicystic benign mesothelioma (MBM) of the peritoneum is a very rare condition. Since the first description of MBM in 1979, approximately 100 cases have been reported. This is a case report of MBM of the pelvic peritoneum presenting as acute abdominal pain in a young woman. Laparoscopy confirmed multiple grapelike clusters of cysts that originated in the peritoneum of the rectouterine pouch and histopathologic diagnosis was confirmed as MBM of the pelvic peritoneum. We hope to alert gynaecologists of the diagnostic and therapeutic approaches to MBM which can be accomplished by laparoscopy. PMID:24327991

Hong, Jung-Hee; Lee, Ji-Hye; Nam, Kye-Hyun; Bae, Dong-Han

2013-01-01

106

Acute Abdominal Pain in Childhood, with Special Reference to Cases not due to Acute Appendicitis*  

PubMed Central

Appendicitis is not the only common cause of acute abdominal pain in childhood. Almost equally common is an acute episode which in its early stages resembles acute appendicitis but which subsides without treatment in 24 to 48 hours. The clinical features of this syndrome are contrasted with those of appendicitis. The two conditions cannot always be distinguished on clinical grounds, leading to admission to hospital for observation and the finding of a normal appendix in 14% of operations for suspected appendicitis. Reasons are given for abandoning attempts to diagnose acute mesenteric adenitis at the bedside. PMID:5762646

Jones, Peter F.

1969-01-01

107

[Hypnotherapeutic treatment approaches in children and adolescents suffering from functional abdominal pain].  

PubMed

Functional abdominal pain significantly impairs day-to-day function. It is one of the most frequent somatic complaints among children and adolescents. For most of those affected, despite some indication of their possible presence, physiological factors fail to explain the symptoms adequately. The increased level of psychological symptoms suggests that the focus should be on behavioural and psychological aspects. Brief hypnotherapeutic treatment methods show encouraging results. A review of the current literature; potential mechanisms of effective intervention and their practical applicability are discussed. PMID:21751534

Gulewitsch, Marco D; Schlarb, Angelika A

2011-01-01

108

Jejunojejunal intussusception secondary to submucosal lipoma resulting in a 5-year history of intermittent abdominal pain.  

PubMed

Jejunal lipomata are an unusual cause of adult intussusception. We report a case of a 44-year-old Chinese woman who presented with a 3-day history of abdominal pain and nausea; she had a 5-year history of similar episodic symptoms after meals. Contrast-enhanced CT revealed a fat-density lead point in the jejunum resulting in intussusception. Single port laparoscopic surgery was performed with reduction of the intussusception, bowel resection and primary anastamosis. Histology confirmed a benign submucosal lipoma. We discuss the recent published literature on this rare entity and show CT images and intraoperative pictures. PMID:25355752

Seow-En, Isaac; Foo, Fung Joon; Tang, Choong Leong

2014-01-01

109

Abdominal Implantation of Testicles in the Management of Intractable Testicular Pain in Fournier Gangrene  

PubMed Central

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

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

2013-01-01

110

Functional Abdominal Pain Syndrome in Morbidly Obese Patients Following Laparoscopic Gastric Bypass Surgery  

PubMed Central

Background: Roux-en-Y gastric bypass surgery (RYGBP) is one of the most common bariatric surgeries, which is being performed using various techniques like gastrojejunostomy by hand swen, linear or circular stapler. Abdominal pain is a common complaint following laparoscopic gastric bypass procedure (LGBP), which has different aetiologies, such as overeating, adhesion, internal herniation, bile reflux and many more. In this study LGBP was performed in an ante-colic ante-gastric pattern in a double loop manner and the prevalence and distribution of pain in morbidly obese patients undergoing LGBP was assessed. Objectives: The aim of this study was to analyze the distribution and frequency of post LGBP pain in morbidly obese patients. Patients and Methods: This study was performed on 190 morbidly obese patients referred to Hazrat Rasoul Hospital in Tehran. After LGBP, pain was measured in the following intervals: 24 hours, one week and one month after the operation. Before the operation onset, 2 mg Keflin and 5000 IU subcutaneous heparin were administered as prophylaxis. LGBP was performed using five ports including: one 11 mm port was placed 15-20 cm far from the xiphoid, one 12-mm port in mid-clavicular line at the level of camera port, one 5-mm port in subcostal area in ante-axillary region in the left, another 5-mm port in the right mid-clavicular area and a 5-mm port in sub-xyphoid. All operations were done by the same team. Staple was used for all anastomoses and hand sewn technique to close the staple insertion site. The mesenteric defect was left open and no effort was made to repair it. Results: The results of this study showed that 99.94 % of the patients had complains of pain in the first 24 hours of post operation, about 60% after one week and 29.5 % still had pain after one month. In addition, left upper quadrant (LUQ) was found to be the most prevalent site for the pain in 53.7% of the patients in the first 24 hours, 59.6% after one week and 16.8% after one month (except for obscure pain) with a significance of < 0.05. Conclusions: In this study, the authors analyzed the location and disturbance level of pain after LGBP, which could serve as a cornerstone for further researches. The authors suggest that long-term follow-up (for more than a year after operation) should be considered in future studies and also the relationship between the drainage site and pain should be investigated. PMID:25032167

Eidy, Mohammad; Pazouki, Abdolreza; Raygan, Fahimeh; Ariyazand, Yazdan; Pishgahroudsari, Mohadeseh; Jesmi, Fatemeh

2014-01-01

111

A randomised controlled trial of written self-disclosure for functional recurrent abdominal pain in youth.  

PubMed

Written self-disclosure (WSD) has rarely been evaluated as an intervention for paediatric diseases. To test the efficacy of WSD for youths aged 11-18 years with a diagnosis of functional recurrent abdominal pain (RAP), 63 were randomly assigned to receive standard medical care (SMC) alone or WSD in addition to SMC. WSD was administered in three 20-min sessions, one in the clinic and two by phone in the home. Measures of self-reported pain frequency, somatisation severity and quality of life (QOL) were completed at baseline and 3- and 6-month follow-up points. Blind review of electronic medical records provided data on clinic visit and phone consultation utilisation for the 6 months prior to and following baseline. Practice of WSD in addition to SMC was associated with significantly fewer activity-limiting gastrointestinal pain experiences (d = 0.61) and reduced health care utilisation (d = 0.59) 6 months later compared to SMC alone. There were no significant effects for somatisation severity or QOL in 6 months. WSD may be a useful treatment adjunct for reducing pain frequency and resulting health care utilisation in a portion of youths with functional RAP. PMID:20419562

Wallander, Jan L; Madan-Swain, Avi; Klapow, Josh; Saeed, Shehzad

2011-04-01

112

Acute right lower abdominal pain in women of reproductive age: Clinical clues  

PubMed Central

AIM: To study possible gynecological organ pathologies in the differential diagnosis of acute right lower abdominal pain in patients of reproductive age. METHODS: Following Clinical Trials Ethical Committee approval, the retrospective data consisting of physical examination and laboratory findings in 290 patients with sudden onset right lower abdominal pain who used the emergency surgery service between April 2009 and September 2013, and underwent surgery and general anesthesia with a diagnosis of acute appendicitis were collated. RESULTS: Total data on 290 patients were obtained. Two hundred and twenty-four (77.2%) patients had acute appendicitis, whereas 29 (10%) had perforated appendicitis and 37 (12.8%) had gynecological organ pathologies. Of the latter, 21 (7.2%) had ovarian cyst rupture, 12 (4.2%) had corpus hemorrhagicum cyst rupture and 4 (1.4%) had adnexal torsion. Defense, Rovsing’s sign, increased body temperature and increased leukocyte count were found to be statistically significant in the differential diagnosis of acute appendicitis and gynecological organ pathologies. CONCLUSION: Gynecological pathologies in women of reproductive age are misleading in the diagnosis of acute appendicitis. PMID:24744594

Hatipoglu, Sinan; Hatipoglu, Filiz; Abdullayev, Ruslan

2014-01-01

113

Upper Endoscopic Findings in Children with Recurrent Abdominal Pain: High Prevalence of Hiatus Hernia  

PubMed Central

Objective Recurrent abdominal pain (RAP) by itself is one of the common reasons in child-aged patients to refer to a clinician. Some of these patients are presented with more serious features, so-called the “red flag”. The most important issue in management of RAP is to distinguish the type of it, whether it is functional or organic. In this study we aimed to assess the redundancy of red-flagged RAP with findings of esophago-gastro-deudonoscopy. Methods In a 2 year prospective study 150 consecutive children with RAP who showed red flags underwent esophago-gastro-deudonoscopy. The prevalence of each finding was recorded. Overall positive predictive value of predicting an endoscopic finding while having a red-flag was calculated. Findings Among all the patients, 126 cases showed at least a positive finding in their endoscopy that corresponded to the positive predictive value of 84% for predicting the presence of an endoscopic finding according to red flags. Interestingly, 20% of patients showed hiatus hernia when surveyed. Conclusion Comprehensive physical examination is needed to avoid performing esophago-gastro-deudonoscopy without indication in patients with recurrent abdominal pain. PMID:23399792

Motamed, Farzaneh; Norouzi, Sayna; Najafi, Mehri; Khodadad, Ahmad; Farahmand, Fatemeh; Mossahebi, Sara; Heidari-Bateni, Giv

2012-01-01

114

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

PubMed Central

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

Ong, Eugene Mun Wai; Venkatesh, Sudhakar Kundapur

2009-01-01

115

Diagnosing the patient with abdominal pain and altered bowel habits: is it irritable bowel syndrome?  

PubMed

Diagnosing a patient who presents with abdominal pain and altered bowel habits can be challenging. Although serious organic illnesses can cause these symptoms, irritable bowel syndrome is commonly responsible. It can be difficult to properly evaluate these patients without overusing diagnostic tests and consultation. A practical approach for diagnosing irritable bowel syndrome is suggested, using the Rome II criteria and the presence of alarm symptoms such as weight loss, gastrointestinal bleeding, anemia, fever, or frequent nocturnal symptoms as starting points. If there are no alarm symptoms and the Rome II criteria are not met, it is acceptable to reevaluate the patient at a later date. If there are no alarm symptoms and the Rome II criteria are met, the patient should be categorized on the basis of age: patients 50 years or younger can be evaluated on the basis of predominant symptoms--constipation, diarrhea, or abdominal pain. Patients older than 50 years should be fully evaluated and considered for gastroenterology referral. If alarm symptoms are present, a full evaluation should be performed (and gastroenterology referral considered), regardless of the patient's age. PMID:12776965

Holten, Keith B; Wetherington, Anthony; Bankston, Laurie

2003-05-15

116

Increased capsaicin receptor TRPV1-expressing sensory fibres in irritable bowel syndrome and their correlation with abdominal pain  

PubMed Central

Objective: The capsaicin receptor TRPV1 (transient receptor potential vanilloid type-1) may play an important role in visceral pain and hypersensitivity states. In irritable bowel syndrome (IBS), abdominal pain is a common and distressing symptom where the pathophysiology is still not clearly defined. TRPV1-immunoreactive nerve fibres were investigated in colonic biopsies from patients with IBS, and this was related to abdominal pain. Methods: Rectosigmoid biopsies were collected from 23 IBS patients fulfilling Rome II criteria, and from 22 controls. Abdominal pain scores were recorded using a validated questionnaire. TRPV1-, substance P- and neuronal marker protein gene product (PGP) 9.5-expressing nerve fibres, mast cells (c-kit) and lymphocytes (CD3 and CD4) were quantified, following immunohistochemistry with specific antibodies. The biopsy findings were related to the abdominal pain scores. Results: A significant 3.5-fold increase in median numbers of TRPV1-immunoreactive fibres was found in biopsies from IBS patients compared with controls (p<0.0001). Substance P-immunoreactive fibres (p?=?0.01), total nerve fibres (PGP9.5) (p?=?0.002), mast cells (c-kit) (p?=?0.02) and lymphocytes (CD3) (p?=?0.03) were also significantly increased in the IBS group. In multivariate regression analysis, only TRPV1-immuno-reactive fibres (p?=?0.005) and mast cells (p?=?0.008) were significantly related to the abdominal pain score. Conclusions: Increased TRPV1 nerve fibres are observed in IBS, together with a low-grade inflammatory response. The increased TRPV1 nerve fibres may contribute to visceral hypersensitivity and pain in IBS, and provide a novel therapeutic target. PMID:18252749

Akbar, A; Yiangou, Y; Facer, P; Walters, J R F; Anand, P; Ghosh, S

2008-01-01

117

Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience  

Microsoft Academic Search

OBJECTIVE:In our previous randomized trial, we suggested a possible role for endoscopic ultrasound (EUS) guided celiac plexus block in the treatment of abdominal pain associated with chronic pancreatitis. The purpose of this study was to evaluate our prospective experience with EUS-guided celiac plexus block for controlling pain attributed to chronic pancreatitis, including follow-up on response rates and complications.METHODS:All subjects enrolled

Frank Gress; Colleen Schmitt; Stuart Sherman; Donato Ciaccia; Steven Ikenberry; Glen Lehman

2001-01-01

118

Upper GI Endoscopy  

MedlinePLUS

... particularly vomit that is bloody or looks like coffee grounds abdominal pain that worsens bloody or black, ... particularly vomit that is bloody or looks like coffee grounds abdominal pain that worsens bloody or black, ...

119

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

PubMed Central

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

Chiou, Eric; Nurko, Samuel

2010-01-01

120

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

PubMed

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

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

2010-11-01

121

An unusual cause of abdominal pain in a male patient: Endometriosis.  

PubMed

A rare case of abdominal pain secondary to endometriosis in a 52-year-old man with cirrhosis is presented. The patient had a repair of recurrent inguinal hernia 7 months prior to presentation. An exploratory laparotomy revealed a 4.5 cm × 2.5 cm cystic mass attached to the urinary bladder and the inguinal area. The mass pathology showed a cystic lumen of diameter of 1.5 cm filled with old blood and surrounded by thick muscular mass. Microscopically, the lesion consisted of thick smooth muscle fibers that concentrically surround a central lumen that is bordered by endometrium such as glands and stroma. Immunostains were positive for estrogen receptors and progesterone receptors in the glandular component and for CD10 in the stroma, which is consistent with endometriosis. PMID:25298953

Jabr, Fadi I; Mani, Venk

2014-10-01

122

Trajectories of Symptoms and Impairment for Pediatric Patients with Functional Abdominal Pain: A 5-Year Longitudinal Study  

ERIC Educational Resources Information Center

Objective: This prospective study characterizes trajectories of symptoms and impairment in pediatric patients with abdominal pain not associated with identifiable organic disease. Method: The Children's Somatization Inventory and the Functional Disability Inventory were administered four times over 5 years to 132 patients (6-18 years old) seen in…

Mulvaney, Shelagh; Lambert, E. Warren; Garber, Judy; Walker, Lynn S.

2006-01-01

123

Splenic infarction: a rare cause of acute abdominal pain presenting in an older patient with primary antiphospholipid antibodies syndrome  

Microsoft Academic Search

Splenic infarction is an uncommon condition that is rarely encountered in emergency and internal medicine. This condition is usually associated with systemic conditions such as hypercoagulable states, hemoglobinopathies, systemic lupus erythematosus, hematologic disorders, and cardiac thromboembolism during atrial fibrillation and endocarditis [1]. We describe a case of a woman with an acute abdominal pain due to splenic infarction from splenic

Marco Rossato; Martina Paccagnella; Marta Burei; Giovanni Federspil; Roberto Vettor

2009-01-01

124

Consumerism in healthcare can be detrimental to child health: lessons from children with functional abdominal pain  

PubMed Central

Aims: To determine prognostic indicators in children with severe functional abdominal pain (FAP) and to test the hypothesis that "healthcare consumerism" in these families might be deleterious to the child. Methods: Retrospective analysis of a cohort of 23 children aged <16 years fulfilling the Rome II diagnostic criteria for FAP during the period December 1997 to February 2001. Poor outcome was defined as continued pain and failure to return to normal functioning >12 months after onset. Results: Poor outcome was associated with refusal to engage with psychological services, involvement of more than three consultants, lodging of a manipulative complaint with hospital management by the child's family, and lack of development of insight into psychosocial influences on symptoms. Three of four adverse prognostic indicators reflected healthcare consumerism by the families. Conclusions: Actions of families who lack insight into their child's illness may perpetuate FAP in childhood. A culture of parental consumerism in healthcare, however well intentioned, needs to be accompanied by robust systems to protect the interests of the child. PMID:15781917

Lindley, K; Glaser, D; Milla, P

2005-01-01

125

Revisiting Russell's viper (Daboia russelii) bite in Sri Lanka: is abdominal pain an early feature of systemic envenoming?  

PubMed

The Russell's viper (Daboia russelii) is responsible for 30-40% of all snakebites and the most number of life-threatening bites of any snake in Sri Lanka. The clinical profile of Russell's viper bite includes local swelling, coagulopathy, renal dysfunction and neuromuscular paralysis, based on which the syndromic diagnostic tools have been developed. The currently available Indian polyvalent antivenom is not very effective in treating Russell's viper bite patients in Sri Lanka and the decision regarding antivenom therapy is primarily driven by clinical and laboratory evidence of envenoming. The non-availability of early predictors of Russell's viper systemic envenoming is responsible for considerable delay in commencing antivenom. The objective of this study is to evaluate abdominal pain as an early feature of systemic envenoming following Russell's viper bites. We evaluated the clinical profile of Russell's viper bite patients admitted to a tertiary care centre in Sri Lanka. Fifty-five patients were proven Russell's viper bite victims who produced the biting snake, while one hundred and fifty-four were suspected to have been bitten by the same snake species. Coagulopathy (159, 76.1%), renal dysfunction (39, 18.7%), neuromuscular paralysis (146, 69.9%) and local envenoming (192, 91.9%) were seen in the victims, ranging from mono-systemic involvement to various combinations. Abdominal pain was present in 79.5% of these patients, appearing 5 minutes to 4 hours after the bite. The severity of the abdominal pain, assessed using a scoring system, correlated well with the severity of the coagulopathy (p<0.001) and the neurotoxicity (p<0.001). Its diagnostic validity to predict systemic envenoming is - Sensitivity 81.6%, Specificity 82.4%, Positive predictive value 91.2%. Thus, abdominal pain is an early clinical feature of systemic Russell's viper bite envenoming in Sri Lanka. However, it is best to judge abdominal pain together with other clinical manifestations on decision making. PMID:24587278

Kularatne, Senanayake A M; Silva, Anjana; Weerakoon, Kosala; Maduwage, Kalana; Walathara, Chamara; Paranagama, Ranjith; Mendis, Suresh

2014-01-01

126

Revisiting Russell's Viper (Daboia russelii) Bite in Sri Lanka: Is Abdominal Pain an Early Feature of Systemic Envenoming?  

PubMed Central

The Russell's viper (Daboia russelii) is responsible for 30–40% of all snakebites and the most number of life-threatening bites of any snake in Sri Lanka. The clinical profile of Russell's viper bite includes local swelling, coagulopathy, renal dysfunction and neuromuscular paralysis, based on which the syndromic diagnostic tools have been developed. The currently available Indian polyvalent antivenom is not very effective in treating Russell's viper bite patients in Sri Lanka and the decision regarding antivenom therapy is primarily driven by clinical and laboratory evidence of envenoming. The non-availability of early predictors of Russell's viper systemic envenoming is responsible for considerable delay in commencing antivenom. The objective of this study is to evaluate abdominal pain as an early feature of systemic envenoming following Russell's viper bites. We evaluated the clinical profile of Russell's viper bite patients admitted to a tertiary care centre in Sri Lanka. Fifty-five patients were proven Russell's viper bite victims who produced the biting snake, while one hundred and fifty-four were suspected to have been bitten by the same snake species. Coagulopathy (159, 76.1%), renal dysfunction (39, 18.7%), neuromuscular paralysis (146, 69.9%) and local envenoming (192, 91.9%) were seen in the victims, ranging from mono-systemic involvement to various combinations. Abdominal pain was present in 79.5% of these patients, appearing 5 minutes to 4 hours after the bite. The severity of the abdominal pain, assessed using a scoring system, correlated well with the severity of the coagulopathy (p<0.001) and the neurotoxicity (p<0.001). Its diagnostic validity to predict systemic envenoming is – Sensitivity 81.6%, Specificity 82.4%, Positive predictive value 91.2%. Thus, abdominal pain is an early clinical feature of systemic Russell's viper bite envenoming in Sri Lanka. However, it is best to judge abdominal pain together with other clinical manifestations on decision making. PMID:24587278

Kularatne, Senanayake A. M.; Silva, Anjana; Weerakoon, Kosala; Maduwage, Kalana; Walathara, Chamara; Paranagama, Ranjith; Mendis, Suresh

2014-01-01

127

Effects of Adding Ketamine to Fentanyl Plus Acetaminophen on Postoperative Pain by Patient Controlled Analgesia in Abdominal Surgery  

PubMed Central

Background: Postoperative pain is one of the most important complications encountered after surgery. A number of options are available for treating pain following surgery. One of those options is the use of intravenous patient-controlled analgesia (PCA). Ketamine is an anesthetic drug relieving pain with its NMDA receptor antagonistic effect. Objectives: This study is aiming at better pain management after abdominal surgery; the effects of adding ketamine to intravenous fentanyl plus acetaminophen PCA were evaluated. Patients and Methods: In a double-blind randomized clinical trial 100 patients, ASA I or II, 20 - 60 years old were divided into two groups. These patients were abdominal surgery candidates. In order to control postoperative pain in the control group an IV patient-control analgesia (PCA) containing fentanyl 10 ?g/mL plus acetaminophen 10 mg/mL was instructed to be used for the patients, but the patients in ketamine group received ketamine 0.5 mg/mL plus control group PCA content. During the first 48 hours after surgery, ketamine patients were evaluated every 8 hours (at rest, while moving and coughing) to determine their pain scores using VAS scale, sedation score, additional analgesics, nausea and vomiting. Results: There were no significant demographic differences between two groups. Pain scores (at rest, while moving and coughing) during the first 48 hours were not significantly different between two groups (P values = 0.361, 0.367 and 0.204, respectively). Nausea scores were significantly lower in the ketamine group (P = 0.026). Conclusions: The addition of ketamine to intravenous fentanyl plus acetaminophen PCA had not extra effects in relieving post abdominal surgery pain. PMID:24660145

Imani, Farnad; Faiz, Hamid Reza; Sedaghat, Minow; Hajiashrafi, Maryam

2013-01-01

128

The effects of abdominal draw-in maneuver and core exercise on abdominal muscle thickness and Oswestry disability index in subjects with chronic low back pain  

PubMed Central

The purpose of this study was to effects of abdominal draw-in maneuver and core exercise with 4 weeks using the musculoskeletal ultrasonography on muscle thickness and disability in subjects with low back pain. Twenty patients with nonspecific back pain (abdominal draw-in maneuver group: n= 10, core exercise group: n= 10) were recruited in the study. Both group received exercise intervention 3 times a week for 4weeks. The test were based on muscle thickness (transversus abdominis; Tra, internal oblique; IO and external oblique; EO), disability (Oswestry disability index; ODI) measured immediately before and after intervention. The data was measured by SPSS program 12.0 version and analyzed by Paired t-test and Independent t-test. The following results were obtained. The thickness of IO, EO for both group significantly improved except for muscle thickness of Tra. The ODI were significant difference for both groups. As the results of this study, we suggest that it may be effective method to apply to increase for the thickness of Tra, EO using abdominal draw-in maneuver and thickness of IO using core exercise. PMID:24278873

Park, Seong-Doo; Yu, Seong-Hun

2013-01-01

129

Sex and disease-related alterations of anterior insula functional connectivity in chronic abdominal pain.  

PubMed

Resting-state functional magnetic resonance imaging has been used to investigate intrinsic brain connectivity in healthy subjects and patients with chronic pain. Sex-related differences in the frequency power distribution within the human insula (INS), a brain region involved in the integration of interoceptive, affective, and cognitive influences, have been reported. Here we aimed to test sex and disease-related alterations in the intrinsic functional connectivity of the dorsal anterior INS. The anterior INS is engaged during goal-directed tasks and modulates the default mode and executive control networks. By comparing functional connectivity of the dorsal anterior INS in age-matched female and male healthy subjects and patients with irritable bowel syndrome (IBS), a common chronic abdominal pain condition, we show evidence for sex and disease-related alterations in the functional connectivity of this region: (1) male patients compared with female patients had increased positive connectivity of the dorsal anterior INS bilaterally with the medial prefrontal cortex (PFC) and dorsal posterior INS; (2) female patients compared with male patients had greater negative connectivity of the left dorsal anterior INS with the left precuneus; (3) disease-related differences in the connectivity between the bilateral dorsal anterior INS and the dorsal medial PFC were observed in female subjects; and (4) clinical characteristics were significantly correlated to the insular connectivity with the dorsal medial PFC in male IBS subjects and with the precuneus in female IBS subjects. These findings are consistent with the INS playing an important role in modulating the intrinsic functional connectivity of major networks in the resting brain and show that this role is influenced by sex and diagnosis. PMID:25339739

Hong, Jui-Yang; Kilpatrick, Lisa A; Labus, Jennifer S; Gupta, Arpana; Katibian, David; Ashe-McNalley, Cody; Stains, Jean; Heendeniya, Nuwanthi; Smith, Suzanne R; Tillisch, Kirsten; Naliboff, Bruce; Mayer, Emeran A

2014-10-22

130

Chronic abdominal pain secondary to mesh erosion into ceacum following incisional hernia repair: a case report and literature review.  

PubMed

Incisional hernias following abdominal operations are a common complication. Mesh is frequently employed in repair of these hernias. Mesh migration is an infrequent occurrence. We present the case of transmural mesh migration from the abdominal wall into the ceacum presenting as chronic abdominal pain. Given the popularity of minimally invasive surgery utilizing polypropylene mesh for incisional hernia repair, related complications such as postoperative hematoma and seroma, foreign body reaction, organ injury, infection, mesh rejection and fistula are increasingly being noted. Most of the mesh migrations reported in the literature involve the urinary bladder. We present a case of delayed mesh migration into the ceacum. Mesh migration is a rare and peculiar complication that is rarely reported in the literature. A review of the literature shows that there are no other cases of mesh migration into ceacum several years after open type incisional hernia repair. PMID:24578759

Aziz, Fahad; Zaeem, Misbah

2014-04-01

131

Chronic Abdominal Pain Secondary to Mesh Erosion Into Ceacum Following Incisional Hernia Repair: A Case Report and Literature Review  

PubMed Central

Incisional hernias following abdominal operations are a common complication. Mesh is frequently employed in repair of these hernias. Mesh migration is an infrequent occurrence. We present the case of transmural mesh migration from the abdominal wall into the ceacum presenting as chronic abdominal pain. Given the popularity of minimally invasive surgery utilizing polypropylene mesh for incisional hernia repair, related complications such as postoperative hematoma and seroma, foreign body reaction, organ injury, infection, mesh rejection and fistula are increasingly being noted. Most of the mesh migrations reported in the literature involve the urinary bladder. We present a case of delayed mesh migration into the ceacum. Mesh migration is a rare and peculiar complication that is rarely reported in the literature. A review of the literature shows that there are no other cases of mesh migration into ceacum several years after open type incisional hernia repair. PMID:24578759

Aziz, Fahad; Zaeem, Misbah

2014-01-01

132

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

PubMed Central

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?

2014-01-01

133

No Change in Rectal Sensitivity After Gut-Directed Hypnotherapy in Children With Functional Abdominal Pain or Irritable Bowel Syndrome  

Microsoft Academic Search

OBJECTIVES:Gut-directed hypnotherapy (HT) has recently been shown to be highly effective in treating children with functional abdominal pain (FAP) and irritable bowel syndrome (IBS). This study was conducted to determine the extent to which this treatment success is because of an improvement in rectal sensitivity.METHODS:A total of 46 patients (aged 8–18 years) with FAP (n=28) or IBS (n=18) were randomized

A M Vlieger; M M van den Berg; C Menko-Frankenhuis; M E J Bongers; E Tromp; M A Benninga

2010-01-01

134

Cases in Space Medicine: Right Lower Quadrant Abdominal Pain in a Female Crewmember on the International Space Station  

NASA Technical Reports Server (NTRS)

A case study of a medical emergency aboard the International Space Station is reviewed. The case involves a female crewmember who is experiencing acute abdominal pain. The interplay of the Crew Medical Officer (CMO) and the NASA Flight Surgeon is given. Possible diagnoses, and advised medical actions are reviewed. Along the case study questions are posed to the reader, and at the end answers are given.

Hamilton, Douglas R.; Scheuring, Richard; Jones, Jeffery

2007-01-01

135

Rapid 13C Urea Breath Test to Identify Helicobacter pylori Infection in Emergency Department Patients with Upper Abdominal Pain  

PubMed Central

Introduction: In emergency department (ED) patients with upper abdominal pain, management includes ruling out serious diseases and providing symptomatic relief. One of the major causes of upper abdominal pain is an ulcer caused by Helicobacter pylori (H. pylori), which can be treated and cured with antibiotics. We sought to estimate the prevalence of H. pylori infection in symptomatic patients using a convenience sample at a single urban academic ED and demonstrate the feasibility of ED-based testing. Methods: We prospectively enrolled patients with a chief complaint of pain or discomfort in the upper abdomen for 1 year from February 2011 until February 2012 at a single academic urban ED. Enrolled subjects were tested for H. pylori using a rapid point of care 13C Urea Breath Test (UBT) [Exalenz Bioscience]. We compared patient characteristics between those who tested positive versus negative for the disease. Results: A total of 205 patients with upper abdominal pain were tested over 12 months, and 24% (95% confidence interval: 19% to 30%) tested positive for H. pylori. Black subjects were more likely to test positive than white subjects (28% v. 6%, P < 0.001). Other factors, such as age and sex, were not different between the 2 groups. Conclusion: In our ED, H. pylori infection was present in 1 in 4 patients with epigastric pain, and testing with a UBT was feasible. Further study is needed to determine the risk factors associated with infection, the prevalence of H. pylori in other EDs, the effect of the test on ED length of stay and the costeffectiveness of an ED-based test-and-treat strategy. PMID:23687549

Meltzer, Andrew C.; Pierce, Rebecca; Cummings, Derek A.T.; Pines, Jesse M.; May, Larissa; Smith, Meaghan A.; Marcotte, Joseph; McCarthy, Melissa L.

2013-01-01

136

Changes in muscle strength and pain in response to surgical repair of posterior abdominal wall disruption followed by rehabilitation  

PubMed Central

Background: Posterior abdominal wall deficiency (PAWD) is a tear in the external oblique aponeurosis or the conjoint tendon causing a posterior wall defect at the medial end of the inguinal canal. It is often known as sportsman's hernia and is believed to be caused by repetitive stress. Objective: To assess lower limb and abdominal muscle strength of patients with PAWD before intervention compared with matched controls; to evaluate any changes following surgical repair and rehabilitation. Methods: Sixteen subjects were assessed using a questionnaire, isokinetic testing of the lower limb strength, and pressure biofeedback testing of the abdominals. After surgery and a six week rehabilitation programme, the subjects were re-evaluated. A control group were assessed using the same procedure. Results: Quadriceps and hamstrings strength was not affected by this condition. A deficit hip muscle strength was found on the affected limb before surgery, which was significant for the hip flexors (p = 0.05). Before surgery, 87% of the patients compared with 20% of the controls failed the abdominal obliques test. Both the injured and non-injured sides had improved significantly in strength after surgery and rehabilitation. The strength of the abdominal obliques showed the most significant improvement over the course of the rehabilitation programme. Conclusions: Lower limb muscle strength may have been reduced as the result of disuse atrophy or pain inhibition. Abdominal oblique strength was deficient in the injured patients and this compromises rotational control of the pelvis. More sensitive investigations (such as electromyography) are needed to assess the link between abdominal oblique function and groin injury. PMID:12547744

Hemingway, A; Herrington, L; Blower, A

2003-01-01

137

Effect of ingested fluid composition on exercise-related transient abdominal pain.  

PubMed

The present study investigated the effect of ingested fluid composition on the experience of exercise-related transient abdominal pain (ETAP). Forty subjects, susceptible to ETAP, completed 4 treadmill exercise trials: a no-fluid trial and flavored water (FW, no carbohydrate, osmolality = 48 mosmol/L, pH = 3.3), sports drink (SD, freshly mixed Gatorade, 6% total carbohydrate, 295 mosmol/L, pH = 3.3), and reconstituted fruit juice (FJ, BERRI trade mark orange, 10.4 % total carbohydrate, 489 mosmol/L, pH= 3.2) trials. Measures of the experience of ETAP and gastrointestinal disturbances, particularly bloating, were quantified. The FJ was significantly (p =.01) more provocative of both ETAP and bloating than all other trials. There was no difference among the no-fluid, FW, and SD in the severity of ETAP experienced, although the difference between the no-fluid and SD approached significance at the.05 level (p =.056). There was a significant relationship between both the mean (r = 0.40, p =.01) and peak (r= 0.44, p=.01) levels of ETAP and bloating. When the level of bloating was controlled for, the FJ remained significantly (p =.01) more provocative of ETAP than the other conditions, with no difference between the FW and SD (p =.37). The results indicate that in order to avoid ETAP, susceptible individuals should refrain from consuming reconstituted fruit juices and beverages similarly high in carbohydrate content and osmolality, shortly before and during exercise. Further, the mechanism responsible for the heightened experience of ETAP in the FJ trial extends beyond a gastric mass explanation. PMID:15118193

Morton, Darren Peter; Aragón-Vargas, Luis Fernando; Callister, Robin

2004-04-01

138

A case of eosinophilic cystitis in patients with abdominal pain, dysuria, genital skin hyperemia and slight toxocariasis.  

PubMed

Eosinophilic cystitis is a rare inflammatory disease with controversial aetiology and treatment. We report the case of a 61-year-old man presented with lower quadrant abdominal pain and lower urinary tract symptoms, non responsive to antibiotics and nonsteroidal antiinflammatory drugs. Physical examination was substantially negative, such as laboratory parameters, microscopic, bacteriological and serological evaluations. Cystoscopy revealed red areas involving the mucosa of the bladder and transurethral biopsies revealed infiltrating eosinophils. The patient was treated with corticosteroids and montelukast sodium with improving of the symptoms, and at 5 weeks postoperative pain score was reduced. After discontinuing corticosteroids dysuria recurred with the development of hyperemia at the genital skin; the specific enzyme-linked immunosorbent assay (ELISA) to detect antibodies against several parasites was slightly positive for Toxocara species. Montelukast sodium was discontinued and corticosteroid therapy was started together with albendazole, with improving of patient’s symptoms and pain decreasing after one week. PMID:23820659

Cerruto, Maria Angela; D'Elia, Carolina; Artibani, Walter

2013-06-01

139

Evaluation of the utility of abdominal CT scans in the diagnosis, management, outcome and information given at discharge of patients with non-traumatic acute abdominal pain  

PubMed Central

Objectives The role of CT imaging in the diagnosis and management of acute abdominal pain is well established, but its utility is limited in a minority of cases. The aim of this study was to quantify the degree to which radiological and clinical findings differ. Interobserver variability in CT reporting was also assessed. Methods Clinical data and CT reports were analysed retrospectively for any discrepancies by comparing CT diagnosis, clinical diagnosis as stated on the discharge summary and final diagnosis (based on consensus review of all information). Blinded review of all CT imaging was performed to determine interobserver variability. Results 120 consecutive scans fulfilled the inclusion criteria (114 patients; 79 women; mean age 55 years). The correct clinical diagnosis was made in 87.5% of cases based on CT findings. The lack of intravenous contrast limited diagnostic interpretation in 6 of the 15 discrepant cases. CT was unable to define early inflammatory changes in three patients and early caecal carcinoma in one. A right paraduodenal internal hernia was difficult to detect in another patient. Interobserver agreement was 93%, but with a low kappa value of 0.27. A paradox exists due to an imbalance in the positive and negative agreement of 96% and 31%, respectively. Conclusions The utility of CT imaging in the diagnosis and management of patients presenting with acute abdominal pain is confirmed, but is limited in a minority of cases where poor negative interobserver agreement exists. Good communication to the reporting radiologist of the relevant patient history and clinical question becomes important. PMID:22919012

Chin, J Y; Goldstraw, E; Lunniss, P; Patel, K

2012-01-01

140

The Treatment of Recurrent Abdominal Pain in Children: A Controlled Comparison of Cognitive–Behavioral Family Intervention and Standard Pediatric Care  

Microsoft Academic Search

This study describes the results of a controlled clinical trial involving 44 7- to 14-year-old children with recurrent abdominal pain who were randomly allocated to either cognitive–behavioral family intervention (CBFI) or standard pediatric care (SPC). Both treatment conditions resulted in significant improvements on measures of pain intensity and pain behavior. However, the children receiving CBFI had a higher rate of

Matthew R. Sanders; Ross W. Shepherd; Geoffrey Cleghorn; Hugh Woolford

1994-01-01

141

The treatment of recurrent abdominal pain in children: A controlled comparison of cognitive-behavioral family intervention and standard pediatric care  

Microsoft Academic Search

This study describes the results of a controlled clinical trial involving 44 7- to 14-year-old children with recurrent abdominal pain who were randomly allocated to either cognitive-behavioral family intervention (CBFI) or standard pediatric care (SPC). Both treatment conditions resulted in significant improvements on measures of pain intensity and pain behavior. However, the children receiving CBFI had a higher rate of

Matthew R. Sanders; Ross W. Shepherd; Geoffrey Cleghorn; Hugh Woolford

1994-01-01

142

Reliability of ultrasound measurement of automatic activity of the abdominal muscle in participants with and without chronic low back pain  

PubMed Central

Background Ultrasound (US) imaging has been considered as a non-invasive technique to measure thickness and estimate relative abdominal muscle activity. Although some studies have assessed the reliability of US imaging, no study has assessed the reliability of US measurement of automatic activity of abdominal muscles in positions with different levels of stability in participants with chronic low back pain (cLBP). The purpose of this study was to investigate within-day and between-days reliability of US thickness measurements of automatic activity of the abdominal muscles in asymptomatic participants and within-day reliability in those with cLBP. Methods A total of 20 participants (10 with cLBP, 10 healthy) participated in the study. The reliability of US thickness measurements at supine lying and sitting positions (sitting on a chair, sitting on a gym ball with both feet on the ground or lifting one foot off the floor) were assessed. We evaluated within-day reliability in all participants and between-days reliability in asymptomatic participants. Results We found high ICC scores (0.85-0.95) and also small SEM and MDC scores in both groups. The reliability of the measurements was comparable between participants with and without LBP in each position but the SEMs and MDCs was slightly higher in patient group compared with healthy group. It indicates high intra-tester reliability for the US measurement of the thickness of abdominal muscles in all positions. Conclusion US imaging can be used as a reliable method for assessment of automatic activity of abdominal muscles in positions with low levels of stability in participants with and without LBP. PMID:24479859

2013-01-01

143

Pathology Case Study: Bloody Vaginal Discharge  

NSDL National Science Digital Library

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.

Dickson, H.; Mahood, L.; Manlucu, E. D.; Nath, Manju E.

2008-10-28

144

Bilateral renal infarction following atrial fibrillation and thromboembolism and presenting as acute abdominal pain: a case report  

PubMed Central

Introduction Renal infarct is rare and often misdiagnosed because the symptoms are misleading. The mechanisms are various, mainly thrombotic and embolic. Case presentation In this review, we report the case of a 61-year-old Tunisian woman presented to the emergency unit with a 4-hour history of abdominal pain diffused at both flanks, ultrasounds was performed to remove a surgical emergency, showed a peri-renal fluid collection with heterogeneous parenchyma. We followed by a CT scan, which confirmed the diagnosis of renal infarct. The patient was treated by heparin at a curative dose, and the outcome was favorable. Conclusion Diagnosis is difficult and should be considered in patients with inexplicable flank or abdominal pain and with risk factors to this disease. Our purpose is to raise clinician’s awareness for this condition so that they will be more likely to diagnose it. This will facilitate prompt diagnosis and treatment. A review of the literature was performed and the case is discussed in the context of the current knowledge of this condition. PMID:22691187

2012-01-01

145

Abdominal muscle contraction thickness and function after specific and general exercises: a randomized controlled trial in chronic low back pain patients.  

PubMed

The aim of this study was to assess changes in deep abdominal muscle function after 8 weeks of exercise in chronic low back pain patients. Patients (n = 109) were randomized to specific ultrasound guided, sling or general exercises. Contraction thickness ratio in transversus abdominis (TrA), obliquus internus (OI) and externus (OE), and TrA lateral slide were assessed during the abdominal drawing-in maneuver by b-mode ultrasound. Changes in abdominal muscle function were also regressed on changes in pain. Only modest effects in deep abdominal muscle function were observed, mainly due to reduced activation of OI (contraction thickness ratio: 1.42-1.22, p = 0.01) and reduced TrA lateral slide (1.26-1.01 cm, p = 0.02) in the ultrasound group on the left side. Reduced pain was associated with increased TrA and reduced OI contraction ratio (R(2) = 0.18). It is concluded that 6-8 treatments with specific or general exercises for chronic low back patients attained only marginal changes in contraction thickness and slide in deep abdominal muscles, and could only to a limited extent account for reductions in pain. PMID:20621545

Vasseljen, Ottar; Fladmark, Anne Margrethe

2010-10-01

146

Ovarian torsion: An unusual cause of abdominal pain in a young girl  

Microsoft Academic Search

The case of a 6-year-old girl with right lower quadrant pain is presented. For several days, she had experienced pain that worsened and then was accompanied by vomiting and low-grade fever. Acute appendicitis was considered, but at laparotomy she was found to have a necrotic, torsed ovary. The natural history, clinical presentation, and diagnostic features of ovarian torsion are reviewed.

Nestor M Shust; David K Hendricksen

1995-01-01

147

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

PubMed Central

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 acupuncture points PC6, SP4 and DU20. Visual analog scales (VAS) assessing severity of nausea, pain and bloating were obtained before and after acupuncture treatment. Nineteen patients received three and three patients received two treatments. RESULTS: VAS scores for nausea reflected the clinical assessment and differed significantly between mild and moderate/severe nausea groups. Acupuncture significantly improved severity of nausea in both groups with improved pre-treatment nausea between the first and third treatments in the moderate/severe nausea group. Pain scores improved with acupuncture in the mild nausea group only and bloating improved only with the first treatment in this group. Patients with bloating with VAS scores greater than 35 pre-treatment improved with acupuncture and over all VAS scores for pain improved with treatment. Acupuncture increased the power in the 2.7 to 3.5 cpm range in the EGG. CONCLUSION: In this uncontrolled clinical study, a holistic acupuncture approach significantly improved nausea in patients with refractory symptoms and increased the power in the 2.7-3.5 cpm component of the electrogastrogram. Bloating and pain VAS scores improved acutely with treatment. This study suggests that acupuncture may be effective in this refractory group of patients and further study using appropriate controls is warranted. PMID:17879407

Ouyang, Ann; Xu, Lihua

2007-01-01

148

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

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…

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

2003-01-01

149

Delayed Bleeding and Pelvic Haematoma after Low-Energy Osteoporotic Pubic Rami Fracture in a Warfarin Patient: An Unusual Cause of Abdominal Pain  

PubMed Central

Introduction. Acute abdominal pain may be the presenting symptom in a wide range of diseases in the elderly. Acute abdominal pain related to a delayed bleeding and pelvic haematoma after a low-energy pubic rami fracture is rare and can have important consequences; to the best of our knowledge, only one case has been previously described. Case Report. We present an unusual case of an 83-year-old woman taking warfarin for atrial fibrillation, admitted to the Emergency Department (ED) with acute abdominal pain and progressive anemia related to a delayed bleeding and pelvic haematoma 72 hours after a low-energy osteoporotic pubic rami fracture. Warfarin was withheld, anticoagulation was reversed by using fresh frozen plasma and vitamin K, and concentrated red blood cells were given. Haemoglobin level gradually returned to normal with a progressive resorption of the haematoma. Conclusion. Delayed bleeding and pelvic haematoma after osteoporotic pubic rami fracture should be considered in the differential diagnosis of acute abdominal pain in the elderly. This case indicates the need for hospital admission, careful haemodynamic monitoring, and early identification of bleeding in patients with “benign” osteoporotic pubic rami fracture, especially those receiving anticoagulants, to provide an adequate management and prevent severe complications. PMID:25143839

Sandri, Andrea

2014-01-01

150

Pathological origins of trunk and neck pain: part I - pelvic and abdominal visceral disorders.  

PubMed

An important initial responsibility for a physical therapist examining a patient with back or neck pain is to determine whether the symptoms are a result of mechanical musculoskeletal dysfunction or of a pathological disorder such as visceral pathology or other diseases that would not be amenable to physical therapy management. This responsibility is magnified as direct access legislation continues to be passed. To assist the therapist in this decision making process, this article includes a neuro anatomic overview of visceral pain, along with general evaluation principles and information that suggest the presence of a variety of pathological conditions. In addition, signs and symptoms of specific gastrointestinal and urogenital diseases are presented to familiarize the therapist with conditions that may be manifested as trunk or neck pain. The two subsequent articles in this series will address additional sources of pathological pain, including disorders of the cardiovascular and pulmonary systems and diseases of the musculoskeletal system. J Orthop Sports Phys Ther 1990;12(5);192-207. PMID:18796872

Boissonnault, W G; Bass, C

1990-01-01

151

Postsurgical pain outcome of vertical and transverse abdominal incision: Design of a randomized controlled equivalence trial [ISRCTN60734227  

PubMed Central

Background There are two ways to open the abdominal cavity in elective general surgery: vertically or transversely. Various clinical studies and a meta-analysis have postulated that the transverse approach is superior to other approaches as regards complications. However, in a recent survey it was shown that 90 % of all abdominal incisions in visceral surgery are still vertical incisions. This discrepancy between existing recommendations of clinical trials and clinical practice could be explained by the lack of acceptance of these results due to a number of deficits in the study design and analysis, subsequent low internal validity, and therefore limited external generalisability. The objective of this study is to address the issue from the patient's perspective. Methods This is an intraoperatively randomized controlled observer and patient-blinded two-group parallel equivalence trial. The study setting is the Department of General-, Visceral-, Trauma Surgery and Outpatient Clinic of the University of Heidelberg, Medical School. A total of 172 patients of both genders, aged over 18 years who are scheduled for an elective abdominal operation and are eligible for either a transverse or vertical incision. To show equivalence of the two approaches or the superiority of one of them from the perspective of the patient, a primary endpoint is defined: the pain experienced by the patient (VAS 0–100) on day two after surgery and the amount of analgesic required (piritramide [mg/h]). A confidence interval approach will be used for analysis. A global ?-Level of 0.05 and a power of 0.8 is guaranteed, resulting in a size of 86 patients for each group. Secondary endpoints are: time interval to open and close the abdomen, early-onset complications (frequency of burst abdomen, postoperative pulmonary complications, and wound infection) and late complications (frequency of incisional hernias). Different outcome variables will be ranked by patients and surgeons to assess the relevance of possible endpoints from the patients' and surgeons' perspective. Conclusion This is a randomized controlled observer and patient-blinded two-group parallel trial to answer the question if the transverse abdominal incision is equivalent to the vertical one due to the described endpoints. PMID:14614782

Reidel, Margot A; Knaebel, Hanns-Peter; Seiler, Christoph M; Knauer, Christine; Motsch, Johann; Victor, Norbert; Buchler, Markus W

2003-01-01

152

[Differential diagnosis of pain in the right lower abdominal quadrant--case reports].  

PubMed

In the submitted case-records the authors present interesting peroperative findings--a coprolith obturing the lumen of the appendix, the torsion of an ovarian cyst and torsion of the omentum during diagnosis of acute appendicitis. The authors discuss the reliability of preoperative sonography for the diagnosis of pathological conditions in the appendical region which despite its falsely negative results are considered by the authors a useful method in the differential diagnosis of pain in the right iliac fossa. PMID:10377778

Smajer, B; Horálek, F; Chvátalová, N

1999-02-01

153

The young patient with acute bloody diarrhoea.  

PubMed

Acute bloody diarrhoea may be commonly encountered in the acute medical unit. Among young patients, the main differential diagnoses are acute infectious colitis, and first presentation of inflammatory bowel disease (IBD). A combination of clinical, laboratory, radiological, endoscopic and histological investigations are required to make the diagnosis. If inflammatory bowel disease is suspected, then the patient should be admitted to a specialist gastroenterology ward and receive input from the surgical team, IBD nurses and specialist stoma nurses. Intravenous steroid therapy for acute severe disease should be started before stool cultures are back unless there is a strong clinical suspicion of amoebiasis. All patients require thromboprophylaxis and close attention paid to fluid balance and nutritional requirements. Daily clinical review is required. The Travis criteria may be employed at day 3 to assess the likelihood of requiring surgery and plans for rescue therapy, medical or surgical should be made between day 3-7 if the patient is not responding adequately to initial medical therapy. PMID:24940574

Ninan, S; Hamlin, J

2014-01-01

154

Teleconsultation in children with abdominal pain: a comparison of physician triage recommendations and an established paediatric telephone triage protocol  

PubMed Central

Background Quality assessment and continuous quality feedback to the staff is crucial for safety and efficiency of teleconsultation and triage. This study evaluates whether it is feasible to use an already existing telephone triage protocol to assess the appropriateness of point-of-care and time-to-treat recommendations after teleconsultations. Methods Based on electronic patient records, we retrospectively compared the point-of-care and time-to-treat recommendations of the paediatric telephone triage protocol with the actual recommendations of trained physicians for children with abdominal pain, following a teleconsultation. Results In 59 of 96 cases (61%) these recommendations were congruent with the paediatric telephone protocol. Discrepancies were either of organizational nature, due to factors such as local referral policies or gatekeeping insurance models, or of medical origin, such as milder than usual symptoms or clear diagnosis of a minor ailment. Conclusions A paediatric telephone triage protocol may be applicable in healthcare systems other than the one in which it has been developed, if triage rules are adapted to match the organisational aspects of the local healthcare system. PMID:24079719

2013-01-01

155

Cryptogenia multifocal ulcerous stenosing enteritis: an entity on its own as a cause of abdominal pain, iron deficiency anemia and protein-losing enteropathy.  

PubMed

We studied a patient with edema secondary to protein losing enteropathy, and recurrent bouts of bloating and abdominal pain secondary to intestinal subocclusion episodes. After the clinical study, the patient was diagnosed of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE), that is a rare disease, probably caused by mutations in the gene PLA2G4A, and characterized by multiple short stenosis of the small bowel with superficial ulcers, which do not exceed the submucosa layer. Inflammatory bowel disease (Chron's disease), intestinal tuberculosis and intestinal ulcers secondary to non-steroidal anti-inflammatory drugs are the main differential diagnosis. To sum up, physicians should included CMUSE in the differential diagnosis of recurrent abdominal pain, iron deficiency anaemia, occult intestinal bleeding, edema and protein losing enteropathy. PMID:24035666

Guisado Vasco, P; Fraile Rodríguez, G

2014-01-01

156

Unexplained abdominal pain as a driver for inappropriate therapeutics: an audit on the use of intravenous proton pump inhibitors  

PubMed Central

Background. Proton pump inhibitors (PPIs) are currently the most effective agents for acid-related disorders. However, studies show that 25–75% of patients receiving intravenous PPIs had no appropriate justification, indicating high rates of inappropriate prescribing. Objective. To examine the appropriate use of intravenous PPIs in accordance with guidelines and the efficacy of a prescribing awareness intervention at an Asian teaching institution. Setting. Prospective audit in a tertiary hospital in Malaysia. Method. Every 4th intravenous PPI prescription received in the pharmacy was screened against hospital guidelines. Interventions for incorrect indication/dose/duration were performed. Patients’ demographic data, medical history and the use of intravenous PPI were collected. Included were all adult inpatients prescribed intravenous PPI. Main Outcome Measure. Proportion of appropriate IV PPI prescriptions. Results. Data for 106 patients were collected. Most patients were male [65(61.3%)], Chinese [50(47.2%)], with mean age ± SD = 60.3 ± 18.0 years. Most intravenous PPI prescriptions were initiated by junior doctors from the surgical [47(44.3%)] and medical [42(39.6%)] departments. Only 50/106(47.2%) patients had upper gastrointestinal endoscopy/surgery performed to verify the source of bleeding. Unexplained abdominal pain [81(76.4%)] was the main driver for prescribing intravenous PPIs empirically, out of which 73(68.9%) were for suspected upper gastrointestinal bleed. Overall, intravenous PPI was found to be inappropriately prescribed in 56(52.8%) patients for indication, dose or duration. Interventions on the use of intravenous PPI were most effective when performed by senior doctors (100%), followed by clinical pharmacists (50%), and inpatient pharmacists (37.5%, p = 0.027). Conclusion. Inappropriate intravenous PPI usage is still prevalent despite the enforcement of hospital guidelines. The promotion of prescribing awareness and evidence-based prescribing through education of medical staff could result in more judicious use of intravenous PPI and dose-optimization. PMID:25024919

Wong, Yin Yen; Low, Yong Chia; Lau, Hui Ling; Chin, Kin-Fah; Mahadeva, Sanjiv

2014-01-01

157

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

PubMed Central

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

2014-01-01

158

Unexplained abdominal pain as a driver for inappropriate therapeutics: an audit on the use of intravenous proton pump inhibitors.  

PubMed

Background. Proton pump inhibitors (PPIs) are currently the most effective agents for acid-related disorders. However, studies show that 25-75% of patients receiving intravenous PPIs had no appropriate justification, indicating high rates of inappropriate prescribing. Objective. To examine the appropriate use of intravenous PPIs in accordance with guidelines and the efficacy of a prescribing awareness intervention at an Asian teaching institution. Setting. Prospective audit in a tertiary hospital in Malaysia. Method. Every 4th intravenous PPI prescription received in the pharmacy was screened against hospital guidelines. Interventions for incorrect indication/dose/duration were performed. Patients' demographic data, medical history and the use of intravenous PPI were collected. Included were all adult inpatients prescribed intravenous PPI. Main Outcome Measure. Proportion of appropriate IV PPI prescriptions. Results. Data for 106 patients were collected. Most patients were male [65(61.3%)], Chinese [50(47.2%)], with mean age ± SD = 60.3 ± 18.0 years. Most intravenous PPI prescriptions were initiated by junior doctors from the surgical [47(44.3%)] and medical [42(39.6%)] departments. Only 50/106(47.2%) patients had upper gastrointestinal endoscopy/surgery performed to verify the source of bleeding. Unexplained abdominal pain [81(76.4%)] was the main driver for prescribing intravenous PPIs empirically, out of which 73(68.9%) were for suspected upper gastrointestinal bleed. Overall, intravenous PPI was found to be inappropriately prescribed in 56(52.8%) patients for indication, dose or duration. Interventions on the use of intravenous PPI were most effective when performed by senior doctors (100%), followed by clinical pharmacists (50%), and inpatient pharmacists (37.5%, p = 0.027). Conclusion. Inappropriate intravenous PPI usage is still prevalent despite the enforcement of hospital guidelines. The promotion of prescribing awareness and evidence-based prescribing through education of medical staff could result in more judicious use of intravenous PPI and dose-optimization. PMID:25024919

Lai, Pauline Siew Mei; Wong, Yin Yen; Low, Yong Chia; Lau, Hui Ling; Chin, Kin-Fah; Mahadeva, Sanjiv

2014-01-01

159

An Evaluation of the Effect of Morphine on Abdominal Pain and PeritonealIrritation Signs in Patients with Acute Surgical Abdomen  

PubMed Central

Introduction Acute surgical abdomen is one of the most common emergency surgical causes all over the world and also one of the most important abdominal pain causes which is sometimes intolerable for the patients referring to the emergency departments. Diagnosis and planning for operation in these cases is based on time-demanding serial examinations and results of paraclinical data. In this waiting period, patients have to tolerate pain.Therefore, we aimed to study the hypothesis that relieving pain has no influence on valuable findings in physical examination. Methods This double blind randomized clinical trial was carried out on 120 patients above 12 years old referred to an emergency department of a referral hospital with acute abdomen. Patients were divided into two groups of receiving intravenous placebo and Morphine randomly. Pain score, change in tenderness as well as change in rebound tenderness before and after receiving morphine or placebo were measured based on Numeric Pain Assessment Scale. Results Statistically significant difference was observed between both groups regarding the mean pain score. Prevalence of tenderness and rebound tenderness after medication administration revealed a significant difference between two groups. Furthermore, pain and tenderness showed a significant decrease in patients receiving morphine also a significant difference occurred in rebound tenderness between two groups. Conclusion Despite the fact that opioid analgesics decrease pain in patients with acute surgical abdomen, they do not tend to eliminate required diagnostic data being obtained from physical examination like tenderness and rebound tenderness. Surprisingly, all the acute abdomen cases had rebound tenderness after morphine administration. Therefore, this research advises a cautious usage of morphine in patients with acute abdomen. PMID:24250982

Aghamohammadi, Dawood; Gholipouri, Changiz; Hosseinzadeh, Hamzeh; Khajehee, Mohammad Ali; Ghabili, Kamyar; Golzari, Samad EJ

2012-01-01

160

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

PubMed Central

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

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

2014-01-01

161

Reliability of ultrasound in combination with surface electromyogram for evaluating the activity of abdominal muscles in individuals with and without low back pain  

PubMed Central

This study investigated the reliability of ultrasound in combination with surface electromyogram (EMG) for evaluating the activity of the abdominal muscles in individuals with and without low back pain during the abdominal drawing-in maneuver (ADIM). The study recruited ten individuals with or without low back pain, respectively. While the participants were performing the ADIM, the activities of the transversus abdominis (TrA) and the internal oblique (IO) were measured using ultra-sound, while the activities of the external oblique (EO) and the rectus abdominis (RA) were measured using surface EMG. Intra-class correlation coefficients (ICC) were used to verify the inter-rater reliability of ultrasound in combination with surface EMG at rest and during the ADIM, and Bland-Altman plots were used to verify intra-rater reliability. The inter-rater reliability for the two groups at rest and during the ADIM was excellent (ICC2,1 = 0.77–0.95). In the Bland-Altman plots, the mean differences and 95% limits of agreement in the abdominal muscles of the two groups at rest were ?0.03?0.03 mm (?0.66 to 0.60 mm) and ?0.12? ?0.05 (?0.58 to 0.48% MVIC), respectively. The mean differences and 95% limits of agreement in the abdominal muscles of the two groups during the ADIM were ?0.04?0.02 mm (?0.73 to 0.65 mm) and ?0.19?0.05% MVIC (?1.24 to 1.34% MVIC), respectively. The ultrasound in combination with surface EMG showed excellent inter-rater and intra-rater reliability at rest and during the ADIM. PMID:25210698

Yang, Kyung-Hye; Park, Du-Jin

2014-01-01

162

The comparison of spinal anesthesia with general anesthesia on the postoperative pain scores and analgesic requirements after elective lower abdominal surgery: A randomized, double-blinded study  

PubMed Central

Background: The aim of this study was to compare the postoperative pain scores and morphine requirements between spinal anesthesia (SA) with hyperbaric bupivacaine 0.5% and general anesthesia (GA) with 1 Minimal alveolar concentration minimal alveolar concentration (MAC) of isoflurane in 50% N2O and O2 after elective lower abdominal surgery. Materials and Methods: In this randomized clinical trial, 68 patients with American Society of Anesthesiologists (ASA) I or II undergoing lower abdominal surgery were randomly assigned to have elective lower abdominal surgery under SA (n = 34) or GA (n = 34). The SA group received 3 cc of 0.5% hyperbaric bupivacaine (15 mg), at L3–L4 interspace intrathecally and also 2 mic/kg fentanyl and 0.15 mg/kg morphine intravenously for intraoperative analgesia. In the GA group, induction of anesthesia was carried out with Na thiopental 6 mg/kg body weight, fentanyl 2 mic/kg body weight, morphine 0.15 mg/kg, and atracurium 0.6 mg/kg body weight, and then, trachea was intubated. The primary outcome was postoperative pain scores at rest and under stress on a visual analog scale and the secondary outcome was morphine requirement by the patients. Outcome measures were recorded at 2, 4, 6, 12, and 24 h postoperatively. The duration of postanesthesia care unit (PACU) and hospital stay were recorded. Intraoperative parameters, postoperative pain scores, complications, recovery time, and the duration of hospital stay at follow up were compared between the two groups. Results: Patients in SA group had significantly lower scores of a postoperative pain at rest (3.4 ± 1.6 and 4.1 ± 1.2 at 2 and 4 h postoperatively vs. 5.2 ± 1.5 and 5.8 ± 0.9 in the GA group with P < 0.05), but there were no significant differences between both groups for scores of postoperative pain at 6, 12, and 24 h. The amount of morphine requirement in 6 h postoperatively was significantly lower in the SA group (10.2 ± 4.3 mg vs. 15.6 ± 5.6 mg in the GA group with P < 0.05), but there were not significant differences between the two groups after 6 h postoperatively. The duration of PACU stay was shorter for the GA group than the SA group (75 ± 6 vs. 126 ± 12 min, P < 0.001), but there was no significant differences between the duration of hospital stay between the two groups (1.8 ± 0.6 vs. 2.1 ± 0.8 days). Conclusion: Although in patients undergoing elective lower abdominal surgery with SA may have lower pain scores and also lower morphine requirement in the first 6 h postoperatively, but after that there were no significant differences between SA and GA regarding postoperative pain scores and analgesic requirements and so more attention should be given to their postoperation pain relief. PMID:24516483

Naghibi, Khosrou; Saryazdi, Hamid; Kashefi, Parviz; Rohani, Farnaz

2013-01-01

163

Comparative study between effect of pre- versus post-incisional transversus abdominis plane block on acute and chronic post-abdominal hysterectomy pain  

PubMed Central

Background: The prevalence of persistent chronic pain after abdominal hysterectomy is 5–32%. Our objectives were to determine the influence of transversus abdominis plane (TAP) block on the incidence of acute and chronic post-hysterectomy pain and to examine potential associations between time of block administration, either before surgical incision (preemptive) or after end of surgical procedure and its effect. Materials and Methods: Seventy-five patients undergoing elective total abdominal hysterectomy under general anesthesia were allocated randomly to receive TAP block either pre-incisional, or before emergence from anesthesia or sham block (just a needle puncture, control group). Pain was evaluated postoperatively at rest and movement by visual analogue scale. Peri-operative analgesic requirements, sedation, postoperative nausea and vomiting scores were recorded. Patients were questioned at three, and six months after surgery for type and severity of chronic pain. Results: Pain scores were significantly higher in Group II versus Group I (P<0.05), but both demonstrated significantly lower pain scores than control Group. Analgesic requirements decreased significantly in patients received TAP block (P<0.0001) with more significant decrease in the pre-incisional group. The incidence of chronic pain was significantly reduced in the pre-incisional group than others. The incidence of sedation was noted to be higher in the control group (61%) versus other groups (18% and 32% respectively), at time point 12 h postoperatively but was comparable between 12, 48 h (awake and alert). Incidence of postoperative nausea and vomiting (PONV) was reduced in patients who received TAP block (16% and 29%) in Group I and II respectively versus 66.5% in Group III. There were no complications attributed to the TAP block. Results: Pain scores were significantly higher in Group II versus Group I (P<0.05), but both demonstrated significantly lower pain scores than control Group. Analgesic requirements decreased significantly in patients received TAP block (P<0.0001) with more significant decrease in the pre-incisional group. The incidence of chronic pain was significantly reduced in the pre-incisional group than others. The incidence of sedation was noted to be higher in the control group (61%) versus other groups (18% and 32% respectively), at time point 12 h postoperatively but was comparable between 12, 48 h (awake and alert). Incidence of postoperative nausea and vomiting (PONV) was reduced in patients who received TAP block (16% and 29%) in Group I and II respectively versus 66.5% in Group III. There were no complications attributed to the TAP block. Conclusions: TAP block seems to be an acceptable choice for postoperative analgesia; pre-incisional TAP block appeared to reduce the severity of acute pain, analgesic requirements with its undesirable side-effects and incidence of chronic pain in comparison with blockade before emergence from anesthesia.

Amr, Yasser Mohamed; Amin, Sabry M.

2011-01-01

164

The Influence of Dual Pressure Biofeedback Units on Pelvic Rotation and Abdominal Muscle Activity during the Active Straight Leg Raise in Women with Chronic Lower Back Pain  

PubMed Central

[Purpose] This study was performed to assess the influence of applying dual pressure biofeedback units (DPBUs) on the angle of pelvic rotation and abdominal muscle activity during the active straight leg raise (ASLR). [Subjects] Seventeen patients with low-back pain (LBP) participated in this study. [Methods] The subjects were asked to perform an active straight leg raise (ASLR) without a PBU, with a single PBU, and with DPBUs. The angles of pelvic rotation were measured using a three-dimensional motion-analysis system, and the muscle activity of the bilateral internal oblique abdominis (IO), external oblique abdominis (EO), and rectus abdominis (RA) was recorded using surface electromyography (EMG). One-way repeated-measures ANOVA was performed to determine the rotation angles and muscle activity under the three conditions. [Results] The EMG activity of the ipsilateral IO, contralateral EO, and bilateral RA was greater and pelvic rotation was lower with the DPBUs than with no PBU or a single PBU. [Conclusion] The results of this study suggest that applying DPBUs during ASLR is effective in decreasing unwanted pelvic rotation and increasing abdominal muscle activity in women with chronic low back pain. PMID:24926138

Noh, Kyung-Hee; Kim, Ji-Won; Kim, Gyoung-Mo; Ha, Sung-Min; Oh, Jae-Seop

2014-01-01

165

Abdominal CT scan  

MedlinePLUS

... care provider if you take the diabetes medication metformin(Glucophage). People taking this medicine may have to ... be used to look for: Cause of abdominal pain or swelling Hernia Cause of a fever Masses ...

166

Bloody diarrhoea cases caused by Shigella and amoeba in Jordan.  

PubMed

This study was done to evaluate the occurrence of bloody diarrhoea in Jordan in the period 1988-2000, with particular interest in Shigilla and amoeba cases in relation to the surveillance control system and hygiene policy. The cases were collected from various medical diagnostic laboratories. In addition to the clinical presentation, stool specimens or rectal swabs were collected and sub-cultured on the appropriate media. Shigella spp. and amoeba were identified using standard methods. Anti-microbial susceptibility tests were performed. One-way ANOVA and Least Significant Difference (LSD) were used for statistical analysis. The number of stool specimens tested for bloody diarrhoea was 34,529 in the study period. Positive stool samples were reported in 711 (2.1%) patients. Out of these 55% were males and 45 % were females. The highest number of cases 96 (13.5%) was reported in the year 1999. The highest incidence rate was (20.6) in the year 1996 and the lowest incidence rate (8.9) was in the year 2000. The highest number of cases during the period 1998-1992 was among age group 1-4 year. During the year 1993-1996 the highest number of cases was among group 5-14 year. The highest number of cases during the year 1997-2000 was among age group 15-24 year. There was a significant variation between numbers of bloody diarrhoeal cases and age groups (P < 0.001) as well as sex (P = 0.028). No significant variation (P = 0.06) was observed between number of bloody diarrhoea cases and seasons or months. The number of stool specimens tested for amoebiasis during the study period 1994-2000 was 229,040. Shigella was isolated from 304(0.13%) cases and amoeba was found in 24,211(10.6%) cases. The lowest incidence rate in bloody diarrhoeal cases in the year 2000 indicates good quality hygienic control. The increased resistance of Shigella to antibiotics may produce a future problem, which might require a further prescribing policy for treatment. PMID:14964404

Battikhi, M N G

2004-01-01

167

X-Chromosomal recessive microcephaly with epilepsy, spastic tetraplegia and absent abdominal reflexes. New variety of “Paine syndrome”?  

Microsoft Academic Search

Two brothers (7 years of age and 8 months respectively) are reported. They both suffered from a combination of severe microcephaly, spastic tetraplegia, clonic epileptic fits, absent abdominal cutaneous reflexes and severe mental retardation. This syndrome shows an X-chromosomal mode of inheritance. Dermatoglyphic patterns were characteristic. There was no change in aminoacids in CSF and the birth weight was high

E. Seemanová; I. Lesný; J. Hyánek; K. Brachfeld; M. Rössler; M. Prošková

1973-01-01

168

Vascular thrombosis as a cause of abdominal pain in a patient with neuroendocrine carcinoma of pancreas: Findings on (68)Ga-DOTANOC PET/CT.  

PubMed

Neuroendocrine tumors of pancreas are relatively rare neoplasms and are classified as either functioning or non-functioning tumors. A 55-year-old female diagnosed with a large, well-differentiated, non-functional neuroendocrine carcinoma of pancreas, presented with abdominal pain of increasing severity. A contrast-enhanced examination of the abdomen was performed to reveal a large, diffuse, enhancing pancreatic mass with multiple filling defects within the mesenteric vasculature. We present findings on (68)Ga-labeled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-1-NaI(3)-Octreotide, positron emission tomography-computed tomography ((68)Ga-DOTANOC PET/CT) and the importance of somatostatin receptor-based PET imaging in such patients. PMID:23599597

Naswa, Niraj; Kumar, Rakesh; Bal, Chandrasekhar; Malhotra, Arun

2012-01-01

169

Vascular thrombosis as a cause of abdominal pain in a patient with neuroendocrine carcinoma of pancreas: Findings on 68Ga-DOTANOC PET/CT  

PubMed Central

Neuroendocrine tumors of pancreas are relatively rare neoplasms and are classified as either functioning or non-functioning tumors. A 55-year-old female diagnosed with a large, well-differentiated, non-functional neuroendocrine carcinoma of pancreas, presented with abdominal pain of increasing severity. A contrast-enhanced examination of the abdomen was performed to reveal a large, diffuse, enhancing pancreatic mass with multiple filling defects within the mesenteric vasculature. We present findings on 68Ga-labeled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-1-NaI3-Octreotide, positron emission tomography-computed tomography (68Ga-DOTANOC PET/CT) and the importance of somatostatin receptor-based PET imaging in such patients. PMID:23599597

Naswa, Niraj; Kumar, Rakesh; Bal, Chandrasekhar; Malhotra, Arun

2012-01-01

170

An Open Randomized Comparison of Clinical Effectiveness of Protocol-Driven Opioid Analgesia, Celiac Plexus Block or Thoracoscopic Splanchnicectomy for Pain Management in Patients with Pancreatic and Other Abdominal Malignancies  

Microsoft Academic Search

In inoperable malignancy, pain relief with opioids is often inadequate. Nerve block procedures may improve symptom control. Our aim was to assess celiac plexus block (CPB) and thoracoscopic splanchnicectomy (TS) in patients receiving appropriate medical management (MM). Methods: Patients with confirmed irresectable malignancy of the pancreas or upper abdominal viscera who required opioid analgesia were randomized to MM alone, MM+CPB,

C. D. Johnson; D. P. Berry; S. Harris; R. M. Pickering; C. Davis; S. George; C. W. Imrie; J. P. Neoptolemos; R. Sutton

2009-01-01

171

Effect of preoperative oral dextromethorphan on immediate and late postoperative pain and hyperalgesia after total abdominal hysterectomy  

Microsoft Academic Search

Dextromethorphan is a noncompetitive N-methyl-d-aspartate (NMDA) receptor antagonist known to inhibit wind-up and NMDA-mediated nociceptive responses of dorsal horn neurons. Experimental and clinical studies indicate that NMDA-receptor antagonists may potentiate the effect of analgesics such as morphine, local anesthetics and NSAIDs. Results from previous clinical studies of dextromethorphan in postoperative pain are conflicting, possibly related to administration of insufficient doses

Susanne Ilkjaer; Leif F Bach; Peter A Nielsen; Mogens Wernberg; Jørgen B Dahl

2000-01-01

172

Pain.  

PubMed

Invasive stimulation of the motor (precentral) cortex using surgically implanted epidural electrodes is indicated for the treatment of neuropathic pain that is refractory to medical treatment. Controlled trials have demonstrated the efficacy of epidural motor cortex stimulation (MCS), but MCS outcome remains variable and validated criteria for selecting good candidates for implantation are lacking. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive approach that could be used as a preoperative tool to predict MCS outcome and also could serve as a therapeutic procedure in itself to treat pain disorders. This requires repeated rTMS sessions and a maintenance protocol. Other studies have also demonstrated the efficacy of transcranial direct current stimulation (tDCS) in relieving chronic pain syndromes. The most studied target is the precentral cortex, but other targets, such as the prefrontal and parietal cortices, could be of interest. The analgesic effects of cortical stimulation relate to the activation of various circuits modulating neural activities in remote structures, such as the thalamus, limbic cortex, insula, or descending inhibitory controls. In addition to the treatment of refractory neuropathic pain by epidural MCS, new developments of this type of strategy are ongoing, for other types of pain syndrome and stimulation techniques. PMID:24112914

Lefaucheur, Jean-Pascal

2013-01-01

173

Transforming conflict toward and away from violence: Bloody Sunday and the hunger strikes in Northern Ireland  

Microsoft Academic Search

This paper examines two major events in the history of the Northern Ireland conflict, Bloody Sunday and the hunger strikes, in order to explore the specific and often contradictory dynamics of violence and nonviolence. Whereas Bloody Sunday transformed nonviolent into violent resistance, the hunger strikes undermined the IRA's violent campaign. Thus, nonviolent resistance became the first step towards a successful

Marcel M. Baumann

2009-01-01

174

[Contrast mammography in spontaneous bloody secretion from the nipple].  

PubMed

43 women with spontaneous bloody nipple discharge were examined by galactography performed with water soluble contrast medium. The purpose of this study was to evaluate the use of galactography in these patients, to localize the cause of this particular type of discharge and to register the therapeutic consequences of the findings. Surgical resection was carried out in all cases where galactography showed intraductal pathology. The remaining patients (except for four who also underwent surgery) were observed without treatment. No sign of carcinoma was found in a follow-up examination of the non-operated patients after two to four years. The results show that galactography can be suitably used to demonstrate and localize intraductal pathology, and may therefore be of importance in the preoperative investigation of spontaneous blood-stained secretion. PMID:2274945

Johanson, A; Sager, E M

1990-11-30

175

Abdominal hernias: Radiological features  

PubMed Central

Abdominal wall hernias are common diseases of the abdomen with a global incidence approximately 4%-5%. They are distinguished in external, diaphragmatic and internal hernias on the basis of their localisation. Groin hernias are the most common with a prevalence of 75%, followed by femoral (15%) and umbilical (8%). There is a higher prevalence in males (M:F, 8:1). Diagnosis is usually made on physical examination. However, clinical diagnosis may be difficult, especially in patients with obesity, pain or abdominal wall scarring. In these cases, abdominal imaging may be the first clue to the correct diagnosis and to confirm suspected complications. Different imaging modalities are used: conventional radiographs or barium studies, ultrasonography and Computed Tomography. Imaging modalities can aid in the differential diagnosis of palpable abdominal wall masses and can help to define hernial contents such as fatty tissue, bowel, other organs or fluid. This work focuses on the main radiological findings of abdominal herniations. PMID:21860678

Lassandro, Francesco; Iasiello, Francesca; Pizza, Nunzia Luisa; Valente, Tullio; Stefano, Maria Luisa Mangoni di Santo; Grassi, Roberto; Muto, Roberto

2011-01-01

176

Spontaneous dissection of the celiac trunk: a rare cause of abdominal pain--case report and review of the literature.  

PubMed

Spontaneous dissection of the celiac trunk is uncommon and rarely considered in patients presenting with acute onset of epigastric pain. We report the case of a 48-year old male, diagnosed with a spontaneous dissection of the celiac trunk extending towards the common hepatic artery. He was treated conservatively and remained asymptomatic after two years of follow-up. Conservative treatment seems justified in the absence of bowel ischemia or signs of hemorrhage. Initial Computed Tomography angiography revealed the presence of a dissection with a pseudoaneurysm that remained stable and regressed towards a normal Computed Tomography angiography after 7 months of follow-up. Radiologic follow-up is warranted as progression of the dissection and/or total occlusion with or without symptoms can occur. The risk factors, the natural course and optimal treatment remain unclear due to the rarity of the disorder. Our patient had no predisposing cardiovascular risk factors. Nevertheless, we observed a hypertrophic ligamentum arcuatum on Computed Tomography, possibly facilitating the evolution towards a dissection. Next to the case report, we provide a review of the available literature. PMID:24261029

Schrijvers, Rik; Van De Mierop, Frank; De Schepper, Bart; Sprengers, Dirk; Dero, Isabel; D'Archambeau, Olivier; Botelberge, Thomas

2013-09-01

177

Obesity-Associated Abdominal Elephantiasis  

PubMed Central

Abdominal elephantiasis is a rare entity. Abdominal elephantiasis is an uncommon, but deformative and progressive cutaneous disease caused by chronic lymphedema and recurrent streptococcal or Staphylococcus infections of the abdominal wall. We present 3 cases of patients with morbid obesity who presented to our hospital with abdominal wall swelling, thickening, erythema, and pain. The abdominal wall and legs were edematous, with cobblestone-like, thickened, hyperpigmented, and fissured plaques on the abdomen. Two patients had localised areas of skin erythema, tenderness, and increased warmth. There was purulent drainage from the abdominal wall in one patient. They were managed with antibiotics with some initial improvement. Meticulous skin care and local keratolytic treatment for the lesions were initiated with limited success due to their late presentation. All three patients refused surgical therapy. Conclusion. Early diagnosis is important for the treatment of abdominal elephantiasis and prevention of complications. PMID:23606857

Kohli, Ritesh; Argento, Vivian; Amoateng-Adjepong, Yaw

2013-01-01

178

Functional Abdominal Pain in Children  

MedlinePLUS

... IBD) such as Crohn’s disease and ulcerative colitis, celiac disease which is a sensitivity to cereal grains, food ... of certain infections and disorders like IBD and celiac disease. Normal test results in a child without alarm ...

179

Abdominal Inflammatory Myofibroblastic Tumor  

PubMed Central

A 28-year-old woman was referred to our hospital because of abdominal pain, weight loss and a palpable intra-abdominal mass. A CT scan revealed a tumor with a diameter of 7 cm with sharp margins, intra-tumoral fatty components and enhancing soft tissue. After initial workup, which suggested an inflammatory myofibroblastic tumor (IMT), she underwent laparotomy with complete resection. Pathological examination indeed revealed IMT. IMT is a rare benign neoplasm and has been described in nearly the entire body. It presents with nonspecific symptoms. The therapy of abdominal IMT consists of radical surgery because of high local recurrence rates. In this case report clinical, surgical, radiological and histological features with a review of the relevant literature are described. PMID:24707245

Groenveld, Roosmarijn L.; Raber, Menno H.; Oosterhof-Berktas, Richard; Eijken, Erik; Klaase, Joost M.

2014-01-01

180

A Case of Phyllodes Tumor with Bloody Nipple Discharge in Juvenile Patient.  

PubMed

We report a rare case of phyllodes tumor of the breast in a juvenile patient with bloody nipple discharge. An 11-year-old girl had a chief complaint of a palpable 5 cm well-circumscribed tumor with nipple discharge in the left breast. The histopathological diagnosis of the resected specimen was benign phyllodes tumor showing extensive areas of hemorrhagic necrosis. The bloody nipple discharge was caused by spontaneous infarction of the tumor. Preoperative ultrasonography and galactography were helpful in evaluating the mechanism of nipple dicharge from the tumor. Although phyllodes tumor must be differentiated from fibroadenoma, the present case was histopathologically identical to phyllodes tumor. PMID:11091717

Tagaya; Kodaira; Kogure; Shimizu

1999-07-25

181

Endovascular treatment of a temporal bone pseudoaneurysm presenting as bloody otorrhea.  

PubMed

Objective?This case report is designed to illustrate an uncommon presentation of osteoradionecrosis (ORN) of the temporal bone and a treatment method for bloody otorrhea from a pseudoaneurysm of the internal carotid artery (ICA). Design?This is a single patient case report Setting?University of Missouri-Columbia Hospital and Clinics. Participants?The report describes a patient with a history of hypopharyngeal squamous cell carcinoma (SCCA) who was previously treated with chemoradiation therapy and salvage bilateral neck dissections and then presented in a delayed fashion with profuse, episodic bloody otorrhea. Computed tomography (CT) was consistent with ORN of the temporal bone. The patient underwent emergent cerebral angiography. A pseudoaneurysm of the cervicopetrous ICA was confirmed to be the source of the patient's bloody otorrhea. The lesion was treated by endovascular sacrifice of the ICA using the two-catheter coiling technique. Results?The patient had no neurologic sequelae or further bleeding after treatment. Conclusions?Bloody otorrhea is an uncommon presentation of ORN. Sacrifice of the internal carotid can be considered as a treatment when the source is pseudoaneurysmal. PMID:24294565

Bien, Alexander G; Cress, Marshall C; Nguyen, Susan B; Westgate, Steven J; Nanda, Ashish

2013-12-01

182

Endovascular Treatment of a Temporal Bone Pseudoaneurysm Presenting as Bloody Otorrhea  

PubMed Central

Objective?This case report is designed to illustrate an uncommon presentation of osteoradionecrosis (ORN) of the temporal bone and a treatment method for bloody otorrhea from a pseudoaneurysm of the internal carotid artery (ICA). Design?This is a single patient case report Setting?University of Missouri-Columbia Hospital and Clinics. Participants?The report describes a patient with a history of hypopharyngeal squamous cell carcinoma (SCCA) who was previously treated with chemoradiation therapy and salvage bilateral neck dissections and then presented in a delayed fashion with profuse, episodic bloody otorrhea. Computed tomography (CT) was consistent with ORN of the temporal bone. The patient underwent emergent cerebral angiography. A pseudoaneurysm of the cervicopetrous ICA was confirmed to be the source of the patient's bloody otorrhea. The lesion was treated by endovascular sacrifice of the ICA using the two-catheter coiling technique. Results?The patient had no neurologic sequelae or further bleeding after treatment. Conclusions?Bloody otorrhea is an uncommon presentation of ORN. Sacrifice of the internal carotid can be considered as a treatment when the source is pseudoaneurysmal. PMID:24294565

Bien, Alexander G.; Cress, Marshall C.; Nguyen, Susan B.; Westgate, Steven J.; Nanda, Ashish

2013-01-01

183

Aileen Blaney - Remembering Historical Trauma in Paul Greengrass's Bloody Sunday - History & Memory 19:2  

Microsoft Academic Search

Since the instigation of the peace process in Northern Ireland, issues relating to the commemoration of the political conflict there have moved to center stage in media, political, cultural and academic discourses. This essay locates the film Bloody Sunday (Paul Greengrass, 2002) within the framework of a growing body of literature on historical trauma and memory studies in order to

Aileen Blaney

2007-01-01

184

Active Remembering, Selective Forgetting, and Collective Identity: The Case of Bloody Sunday  

Microsoft Academic Search

Abstract Bloody Sunday, Derry, Northern Ireland, January 30, 1972, in which 13 Catholic civilians were shot dead by the British army has evoked two contesting memories,– an ‘official’ or elite memory and a folk memory among the Nationalist community that, it is argued, has been omitted from dominant memory discourses. The official memory of this life-destroying historical event is encoded

Brian Conway

2003-01-01

185

Sex differences in brain activity during aversive visceral stimulation and its expectation in patients with chronic abdominal pain: A network analysis  

Microsoft Academic Search

Differences in brain responses to aversive visceral stimuli may underlie previously reported sex differences in symptoms as well as perceptual and emotional responses to such stimuli in patients with irritable bowel syndrome (IBS). The goal of the current study was to identify brain networks activated by expected and delivered aversive visceral stimuli in male and female patients with chronic abdominal

J. S. Labus; B. N. Naliboff; J. Fallon; S. M. Berman; B. Suyenobu; J. A. Bueller; M. Mandelkern; E. A. Mayer

2008-01-01

186

Acute appendicitis in late adulthood: incidence, presentation, and outcome. Results of a prospective multicenter acute abdominal pain study and a review of the literature  

Microsoft Academic Search

Background: Acute appendicitis is the second most common cause of surgical abdominal disease in late adulthood. It is a serious condition: major errors in management are made frequently and the condition is associated with significant morbidity and mortality. Data collected within a multicenter prospective trial and a literature review were used to analyze diagnostic and therapeutic difficulties in detail. Methods:

Matthias Kraemer; Claus Franke; Christian Ohmann; Qin Yang

2000-01-01

187

Non-traumatic lateral abdominal wall hernia  

Microsoft Academic Search

A rare lateral abdominal wall hernia is described in an adult patient. This was diagnosed in a patient with a prominent right\\u000a lateral abdominal wall deformity. The patient had been experiencing pain that increased progressively in severity over time.\\u000a A computerized tomography (CT) scan of the abdomen revealed the location of the lateral abdominal wall defect. The hernia\\u000a defect was

M. Castillo-Sang; B. Gociman; B. Almaroof; J. Fath; F. Cason

2009-01-01

188

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

E-print Network

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... 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...

You, Dokyoung Sophia

2012-10-19

189

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

PubMed

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

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

2013-05-01

190

Rusty pipe syndrome, a cause of bloody nipple discharge: case report.  

PubMed

Abstract Breastfeeding has universally known advantages to the mother and child that include nutritional and immunological benefits but also involve reasons of ecological and economic order. Initiation and maintenance of breastfeeding can be associated with common problems. The beginning of milk production may course with bloody nipple discharge, which, after exclusion of pathological entities, concerns a self-resolving physiological syndrome called rusty pipe. We present a case of rusty pipe syndrome and discuss the implications. PMID:24964086

Silva, Joana Raquel; Carvalho, Rita; Maia, Catarina; Osório, Marta; Barbosa, Marta

2014-10-01

191

Abdominal rectovaginopexy  

Microsoft Academic Search

PURPOSE: We noted the combination of obstructed defecation or constipation and fecal incontinence, the poor results of abdominal rectopexy for constipation, and the well-known risk of postoperative induction of constipation after rectopexy. We developed a new operation to treat patients with constipation or fecal incontinence (with a concomitant rectocele, internal rectal intussusception, enterocele at dynamic defecography, or all three) or

R. Silvis; H. G. Gooszen; A. van Essen; A. Th. C. M. Kruif; L. W. M. Janssen

1999-01-01

192

Abdominal Aortic Aneurysms: Treatments  

MedlinePLUS

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

193

Bloody Ejaculation  

MedlinePLUS

... Schueler, MD How it Works Testimonials FAQ for Consumers FAQ for Physicians News Advertising Terms of Use Contact Us Site Map How ... yourself? About Stephen J. Schueler, M.D News Advertising How It Works FAQ for Consumers FAQ for Physicians Testimonials Site Map Terms of ...

194

[Abdominal cystic tumor revealing lymphangioleiomyomatosis].  

PubMed

We report the case of a 39 year-old woman with many years of intermittent abdominal pain who was found to have cystic masses evocative of cystic lymphangioma involving the posterior mediastinal and retroperitoneum. Worsening abdominal pain led to a recommendation for laparoscopic unroofing and decompression of the cysts. During the postoperative period, hemorrhagic shock required reintervention with excision of the tumoral mass. Pathologic examination revealed lymphangioleiomyomatosis (LAM). On the 15th postoperative day, the patient developed a chylopneumothorax which required prolonged chest tube drainage. The presence of multiple polycystic lesions in the pulmonary parenchyma supported the diagnosis of diffuse LAM with primary extrapulmonary presentation. This diagnosis should be considered preoperatively since it modifies the treatment: a complete excision of the cystic lesions seems to be necessary in order to prevent bleeding and lymphatic extravasation. PMID:19446700

Barbier, L; Ebbo, M; Andrac-Meyer, L; Schneilitz, N; Le Treut, Y-P; Reynaud-Gaubert, M; Hardwigsen, J

2009-02-01

195

Spontaneous hemopneumothorax simulating acute abdominal affections.  

PubMed

Spontaneous hemopneumothorax (SHP) is a rare potentially life-threatening condition that occurs in predominantly young adolescents. The resultant massive hemorrhage leading to hypovolemic shock can be a surgical emergency. It constitutes 1-12% of all spontaneous pneumothoraces and presents with two cardinal features, chest pain and dyspnea. However, the pain of SHP may be confined to the abdomen secondary to the irritation of diaphragmatic pleura, which produces signs simulating an acute abdomen. SHP masquerading as an abdominal affection is apparently regarded as extremely rare. We present a case of a 16-year-old male with SHP presenting features simulating acute gallbladder disease. After prompt diagnosis with appropriate surgical intervention, he had an uneventful recovery. Our experience emphasizes the importance of careful and thorough chest examination for each child with atypical pictures for abdominal pain to exclude possible extra-abdominal lesions, even rare as SHP. PMID:23169600

Chen, Tai-Heng; Tseng, Yung-Hao; Tseng, Chien-Ming; Chiang, Hung-Hsing; Lin, Tzeng-Jih

2014-01-01

196

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 ...

197

Neuropathic pain in hereditary coproporphyria  

PubMed Central

Acute porphyrias are rare diseases with varying incidences worldwide. These diseases are disorders of heme biosynthesis characterized by acute attacks of neurological symptoms. Acute porphyria should be considered in patients with unexplained abdominal pain or neurological damage. Clinical manifestations of acute porphyria are nonspecific and are associated with multiple organ systems. This report examines a rare case of an uncommon type of acute porphyria in a patient with an initial presentation of abdominal pain and progressive polyneuropathy. PMID:24353603

Chen, Guan-Liang; Yang, Deng-Ho; Wu, Jeng-Yuau; Kuo, Chia-Wen; Hsu, Wen-Hsiu

2013-01-01

198

A case report of abdominal distention caused by herpes zoster.  

PubMed

Gastrointestinal complications caused by herpes zoster are extremely rare. Here, we described a case of abdominal distention caused by herpes zoster. The patient was a 59-year-old female who suffered from unexplained paroxysmal and a burning pain on the right part of her waist and abdomen, accompanied by abdominal distention. Intestinal pseudo-obstruction was diagnosed by abdominal radiography. Distention of the right abdominal wall was still apparent after one month. In this report, we found that recovery from abdominal distention caused by herpes zoster is difficult and may require surgical intervention. PMID:22969239

Zhou, Su-Rong; Liu, Chuan-Yu

2012-09-01

199

Abdominal Aortic Aneurysm  

MedlinePLUS

Abdominal Aortic Aneurysm Surgery Introduction Aorta Common Iliac Arteries Ballooning of the aorta, also known as an "abdominal aortic aneurysm," can lead to life threatening bleeding. Doctors may ...

200

Chronic non-bloody diarrhoea: a prospective study in Malm?, Sweden, with focus on microscopic colitis  

PubMed Central

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

2014-01-01

201

38 CFR 4.113 - Coexisting abdominal conditions.  

Code of Federal Regulations, 2010 CFR

...of pathology, produce a common disability picture characterized in the main by varying degrees of abdominal distress or pain, anemia and disturbances in nutrition. Consequently, certain coexisting diseases in this area, as indicated in the instruction...

2010-07-01

202

Abdominal actinomycosis associated with intrauterine device: CT features  

Microsoft Academic Search

Abdominal actinomycosis is a severe and progressive peritoneal infection, due to an anerobic gram-positive bacterium, Actinomyces israelii. The presence of a long-standing intrautrine device (IUD) is a well-known risk factor in young women. We report two cases of pelviperitoneal actinomycosis appearing in two young women with acute low abdominal pain. Abdominal CT demonstrated multiple solid or encapsulated peritoneal masses with

Th. Laurent; P. Grandi; P. Schnyder

1996-01-01

203

Acute Abdominal Pain Secondary to Chilaiditi Syndrome  

PubMed Central

Chilaiditi syndrome is a rare condition occurring in 0.025% to 0.28% of the population. In these patients, the colon is displaced and caught between the liver and the right hemidiaphragm. Patients' symptoms can range from asymptomatic to acute intermittent bowel obstruction. Diagnosis is best achieved with CT imaging. Identification of Chilaiditi syndrome is clinically significant as it can lead to many significant complications such as volvulus, perforation, and bowel obstruction. If the patient is symptomatic, treatment is usually conservative. Surgery is rarely indicated with indications including ischemia and failure of resolution with conservative management. PMID:23936720

Pan, Andrew S.; Lopez, Michael A.; Buicko, Jessica L.; Lopez-Viego, Miguel

2013-01-01

204

Understanding noninguinal abdominal hernias in the athlete.  

PubMed

Abdominal hernias are common with over 20 million hernia repairs performed worldwide. Inguinal hernias are the most common type of hernia. Inguinal and sports hernia have been discussed at length in recent literature, and therefore, they will not be addressed in this article. The noninguinal hernias are much less common but do occur, and knowledge of these hernias is important when assessing the athlete with abdominal pain. Approximately 25% of abdominal wall hernias are noninguinal, and new data show the order of frequency as umbilical, epigastric, incisional, femoral, and all others (i.e., Spigelian, obturator, traumatic). Return-to-play guidelines need to be tailored to the athlete and the needs of their sport. Using guidelines similar to abdominal strain injuries can be a starting point for the treatment plan. Laparoscopic repair is becoming more popular because of safety and efficacy, and it may lead to a more rapid return to play. PMID:24614421

Cabry, Robert J; Thorell, Erik; Heck, Keith; Hong, Eugene; Berkson, David

2014-01-01

205

Galactography with contrast and dye--a two stage radiological/surgical approach to serous or bloody nipple discharge.  

PubMed

Patients with serous or bloody nipple discharge arising from a single duct are treated by a joint radiological/surgical approach at our institution. Two galactograms are performed; the first with contrast medium alone to identify any lesion and the second, one hour prior to surgery, using both contrast and methylene blue. This defines the area for the surgeon ensuring the involved duct is removed. Several case histories are described and the galactographic technique is detailed. PMID:2604637

Osborne, J

1989-08-01

206

Hemoglobin of the bloody clam Tegillarca granosa (Tg-HbI) is involved in the immune response against bacterial infection  

Microsoft Academic Search

Hemoglobins (Hb) are the major protein components of erythrocytes circulating in the red blood, but can serve additional functions besides the transport of oxygen. Here, the cDNA of the bloody clam (Tegillarca granosa) Hb dimer (designated Tg-HbI) was cloned and was found to be 748 bp in length, consisting of an open reading frame of 441 bp encoding a polypeptide of 147

Yongbo Bao; Qing Wang; Zhihua Lin

2011-01-01

207

[Factors associated with refractory cancer pain].  

PubMed

Cancer pain can be effectively controlled in most patients by classical pharmacological treatment. We retrospectively studied the characteristics and factors associated with non responsive pain. Between 1989 and 1996, 1767 patients were referred to our pain center; 831 (47%) had cancer pain and from 787 evaluable cases 118 (15%) experienced non-controlled pain whereas good pain control was achieved within a few days in 669 (85%) patients. Gender, age, cancer type, metastasis, initial pain intensity, nociceptive or neuropathic components and administration of adjuvant therapies were similar in both groups. On the other hand, diffuse pain, abdominal pain, terminal care, near death and doses of strong opioids were significantly different. Factors associated with therapeutic failure were conflicts, life and complications and breakthrough pain. In the presence of refractory cancer pain the factors predictive of therapeutic failure should be identified in order to optimize individual pain treatment. PMID:9540143

Piguet, V; Desmeules, J; Allaz, A F; Kondo Oestreicher, M; Dayer, P

1998-02-01

208

Jejunal perforation caused by abdominal angiostrongyliasis.  

PubMed

The authors describe a case of abdominal angiostrongyliasis in an adult patient presenting acute abdominal pain caused by jejunal perforation. The case was unusual, as this affliction habitually involves the terminal ileum, appendix, cecum or ascending colon. The disease is caused by the nematode Angiostrongylus costaricensis, whose definitive hosts are forest rodents while snails and slugs are its intermediate hosts. Infection in humans is accidental and occurs via the ingestion of snail or slug mucoid secretions found on vegetables, or by direct contact with the mucus. Abdominal angiostrongyliasis is clinically characterized by prolonged fever, anorexia, abdominal pain in the right-lower quadrant, and peripheral blood eosinophilia. Although usually of a benign nature, its course may evolve to more complicated forms such as intestinal obstruction or perforation likely to require a surgical approach. Currently, no efficient medication for the treatment of abdominal angiostrongyliasis is known to be available. In this study, the authors provide a review on the subject, considering its etiopathogeny, clinical picture, diagnosis and treatment. PMID:10602548

Waisberg, J; Corsi, C E; Rebelo, M V; Vieira, V T; Bromberg, S H; dos Santos, P A; Monteiro, R

1999-01-01

209

Identification of the Bloody Creek structure, a possible impact crater in southwestern Nova Scotia, Canada  

NASA Astrophysics Data System (ADS)

An approximately 0.4 km diameter elliptical structure formed in Devonian granite in southwestern Nova Scotia, herein named the Bloody Creek structure (BCS), is identified as a possible impact crater. Evidence for an impact origin is based on integrated geomorphic, geophysical, and petrographic data. A near-continuous geomorphic rim and a 10 m deep crater that is infilled with lacustrine sediments and peat define the BCS. Ground penetrating radar shows that the crater has a depressed inner floor that is sharply ringed by a 1 m high buried scarp. Heterogeneous material under the floor, interpreted as deposits from collapse of the transient cavity walls, is overlain by stratified and faulted lacustrine and wetland sediments. Alteration features found only in rim rocks include common grain comminution, polymict lithic microbreccias, kink-banded feldspar and biotite, single and multiple sets of closely spaced planar microstructures (PMs) in quartz and feldspar, and quartz mosaicism, rare reduced mineral birefringence, and chlorite showing plastic deformation and flow microtextures. Based on their form and crystallographic orientations, the quartz PMs consist of planar deformation features that document shock-metamorphic pressures ?25 GPa. The age of the BCS is not determined. The low depth to diameter ratio of the crater, coupled with anomalously high shock-metamorphic pressures recorded at its exposed rim, may be a result of significant post-impact erosion. Alternatively, impact onto glacier ice during the waning stages of Wisconsinian deglaciation (about 12 ka BP) may have resulted in dissipation of much impact energy into the ice, resulting in the present morphology of the BCS.

Spooner, Ian; Stevens, George; Morrow, Jared; Pufahl, Peir; Grieve, Richard; Raeside, Rob; Pilon, Jean; Stanley, Cliff; Barr, Sandra; McMullin, David

2009-08-01

210

Renal Artery Embolization Controls Intractable Pain in a Patient with Polycystic Kidney Disease  

SciTech Connect

A 65-year-old man with adult polycystic kidney disease (APKD) and chronic renal failure suffered from intractable abdominal pain and distension for 2 weeks. Meperidine infusion did not alleviate his pain. However, pain and abdominal distension were successfully controlled by embolization of both renal arteries.

Hahn, Seong Tai; Park, Seog Hee; Lee, Jae Mun; Kim, Choon-Yul [Department of Radiology, St. Mary's Hospital, Catholic Medical Center, Catholic University of Korea, 62, Youido-dong, Yongdungpo-gu, Seoul, 150-010 (Korea, Republic of); Chang, Yoon Sik [Department of Internal Medicine, St. Mary's Hospital, Catholic Medical Center, Catholic University of Korea, 62, Youido-dong, Yongdungpo-gu, Seoul, 150-010, Korea (Korea, Republic of)

1999-09-15

211

Presentation and management of chronic pain.  

PubMed

Chronic pain is an important clinical problem affecting significant numbers of children and their families. The severity and impact of chronic pain on everyday function is shaped by the complex interaction of biological, psychological and social factors that determine the experience of pain for each individual, rather than a straightforward reflection of the severity of disease or extent of tissue damage. In this article we present the research findings that strongly support a biopsychosocial concept of chronic pain, describe the current best evidence for management strategies and suggest a common general pathway for all types of chronic pain. The principles of management of some of the most important or frequently encountered chronic pain problems in paediatric practice; neuropathic pain, complex regional pain syndrome (CRPS), musculoskeletal pain, abdominal pain and headache are also described. PMID:24554056

Rajapakse, Dilini; Liossi, Christina; Howard, Richard F

2014-05-01

212

Flank pain  

MedlinePLUS

Pain - side; Side pain ... Flank pain can be a sign of a kidney problem. However, since many organs are in this area, other causes are possible. If you have flank pain and fever , chills, blood in the urine, or ...

213

Chronic Pain  

MedlinePLUS

... a problem you need to take care of. Chronic pain is different. The pain signals go on for ... there is no clear cause. Problems that cause chronic pain include Headache Low back strain Cancer Arthritis Pain ...

214

Abdominal vacuum lift as an aid to diagnosing abdominal adhesions  

E-print Network

The internal organs are designed to move freely and slide over one another during normal body movement. The abdominal organs, however, have a tendency to adhere to the abdominal cavity (peritoneum) and other abdominal ...

Strauss, Julius (Julius Y.)

2006-01-01

215

Chronic Pain  

MedlinePLUS

MENU Return to Web version Chronic Pain Overview What is chronic pain? There are 2 types of pain: acute and chronic. Acute pain lets you know that your ... It should go away as your body heals. Chronic pain lasts much longer. Chronic pain may last months ...

216

Abdominal Wall Endometriomas  

Microsoft Academic Search

Endometriosis is a condition in which uterine mucosal tissue is located outside the uterus. Endometriosis may be pelvic or extrapelvic. The term endometrioma is used when endometriosis appears as a circumscribed mass. Abdominal wall endometriomas are usually a secondary process in scars after surgical procedures. A retrospective study of abdominal wall endometrioma, from March 1992 through April 1999 at our

Amit J. Dwivedi; Sunita N. Agrawal; Yvan J. Silva

2002-01-01

217

Antimicrobial susceptibility of Shigella flexneri and S. dysenteriae isolated from stool specimens of patients with bloody diarrhoea in Mwanza, Tanzania.  

PubMed

This study was conducted to determine frequency and pattern of antimicrobial susceptibility of Shigella species isolated from stool specimens collected from patients presenting with bloody diarrhoea in Mwanza City, Tanzania. The study was carried out from October 2004 to October 2005 and involved patients attending Sekou Toure Regional Hospital and Butimba Health Centre. Bacteriological cultures were done at the National Institute for Medical Research laboratory. A total of 489 patients (median age = 20 years) participated in the study and were able to provide stool specimens. Shigella species were isolated from 14% (69/489) of the stool specimens collected. Of the sixty nine strains of Shigella spp isolated, 62 (90%) were S. flexneri and 7 (10%) were S. dysenteriae. All Shigella strains isolated showed high resistance to ampicillin, tetracycline, trimethoprim-sulphamethoxazole and chloramphenicol, drugs commonly used for management of shigellosis in Tanzania. However all isolates were fully susceptible to ciprofloxacin, nalidixic acid, erythromycin, cefuroxime and gentamycin. S. flexneri showed resistance to amoxy-clavulanic_acid and azithromycin in 5% and 2% of isolates, respectively. None of the S. dysenteriae isolates were resistant to these two drugs. Entamoeba histolytica, Giardia lamblia and Schistosoma mansoni were microscopically detected in 16.5%, 4.4% and 5.3% of patients, respectively. These findings suggest that there is a need to carry out extensive susceptibility studies in different parts of the country with view of re-appraising the current guidelines for management of bloody diarrhoea in Tanzania. PMID:18087897

Temu, M M; Kaatano, G M; Miyaye, N D; Buhalata, S N; Shushu, M L; Kishamawe, C; Changalucha, J M

2007-09-01

218

JAMA Patient Page: Acute Pain Treatment  

MedlinePLUS

... English and Spanish. A previous Patient Page on acute abdominal pain was published in the October 11, 2006, issue; one on opioid abuse was published in the September 15, 2004, issue; and one on pain management in the November 12, 2003, issue. John L. ...

219

Pain without nociception?  

PubMed

We describe a young woman with complete cervical spinal cord transsection, who developed significant abdominal pain, triggered by gastric distension and deep abdominal palpation. On the basis of the nature of her spinal cord injury, her brain-gut axis was limited to vagal pathways. Studies in mammalian models of human visceral sensation consistently showed that the subdiaphragmatic vagus contains a homogeneous population of afferents that are activated by low-intensity stimuli, which are generally believed to be important in regulating autonomic function and perhaps contributing to visceral sensory experiences triggered by such low-intensity stimuli (e.g. fullness, nausea), but not pain, although many fibers encode stimuli well into the noxious range. In contrast, spinal afferent pathways include fibers with high-activation thresholds that are thought to represent specialized nociceptors. This illustrative case argues against an exclusive role of specialized nociceptive pathways in visceral pain, but supports a concept of intensity coding with the composite of vagal and spinal input contributing to conscious perception and pain. PMID:22266836

Levinthal, David J; Bielefeldt, Klaus

2012-03-01

220

The Effect of Abdominal Support on Functional Outcomes in Patients Following Major Abdominal Surgery: A Randomized Controlled Trial  

PubMed Central

ABSTRACT Purpose: Immobility and pain are modifiable risk factors for development of venous thromboembolism and pulmonary morbidity after major abdominal surgery (MAS). The purpose of this study was to investigate the effect of abdominal incision support with an elasticized abdominal binder on postoperative walk performance (mobility), perceived distress, pain, and pulmonary function in patients following MAS. Methods: Seventy-five patients scheduled to undergo MAS via laparotomy were randomized to experimental (binder) or control (no binder) groups. Sixty (33 male, 27 female; mean age 58±14.9 years) completed the study. Preoperative measurements of 6-minute walk test (6MWT) distance, perceived distress, pain, and pulmonary function were repeated 1, 3, and 5 days after surgery. Results: Surgery was associated with marked postoperative reductions (p<0.001) in walk distance (?75–78%, day 3) and forced vital capacity (35%, all days) for both groups. Improved 6MWT distance by day 5 was greater (p<0.05) for patients wearing a binder (80%) than for the control group (48%). Pain and symptom-associated distress remained unchanged following surgery with binder usage, increasing significantly (p<0.05) only in the no binder group. Conclusion: Elasticized abdominal binders provide a non-invasive intervention for enhancing recovery of walk performance, controlling pain and distress, and improving patients' experience following MAS. PMID:21629603

Cheifetz, Oren; Overend, Tom J.; Crowe, Jean

2010-01-01

221

Low back pain caused by a duodenal ulcer  

Microsoft Academic Search

The common diagnoses in low back pain are lumbar strain, lumbosacral radiculopathy, osteoarthritis, degenerative disc disease, spinal stenosis, and sacroiliac joint dysfunction. Unusual causes of low back pain that have been previously identified include abdominal aortic aneurysms, pelvic neoplasms, and retroperitoneal hemorrhages. This report describes a case of back pain that was apparently caused by a duodenal ulcer. A 54-year-old

David J. Weiss; Theodore Conliffe; Narayan Tata

1998-01-01

222

Jewelry cleaners  

MedlinePLUS

... nose, eyes, ears, lips, or tongue Vision loss Gastrointestinal tract Abdominal pain - severe Bloody stools Burns and possible ... cause severe burns to the inside of the gastrointestinal tract. Extensive damage to the mouth, throat, eyes, lungs, ...

223

Chronic Pain  

MedlinePLUS

NINDS Chronic Pain Information Page Synonym(s): Pain - Chronic Condensed from Pain: Hope Through Research Table of Contents (click to jump ... Trials Organizations Additional resources from MedlinePlus What is Chronic Pain? While acute pain is a normal sensation triggered ...

224

Abdominal ultrasound (image)  

MedlinePLUS

Abdominal ultrasound is a scanning technique used to image the interior of the abdomen. Like the X- ... use high frequency sound waves to produce an image and do not expose the individual to radiation. ...

225

Intra-abdominal abscess  

MedlinePLUS

... abscess requires antibiotics (given by an IV) and drainage. Drainage involves placing a needle through the skin in ... abscess and how bad the infection is. Generally, drainage is successful in treating intra-abdominal abscesses that ...

226

Anti-inflammatory and antinociceptive action of the dimeric enkephalin peptide biphalin in the mouse model of colitis: New potential treatment of abdominal pain associated with inflammatory bowel diseases.  

PubMed

Biphalin, a mixed MOP/DOP agonist, displays a potent antinociceptive activity in numerous animal models of pain. The aim of the study was to characterize the anti-inflammatory and antinociceptive action of biphalin in the mouse models of colitis. The anti-inflammatory effect of biphalin (5mg/kg, twice daily, i.c. and i.p.) was characterized in a semi-chronic mouse model of colitis, induced by i.c. injection of trinitrobenzenesulfonic acid (TNBS). The antinociceptive action of biphalin (5mg/kg, i.p. and i.c.) in inflamed mice was assessed in mustard oil-induced model of visceral pain and in the hot plate test. In the semi-chronic mouse model of colitis, biphalin i.c. (5mg/kg), but not i.p. improved colitis macroscopic score (2.88±0.19 and 4.99±0.80 units for biphalin and vehicle treated animals, respectively). Biphalin injected i.p. and i.c. (5mg/kg) displayed a potent antinociceptive action in the mustard oil-induced pain test. In the hot plate test, biphalin (5mg/kg, i.p.) produced a potent antinociceptive activity in inflamed mice, suggesting central site of action. Our data suggest that biphalin may become a novel opioid-based analgesic agent in IBD therapy and warrant further investigation of its pharmacological profile. PMID:25151037

Sobczak, Marta; Pilarczyk, Andrzej; Jonakowski, Mateusz; Jarmu?, Agata; Sa?aga, Maciej; Lipkowski, Andrzej W; Fichna, Jakub

2014-10-01

227

Foetal pain?  

PubMed

The majority of commentary on foetal pain has looked at the maturation of neural pathways to decide a lower age limit for foetal pain. This approach is sensible because there must be a minimal necessary neural development that makes pain possible. Very broadly, it is generally agreed that the minimal necessary neural pathways for pain are in place by 24 weeks gestation. Arguments remain, however, as to the possibility of foetal pain before or after 24 weeks. Some argue that the foetus can feel pain earlier than 24 weeks because pain can be supported by subcortical structures. Others argue that the foetus cannot feel pain at any stage because it is maintained in a state of sedation in the womb and lacks further neural and conceptual development necessary for pain. Much of this argument rests on the definition of terms such as 'wakefulness' and 'pain'. If a behavioural and neural reaction to a noxious stimulus is considered sufficient for pain, then pain is possible from 24 weeks and probably much earlier. If a conceptual subjectivity is considered necessary for pain, however, then pain is not possible at any gestational age. Regardless of how pain is defined, it is clear that pain for conceptual beings is qualitatively different than pain for non-conceptual beings. It is therefore a mistake to draw an equivalence between foetal pain and pain in the older infant or adult. PMID:20356798

Derbyshire, Stuart W G

2010-10-01

228

Full-Term Abdominal Pregnancy: A Case Report and Review of the Literature  

Microsoft Academic Search

Background: Abdominal pregnancy is a rare, life-threatening condition. Case: A 30-year-old pregnant, gravida 3, para 1, was presented to hospital at 38 weeks gestation. She suffered from abdominal pain at 16 weeks gestation. At admission, obstetrical examination and transabdominal ultrasonography revealed that it was uterine pregnancy with a single living fetus and oligohydramnios. The diagnosis of abdominal pregnancy was made

Jianping Zhang; Fen Li; Qiu Sheng

2008-01-01

229

Pain and Inflammatory Bowel Disease  

PubMed Central

Abdominal pain is a common symptom of inflammatory bowel disease (IBD: Crohn’s disease, ulcerative colitis). Pain may arise from different mechanisms, which can include partial blockage and gut distention as well as severe intestinal inflammation. A majority of patients suffering from acute flares of IBD will experience pain, which will typically improve as disease activity decreases. However, a significant percentage of IBD patients continue experiencing symptoms of pain despite resolving inflammation and achieving what appears to be clinical remission. Current evidence suggests that sensory pathways sensitize during inflammation, leading to persistent changes in afferent neurons and central nervous system pain processing. Such persistent pain is not only a simple result of sensory input. Pain processing and even the activation of sensory pathways is modulated by arousal, emotion, and cognitive factors. Considering the high prevalence of iatrogenic as well as essential neuropsychiatric comorbidities including anxiety and depression in IBD patients, these central modulating factors may significantly contribute to the clinical manifestation of chronic pain. The improved understanding of peripheral and central pain mechanisms is leading to new treatment strategies that view pain as a biopsychosocial problem. Thus, improving the underlying inflammation, decreasing the excitability of sensitized afferent pathways, and altering emotional and/or cognitive functions may be required to more effectively address the difficult and disabling disease manifestations. PMID:19130619

Bielefeldt, Klaus; Davis, Brian; Binion, David G.

2010-01-01

230

Heel pain  

MedlinePLUS

Pain - heel ... Heel pain is most often the result of overuse. Rarely, it may be caused by an injury. Your heel ... on the heel Conditions that may cause heel pain include: When the tendon that connects the back ...

231

Neck Pain  

MedlinePLUS

... Pregnancy and Rheumatic Disease Sex and Arthritis Neck Pain PRINT Download PDF Description Saying, “It’s a pain ... requires expensive or uncomfortable tests. What is neck pain? Acute strain may occur after sleeping in an ...

232

Wrist pain  

MedlinePLUS

Pain - wrist ... Carpal tunnel syndrome: A common cause of wrist pain is carpal tunnel syndrome . You may feel aching, ... become weak, making it difficult to grasp things. Pain may extend up to your elbow. Carpal tunnel ...

233

Elbow pain  

MedlinePLUS

Pain - elbow ... Elbow pain can be caused by a variety of problems. A common cause in adults is tendinitis , an inflammation ... a partial dislocation ). Other common causes of elbow pain are: Bursitis -- inflammation of a fluid-filled cushion ...

234

Pain Relievers  

MedlinePLUS

Pain relievers are medicines that reduce or relieve headaches, sore muscles, arthritis, or other aches and pains. There ... also have a slightly different response to a pain reliever. Over-the-counter (OTC) medicines are good for ...

235

Prospects for Justice: The Procedural Aspect of the Right to Life Under the European Convention on Human Rights and Its Applications to Investigations of Northern Ireland's Bloody Sunday  

Microsoft Academic Search

This Comment examines how the new doctrine of the procedural aspect of Article 2 of the European Convention can provide recourse for the travesty of justice inherent in failed investigations of alleged violations of the right to life, such as the contended failure of the Widgery Tribunal's investigation of Bloody Sunday in Northern Ireland.

Kara E. Irwin

1998-01-01

236

Depression, Pain, and Pain Behavior.  

ERIC Educational Resources Information Center

Examined the degree to which depression predicted pain and pain behavior. The Beck Depression Inventory was administered to 207 low back pain patients. Depression and physical findings were the most important predictors of pain and pain behavior. Depression proved significant even after controlling for important demographic and medical status…

Keefe, Francis J.; And Others

1986-01-01

237

Pain Medication Requirements After Sacropexy and Combination Interventions  

PubMed Central

Background and Objectives: Laparoscopic surgery is associated with reduced morbidity, and postoperative pain is reduced. The aim of this study was to assess postoperative pain intensity, analgesic requirements, and the influence of cofactors after laparoscopic sacral colpopexy. Methods: The study assessed 287 patients treated with laparoscopic sacropexy for genital prolapse with a Pelvic Organ Prolapse Quantification grade >1. Patients were asked to evaluate their pain postoperatively using a 4-point verbal pain rating scale. In addition, medical records were analyzed regarding the requirement for analgesic medication. Results: Patients distinguished between abdominal pain and shoulder pain after laparoscopy. Abdominal pain reached maximum severity on day 1 and showed a good response to nonsteroidal antiphlogistics, whereas shoulder pain was rarely found (6.27%). Of the patients, 38% required no pain treatment or required 1 dose at most. The need for pain medication reached its climax on day 1 and decreased during the 5 following days. Non-opioid analgesics provided a sufficient therapeutic effect. Conclusion: Laparoscopic sacropexy is associated with a moderate degree of postoperative pain. Non-opioid analgesics should be preferred as first-line therapy. The typical shoulder-tip pain showed only a low prevalence in our study group. From our point of view, the low rate of shoulder-tip pain corresponded with the low intra-abdominal carbon dioxide pressure.

Schiermeier, Sven; Hatzmann, Wolfgang; Soltesz, Stefan; Spuntrup, Carolin; Anapolski, Michael

2014-01-01

238

Shoulder pain  

MedlinePLUS

Pain - shoulder ... changes around the rotator cuff can cause shoulder pain. You may have pain when lifting the arm above your head or ... The most common cause of shoulder pain occurs when rotator cuff tendons ... The tendons become inflamed or damaged. This condition ...

239

Pelvic Pain  

MedlinePLUS

Pelvic pain occurs mostly in the lower abdomen area. The pain might be steady, or it might come and go. If the pain is severe, it might get in the way ... re a woman, you might feel a dull pain during your period. It could also happen during ...

240

Pharmacological pain management in chronic pancreatitis.  

PubMed

Intense abdominal pain is a prominent feature of chronic pancreatitis and its treatment remains a major clinical challenge. Basic studies of pancreatic nerves and experimental human pain research have provided evidence that pain processing is abnormal in these patients and in many cases resembles that seen in neuropathic and chronic pain disorders. An important ultimate outcome of such aberrant pain processing is that once the disease has advanced and the pathophysiological processes are firmly established, the generation of pain can become self-perpetuating and independent of the initial peripheral nociceptive drive. Consequently, the management of pain by traditional methods based on nociceptive deafferentation (e.g., surgery and visceral nerve blockade) becomes difficult and often ineffective. This novel and improved understanding of pain aetiology requires a paradigm shift in pain management of chronic pancreatitis. Modern mechanism based pain treatments taking into account altered pain processing are likely to increasingly replace invasive therapies targeting the nociceptive source, which should be reserved for special and carefully selected cases. In this review, we offer an overview of the current available pharmacological options for pain management in chronic pancreatitis. In addition, future options for pain management are discussed with special emphasis on personalized pain medicine and multidisciplinarity. PMID:24259960

Olesen, Søren S; Juel, Jacob; Graversen, Carina; Kolesnikov, Yuri; Wilder-Smith, Oliver H G; Drewes, Asbjørn M

2013-11-14

241

Endovascular Repair of Abdominal Aortic Aneurysms  

PubMed Central

Endovascular treatment of abdominal aortic aneurysms (AAAs) is an exciting new minimally invasive treatment option for patients with this disease. Ochsner Clinic has been the only institution in the Gulf South participating in FDA clinical trials of these investigational devices. Early results with endovascular AAA repair demonstrate a trend towards lower mortality and morbidity when compared with traditional open surgery. Length of stay has been reduced by two-thirds with a marked reduction in postoperative pain and at-home convalescence. If the long-term data on efficacy and durability of these devices are good, most AAAs in the future will be treated with this minimally invasive technique. PMID:21845135

Sternbergh, W. Charles; Yoselevitz, Moises; Money, Samuel R.

1999-01-01

242

Laparoscopic total abdominal colectomy  

Microsoft Academic Search

The aim of this study was to prospectively assess the impact of laparoscopy upon the outcome of total abdominal colectomy (TAC). Specifically, patients underwent standard laparotomy with TAC and ileoproctostomy (TAC + IP), TAC and ileoanal reservoir (TAC + IAR), laparoscopically assisted TAC + IP (L-TAC + IP), or laparoscopically assisted TAC + IAR (L-TAC + IAR). Parameters studied included

Steven D. Wexner; Olaf B. Johansen; Juan J. Nogueras; David G. Jagelman

1992-01-01

243

Abdominal cerebrospinal fluid pseudocyst due to infection with enterococcus faecalis. A case report.  

PubMed

Abdominal cerebrospinal fluid pseudocyst is a rare complication of ventriculo-peritoneal shunt occurring as a result of non-absorption of cerebrospinal fluid from the abdominal cavity due to inflammation. Usual presentations include abdominal symptoms; abdominal distention, pain, nausea, vomiting and symptoms of raised intracranial pressure like headache due to shunt dysfunction. The diagnosis may be delayed in severely handicapped patients due to poor communicability, multiple associated complications or co-morbidities. Radiological modalities are used for diagnosis as well as treatment. PMID:24148340

Muttikkal, T J E; Dashti, K; Muqim, A T; Ben Nakhi, A; Hayat, A

2010-03-01

244

Abdominal Aortic Aneurysm (AAA) Screening  

MedlinePLUS

... covered? Search Medicare.gov for covered items Abdominal aortic aneurysm screening How often is it covered? Medicare Part B (Medical Insurance) covers a one-time abdominal aortic aneurysm ultrasound. You must get a referral for it ...

245

Abdominal cystic lymphangiomas: US and CT findings.  

PubMed

We retrospectively analyzed six cases of abdominal cystic lymphangiomas (CL), who had undergone surgical resection. These cases had been evaluated by several modalities: ultrasonography (US), computed tomography (CT), angiography and fine needle aspiration. No age predilection was found. All patients were symptomatic. The most common presenting symptoms were abdominal pain (66%), palpable mass (66%), fever (50%) and vomiting (30%). US showed septations (85%) and unicameral mass (15%); in three cases (50%) echogenic material within the cyst was found, probably due to hemorrhage and infection. CT showed capsular enhancement in all cases. Capsular and septation thickness were slightly increased in cases of infection or bleeding. At CT the contents were usually of fluid attenuation (66%); in 33% the attenuation values were higher, probably because of internal bleeding and infection. US was superior to CT in the demonstration of septations and the internal nature of the cysts. The major role of imaging is to demonstrate the cystic nature of these abdominal masses, because they do not have specific signs or symptoms that could allow a clinical diagnosis. PMID:7601168

Vargas-Serrano, B; Alegre-Bernal, N; Cortina-Moreno, B; Rodriguez-Romero, R; Sanchez-Ortega, F

1995-03-01

246

[Abdominal aortic aneurysm: an uncommon presentation].  

PubMed

Most abdominal aortic aneurysms are asymptomatic, being accidentally found on physical examination or in routinely performed imaging studies. They only require surveillance (which is variable according to the aneurism size) and medical therapy in order to achieve risk factor reduction. However, in certain situations, according to the risk of aneurism rupture, elective surgery or endovascular procedure may be necessary. About 80% of the cases of aneurism rupture occur into the retroperitoneal space, with a high mortality rate. There are uncommon presentations of aneurism rupture as the aorto-caval fistula, which also require fast diagnosis and intervention. The authors present the case of a 71-year-old man, with the previous diagnosis of hypertension, acute myocardial infarction 2 months earlier (undergone primary Percutaneous Coronary Intervention) and tabagism, who was admitted at the emergency department with intense 24-hour-evolution epigastric pain. On physical examination, the Blood Pressure values measured at the lower limbs were about half the ones measured at the upper limbs and there was an abdominal pulsatile mass, with a high-intensity murmur. As the authors suspected aortic dissection, aneurysm, coarctation or thrombosis, it was done a Computed Tomography scanning with intravenous contrast, which revealed a ruptured abdominal aorta aneurysm with a mural thrombus. The doppler ultrasound confirmed the presence of a high debit aorto-caval fistula. The patient was immediately transferred to the Vascular Surgery. However he died 2 hours later, during surgery. PMID:22525642

Taborda, Lúcia; Pereira, Laurinda; Amona, Eurides; Pinto, Erique Guedes; Rodrigues, Joaquim

2011-01-01

247

Non-traumatic lateral abdominal wall hernia.  

PubMed

A rare lateral abdominal wall hernia is described in an adult patient. This was diagnosed in a patient with a prominent right lateral abdominal wall deformity. The patient had been experiencing pain that increased progressively in severity over time. A computerized tomography (CT) scan of the abdomen revealed the location of the lateral abdominal wall defect. The hernia defect was through the transversus abdominis and the internal oblique, with the inferior aspect of the 11th rib forming part of the superior border of the defect. A 4-cm bony spur from the inferior aspect of the rib formed part of the lateral margin of the defect. The hernia sac was contained within a space underneath the external oblique muscle. The association of the hernia defect with a bony spur was highly suggestive of a congenital etiology. The hernia was successfully repaired laparoscopically with Parietex mesh (Sofradim, Lyons, France), and the patient had resolution of the symptoms on discharge and follow-up visits. PMID:18949442

Castillo-Sang, M; Gociman, B; Almaroof, B; Fath, J; Cason, F

2009-06-01

248

Intra-abdominal pulmonary secuestration as an exceptional cause of abdominal mass in the adult?  

PubMed Central

INTRODUCTION Pulmonary sequestration (PS) is an extremely rare malformation defined as a portion of lung tissue isolated from the pulmonary system. PSs are classified into intralobar type and intra-abdominal PS that represents only 2.5% of cases. There are 20 cases of PS reported in adults and only two were managed by laparoscopic approach. We report a case of intra-abdominal PS mimicking a gastroesophageal duplication cyst in an adult. Besides its rarity, this is the first intra-abdominal PS in an adult managed by an anterior laparoscopic approach. PRESENTATION OF CASE A 60-year-old female patient had had epigastric and left upper quadrant pain for several days. Physical examination was normal. Image test were consistent with a gastroesophageal duplication. The patient was taken to the operating room for laparoscopic exploration and resection. The pathological diagnosis was extralobar pulmonary sequestration. DISCUSSION Less than 20 cases of PS have been reported in adults and only two cases were managed by a lateral laparoscopic approach. In contrast to these reports, we used an anterior approach due to the GEJ suspected origin of the mass. CONCLUSION Extralobar intra-abdominal PS is an extremely rare condition during adulthood but this diagnosis should be included in the differential diagnosis of a left-sided suprarenal mass. Due to the difficulty in achieving a definitive preoperative diagnosis, surgery is recommended. Laparoscopic resection is safe and effective but careful preoperative imaging studies are recommended in order to plan the most suitable approach. PMID:24091075

Moreno-Sanz, C.; Herrero Bogajo, M.L.; Picazo-Yeste, J.; Morandeira Rivas, A.; Manzanera-Diaz, M.; Sedano-Vizcaino, C.

2013-01-01

249

Back Pain  

MedlinePLUS

... Oh, my aching back!", you are not alone. Back pain is one of the most common medical problems, ... 10 people at some point during their lives. Back pain can range from a dull, constant ache to ...

250

Back Pain  

MedlinePLUS

Back Pain The Centers for Disease Control and Prevention’s 2008 Health Report states that over 27% of the ... States population age 18 and older have active back pain. As many as 80-90% of Americans will ...

251

Breast pain  

MedlinePLUS

Pain - breast; Mastalgia; Mastodynia; Breast tenderness ... There are many possible causes for breast pain. For example, hormone level changes from menstruation or pregnancy often cause breast tenderness. Some amount of swelling and tenderness just before ...

252

Ribcage pain  

MedlinePLUS

... not cause the pain in those who have pleurisy (swelling of the lining of the lungs) or ... Inflammation of cartilage near the breastbone ( costochondritis ) Osteoporosis Pleurisy (the pain is worse when breathing deeply)

253

Neck Pain  

MedlinePLUS

... over-the counter medicine, such as acetaminophen or ibuprofen, to relieve pain, and apply heat to the ... an injury. Use anti-inflammatory medicines, such as ibuprofen and aspirin, to relieve pain and discomfort, and ...

254

Neuropathic Pain  

MedlinePLUS

... know that it can erode quality of life. Communication Tools View All Everyday Tools During Your Visit ... tires. Video Download Transcript Pain Matters This Discovery Channel documentary explores what chronic pain is, its individual ...

255

Pain Assessment  

Microsoft Academic Search

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

Frank Andrasik; Carla Rime

256

[Blunt abdominal trauma].  

PubMed

Serious intraabdominal injury due to intraabdominal hemorrhage, gastro-intestinal laceration with peritonitis or incarceration of abdominal organs. The most important question in the management is to ascertain a laparotomy or the diagnostic of a specific organ injury is needed. The peritoneal lavage is a great help in making this decision. The x-ray examinations of thorax, abdomen and bones are required. Adjunctive diagnostic modalities for subtile examination of organs are ultrasound, computed tomography and angiography. These examinations have a limited application. Exploratory laparotomy should be done if there are signs of peritoneal irritation with an increased tendency. 168 patients with blunt abdominal trauma where treated in Charity-hospital of Berlin. The laparotomy was necessary in 78 patients. In 70 cases we found organ injuries. It was pointed to splenic repair, the management of liver injury especially the packing of the laceration and the treatment of the injuries of gastro-intestinal tract, pancreas- and diaphragmatic rupture. PMID:3281391

Wolff, H; Lippert, H

1988-01-01

257

Managing Pain  

MedlinePLUS

... pain such as aching, burning, gnawing, grabbing • The effect of the pain on the patient and family (for example, is the family anxious or unsure about how to give the medicines; is the patient becoming irritable from lack of sleep because of the pain) What can be done? ...

258

Ultrasound-guided percutaneous drainage of a traumatic abdominal wall hematoma in the emergency department  

PubMed Central

BACKGROUND: Abdominal wall hematoma is due to trauma, coagulation disorders or anticoagulation therapy complications. METHODS: In this report we present a case of a 44-year-old female who suffered from blunt abdominal trauma and presented to the emergency department with sharp abdominal pain and ecchymosis. FAST and abdominal computerized tomography (CT) revealed an abdominal wall hematoma. Treatment with an ultrasound-guided percutaneous drainage was performed successfully. RESULTS: The patient remained under observation for six hours with serial ultrasound scans, and no signs of hematoma recurrence were present. She was discharged the same day with clinical improvement. CONCLUSION: Complete history investigation and clinical examination help to make a correct diagnosis of abdominal wall hematoma, select a prompt treatment, and reduce complications. PMID:25215083

Trujillo, Laura; Naranjo, Sara; Cardozo, Alejandro; Alvarez, Bryan

2012-01-01

259

[Abdominal catastrophe--surgeon's view].  

PubMed

Abdominal catastrophe is a serious clinical condition, usually being a complication arising during treatment of intraabdominal nontraumatic disorders or abdominal injuries. Most commonly, inflamation- secondary peritonitis, is concerned. Abdominal catastrophe also includes secondary signs of sepsis, abdominal compartment syndrome and enterocutaneous fistules. Most septic abdominal disorders which show signs of abdominal catastrophy, require surgical intervention and reinterventions--planned or "on demand" laparotomies. During the postoperative period, the patient requires intensive care management, including steps taken to stabilize his/hers condition, management of sepsis and metabolic and nutritional support measures, as well as adequate indication for reoperations. New technologies aimed at prevention of complications in laparostomies and to improve conditions for final laparotomy closure are used in phase procedures for surgical management of intraabdominal infections. Despite the new technologies, abdominal catastrophe has higher morbidity and lethality risk rates. PMID:20731313

Vyhnánek, F

2010-07-01

260

Complementary and Alternative Approaches for Chronic Pain  

Microsoft Academic Search

\\u000a Chronic pain in children and adolescents can be diffi cult to treat. Many parents and children are turning to complementary\\u000a and alternative medicine (CAM) to gain relief for conditions as varied as migraines, juvenile arthritis, sickle cell disease,\\u000a and functional abdominal pain (FAP). This chapter highlights some of the more well-known, safe, and effi cacious CAM treatments\\u000a for children and

Subhadra Evans; Lonnie K. Zeltzer

261

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

PubMed Central

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

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

2012-01-01

262

A new paradigm in chronic bladder pain.  

PubMed

ABSTRACT The concept of visceral pain has moved from organ-centered disease to a conceptualization based on pathophysiological mechanisms, integrating psychosocial and sexual dimensions. The terms painful bladder syndrome and bladder pain syndrome have been coined to include all patients with bladder pain. There is substantial overlap between IC/BPS and other pelvic/abdominal pain syndromes IC/BPS is likely to be underdiagnosed and undertreated in both men and women IC/BPS requires a multidisciplinary team approach toward management. This report is adapted from paineurope 2014; Issue 2, ©Haymarket Medical Publications Ltd, and is presented with permission. Paineurope is provided as a service to pain management by Mundipharma International, LTD and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication. PMID:25348226

Wesselmann, Ursula

2014-12-01

263

Contralateral Abdominal Pocketing in Salvation of Replanted Fingertips with Compromised Circulation  

PubMed Central

Abdominal pocketing is one of the most useful methods in salvation of compromised replanted fingertips. Abdominal pocketing has generally been performed in the ipsilateral lower abdominal quadrant, but we have also performed contralateral pocketing at our institute. To determine which approach is more beneficial, a total of 40 patients underwent an abdominal pocketing procedure in either the ipsilateral or contralateral lower abdominal quadrant after fingertip replantation. Dates of abdominal pocketing after initial replantation, detachment after abdominal pocketing, range of motion (ROM) before abdominal pocketing, and sequential ROM after the detachment operation and date of full ROM recovery and Disabilities of Arm, Shoulder, and Hand questionnaire (DASH) score were recorded through medical chart review. Mean detachment date, mean abduction of shoulder after the detachment operation, and mean days to return to full ROM were not significantly different between the ipsilateral and contralateral pocketing groups. However, the mean DASH score was significantly lower in the contralateral group than the ipsilateral group. There were also fewer postoperative wound complications in the contralateral group than in the ipsilateral group. We, therefore, recommend contralateral abdominal pocketing rather than ipsilateral abdominal pocketing to increase patient comfort and reduce pain and complications. PMID:25379539

Shim, Hyung-Sup; Kim, Dong-Hwi; Kwon, Ho; Jung, Sung-No

2014-01-01

264

Pain Genes  

PubMed Central

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 pain pathways using model organisms have identified the molecular nature of the transducers, regulatory mechanisms involved in changing neuronal activity, as well as the critical role of immune system cells in driving pain pathways. In man, mapping of human pain mutants as well as twin studies and association studies of altered pain behaviour have identified important regulators of the pain system. In turn, new drug targets for chronic pain treatment have been validated in transgenic mouse studies. Thus, genetic studies of pain pathways have complemented the traditional neuroscience approaches of electrophysiology and pharmacology to give us fresh insights into the molecular basis of pain perception. PMID:18654615

Foulkes, Tom; Wood, John N.

2008-01-01

265

Complicated intra-abdominal infections: a focus on appendicitis and diverticulitis.  

PubMed

Severe abdominal pain is a common complaint encountered by primary care and emergency room physicians. Caused by many conditions, including appendicitis and diverticulitis, severe abdominal pain may be a diagnostic challenge. Although different in many ways, appendicitis and diverticulitis are caused by obstruction of a blind pouch that leads to inflammation of the structure and surrounding tissue. Appendicitis and diverticulitis are 2 of the most frequently diagnosed causes of complicated intra-abdominal infections. Combined, appendicitis and diverticulitis comprise > 80% of all community-acquired complicated intra-abdominal infections. These conditions are serious and require prompt diagnosis and treatment. Because complicated intra-abdominal infections are typically polymicrobial, a wide variety of causative pathogens are identified, including Gram-positive and Gram-negative aerobic and anaerobic microorganisms. Treatment for these disorders often requires surgical and medical management. Although surgical intervention can be the definitive treatment for complicated intra-abdominal infections, successful management of appendicitis and diverticulitis will depend on appropriate selection of antimicrobials and optimal duration of therapy to maximize the coverage of potential causative pathogens and to minimize the development of resistance. Guidelines for empiric treatment of complicated intra-abdominal infections recommend broad-spectrum antimicrobials as monotherapy or in combinations, including standard antimicrobial regimens, such as piperacillin/tazobactam, imipenem/cilastatin, and piperacillin-tazobactam/amoxicillin-clavulanate regimens, and fluoroquinolone-based regimens. This review article compares the presentations and treatments of these common complicated intra-abdominal infections. PMID:20107288

Spirt, Mitchell J

2010-01-01

266

Complex abdominal wall repair using a porcine dermal matrix.  

PubMed

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

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

2013-12-01

267

Abdominal imaging: An introduction  

SciTech Connect

This nine-chapter book gives an overview of the integrated approach to abdominal imaging. Chapter 1 provides an introduction to the physics used in medical imaging; chapter 2 is on the selection of imaging modalities. These are followed by four chapters that deal, respectively, with plain radiography, computed tomographic scanning, sonography, and nuclear imaging, as applied to the abdomen. Two chapters then cover contrast material-enhanced studies of the gastrointestinal (GI) tract: one focusing on technical considerations; the other, on radiologic study of disease processes. The final chapter is a brief account of different interventional procedures.

Frick, M.P.; Feinberg, S.B.

1986-01-01

268

Blunt abdominal aortic trauma.  

PubMed

Due to its well protected position within the abdomen, blunt injuries to the abdominal aorta are uncommon. A review of previous reports in the literature, together with four new cases, are presented here. Motor car accidents are the most common cause of this injury, especially if seat belts are worn. Associated gastrointestinal injuries did not lead to any increased mortality; however, delay in the diagnosis was a significant factor in the deaths of several patients. Prompt recognition and early surgical management are essential in the treatment of this problem. PMID:2334357

Frydenberg, M; Royle, J P; Hoare, M

1990-05-01

269

Chronic Pelvic Pain  

MedlinePLUS

... Family > Conditions & Treatments > Pain Disorders > Chronic Pelvic Pain Chronic Pelvic Pain Page Content Pelvic pain is an uncommon but ... and can be injured or weakened causing pain Chronic pain can continue long after tissue injury has healed, ...

270

Low back pain - chronic  

MedlinePLUS

Nonspecific back pain; Backache - chronic; Lumbar pain - chronic; Pain - back - chronic; Chronic back pain - low ... your waist, leads to pain. Many people with chronic back pain have arthritis. Or they may have extra wear ...

271

Chronic Pain  

Microsoft Academic Search

\\u000a \\u000a \\u000a \\u000a \\u000a 1. \\u000a \\u000a Non-cancer-related pain that lasts longer than 3 months is considered chronic pain.\\u000a \\u000a \\u000a \\u000a 2. \\u000a \\u000a According to the National Institutes of Health, chronic pain is the third largest health problem in the world.\\u000a \\u000a \\u000a \\u000a 3. \\u000a \\u000a Approximately 25 million Americans are affected by chronic pain.\\u000a \\u000a \\u000a \\u000a 4. \\u000a \\u000a Chronic pain is one of the most common problems seen in primary care clinics. Pain-related problems account

Jim Nuovo

272

Abdominal MR Elastography  

PubMed Central

MR Elastography (MRE) is an MRI-based technique for quantitatively assessing the mechanical properties of tissues, based on the propagation of shear waves. Multiple studies have described many potential applications of MRE, from characterizing tumors to detecting diffuse disease processes. Studies have shown that MRE can be successfully implemented to assess abdominal organs. The first clinical application MRE to be well documented is the detection and characterization of hepatic fibrosis, which systematically increases the stiffness of liver tissue. In this diagnostic role, offers a safer, and less expensive, and potentially more accurate alternative to invasive liver biopsy. Emerging results suggest that measurements of liver and spleen stiffness may provide an indirect way to assess portal hypertension. Preliminary studies have demonstrated that is possible to use MRE to evaluate the mechanical properties of other abdominal structures, such as the pancreas and kidneys. Steady technical progress in developing practical protocols for applying MRE in the abdomen and pelvis provides opportunities to explore many other potential applications of this emerging technology. PMID:20010062

Yin, Meng; Chen, Jun; Glaser, Kevin J.; Talwalkar, Jayant A.; Ehman, Richard L.

2011-01-01

273

Abdominal aortic aneurysms.  

PubMed

Key Clinical Points Abdominal Aortic Aneurysms Abdominal aortic aneurysms are usually asymptomatic until they rupture, with an ensuing mortality of 85 to 90%. Symptomatic patients require urgent repair. U.S. Preventive Services Task Force recommendations support screening in men 65 to 75 years of age with a history of smoking and selective screening in men 65 to 75 years of age without a smoking history, although the optimal cohort to be screened remains controversial. The usual threshold for elective repair is an aortic diameter of 5.5 cm in men and 5.0 cm in women. Endovascular repair results in lower perioperative morbidity and mortality than open repair, but the two methods are associated with similar mortality in the long term (8 to 10 years). Patients treated with endovascular repair require long-term surveillance owing to a small risk of aneurysm sac reperfusion and late rupture. Decisions regarding prophylactic repair - whether to pursue it and, if so, what type of repair to perform - must take into account anatomy (not all patients have anatomy amenable to endovascular repair), operative risk, and patient preference. PMID:25427112

Kent, K Craig

2014-11-27

274

Central pain.  

PubMed

ABSTRACT Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. The topic addressed in this issue is central pain, a neuropathic pain syndrome caused by a lesion in the brain or spinal cord that sensitizes one's perception of pain. It is a debilitating condition caused by various diseases such as multiple sclerosis, strokes, spinal cord injuries, or brain tumors. Varied symptoms and the use of pharmacological medicines and nonpharmacological therapies will be addressed. PMID:25295639

Singh, Supreet

2014-12-01

275

Bloody or tarry stools  

MedlinePLUS

... small intestine Diverticulosis (abnormal pouches in the colon) Hemorrhoids (common cause of bright red blood) Inflammatory bowel ... by your doctor, even if you think that hemorrhoids are causing the blood in your stool. In ...

276

Pain channelopathies  

PubMed Central

Pain remains a major clinical challenge, severely afflicting around 6% of the population at any one time. Channelopathies that underlie monogenic human pain syndromes are of great clinical relevance, as cell surface ion channels are tractable drug targets. The recent discovery that loss-of-function mutations in the sodium channel Nav1.7 underlie a recessive pain-free state in otherwise normal people is particularly significant. Deletion of channel-encoding genes in mice has also provided insights into mammalian pain mechanisms. Ion channels expressed by immune system cells (e.g. P2X7) have been shown to play a pivotal role in changing pain thresholds, whilst channels involved in sensory transduction (e.g. TRPV1), the regulation of neuronal excitability (potassium channels), action potential propagation (sodium channels) and neurotransmitter release (calcium channels) have all been shown to be potentially selective analgesic drug targets in some animal pain models. Migraine and visceral pain have also been associated with voltage-gated ion channel mutations. Insights into such channelopathies thus provide us with a number of potential targets to control pain. PMID:20142270

Cregg, Roman; Momin, Aliakmal; Rugiero, Francois; Wood, John N; Zhao, Jing

2010-01-01

277

Pain Genes  

Microsoft Academic Search

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

Tom Foulkes; John N. Wood

2008-01-01

278

JAMA Patient Page: Abdominal Hernia  

MedlinePLUS

... movement • Cystic fibrosis and chronic lung infections • Previous abdominal surgery COMPLICATIONS A hernia may result in entrapment of other organs (such as the bladder or colon) or nerves, producing constipation or problems with ... of the abdominal cavity) needing surgical removal of part of the ...

279

Relationships Between Family and Parent Characteristics and Functional Abilities in Children with Recurrent Pain Syndromes: An Investigation of Moderating Effects on the Pathway from Pain to Disability  

Microsoft Academic Search

Objective To identify family characteristics associated with children's ability to function with recurrent pain. Methods Seventy-eight children ages 7-17 years with recurrent pain syndromes (migraine headache or recurrent abdominal pain (RAP)) were recruited from clinic settings. Children completed pain diaries and the Functional Disability Inventory (FDI). Mothers and fathers completed self-report measures of psychological distress, and mothers reported on family

Deirdre E. Logan; Lisa Scharff

2005-01-01

280

Abdominal Actinomycosis Associated with a Sigmoid Colon Perforation in a Patient with a Ventriculoperitoneal Shunt  

PubMed Central

Abdominal actinomycosis causing hydronephrosis in a patient with a ventriculoperitoneal shunt is very rare. A 27-year-old female patient was admitted complaining of lower abdominal pain. She had undergone ventriculoperitoneal shunt surgery 10 years ago. Abdominal Ultrasonography and a CT scan demonstrated an inflammatory mass in the lower left quadrant of the abdomen causing obstructive hydroureter and hydronephrosis. Laparotomy revealed a diffusely infiltrating mass involving the small bowel, mesentery, and sigmoid colon, and a 1 cm perforation in the sigmoid colon. Actinomycosis was diagnosed upon histological examination. After treatment with antibiotics and surgery, the patient's condition improved. PMID:16941752

Jung, Eun-Young; Choi, Su-Nyoung; Park, Dong-Jun; You, Jin-Jong; Kim, Hyun-Jung

2006-01-01

281

Intra-abdominal insertion of sewing needles: a rare method of child abuse.  

PubMed

The insertion of sewing needles into the abdominal cavity is an uncommon form of child abuse. We report a 2-and-a-half-year-old boy with 2 intra-abdominal sewing needles that were discovered during the evaluation of chronic abdominal pain and vomiting. This case report illustrates the wide range with which abusive injury can present in children. Pediatricians need to be alerted to this newly-recognized and the increasing form of child abuse so that they examine and diagnose their patients appropriately. PMID:24188948

Alshamrani, Hussain; Bakhswain, Amal; Habib, Zakaria; Kattan, Hoda

2013-01-01

282

Metastatic pleomorphic carcinoma of lung presenting as abdominal pain.  

PubMed Central

Pleomorphic carcinoma of lung is a rare subtype that has a propensity to metastasize to the small bowel. This rarely encountered tumor may present a diagnostic challenge to pathologists and result in delay that could impact clinical decisions. Lung cancer can metastasize to any organ in the body; however, clinical manifestations of metastasis to the small bowel are a relatively rare event. Because they are so rare, small-bowel metastases are usually seen only at autopsy. Clinical presentation of small-bowel metastasis of lung cancer may represent a terminal event if not recognized and surgically resolved. Prompt surgical intervention may significantly extend the life of the patient. Images Figure 1 Figure 2 Figure 3 Figure 4 PMID:15622698

Burnette, Robert E.; Ballard, Billy R.

2004-01-01

283

Urination - painful  

MedlinePLUS

... atrophic vaginitis ) Herpes infection in the genital area Irritation of the vaginal tissue caused by bubble bath, perfumes, or lotions Vulvovaginitis , such as yeast or other infections of the vulva and vagina Other causes of painful urination include: ...

284

Back Pain  

MedlinePLUS

... The procedure is generally performed on an outpatient basis under a mild anesthetic. 3 Used only if ... some cases it is performed on an outpatient basis. For diskogenic low back pain (degenerative disk disease): ...

285

Abdominal Aortic Aneurysm Presenting as a Claudication  

PubMed Central

Back pain and radiating pain to the legs are the most common symptoms encountered in routine neurosurgical practice and usually originates from neurogenic causes including spinal stenosis. The clinial symptoms are often confused with symptoms of peripheral neuropathy, musculo-skeletal disease and vascular disease in elderly patients. Because it is not easy to distinguish out the cause of symptoms by only physical examination, routine spinal MRI is checked first to rule out the spinal diseases in most outpatient clinics. Although it is obvious that spinal MRI is a very strong tool to investigate the spinal circumferences, most spine surgeons ignore the importance of looking at all aspects of their imaging and of remembering the extra-spinal causes of radiculopathy. A 68-year-old man who presented with a sudden aggravated both leg claudication. Although his symptom was mimicked for his long standing neurogenic claudication due to spinal stenosis diagnosed previously, abdominal aortic aneurysm(AAA) was found on routine lumbar MRI and it was repaired successfully. We emphasize to spinal surgeons the importance of remembering to look wider on routine MRI images when considering differential diagnoses in the outpatient clinic and to remember the extra-spinal causes of radiculopathy, especially when encountering in elderly patients. PMID:24891862

Son, Si-Hoon; Kim, Kyoung-Tae; Cho, Dae-Chul

2013-01-01

286

Abdominal aortic aneurysm presenting as a claudication.  

PubMed

Back pain and radiating pain to the legs are the most common symptoms encountered in routine neurosurgical practice and usually originates from neurogenic causes including spinal stenosis. The clinial symptoms are often confused with symptoms of peripheral neuropathy, musculo-skeletal disease and vascular disease in elderly patients. Because it is not easy to distinguish out the cause of symptoms by only physical examination, routine spinal MRI is checked first to rule out the spinal diseases in most outpatient clinics. Although it is obvious that spinal MRI is a very strong tool to investigate the spinal circumferences, most spine surgeons ignore the importance of looking at all aspects of their imaging and of remembering the extra-spinal causes of radiculopathy. A 68-year-old man who presented with a sudden aggravated both leg claudication. Although his symptom was mimicked for his long standing neurogenic claudication due to spinal stenosis diagnosed previously, abdominal aortic aneurysm(AAA) was found on routine lumbar MRI and it was repaired successfully. We emphasize to spinal surgeons the importance of remembering to look wider on routine MRI images when considering differential diagnoses in the outpatient clinic and to remember the extra-spinal causes of radiculopathy, especially when encountering in elderly patients. PMID:24891862

Son, Si-Hoon; Chung, Seok-Won; Kim, Kyoung-Tae; Cho, Dae-Chul

2013-12-01

287

Abdominal aortic feminism.  

PubMed

A 79-year-old woman presented to a private medical practice 2?years previously for an elective ultrasound screening scan. This imaging provided the evidence for a diagnosis of an abdominal aortic aneurysm (AAA) to be made. Despite having a number of recognised risk factors for an AAA, her general practitioner at the time did not follow the guidance set out by the private medical professional, that is, to refer the patient to a vascular specialist to be entered into a surveillance programme and surgically evaluated. The patient became symptomatic with her AAA, was admitted to hospital and found to have a tender, symptomatic, 6?cm leaking AAA. She consented for an emergency open AAA repair within a few hours of being admitted to hospital, despite the 50% perioperative mortality risk. The patient spent 4?days in intensive care where she recovered well. She was discharged after a 12?day hospital stay but unfortunately passed away shortly after her discharge from a previously undiagnosed gastric cancer. PMID:25398912

Mortimer, Alice Emily

2014-01-01

288

Neonatal pain  

PubMed Central

Effective management of procedural and postoperative pain in neonates is required to minimize acute physiological and behavioral distress and may also improve acute and long-term outcomes. Painful stimuli activate nociceptive pathways, from the periphery to the cortex, in neonates and behavioral responses form the basis for validated pain assessment tools. However, there is an increasing awareness of the need to not only reduce acute behavioral responses to pain in neonates, but also to protect the developing nervous system from persistent sensitization of pain pathways and potential damaging effects of altered neural activity on central nervous system development. Analgesic requirements are influenced by age-related changes in both pharmacokinetic and pharmacodynamic response, and increasing data are available to guide safe and effective dosing with opioids and paracetamol. Regional analgesic techniques provide effective perioperative analgesia, but higher complication rates in neonates emphasize the importance of monitoring and choice of the most appropriate drug and dose. There have been significant improvements in the understanding and management of neonatal pain, but additional research evidence will further reduce the need to extrapolate data from older age groups. Translation into improved clinical care will continue to depend on an integrated approach to implementation that encompasses assessment and titration against individual response, education and training, and audit and feedback. PMID:24330444

Walker, Suellen M

2014-01-01

289

Bedside Testing for Chronic Pelvic Pain: Discriminating Visceral from Somatic Pain  

PubMed Central

Objectives. This study was done to evaluate three bedside tests in discriminating visceral pain from somatic pain among women with chronic pelvic pain. Study Design. The study was an exploratory cross-sectional evaluation of 81 women with chronic pelvic pain of 6 or more months' duration. Tests included abdominal cutaneous allodynia (aCA), perineal cutaneous allodynia (pCA), abdominal and perineal myofascial trigger points (aMFTP) and (pMFTP), and reduced pain thresholds (RPTs). Results. Eighty-one women were recruited, and all women provided informed consent. There were 62 women with apparent visceral pain and 19 with apparent somatic sources of pain. The positive predictive values for pelvic visceral disease were aCA-93%, pCA-91%, aMFTP-93%, pMFTP-81%, and RPT-79%. The likelihood ratio (+) and 95% C.I. for the detection of visceral sources of pain were aCA-4.19 (1.46, 12.0), pCA-2.91 (1.19, 7.11), aMTRP-4.19 (1.46, 12.0), pMFTP-1.35 (0.86, 2.13), and RPT-1.14 (0.85, 1.52), respectively. Conclusions. Tests of cutaneous allodynia, myofascial trigger points, and reduced pain thresholds are easily applied and well tolerated. The tests for cutaneous allodynia appear to have the greatest likelihood of identifying a visceral source of pain compared to somatic sources of pain. PMID:22135736

Jarrell, John; Giamberardino, Maria Adele; Robert, Magali; Nasr-Esfahani, Maryam

2011-01-01

290

Groin pain in athletes.  

PubMed

Groin pain in athletes is not infrequently a cause of frustration and aggravation to both doctor and patient. Complaints in the groin region can prove difficult to diagnose, particularly when they are of a chronic nature. These injuries are seen more commonly in sports that require specific use (or overuse) of the proximal musculature of the thigh and lower abdominal muscles. Some of the more common sports would be soccer, skiing, hurdling, and hockey. The differential diagnosis can cover a rather broad area of possibilities. Most common groin injuries are soft-tissue injuries, such as muscular strains, tendinitis, or contusions. More difficult areas to pinpoint are such entities as osteitis pubis, nerve entrapment, the so-called "sports hernia," or avulsion fractures, to name but a few. The evaluation of such patients includes a familiarity with the sport and possible mechanism of injury (i.e., taking a careful history), meticulous physical examination of the groin, abdomen, hips, spine, and lower extremities. Diagnostic examinations may or may not prove helpful in formulating a final diagnosis. Some patients may be required to undergo procedures, such as laparoscopic evaluation of the region to obtain adequate information that allows a proper diagnosis and treatment plan. This article describes many of the possible causes of groin pain in athletes. The list is quite lengthy, and only the more common problems will be discussed in detail. PMID:12820026

LeBlanc, Kim Edward; LeBlanc, Karl A

2003-06-01

291

JAMA Patient Page: Abdominal Paracentesis  

MedlinePLUS

... organs), severe bowel or bladder distention, and previous abdominal-pelvic surgery may increase the risk of the procedure. In those situations, an ultrasound-guided paracentesis should be considered. Procedural complications are rare but can include ANALYSIS OF ASCITIC ...

292

Laparoscopic Inguinal Exploration and Mesh Placement for Chronic Pelvic Pain  

PubMed Central

Background and Objective: Chronic pelvic pain affects 15% of women. Our objective was to evaluate empiric laparoscopic inguinal exploration and mesh placement in this population. Methods: Retrospective cohort with follow-up questionnaire of women with lateralizing chronic pelvic pain (right or left), ipsilateral inguinal tenderness on pelvic examination, no clinical hernia on abdominal examination, and ipsilateral empiric laparoscopic inguinal exploration with mesh placement (2003–2009). Primary outcome was pain level at the last postoperative visit. Secondary outcomes were pain level and SF-36 scores from the follow-up questionnaire. Results: Forty-eight cases met the study criteria. Surgery was done empirically for all patients, with only 7 patients (15%) found to have an ipsilateral patent processus vaginalis (shallow peritoneal dimple or a deeper defect (occult hernia)). Of 43 cases informative for the primary outcome, there was pain improvement in 15 patients (35%); pain improvement then return of the pain in 18 patients (42%); and pain unchanged in 9 patients (21%) and worse in 1 patient (2%). Improvement in pain was associated with a positive Carnett's test in the ipsilateral abdominal lower quadrant (P = .024). Thirteen patients returned the questionnaire (27%), and the pain was now described as improved in 9 patients (69%), unchanged in 4 patients (31%), and worse in none. Three SF-36 subscales showed improvement (physical functioning, social functioning, and pain). Conclusion: In select women with chronic pelvic pain, empiric laparoscopic inguinal exploration and mesh placement results in moderate improvement in outcome. A positive Carnett's test in the ipsilateral abdominal lower quadrant is a predictor of better outcome. PMID:23743375

Williams, Christina; Allaire, Catherine

2013-01-01

293

Cancer pain (classification and pain syndromes).  

PubMed

Inspite the new informations about the physiology and biochemistry of pain, it remains true that pain is only partially understood. Cancer pain is often experienced as several different types of pain, with combined somatic and neuropathic types the most frequently. If the acute cancer pain does not subside with initial therapy, patients experience pain of more constant nature, the characteristics of wich vary with the cause and the involved sites. Chronic pain related to cancer can be considered as tumor-induced pain, chemotherapy-induced pain, and radiation therapy-induced pain. Certain pain mechanisms are present in cancer patients. These include inflammation due to infection, such as local sepsis or the pain of herpes zoster, and pain due to the obstruction or occlusion of a hollow organ, such as that caused by large bowel in cancer of colon. Pain also is commonly due to destruction of tissue, such as is often seen with bony metastases. Bony metastases also produce pain because of periostal irritation, medullary pressure, and fractures. Pain may be produced by the growth of tumor in a closed area richly supplied with pain receptors (nociceptors). Examples are tumors growing within the capsule of an organ such as the pancreas. Chest pain occurring after tumor of the lung or the mediastinum due to invasion of the pleura. Certain tumors produce characteristic types of pain. For example, back pain is seen with multiple myeloma, and severe shoulder pain and arm pain is seen with Pancoast tumors. PMID:16018403

Slavik, E; Ivanovi?, S; Grujici?, D

2004-01-01

294

Abdominal ultrasonography, 2nd Ed  

SciTech Connect

This volume is a new and updated edition of an extensively illustrated text and reference on the capabilities and imaging of gray scale ultrasonography for each major abdominal organ. Each major organ system is treated separately, including liver, gallbladder and bile ducts, pancreas, kidney, retroperitoneum, abdominal vasculature, and more. There are over 500 illustrations and ten pages of full color plates for cross sectional anatomy.

Goldberg, B.B.

1984-01-01

295

Abdominal intrauterine vacuum aspiration.  

PubMed

Evaluating and "cleaning" of the uterine cavity is probably the most performed operation in women. It is done for several reasons: abortion, evaluation of irregular bleeding in premenopausal period, and postmenopausal bleeding. Abortion is undoubtedly the number one procedure with more than 44 million pregnancies terminated every year. This procedure should not be underestimated and a careful preoperative evaluation is needed. Ideally a sensitive pregnancy test should be done together with an ultrasound in order to confirm a uterine pregnancy, excluding extra-uterine pregnancy, and to detect genital and/or uterine malformations. Three out of four abortions are performed by surgical methods. Surgical methods include a sharp, blunt, and suction curettage. Suction curettage or vacuum aspiration is the preferred method. Despite the fact that it is a relative safe procedure with major complications in less than one percent of cases, it is still responsible for 13% of all maternal deaths. All the figures have not declined in the last decade. Trauma, perforation, and bleeding are a danger triage. When there is a perforation, a laparoscopy should be performed immediately, in order to detect intra-abdominal lacerations and bleeding. The bleeding should be stopped as soon as possible in order to not destabilize the patient. When there is a perforation in the uterus, this "entrance" can be used to perform the curettage. This is particularly useful if there is trauma of the isthmus and uterine wall, and it is difficult to identify the uterine canal. A curettage is a frequent performed procedure, which should not be underestimated. If there is a perforation in the uterus, then this opening can safely be used for vacuum aspiration. PMID:25134300

Tjalma, W A A

2014-01-01

296

Muscle activation during exercises to improve trunk stability in men with low back pain  

Microsoft Academic Search

Hubley-Kozey CL, Vezina MJ. Muscle activation during exercises to improve trunk stability in men with low back pain. Arch Phys Med Rehabil 2002;83:1100-8. Objectives: To evaluate the relative activation amplitudes from 3 abdominal and 2 trunk extensor muscle sites of persons with low back pain (LBP) performing the pelvic-tilt, the abdominal-hollowing, and level 1 of the trunk stability test (TST)

Cheryl L. Hubley-Kozey; M. Johanne Vezina

2002-01-01

297

Rare etiology of mechanical intestinal obstruction: Abdominal cocoon syndrome  

PubMed Central

Abdominal cocoon syndrome is a rare cause of intestinal obstruction with unknown etiology. Diagnosis of this syndrome, which can be summarized as the small intestine being surrounded by a fibrous capsule not containing the mesothelium, is difficult in the preoperative period. A 47-year-old male patient was referred to the emergency department with complaints of abdominal pain, nausea, and vomiting for two days. The abdominal computed tomography examination detected dilated small intestinal loops containing air-fluid levels clustered in the left upper quadrant of the abdomen and surrounded by a thick, saclike, contrast-enhanced membrane. During exploratory surgery, a capsular structure was identified in the upper left quadrant with a regular surface that was solid-fibrous in nature. Abdominal cocoon syndrome is a rarely seen condition, for which the preoperative diagnosis is difficult. The combination of physical examination and radiological signs, and the knowledge of “recurrent characteristics of the complaints” that can be learned by a careful history, may be helpful in diagnosis.

Uzunoglu, Yener; Altintoprak, Fatih; Yalkin, Omer; Gunduz, Yasemin; Cakmak, Guner; Ozkan, Orhan V; Celebi, Fehmi

2014-01-01

298

Malignant Schwannoma of Anterior Abdominal Wall: Report of a Case  

PubMed Central

Malignant schwannoma of the anterior abdominal wall nerves is extremely rare. Malignant peripheral nerve sheath tumors (MPNST) represent approximately 10% of all soft tissue sarcomas and it is found in 4% of patients with neurofibromatosis 1. We present a case of malignant schwannoma in a 28-year-old female patient with neurofibromatosis 1. She presented with a painful mass in the right upper quadrant of her abdomen. The tumor location was in the abdominal wall in explorative laparatomy and malignant schwannoma was diagnosed in pathologic assessment. The tumor recurred in 3 months and computed tomography showed two masses in the right side of abdominopelvic cavity. Thereafter, second complete surgical resection was performed and pathologic finding was the same. In spite of administering chemotherapy after second surgery,the tumor recurred and magnetic resonance imaging finding showed a huge heterogeneously enhancing mass with adhesion to the inner side of the abdominal wall. The patient died because of acute respiratory failure due to multiple bilateral pulmonary metastases. Tumor location and rapid recurrence was unique in our patient. Keywords Malignant peripheral nerve sheath tumor; Malignant schwannoma; Abdominal wall PMID:22461875

Khorgami, Zhamak; Nasiri, Shirzad; Rezakhanlu, Freshteh; Sodagari, Nassim

2009-01-01

299

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

PubMed Central

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

D'Haese, Jan G; Hartel, Mark; Demir, Ihsan Ekin; Hinz, Ulf; Bergmann, Frank; Buchler, Markus W; Friess, Helmut; Ceyhan, Guralp O

2014-01-01

300

Pain and chronic pancreatitis: A complex interplay of multiple mechanisms  

PubMed Central

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

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

2013-01-01

301

Diagnosis and management of angioedema with abdominal involvement: A gastroenterology perspective  

PubMed Central

Abdominal involvement in angioedema is often a challenge to diagnose. Acute onset abdominal pain is its most common presenting symptom, and misdiagnosis may lead to unnecessary surgical intervention. Familiarity with the types and presentations of angioedema can be invaluable to clinicians as they consider the differential diagnoses of a patient presenting with abdominal pain. Detailed personal and family histories, careful physical examination of the patient, combined with knowledge of angioedema types, can help clinicians perform their diagnostic evaluation. An accurate diagnosis is essential in order to provide appropriate treatment to patients with angioedema. Depending upon the diagnosis, treatment may be the avoidance of provoking factors (such as allergens or medications), inhibiting histamine-provoked reactions, or treating C1 esterase inhibitor deficiency. PMID:20954277

Nzeako, Ugochukwu C

2010-01-01

302

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

PubMed Central

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

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

2013-01-01

303

Clear Cell Adenocarcinoma Arising from Abdominal Wall Endometriosis  

PubMed Central

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

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

2008-01-01

304

Peritoneal Response to Abdominal Surgery: The Role of Equine Abdominal Adhesions and Current Prophylactic Strategies  

PubMed Central

Intra-abdominal adhesions constitute a significant clinical and surgical problem that can lead to complications such as pain and bowel occlusion or subocclusion. These adhesions are frustrating and potentially fatal, representing a major postoperative complication in abdominal surgery. It is estimated that 32% of horses undergoing laparotomy will present clinical symptoms due to adhesions, but the true prevalence is not known because a large proportion of animals with postoperative recurrent colics are medically treated or submitted to euthanasia without necropsy. Adhesions are highly cellular, vascularized, dynamic structures that are influenced by complex signaling mechanisms. Understanding their pathogenesis could assist in applying better therapeutic strategies and in developing more effective antiadhesion products. Currently, there are no definitive strategies that prevent adhesion formation, and it is difficult to interpret the results of existing studies due to nonstandardization of an induction model and evaluation of their severity. The best clinical results have been obtained from using minimally traumatic surgical techniques, anti-inflammatory agents, antimicrobials, anticoagulants, and mechanical separation of serosal surfaces by viscous intraperitoneal solutions or physical barriers. This paper aims to review adhesion formation pathogenesis, guide the understanding of major products and drugs used to inhibit adhesion formation, and address their effectiveness in the equine species. PMID:24587939

Alonso, Juliana de Moura; Alves, Ana Liz Garcia; Watanabe, Marcos Jun; Rodrigues, Celso Antonio; Hussni, Carlos Alberto

2014-01-01

305

[Social pain].  

PubMed

This chapter focuses on what social pain is and how it should be managed. In order to understand social pain in a cancer patient, it is necessary to recognize the change in the patient's daily life after the diagnosis of cancer. Because the degree of suffering and the relationships with family members and the people he or she worked with differ from patient to patient, it is important to note that the context of social pain is different in each patient. Five points shown below are essential in managing social pain. 1. Economical suffering may be alleviated by utilization of the social security system while taking into account each patient's standard of living. 2. Burdens on family members should be lessened, such as by not having them stay at the patient's bedside every day and letting them go home occasionally. 3. The normal patterns of communication, support, and conflict in the family should be identified, and the extent to which they have been disrupted by the illness should be assessed. 4. It is important to understand the ethnic, cultural, and religious background of the patient and the potential impact of their influence on the individual and the illness. 5. Practical or emotional unfinished business that the patient has needs to be identified, and efforts should be made to support fulfillment. PMID:21950034

Shimoyama, Naohito; Shimoyama, Megumi

2011-09-01

306

Heel Pain  

MedlinePLUS

... or other soft-tissue growth. Prevention A variety of steps can be taken to avoid heel pain and accompanying afflictions: Wear shoes that fit well—front, back, and sides—and have shock-absorbent soles, rigid shanks, and supportive heel counters Wear the proper shoes for each activity Do not wear ...

307

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 ...

308

Fetal pain?  

Microsoft Academic Search

During the last few years a vivid debate, both scientifically and emotionally, has risen in the medical literature as to whether a fetus is able to feel pain during abortion or intrauterine surgery. This debate has mainly been inspired by the demonstration of various hormonal or motor reactions to noxious stimuli at very early stages of fetal development. The aims

Sampsa Vanhatalo; Onno van Nieuwenhuizen

2000-01-01

309

Abdominal radiation causes bacterial translocation  

SciTech Connect

The purpose of this study was to determine if a single dose of radiation to the rat abdomen leads to bacterial translocation into the mesenteric lymph nodes (MLN). A second issue addressed was whether translocation correlates with anatomic damage to the mucosa. The radiated group (1100 cGy) which received anesthesia also was compared with a control group and a third group which received anesthesia alone but no abdominal radiation. Abdominal radiation lead to 100% positive cultures of MLN between 12 hr and 4 days postradiation. Bacterial translocation was almost nonexistent in the control and anesthesia group. Signs of inflammation and ulceration of the intestinal mucosa were not seen until Day 3 postradiation. Mucosal damage was maximal by Day 4. Bacterial translocation onto the MLN after a single dose of abdominal radiation was not apparently dependent on anatomical, histologic damage of the mucosa.

Guzman-Stein, G.; Bonsack, M.; Liberty, J.; Delaney, J.P.

1989-02-01

310

Complex Regional Pain Syndrome  

MedlinePLUS

Complex regional pain syndrome (CRPS) is a chronic pain condition. It causes intense pain, usually in the arms, hands, legs, or feet. ... in skin temperature, color, or texture Intense burning pain Extreme skin sensitivity Swelling and stiffness in affected ...

311

Central Pain Syndrome  

MedlinePLUS

NINDS Central Pain Syndrome Information Page Table of Contents (click to jump to sections) What is Central Pain Syndrome? Is there ... being done? Clinical Trials Organizations What is Central Pain Syndrome? Central pain syndrome is a neurological condition ...

312

Pain in Parkinson's Disease  

MedlinePLUS

... ways to manage it. Causes of Pain in Parkinson’s Researchers classify pain based on the separation of ... syndrome involving both nociceptive and neuropathic pain. Your Parkinson’s specialist, working with a pain specialist, may select ...

313

Complex Regional Pain Syndrome  

MedlinePLUS

... Syndrome? Complex regional pain syndrome (CRPS) is a chronic pain condition. The key symptom of CRPS is continuous, ... Institute of Neurological Disorders and Stroke (NINDS). NINDS Chronic Pain Information Page Chronic pain information page compiled by ...

314

Pain Management Programs  

MedlinePLUS

... Resource Guide to Chronic Pain Medications & Treatments The Art of Pain Management What We Have Learned Going to the ER ... Resource Guide to Chronic Pain Medications & Treatments The Art of Pain Management What We Have Learned Going to the ER ...

315

Splenic artery aneurysm presenting with abdominal discomfort and weight loss.  

PubMed

Splenic artery aneurysm (SAA) is uncommon, but it is the most frequent visceral artery aneurysm. It is more common in women, especially during pregnancy. SAA is usually asymptomatic, but abdominal pain and rupture may develop. At present, computerized tomography (CT) angiogram is the best diagnostic test but not the only. Surgical or endovascular treatment may be considered both in symptomatic or asymptomatic aneurysms greater then 2 cm in diameter. We present the case of an elderly woman with an SAA and review the literature. PMID:25092196

Rodríguez-Cordero, M; González-Quintela, A; Díaz-Peromingo, J A

2014-10-01

316

Fibrolipomas masquerading as abdominal hernias.  

PubMed

A 15-year-old Caucasian girl presented to her general practitioner with a tender, irreducible mass in the paraumbilical region. On examination, two small masses could be felt. She was referred to general surgery. Ultrasound imaging and MRI were unremarkable. However, clinical suspicion suggested multiple areas of abdominal wall herniation. The patient was admitted for elective surgery to exclude herniation. At operation, three subcutaneous masses were found but with no evidence of abdominal wall herniation. Histopathology results from the specimens showed mature adipose tissue mixed with fibrous deposits. There was no evidence of malignancy. A diagnosis of fibrolipoma was given. PMID:24343803

Watson, Hannah Isabella; Saunders, Andrew John

2013-01-01

317

CT appearances of abdominal tuberculosis.  

PubMed

The purpose of this article is to review and illustrate the spectrum of computed tomography (CT) appearances of abdominal tuberculosis. Tuberculosis can affect any organ or tissue in the abdomen, and can be mistaken for other inflammatory or neoplastic conditions. The most common sites of tuberculosis in the abdomen include lymph nodes, genitourinary tract, peritoneal cavity and gastrointestinal tract. The liver, spleen, biliary tract, pancreas and adrenals are rarely affected, but are more likely in HIV-seropositive patients and in miliary tuberculosis. This article should alert the radiologist to consider abdominal tuberculosis in the correct clinical setting to ensure timely diagnosis and enable appropriate treatment. PMID:22212637

Lee, W-K; Van Tonder, F; Tartaglia, C J; Dagia, C; Cazzato, R L; Duddalwar, V A; Chang, S D

2012-06-01

318

Abdominal imaging in child abuse  

Microsoft Academic Search

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

Maria Raissaki; Corinne Veyrac; Eleonore Blondiaux; Christiana Hadjigeorgi

2011-01-01

319

Penetrating abdominal injuries: management controversies  

PubMed Central

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 the rationale and methodology of selecting patients for non-operative management. We also discuss additional controversial issues, as related to antibiotic prophylaxis, management of asymptomatic thoracoabdominal injuries, and the use of colostomy vs. primary repair for colon injuries. PMID:19374761

Butt, Muhammad U; Zacharias, Nikolaos; Velmahos, George C

2009-01-01

320

The spontaneous aortocaval fistula: a complication of the abdominal aortic aneurysm. Case report and review of the literature.  

PubMed

An aortocaval fistula is a rare complication of the abdominal aortic aneurysm: early diagnosis and appropriate surgery improve survival. We report the case of a patient presenting with abdominal pain and oedema of both lower limbs secondary to an aortocaval fistula. CT-scan confirmed the diagnosis and successful surgery was performed in the emergency room. Immediate haemostasis on the inferior vena cava is easier when preoperative diagnosis of the fistula has been made. PMID:9788787

Abbadi, A C; Deldime, P; Van Espen, D; Simon, M; Rosoux, P

1998-08-01

321

The Nepalese patuka in the prevention of back pain.  

PubMed

The patuka is a special piece of cloth worn around the waist by heavy workers and mountain porters in Nepal. An investigation was carried out to study its role in preventing pain in the back. Observations of intra-abdominal pressure and the lumbosacral compression force confirmed that the patuka might be responsible for the low incidence of back pain in those wearing it. PMID:7852008

Shah, R K

1994-10-01

322

Pain and pressure pain thresholds in adolescents with chronic fatigue syndrome and healthy controls: a cross-sectional study  

PubMed Central

Objectives Although pain is a significant symptom in chronic fatigue syndrome (CFS), pain is poorly understood in adolescents with CFS. The aim of this study was to explore pain distribution and prevalence, pain intensity and its functional interference in everyday life, as well as pressure pain thresholds (PPT) in adolescents with CFS and compare this with a control group of healthy adolescents (HC). Methods This is a case–control, cross-sectional study on pain including 120 adolescents with CFS and 39 HCs, aged 12–18?years. We measured pain frequency, pain severity and pain interference using self-reporting questionnaires. PPT was measured using pressure algometry. Data were collected from March 2010 until October 2012 as part of the Norwegian Study of Chronic Fatigue Syndrome in Adolescents: Pathophysiology and Intervention Trial. Results Adolescents with CFS had significantly lower PPTs compared with HCs (p<0.001). The Pain Severity Score and the Pain Interference Score were significantly higher in adolescents with CFS compared with HCs (p<0.001). Almost all adolescents with CFS experienced headache, abdominal pain and/or pain in muscles and joints. Moreover, in all sites, the pain intensity levels were significantly higher than in HCs (p<0.001). Conclusions We found a higher prevalence of severe pain among adolescents with CFS and lowered pain thresholds compared with HCs. The mechanisms, however, are still obscure. Large longitudinal population surveys are warranted measuring pain thresholds prior to the onset of CFS. Trial registration number Clinical Trials, NCT01040429; The Norwegian Study of Chronic Fatigue Syndrome in Adolescents: Pathophysiology and Intervention Trial (NorCAPITAL) http://www.clinicaltrials.gov. PMID:25287104

Winger, Anette; Kvarstein, Gunnvald; Wyller, Vegard Bruun; Sulheim, Dag; Fagermoen, Even; Smastuen, Milada Cvancarova; Helseth, S?lvi

2014-01-01

323

Shoulder pain  

PubMed Central

Introduction Shoulder pain is a common problem with an estimated prevalence of 4% to 26%. About 1% of adults aged over 45 years consult their GP with a new presentation of shoulder pain every year in the UK. The aetiology of shoulder pain is diverse and includes pathology originating from the neck, glenohumeral joint, acromioclavicular joint, rotator cuff, and other soft tissues around the shoulder girdle. The most common source of shoulder pain is the rotator cuff, accounting for over two-thirds of cases. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral drug treatment, topical drug treatment, local injections, non-drug treatment, and surgical treatment? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 71 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, arthroscopic subacromial decompression, autologous whole blood injection, corticosteroids (oral, subacromial injection, or intra-articular injection), electrical stimulation, excision of distal clavicle, extracorporeal shock wave therapy, ice, laser treatment, manipulation under anaesthesia, suprascapular nerve block, non-steroidal anti-inflammatory drugs (oral, topical or intra-articular injection), opioid analgesics, paracetamol, physiotherapy (manual treatment, exercises), platelet-rich plasma injection, rotator cuff repair, shoulder arthroplasty, and ultrasound. PMID:21418673

2010-01-01

324

Social Consequences of Children's Pain: When Do They Encourage Symptom Maintenance?  

Microsoft Academic Search

Objective: To examine the influence of social factors (e.g., attention, relief from responsibility) and children's perceived competence on pediatric symptom maintenance. Methods: Participants were 151 pediatric patients (ages 8-18) with recurrent abdominal pain. They were in- terviewed at a clinic visit and again 2 weeks later. The Social Consequences of Pain questionnaire assessed four types of social consequences: positive attention,

Lynn S. Walker; Robyn Lewis Claar; Judy Garber

2002-01-01

325

Latent Variable Analysis of Coping, Anxiety/Depression, and Somatic Symptoms in Adolescents with Chronic Pain  

ERIC Educational Resources Information Center

Reports of adolescents' coping with recurrent pain, symptoms of anxiety/depression, and somatic complaints were obtained from a sample of 164 adolescents with recurrent abdominal pain and their parents. Confirmatory factor analysis revealed that coping consisted of 3 nonorthogonal factors: Primary Control Engagement Coping (problem solving,…

Compas, Bruce E.; Boyer, Margaret C.; Stanger, Catherine; Colletti, Richard B.; Thomsen, Alexandra H.; Dufton, Lynette M.; Cole, David A.

2006-01-01

326

Pain Management: Post-Amputation Pain  

MedlinePLUS

Pain Management Post-Amputation Pain Volume 8 · Issue 2 · March/April 1998 Text size Larger text Smaller text Java Required Print ... Yahoo MyWeb by G. Edward Jeffries, MD, FACS Post-Amputation Pain Post-amputation pain is one of ...

327

Pitfalls in sonographic diagnosis of abdominal pregnancy.  

PubMed

Abdominal pregnancy is relatively rare, with an estimated frequency of 1/3,000 pregnancies in this country. We have described serial sonographic findings in an abdominal pregnancy from 28 weeks to term. Particular emphasis is placed on the pitfalls facing the sonographer in the diagnosis of advanced abdominal pregnancy. PMID:7221666

Ali, V; Saldana, L R; Balat, I Y; Katragadda, R

1981-04-01

328

Abdominal cocoon secondary to disseminated tuberculosis.  

PubMed

Abdominal cocoon, also known as sclerosing encapsulating peritonitis, represents a rare entity where a variable length of the small bowel is enveloped by a fibrocollagenous membrane giving the appearance of a cocoon. It may be asymptomatic and is often diagnosed incidentally at laparotomy. We present a rare case of abdominal cocoon due to abdominal tuberculosis. PMID:25239980

Puppala, Radha; Sripathi, Smiti; Kadavigere, Rajagopal; Koteshwar, Prakashini; Singh, Jyoti

2014-01-01

329

Abdominal Aortic Aneurysm and Diastasis Recti  

Microsoft Academic Search

Midline abdominal incisional hernias are common following open repair of abdominal aortic aneurysms. These may be caused by the weakness of connective tissue. This study sought to determine the prevalence of diastasis recti among unoperated Caucasian males with abdominal aortic aneurysm compared to a control group with atherosclerotic lower extremity peripheral arterial disease. Forty-two consecutive white males referred for evaluation

Ian McPhail

2009-01-01

330

Patterns of muscular activity during movement in patients with chronic low-back pain.  

PubMed

Bilateral paraspinal electromyogram (EMG) at levels L1-L2 and L4-L5, and abdominal EMG of a group of 20 low-back pain patients were compared to those of a group of 20 pain-free controls during flexion, extension, lateral bending to right and left, and rotation to right and left. The results showed no significant left-right differences in paraspinal EMG levels between low-back pain patients and pain-free controls during any of the movements. However, patterns of paraspinal and abdominal EMG were found to be different for low-back pain patients compared to pain-free controls during flexion only. PMID:2961090

Nouwen, A; Van Akkerveeken, P F; Versloot, J M

1987-10-01

331

The outcome of abdominal aortic aneurysm repair in northern Malaysia.  

PubMed

A prospective study of all infrarenal abdominal aortic aneurysm (AAA) repairs both as electives and emergencies in Penang between January 1997 to December 2000 is presented. The objectives of the study were to determine the age, gender, racial distribution of the patients, the incidence, and risk factors and to summarize treatments undertaken and discuss the outcome. Among the races, the Malays were the most common presenting with infrarenal AAA. The mean age of patients operated was 68.5 years. Males were more commonly affected compared to females (12:1). Most infrarenal AAA repairs were performed as emergency operations, 33 cases (61.1%) compared to electives, 21 cases (38.9%). Total survival was 70.3% (elective 85.7%; emergency 57.6%). Mortality rate was 31.5% and the primary reason is the lack of operating time available for urgent operation and for treatment of concurrent disease states. Mycotic aneurysm with its triad of abdominal pain, fever and abdominal mass resulted in a significantly higher mortality (46.6%). Ninety six percent of the infrarenal AAA had transverse diameter greater than 6 cm. Morphologically 90.7% were fusiform AAA rather than saccular aneurysm (9.3%). Pulmonary complications (35.2%) were more common than cardiac complications (11.1%) possibly related to the urgent nature of the operation, smoking or history of pulmonary tuberculosis. Bleeding (14.8%) was the most common cause of mortality in ruptured mycotic infrarenal AAA. PMID:14750383

Lakhwani, M N; Yeoh, K C; Gooi, B H; Lim, S K

2003-08-01

332

A prospective randomized comparison of endoscopic ultrasound- and computed tomography-guided celiac plexus block for managing chronic pancreatitis pain  

Microsoft Academic Search

OBJECTIVE:Computed tomography (CT)-guided celiac plexus neurolysis has been used for controlling the chronic abdominal pain associated with intra-abdominal malignancy and chronic pancreatitis. Endoscopic ultrasound (EUS)-guided celiac plexus neurolysis has been reported to have some success in controlling pain from pancreatic cancer. The aim of this study is to assess the efficacy of EUS-guided celiac plexus block versus CT-guided celiac plexus

Frank Gress; Colleen Schmitt; Stuart Sherman; Steven Ikenberry; Glen Lehman

1999-01-01

333

Non-cardiac, non-oesophageal chest pain: the relevance of psychological factors  

Microsoft Academic Search

Background—No cause has been determined for chest pain that is neither cardiac nor oesophageal in origin.Aims—To compare the prevalence of lifetime psychiatric disorders and current psychological distress in three consecutive series of patients with chronic chest or abdominal pain.Patients—Thirty nine patients with non-cardiac chest pain and no abnormality on oesophagogastroduodenoscopy, oesophageal manometry, and 24 hour pH monitoring; 22 patients with

K Y Ho; J Y Kang; B Yeo; W L Ng

1998-01-01

334

Gabapentin in Pain Management  

Microsoft Academic Search

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

Jianren Mao; Lucy L. Chen

2000-01-01

335

Low Back Pain  

MedlinePLUS

... Low Back Pain Overview What is low back pain? Low back pain is a common problem for many people. It can be caused by many ... lift and exercise correctly. Symptoms When is low back pain serious? Call your family doctor if: Pain goes ...

336

The psychology of pain  

Microsoft Academic Search

Discusses the aspect theory of pleasure and pain. Aspect theory regards pain as the highest degree of displeasure, and holds that it is always felt with reference to a tactile or temperature sensation. Several experiences of cutaneous pain were examined in order to test the theory. The neurological facts and theories on the psychology of pain indicate that: (1) pain

C. A. Strong

1895-01-01

337

Treating Postlaparoscopic Surgery Shoulder Pain with Acupuncture  

PubMed Central

Objective. The purpose of this study was to examine the effect of acupuncture on postlaparoscopic shoulder pain (PLSP) which is a common side effect in patients undergoing abdominal laparoscopic surgery. Methods. Patients with moderate to severe PLSP in spite of analgesic treatment, which were referred by the medical staff to the Complementary-Integrative Surgery Service (CISS) at our institution, were provided with acupuncture treatment. The severity of PLSP and of general pain was assessed using a Visual Analogue Scale (VAS) from 0 to 10. Pain assessment was conducted prior to and two hours following acupuncture treatment. Acupuncture treatment was individualized based on traditional Chinese medicine diagnosis. Results. A total of 25 patients were evaluated during a 14-month period, from March 2011 to May 2012. A significant reduction in PLSP (mean reduction of 6.4 ± 2.3?P < 0.0001) and general pain (mean reduction 6.4 ± 2.1?P < 0.0001) were observed, and no significant side effects were reported. Conclusion. Individualized acupuncture treatments according to traditional Chinese medicine principles may improve postlaparoscopic shoulder pain and general pain when used in conjunction with conventional therapy. The primary findings of this study warrant verification in controlled studies. PMID:24864149

Attias, Samuel; Kreindler, Anna; Hen, Haim; Haj, Bassel; Matter, Ibrahim; Ben-Arye, Eran; Schiff, Elad

2014-01-01

338

Neuroanatomy of lower gastrointestinal pain disorders.  

PubMed

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

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

2014-01-28

339

Converting Potential Abdominal Hysterectomy to Vaginal One: Laparoscopic Assisted Vaginal Hysterectomy  

PubMed Central

Background. The idea of laparoscopic assisted vaginal hysterectomy (LAVH) is to convert a potential abdominal hysterectomy to a vaginal one, thus decreasing associated morbidity and hastening recovery. We compared intraoperative and postoperative outcomes between LAVH and abdominal hysterectomy, to find out if LAVH achieves better clinical results compared with abdominal hysterectomy. Material and methods. A total of 48 women were enrolled in the study. Finally 17 patients underwent LAVH (cases) and 20 underwent abdominal hysterectomy (controls). All surgeries were performed by a set of gynecologists with more or less same level of surgical experience and expertise. Results.None of the patients in LAVH required conversion to laparotomy. Mean operating time was 30 minutes longer in LAVH group as compared to abdominal hysterectomy group (167.06 + 31.97?min versus 135.25 + 31.72 min; P < 0.05). However, the mean blood loss in LAVH was 100?mL lesser than that in abdominal hysterectomy and the difference was found to be statistically significant (248.24 + 117.79?mL versus 340.00 + 119.86?mL; P < 0.05). Another advantage of LAVH was significantly lower pain scores on second and third postoperative days. Overall complications and postoperative hospital stay were not significantly different between the two groups. PMID:24729873

Shetty, Jyothi; Shanbhag, Asha

2014-01-01

340

The ratio between anterior abdominal wall surface/wall defect surface: a new parameter to classify abdominal incisional hernias.  

PubMed

Current classifications of incisional hernias are often not suitable. The aim of our study was to demonstrate that it is important to consider not only the wall defect surface (WDS) but also the total surface of the anterior abdominal wall (SAW) and the ratio between SAW/WDS). Twenty-three patients affected by > 10 cm size incisional hernias were examined for anthropometric analyses. The SAW, the WDS and the ratio SAW/WDS were calculated. All of the 23 patients were operated on 13 patients were treated with the Rives technique using a polypropylene mesh while the remaning ten patients had an intraperitoneal Parietex Composite mesh (PC). The two groups were compared for post-operative pain (with VAS) and intra-abdominal pressure (IAP) 48 h after the operation: bladder pressure, length of the procedure, average hospital stay and return to work were calculated. In the Rives group, WDS being equal, the higher IAP values were, the lower was the ratio SAW/WDS; furthermore, SAW/WDS ratio being equal, IAP values were low in cases where intraperitoneal mesh was used. Post-operative pain, measured with VAS, was critical when there was a low SAW/WDS ratio and a high IAP. In our experience, it is possible to predict a strong abdominal wall tension if the SAW/WDA ratio is below 15 mmHg. In these cases it is advisable to use a technique requiring the use of an intraperitoneal mesh. Our experience with PC was so positive that it is used in our department for all cases where an intraperitoneal mesh is required. At present, our proposal is that the SAW/WDS ratio is to be considered as a new parameter in current classifications of incisional hernias. PMID:16172802

Ammaturo, C; Bassi, G

2005-12-01

341

Bone pain or tenderness  

MedlinePLUS

... cause of the pain, your doctor may prescribe: Antibiotics Anti-inflammatory medicines Hormones Laxatives (if you develop constipation during prolonged bed rest) Pain relievers If pain is related to thinning bones, you may need treatment for osteoporosis .

342

Medications for back pain  

MedlinePLUS

Your back pain may not go away completely, or it may get more painful at times. Learning to take care ... home and how to prevent repeat episodes of back pain may help you avoid surgery. Different medications can ...

343

Complex regional pain syndrome  

MedlinePLUS

Complex regional pain syndrome (CRPS) is a chronic pain condition that can affect any area of the ... Bailey A, Audette JF. Complex regional pain syndrome. In: Frontera ... of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, ...

344

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 ...

345

Somatoform pain disorder  

MedlinePLUS

The main symptom of somatoform pain disorder is chronic pain that lasts for several months and limits a ... effects, and may carry the risk for abuse. Chronic pain syndromes of all types can often be treated ...

346

Pain and your emotions  

MedlinePLUS

Chronic pain can limit your everyday activities and make it hard to work. It can also affect how ... Depression is very common among people who have chronic pain. Pain can cause depression or make existing depression ...

347

Managing Chronic Pain  

MedlinePLUS

... perform household chores. What can a person with chronic pain do? ? Develop and practice a lifestyle based on ... mind and reduce tensions that aggravate pain. Managing Chronic Pain ® Tips for Living Occupational Therapy: Skills for the ...

348

Chronic Pain and Adherence  

Microsoft Academic Search

\\u000a Chronic pain of non-malignant etiology is a significant problem. Chronic non-malignant pain is typically defined as pain that\\u000a persists for 3 months or longer and that is non-life threatening [1, 2]. Among the most common chronic pain conditions are\\u000a chronic back pain, migraine headaches, and tension headaches. Chronic pain is very common. In the United States, 17% of patients\\u000a seen

Rebecca A. Shelby; Francis J. Keefe

349

Pain drawings and sickle cell disease pain.  

PubMed

This study examined the relationship of pain drawings to somatization in patients with sickle cell disease (SCD). Sixty-nine adult patients with SCD completed a pain drawing in which they shaded in areas of the body in which they experienced pain and also completed the symptom checklist (SCL) 90-R as an index of psychological distress. Analysis of variance indicated that patients who were categorized as having pain drawings with sites inconsistent with expected SCD pain patterns had somatization scores in the clinically significant range. The results suggest that health care professionals who treat SCD patients need to consider pain patterns. In individuals with pain patterns atypical for SCD, the psychological status of the patient may need to be evaluated to facilitate optimal pain management. PMID:2135002

Gil, K M; Phillips, G; Abrams, M R; Williams, D A

1990-06-01

350

Systematic review of family functioning in families of children and adolescents with chronic pain  

PubMed Central

Disturbances in family functioning have been identified in youth with chronic pain and are associated with worse child physical and psychological functioning. Assessment measures of family functioning used in research and clinical settings vary. This systematic review summarizes studies investigating relationships among family functioning, pain and pain-related disability in youth with chronic pain. Sixteen articles were reviewed. All studies were cross-sectional, seven utilized between-group comparisons (chronic pain versus healthy/control) and twelve examined within-group associations among family functioning, pain and/or pain-related disability. Studies represented youth with various pain conditions (e.g., headache, abdominal pain, fibromyalgia) aged 6 – 20 years. Findings revealed group differences in family functioning between children with chronic pain and healthy controls in five of seven studies. Significant associations emerged among family variables and pain-related disability in six of nine studies with worse family functioning associated with greater child disability; relationships between family functioning and children’s pain were less consistent. Different patterns of results emerged depending on family functioning measure used. Overall, findings showed that families of children with chronic pain generally have poorer family functioning than healthy populations, and that pain-related disability is more consistently related to family functioning than pain intensity. PMID:21055709

Lewandowski, Amy S.; Palermo, Tonya M.; Stinson, Jennifer; Handley, Susannah; Chambers, Christine T.

2010-01-01

351

Negotiating the maze: risk factors for suicidal behavior in chronic pain patients.  

PubMed

Chronic pain disorders can exert major negative effects on virtually every aspect of an individual's life. It is not surprising then that many chronic pain sufferers find themselves at a point of emotional fragility where they experience thoughts of ending their life. Suicidal behavior encompasses a spectrum of experience, from "life weariness" or passive suicidal ideation, to more active suicidal intent and suicide completion. A range of risk factors for suicidal behavior in the general population have been identified, and these apply equally to the chronic pain population: a family history of mental illness, past history of suicide attempts, and the presence of comorbid depression. With regard specifically to chronic pain patients, elevated suicide risk is also associated with severe or recurrent headache, ambiguous diagnoses (psychogenic pain, abdominal pain), and medicolegal issues related to the pain. A number of suggestions for clinicians managing chronic pain patients with regards to managing suicide risk are given. PMID:25091131

Newton-John, Toby R O

2014-09-01

352

Abdominal aortic aneurysm repair - open  

MedlinePLUS

... will be asleep and pain-free). Your surgeon opens up your belly and replaces the aortic aneurysm with a man-made, cloth-like material. Here's how it can be done: In one approach, you will lie on your back. The surgeon ...

353

Robotic trans-abdominal transplant nephrectomy for a failed renal allograft.  

PubMed

Minimally invasive surgery for removal of a failed renal allograft has not previously been reported. Herein, we report the first robotic trans-abdominal transplant nephrectomy (TN). A 34-year-old male with Alport's syndrome lost function of his deceased donor allograft after 12 years and presented with fever, pain over his allograft and hematuria. The operation was performed intra-abdominally using the Da Vinci Robotic Surgical System with four trocars. The total operative time was 235?min and the estimated blood loss was less than 25?cm(3) . There were no peri-operative complications observed and the patient was discharged to home less than 24?h postoperatively. The utilization of robotic technology facilitated the successful performance of a minimally invasive, trans-abdominal TN. PMID:25223377

Mulloy, M R; Tan, M; Wolf, J H; D'Annunzio, S H; Pollinger, H S

2014-12-01

354

Unresolved abdominal mass in an adult cryptorchid testis: a case report  

PubMed Central

This case study aims to report an unresolved abdominal mass in an adult with cryptorchid testis and provide a review of related literature. We investigated a 54-year-old man who had cryptorchidism with a history of left orchiectomy 18 years prior. He was diagnosed with an intra-abdominal testicular mass after referring to the emergency ward with pelvic pain. The incidence of testicular cancer in undescended testicles is 40 times greater in the general population. In developed countries, the existence of undescended testicles in adult population is rare, which could be due to systematic practice of elective orchidopexy before the second year of life as well as orchiectomy in post-adolescent patients with undescended testicles. Despite these preventive measures, there are still some isolated cases of intra-abdominal testicular tumors in adults. PMID:21189838

Darzi, Ali Asghar; Aliramaji, Arsalan; Ramezani, Mir Saeid

2010-01-01

355

Endovascular abdominal aortic aneurysm repair  

PubMed Central

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

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

2007-01-01

356

Peripheral Pain Mechanisms in Chronic Widespread Pain  

PubMed Central

Clinical symptoms of chronic widespread pain (CWP) conditions including fibromyalgia (FM), include pain, stiffness, subjective weakness, and muscle fatigue. Muscle pain in CWP is usually described as fluctuating and often associated with local or generalized tenderness (hyperalgesia and/or allodynia). This tenderness related to muscle pain depends on increased peripheral and/or central nervous system responsiveness to peripheral stimuli which can be either noxious (hyperalgesia) or non-noxious (allodynia). For example, patients with muscle hyperalgesia will rate painful muscle stimuli higher than normal controls, whereas patients with allodynia may perceive light touch as painful, something that a “normal” individual will never describe as painful. The pathogenesis of such peripheral and/or central nervous system changes in CWP is unclear, but peripheral soft tissue changes have been implicated. Indirect evidence from interventions that attenuate tonic peripheral nociceptive impulses in patients with CWP syndromes like FM suggest that overall FM pain is dependent on peripheral input. More importantly, allodynia and hyperalgesia can be improved or abolished by removal of peripheral impulse input. Another potential mechanism for CWP pain is central disinhibition. However, this pain mechanism also depends on tonic impulse input, even if only inadequately inhibited. Thus a promising approach to understanding CWP is to determine whether abnormal activity of receptors in deep tissues is fundamental to the development and maintenance of this chronic pain disorder. Conclusions Most CWP patients present with focal tissue abnormalities including myofascial trigger points, ligamentous trigger points, or osteoarthritis of the joints and spine. While not predictive for the development of CWP these changes nevertheless represent important pain generators that may initiate or perpetuate chronic pain. Local chemical mediators, including lactic acid, ATP, and cytokines seem to play an important role in sensitizing deep tissue nociceptors of CWP patients. Thus the combination of peripheral impulse input and increased central pain sensitivity may be responsible for wide-spread chronic pain disorders including FM. PMID:22094192

Staud, Roland

2011-01-01

357

Percutaneous Treatment of Sac Rupture in Abdominal Aortic Aneurysms Previously Excluded with Endovascular Repair (EVAR)  

Microsoft Academic Search

The purpose of this study was to assess the feasibility and effectiveness of percutaneous endovascular repair of ruptured\\u000a abdominal aortic aneurysms (AAAs) previously treated by EVAR. In the last year, two male patients with AAAs, treated 8 and\\u000a 23 months ago with bifurcated stent-graft, were observed because of lumbar pain and hemorragic shock. Multidetector computed\\u000a tomography (MDCT) showed a retroperitoneal hematoma;

Domenico Laganà; Monica Mangini; Federico Fontana; Paolo Nicotera; Gianpaolo Carrafiello; Carlo Fugazzola

2009-01-01

358

Classification of biomaterials and their related complications in abdominal wall hernia surgery  

Microsoft Academic Search

Summary  The value of the use of biomaterials for the repair of abdominal wall hernias is gaining increasing recognition. The use of\\u000a synthetic mesh to achieve a tension-free repair has resulted in a significant reduction in postoperative pain, in length of\\u000a the recovery period, and in the number of recurrences. However, certain physical properties of biomaterials can lead to undesirable\\u000a consequences.

P. K. Amid

1997-01-01

359

Taking narcotics for back pain  

MedlinePLUS

... Narcotics can provide short-term relief of severe back pain. This can allow you to return to your ... Nonspecific back pain - narcotics; Backache - chronic - narcotics; Lumbar pain - chronic - narcotics; Pain - back - chronic - narcotics; Chronic back pain - low - narcotics

360

Pain: You Can Get Help  

MedlinePLUS

... face that shows how you feel. Acute And Chronic Pain There are two kinds of pain. Acute pain ... or years is called chronic (or persistent) pain. Chronic pain may last long after the body has healed. ...

361

Abdominal aortic aneurysm and diastasis recti.  

PubMed

Midline abdominal incisional hernias are common following open repair of abdominal aortic aneurysms. These may be caused by the weakness of connective tissue. This study sought to determine the prevalence of diastasis recti among unoperated Caucasian males with abdominal aortic aneurysm compared to a control group with atherosclerotic lower extremity peripheral arterial disease. Forty-two consecutive white males referred for evaluation of abdominal aortic aneurysm (n = 18) or peripheral arterial disease (n = 24) were examined by a single examiner at the Mayo Clinic. Both groups were similar in terms of age and smoking history, 2 major risk factors for both abdominal aortic aneurysm and peripheral arterial disease. Abdominal aortic aneurysm patients ranged in age from 59 to 89 (mean, 73.2) years. Seventeen of 18 (94.4%) had a history of smoking. Peripheral arterial disease patients ranged in age from 52 to 93 (mean, 70.8) years. Twenty-one of 24 (87.5%) had a history of smoking. Diastasis recti were present in 12 of 18 (66.7%) subjects with abdominal aortic aneurysm versus 4 of 24 (16.7%) subjects with peripheral arterial disease (P = .001, 2-tailed Fisher exact test). Diastasis recti are significantly more common in males with abdominal aortic aneurysm than peripheral arterial disease and may provide an important clue to screen for abdominal aortic aneurysm in those at risk. PMID:18550558

McPhail, Ian

362

Mechanical ventilation in abdominal surgery.  

PubMed

One of the key challenges in perioperative care is to reduce postoperative morbidity and mortality. Patients who develop postoperative morbidity but survive to leave hospital have often reduced functional independence and long-term survival. Mechanical ventilation provides a specific example that may help us to shift thinking from treatment to prevention of postoperative complications. Mechanical ventilation in patients undergoing surgery has long been considered only as a modality to ensure gas exchange while allowing maintenance of anesthesia with delivery of inhaled anesthetics. Evidence is accumulating, however, suggesting an association between intraoperative mechanical ventilation strategy and postoperative pulmonary function and clinical outcome in patients undergoing abdominal surgery. Non-protective ventilator settings, especially high tidal volume (VT) (>10-12mL/kg) and the use of very low level of positive end-expiratory pressure (PEEP) (PEEP<5cmH2O) or no PEEP, may cause alveolar overdistension and repetitive tidal recruitment leading to ventilator-associated lung injury in patients with healthy lungs. Stimulated by previous findings in patients with acute respiratory distress syndrome, the use of lower tidal volume ventilation is becoming increasingly more common in the operating room. However, lowering tidal volume, though important, is only part of the overall multifaceted approach of lung protective mechanical ventilation. In this review, we aimed at providing the most recent and relevant clinical evidence regarding the use of mechanical ventilation in patients undergoing abdominal surgery. PMID:25153670

Futier, E; Godet, T; Millot, A; Constantin, J-M; Jaber, S

2014-01-01

363

Tips for Chronic Pain  

MedlinePLUS

Chronic pain is defined as “persistent pain” and is a common complaint in Sjögren’s syndrome. For example, Sjögren’s ... mental well-being. Some tips for dealing with chronic pain: Continue caring for the condition causing your pain. • ...

364

Thai perspectives on pain.  

PubMed

This qualitative research aimed to study the meaning, the characteristics, and the dimensions of pain from a Thai point of view. It was conducted under the research project on the development of the quality of pain management for people in the hospital. The subjects were 62 patients, experiencing pain and receiving treatment in 4 hospitals in northeast Thailand. Data were analyzed through content analysis. The findings included: 1) concept from experience of pain, perceived pain as suffering physically and psychologically, 2) different characteristics between acute and chronic pain, 3) four levels of pain intensity: mild, moderate, high and severe, 4) pain effects on four dimensions: physical, psychological, behavioral and societal (family-social-economy), 5) two factors related to pain: alleviating factor and predisposing factor, and 6) pain management relies on beliefs, culture and religion i.e. good deeds in Buddhism affected six dimensions: physical, psychological, social, spiritual, treatment seeking and asking health personnel for help. The results of the present study revealed the influence of culture beliefs on the meaning of pain, pain characteristics, and the effects of pain as well as pain management in terms of cultural contexts. The findings may be implemented for the development of pain assessment and the model development of pain management more appropriately according to cultural contexts. PMID:24386747

Mongkhonthawornchai, Siriporn; Sangchart, Bumpenchit; Sornboon, Ariya; Chantarasiri, Jongkolnee

2013-09-01

365

Epidural versus continuous transversus abdominis plane catheter technique for postoperative analgesia after abdominal surgery.  

PubMed

Transversus abdominis plane block is an effective postoperative analgesic technique after abdominal surgery, but no study has compared continuous transversus abdominis plane block with continuous epidural analgesia. We designed a randomised controlled trial comparing these techniques for major abdominal surgery. Patients in the epidural group received a bolus of 8 to 15 ml of ropivacaine 0.2% and an infusion of 5 to 15 ml/hour and the transversus abdominis plane block group a bolus dose of 20 ml of ropivacaine 0.375% bilaterally and an infusion of 0.2% ropivacaine 8 ml/hour bilaterally, for three days. Both groups received paracetamol and patient controlled analgesia with fentanyl for three days. Primary outcomes were numerical rating scores for pain (rest and dynamic over 72 hours) and total fentanyl use; complications and satisfaction scores were also noted. The study was terminated early after 42 patients had been randomised (epidural n=19; transversus abdominis plane block n=22; one excluded). No differences were found in regards to point pain scores or scores over time, either immediately postoperatively or in surgical wards; total fentanyl requirement and Likert satisfaction scores were also similar in both groups. In this underpowered study we found comparable results between continuous transversus abdominis plane technique and epidural analgesia in regard to pain, analgesic use and satisfaction after abdominal surgery. To confirm this finding, randomised trials with larger numbers of participants are needed. PMID:23808506

Rao Kadam, V; Van Wijk, R M; Moran, J I; Miller, D

2013-07-01

366

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

Microsoft Academic Search

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

Hongkai Wang; Jing Bai; Yongxin Zhou; Yonghong Zhang

2008-01-01

367

Severe retroperitoneal and intra-abdominal bleeding after stapling procedure for prolapsed haemorrhoids (PPH); diagnosis, treatment and 6-year follow-up of the case.  

PubMed

Procedure for prolapsed haemorrhoids (PPH) is a popular treatment of haemorrhoids. PPH has the advantages of a shorter operation time, minor degree of postoperative pain, shorter hospital stay and quicker recovery but may be followed by several postoperative complications. Rectal bleeding, acute pain, chronic pain, rectovaginal fistula, complete rectal obliteration, rectal stenosis, rectal pocket, tenesmus, faecal urgency, faecal incontinence, rectal perforation, pelvic sepsis and rectal haematoma have all been reported as postoperative complications of PPH. Additionally, one rare complication of the procedure is intra-abdominal bleeding. There are a few case reports describing intra-abdominal bleeding after the procedure. We report a case of a 26-year-old man who developed severe intra-abdominal and retroperitoneal haemorrhage after PPH. The diagnosis was made on the second postoperative day by CT of the abdomen and pelvis. The patient was treated conservatively and had an uneventful recovery. PMID:25358832

Safadi, Wajdi; Altshuler, Alexander; Kiv, Sakal; Waksman, Igor

2014-01-01

368

Growing pains in children  

PubMed Central

We review the clinical manifestations of "growing pains", the most common form of episodic childhood musculoskeletal pain. Physicians should be careful to adhere to clear clinical criteria as described in this review before diagnosing a child with growing pain. We expand on current theories on possible causes of growing pains and describe the management of these pains and the generally good outcome in nearly all children. PMID:17550631

Uziel, Yosef; Hashkes, Philip J

2007-01-01

369

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

PubMed Central

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

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

2013-01-01

370

Surgical Treatment for Chronic Pelvic Pain  

PubMed Central

The source of chronic pelvic pain may be reproductive organ, urological, musculoskeletal - neurological, gastrointestinal, or myofascial. A psychological component almost always is a factor, whether as an antecedent event or presenting as depression as result of the pain. Surgical interventions for chronic pelvic pain include: 1) resection or vaporization of vulvar/vestibular tissue for human papillion virus (HPV) induced or chronic vulvodynia/vestibulitis; 2) cervical dilation for cervix stenosis; 3) hysteroscopic resection for intracavitary or submucous myomas or intracavitary polyps; 4) myomectomy or myolysis for symptomatic intramural, subserosal or pedunculated myomas; 5) adhesiolysis for peritubular and periovarian adhesions, and enterolysis for bowel adhesions, adhesiolysis for all thick adhesions in areas of pain as well as thin ahesions affecting critical structures such as ovaries and tubes; 6) salpingectomy or neosalpingostomy for symptomatic hydrosalpinx; 7) ovarian treatment for symptomatic ovarian pain; 8) uterosacral nerve vaporization for dysmenorrhea; 9) presacral neurectomy for disabling central pain primarily of uterine but also of bladder origin; 10) resection of endometriosis from all surfaces including removal from bladder and bowel as well as from the rectovaginal septal space. Complete resection of all disease in a debulking operation is essential; 11) appendectomy for symptoms of chronic appendicitis, and chronic right lower quadrant pain; 12) uterine suspension for symptoms of collision dyspareunia, pelvic congestion, severe dysmenorrhea, cul-desac endometriosis; 13) repair of all hernia defects whether sciatic, inguinal, femoral, Spigelian, ventral or incisional; 14) hysterectomy if relief has not been achieved by organ-preserving surgery such as resection of all endometriosis and presacral neurectomy, or the central pain continues to be disabling. Before such a radical step is taken, MRI of the uterus to confirm presence of adenomyosis may be helpful; 15) trigger point injection therapy for myofascial pain and dysfunction in pelvic and abdominal muscles. With application of all currently available laparoscopic modalities, 80% of women with chronic pelvic pain will report a decrease of pain to tolerable levels, a significant average reduction which is maintained in 3-year follow-up. Individual factors contributing to pain cannot be determined, although the frequency of endometriosis dictates that its complete treatment be attempted. The beneficial effect of uterosacral nerve ablation may be as much due to treatment of occult endometriosis in the uterosacral ligaments as to transection of the nerve fibers themselves. The benefit of the presacral neurectomy appears to be definite but strictly limited to midline pain. Appendectomy, herniorraphy, and even hysterectomy are all appropriate therapies for patients with chronic pelvic pain. Even with all laparoscopic procedures employed, fully 20% of patients experience unsatisfactory results. In addition, these patients are often depressed. Whether the pain contributes to the depression or the depression to the pain is irrelevant to them. Selected referrals to an integrated pain center with psychologic assistance together with judicious prescription of antidepressant drugs will likely benefit both women who respond to surgical intervention and those who do not. A maximum surgical effort must be expended to resect all endometriosis, restore normal pelvic anatomy, resect nerve fibers, and treat surgically accessible disease. In addition, it is important to provide patients with chronic pelvic pain sufficient psychologic support to overcome the effects of the condition, and to assist them with underlying psychologic disorders. PMID:9876726

1998-01-01

371

Breakthrough pain: characteristics and impact in patients with cancer pain  

Microsoft Academic Search

Few surveys have been performed to define the characteristics and impact of breakthrough pain in the cancer population. In this cross-sectional survey of inpatients with cancer, patients responded to a structured interview (the Breakthrough Pain Questionnaire) designed to characterize breakthrough pain, and also completed measures of pain and mood (Memorial Pain Assessment Card (MPAC)), pain-related interference in function (Brief Pain

Russell K Portenoy; David Payne; Paul Jacobsen

1999-01-01

372

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

PubMed Central

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

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

2012-01-01

373

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

PubMed

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

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

2012-05-01

374

Idiopathic sclerosing encapsulating peritonitis (abdominal cocoon) in adult male. A case report  

PubMed Central

INTRODUCTION Abdominal cocoon (sclerosing encapsulating peritonitis) (SEP) is a rare condition, mostly affecting adolescent girls living in tropical/subtropical region. Its etiology is unknown. It may cause acute or sub-acute intestinal obstruction. PRESENTATION OF CASE We report here a 39 year old male who complained of long standing colicky abdominal pain, with significant weight loss. Abdomen CT scan showed clumping of ileal loops at the level of umbilicus, with a thin capsule surrounding it. Laparoscopy revealed abdominal cocoon, biopsy of which showed dense hypocellular fibro-collagenous tissue with no neoplastic or granulomatous process. Excision of fibrous tissue and release of adhesions was done. Patient was symptoms free after five months follow up. DISCUSSION Abdominal exploration is usually needed for the diagnosis and treatment of abdominal cocoon. A thick fibrotic peritoneal wrapping of the bowel is usually found. Complete recovery is the result in majority of cases after surgical removal of the wrap causing the cocoon. CONCLUSION Primary sclerosing encapsulating peritonitis (cocoon abdomen) diagnosis needs a high index of suspicion, as signs and symptoms are nonspecific and imaging findings are not always conclusive. Careful excision of the accessory peritoneal sac and lysis of adhesions between bowels is the best treatment. Prognosis is generally good. PMID:25217877

Al Ani, Amer Hashim; Al Zayani, Najah; Najmeddine, Mohammad; Jacob, Sunitha; Nair, Sunil

2014-01-01

375

Laparoscopic approach for the multiple abdominal vascular entrapment syndrome.  

PubMed

We report an unusual case of a 25-year-old man affected by several vascular entrapment abdominal processes: celiac axis compression or Dunbar syndrome, superior mesenteric artery syndrome or Wilkie's disease and Nutcracker syndrome implying compression of the left renal vein. We discuss the diagnosis that was established by contrast-enhanced spiral computed tomography scan and magnetic resonance angiography. Once diagnosed the patient was treated conservatively by enteral high caloric diet in order to obtain a weight gain, however as it did not relieve the symptomatology of pain and vomit we opted for a surgical procedure. The therapeutic options were reviewed, highlighting the laparoscopic approach, which was the one we chose since it provides a less invasive procedure than open surgery but is an equally effective method of treatment. PMID:22251534

Estraviz, Begoña; Arévalo, J Antonio; Eizaguirre, Enma; Jiménez, Eduardo; Corcostegui, Miguel; Goicoechea, Juan M; Maniega, Roberto; Ibáñez, F Javier

2012-01-01

376

Respiration-related control of abdominal motoneurons.  

PubMed

The abdominal muscles form part of the expiratory pump in cooperation with the other expiratory muscles, primarily the internal intercostal and triangularis sterni muscles. The discharge of abdominal muscles is divided into four main patterns: augmenting, plateau, spindle and decrementing. The patterns tend to be species-specific and dependent on the state of the central nervous system. Recent studies suggest that the abdominal muscles are more active than classically thought, even under resting conditions. Expiratory bulbospinal neurons (EBSN) in the caudal ventral respiratory group are the final output pathway to abdominal motoneurons in the spinal cord. Electrophysiological and anatomical studies indicated the excitatory monosynaptic inputs from EBSN to the abdominal motoneurons, although inputs from the propriospinal neurons seemed to be necessary to produce useful motor outputs. Respiration-related sensory modulation of expiratory neurons by vagal afferents that monitor the rate of change of lung volume and the end-expiratory lung volume (EELV) play a crucial role in modulating the drive to the abdominal musculature. Studies using in vitro and in situ preparations of neonatal and juvenile rats show bi-phasic abdominal activity, characterized by bursting at the end of expiration, a silent period during the inspiratory period, and another burst that occurs abruptly after inspiratory termination. Since the abdominal muscles rarely show these post-inspiratory bursts in the adult rat, the organization of the expiratory output pathway must undergo significant development alterations. PMID:21255690

Iizuka, Makito

2011-10-15

377

Infected abdominal sacrocolpopexies: diagnosis and treatment  

Microsoft Academic Search

The abdominal sacrocolpopexy is an excellent procedure to surgically treat vaginal vault prolapse. A synthetic graft is often used to support the vaginal apex, but has the potential to become infected or erode, requiring its removal or revision. The purpose of this paper is to report our experience in the management of patients with infected synthetic grafts after abdominal sacrocolpopexy.

T. Fleming Mattox; Edward J. Stanford; E. Varner

2004-01-01

378

Endografts, Pressure, and the Abdominal Aortic Aneurysm  

E-print Network

Abdominal aortic aneurysms (AAA) are an expansion in diameter of the abdominal aorta and their rupture is a leading cause of mortality. One of the treatments for AAA is the implantation of an endograft (also called a stent graft), a combination...

Meyer, Clark A.

2010-07-14

379

Pathology Case Study: Abdominal Distention  

NSDL National Science Digital Library

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.

Rao, Uma N.; Sepulveda, Antonia; Yu, Hongbo

2009-03-18

380

Abdominal tuberculosis of the gastrointestinal tract: Revisited  

PubMed Central

Abdominal tuberculosis is an increasingly common disease that poses diagnostic challenge, as the nonspecific features of the disease which may lead to diagnostic delays and development of complications. This condition is regarded as a great mimicker of other abdominal pathology. A high index of suspicion is an important factor in early diagnosis. Abdominal involvement may occur in the gastrointestinal tract, peritoneum, lymphnodes or solid viscera. Various investigative methods have been used to aid in the diagnosis of abdominal tuberculosis. Early diagnosis and initiation of antituberculous therapy and surgical treatment are essential to prevent morbidity and mortality. Most of the patients respond very well to standard antitubercular therapy and surgery is required only in a minority of cases. Imaging plays an important role in diagnosis of abdominal tuberculosis because early recognition of this condition is important. We reviewed our experience with the findings on various imaging modalities for diagnosis of this potentially treatable disease.

Debi, Uma; Ravisankar, Vasudevan; Prasad, Kaushal Kishor; Sinha, Saroj Kant; Sharma, Arun Kumar

2014-01-01

381

[Optimization of surgical treatment of median postoperative abdominal hernias].  

PubMed

The analysis surgical treatment results in 1187 patients. ageing 30-80 yrs old, in 2000-2009 period, for median postoperative abdominal hernia (MPOAH) is presented. Autoplasty was performed in 43 (3.6%) patients, suffering MPOAH of small and middle size without mm. recti abdomini diastasis. The "sub lay" method constitutes an optimal variant of alloplasty for MPOAH of small and middle size with mm. recti abdomini diastasis and of big size, and for giant MPOAH - the operations according to Ramirez method in our modification together with the net implants application. Intraabdominal hypertension was noted in 2 (0.8%) of 231 patients, suffering giant MPOAH, seroma--in 86 (7.2%), the wound suppuration - in 16 (1.3%). Pulmonary thromboembolism had constituted the cause of death in 2 (0.8%) patients, suffering giant MPOAH. Late results in terms 1-5 yrs were studied up in 520 patients. Chronic pain in the abdominal wall portion was noted by 17 (3.2%) patients and the hernia recurrence--7 (1.3%). PMID:20491258

Feleshtyns'ky?, Ia P; Vatamaniuk, V F; Dubenets', V O; Svyrydovs'ky?, S A

2010-03-01

382

The problem of pain.  

PubMed

Pain problems, especially posttraumatic headache, are very common following head trauma. Pain may be the most significant problem, more disabling than any brain or other injuries, and interfering with aspects of cognition or other function. However, posttraumatic headache and most other chronic posttraumatic pain problems remain poorly understood. This article reviews fundamental issues that should be considered in understanding the nature of chronic pain including the distinction between acute and chronic pain; neurobiological distinctions between the lateral and medial pain system; nociceptive versus neuropathic or other central pain; sensitization effects; the widely accepted view of chronic pain as a multidimensional subjective experience involving sensory, motivational-affective and cognitive-behavioral components; the problem of mind-body dualism; the role of psychosocial factors in the onset, maintenance, exacerbation or severity of pain; plus issues of response bias and malingering. PMID:14732827

Nicholson, Keith; Martelli, Michael F

2004-01-01

383

[The pain from burns].  

PubMed

The painful events associated with the treatment of a severe burn can, because of their long-lasting and repetitive characteristics, be one of the most excruciating experiences in clinical practice. Moreover, burn pain has been shown to be detrimental to burn patients. Although nociception and peripheral hyperalgesia are considered the major causes of burn pain, the study of more hypothetical mechanisms like central hyperalgesia and neuropathic pain may lead to a better understanding of burn pain symptoms and to new therapeutic approaches. Continuous pain and intermittent pain due to therapeutic procedures are two distinct components of burn pain. They have to be evaluated and managed separately. Although continuous pain is by far less severe than intermittent pain, the treatment is, in both cases, essentially pharmacological relying basically on opioids. Because of wide intra- and inter-individual variations, protocols will have to leave large possibilities of adaptation for each case, systematic pain evaluation being mandatory to achieve the best risk/benefit ratio. Surprisingly, the dose of medication decreases only slowly with time, a burn often remaining painful for long periods after healing. Non pharmacological treatments are often useful and sometimes indispensable adjuncts; but their rationale and their feasibility depends entirely on previous optimal pharmacological control of burn pain. Several recent studies show that burn pain management is inadequate in most burn centres. PMID:11933833

Latarjet, J

2002-03-01

384

An Analysis of Bloody Sunday  

Microsoft Academic Search

A case study exploring the events leading up to the day of violence and the climate following the conflict will be provided through the lens of the British government and the Catholic residents of Northern Ireland. The majority of the literature available regarding \\

Scott M. Woods

385

Pain as a channelopathy  

PubMed Central

Mendelian heritable pain disorders have provided insights into human pain mechanisms and suggested new analgesic drug targets. Interestingly, many of the heritable monogenic pain disorders have been mapped to mutations in genes encoding ion channels. Studies in transgenic mice have also implicated many ion channels in damage sensing and pain modulation. It seems likely that aberrant peripheral or central ion channel activity underlies or initiates many pathological pain conditions. Understanding the mechanistic basis of ion channel malfunction in terms of trafficking, localization, biophysics, and consequences for neurotransmission is a potential route to new pain therapies. PMID:21041956

Raouf, Ramin; Quick, Kathryn; Wood, John N.

2010-01-01

386

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

PubMed

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

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

2008-08-01

387

Arsenic in a child's world.  

PubMed

Ten-year-old Tim P. presented at a local emergency room complaining of bloody diarrhea. Despite treatment, his diarrhea continued with additional symptoms of nausea, raspy voice, headaches, abdominal pain, tingling of the feet and hands, lethargy, and eczema. Do you recognize the health risks and clinical aspects of arsenic, and could you assist Tim and his family? PMID:15311647

Pike-Paris, Ann

2004-01-01

388

Intraperitoneal hydrocortisone for pain relief after laparoscopic cholecystectomy  

PubMed Central

Background: Laparoscopic cholecystectomy is associated with shorter hospital stay and less pain in comparison to open surgery. The aim of this study was to evaluate the effect of intraperitoneal hydrocortisone on pain relief following laparoscopic cholecystectomy. Methods: Sixty two patients were enrolled in a double-blind, randomized clinical trial. Patients randomly received intraperitoneal instillation of either 250 ml normal saline (n=31) or 100 mg hydrocortisone in 250 ml normal saline (n=31) before insufflation of CO2 into the peritoneum. Abdominal and shoulder pain were evaluated using VAS after surgery and at 6, 12, and 24 hours postoperatively. The patients were also followed for postoperative analgesic requirements, nausea and vomiting, and return of bowel function. Results: Sixty patients completed the study. Patients in the hydrocortisone group had significantly lower abdominal and shoulder pain scores (10.95 vs 12.95; P<0.01). The patients were similar regarding analgesic requirements in the recovery room. However, those in the hydrocortisone group required less meperidine than the saline group (151.66 (±49.9) mg vs 61.66 (±38.69) mg; P=0.00). The patients were similar with respect to return of bowel function, nausea and vomiting. No adverse reaction was observed in either group. Conclusion: Intraperitoneal administration of hydrocortisone can significantly decrease pain and analgesic requirements after laparoscopic cholecystectomy with no adverse effects. PMID:23717225

Sarvestani, Amene S.; Amini, Shahram; Kalhor, Mohsen; Roshanravan, Reza; Mohammadi, Mehdi; Lebaschi, Amir Hussein

2013-01-01

389

Intra-abdominal pressure during swimming.  

PubMed

The present study aimed to determine the intra-abdominal pressure during front crawl swimming at different velocities in competitive swimmers and to clarify the relationships between stroke indices and changes in intra-abdominal pressure. The subjects were 7 highly trained competitive collegiate male swimmers. Intra-abdominal pressure was measured during front crawl swimming at 1.0, 1.2 and 1.4?m?·?s(-1) and during the Valsalva maneuver. Intra-abdominal pressure was taken as the difference between minimum and maximum values, and the mean of 6 stable front crawl stroke cycles was used. Stroke rate and stroke length were also measured as stroke indices. There were significant differences in stroke rate among all velocities (P < 0.05). However, there was no significant difference in stroke length by velocity. Significant within-subject correlations between intra-abdominal pressure and stroke rate or stroke length (P < 0.01) were observed, although there were no significant correlations between intra-abdominal pressure and stroke indices when controlling for swimming velocity. These findings do not appear to support the effectiveness of trunk training performed by competitive swimmers aimed at increasing intra-abdominal pressure. PMID:23868677

Moriyama, S; Ogita, F; Huang, Z; Kurobe, K; Nagira, A; Tanaka, T; Takahashi, H; Hirano, Y

2014-02-01

390

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

PubMed Central

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

2014-01-01

391

Managing pain during labor  

MedlinePLUS

... a childbirth class. Childbirth classes teach breathing and relaxation techniques. The techniques can help you relieve pain ... to childbirth classes and learn about breathing and relaxation techniques, even if you plan to get pain ...

392

American Chronic Pain Association  

MedlinePLUS

... of their pain. To raise awareness among the health care community, policy makers, and the public at large about issues of living with chronic pain. Recent News View All News OTC ... Verify here Certified by: Independent Charities of ...

393

Treatments for Managing Pain  

MedlinePLUS

... pain by stimulating nerve fibers through the skin. Acupuncture - This ancient Chinese practice uses very thin needles ... skin to treat disease and pain. Practitioners of acupuncture undergo specialized training in these techniques and may ...

394

What's wrong with pain?  

E-print Network

are quickly confronted with difficult questions. This thesis, through an examination of a particular feature of moral language and a description of recent research on pain, provides an analysis of how pain fits into ethical theory. It is argued...

Shriver, Adam Joseph

2006-10-30

395

Communicating about Cancer Pain  

Cancer.gov

Patients with cancer may be reluctant to discuss their pain with their doctors for a variety of reasons. NCI sponsors research that examines the barriers that prevent patients from talking about pain.

396

Fighting Chronic Pain  

MedlinePLUS

... Navigation Bar Home Current Issue Past Issues Fighting Chronic Pain Past Issues / Fall 2007 Table of Contents For ... diagnose, health care professionals and scientists know that chronic pain is very complex. Below are some of the ...

397

Traumatic mesenteric cyst after blunt abdominal trauma  

PubMed Central

Mesenteric cysts are rare abdominal tumors of unclear histologic origin, usually asymptomatic. Post-traumatic mesenteric cyst usually results as a consequence of a mesenteric lymphangitic rupture or a hematoma followed by absorption and cystic degeneration. The preoperative histological and radiological diagnosis is difficult. We present the case of a 45-year-old male patient with sizable, palpable abdominal tumor, the gradual swelling of which the patient himself combined with the blunt abdominal trauma he acquired from an opponent's knee in a football game 5 months ago. PMID:22096714

Falidas, Evangelos; Mathioulakis, Stavros; Vlachos, Konstantinos; Pavlakis, Emmanouil; Anyfantakis, Georgios; Villias, Constantinos

2011-01-01

398

[Abdominal tuberculosis: clinical and therapeutic evaluation].  

PubMed

In this paper we present our experience concerning abdominal tuberculosis. The aim of this study is to evaluate various methods and to establish therapeutic approach to patients with abdominal tuberculosis. There were six patients (3 males and 3 females), aged between 22 and 67 years old, such as: 2 patients developed peritoneal tuberculosis, 3 patients developed intestinal tuberculosis and one patient developed mesenteric lymph node tuberculosis. We concluded that early diagnosis is often impossible and laboratory report was non-specific. Because surgical treatment in abdominal tuberculosis was made in complicate forms, we concluded that enterostomy "a minima" is the best therapeutic method. PMID:15675286

Me?in?, C; Pa?alega, M; Vâlcea, D; Vasile, I

2004-01-01

399

Posttonsillectomy pain in children.  

PubMed

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

Sutters, Kimberly A; Isaacson, Glenn

2014-02-01

400

Neuropathic low back pain  

Microsoft Academic Search

In this discussion, we hope to advance a clinical approach to low back pain that is more in line with our modern understanding\\u000a of neuropathic pain. We review the current understanding of normal and pathologic neuroanatomy of the lumbar spine and then\\u000a outline how pathology in the different structures can lead to neuropathic pain and cause common pain patterns seen

Joseph F. Audette; Emmanuel Emenike; Alec L. Meleger

2005-01-01

401

[The bikini incision: nice, but not without painful complications].  

PubMed

The low transverse abdominal incision, described by Pfannenstiel, is, mostly because of its decent scar, the incision of choice for most gynaecological operations. Making this incision, the ilioinguinal nerve and the iliohypogastric nerve can be involved. In many cases this causes a lasting numbness in the region around the scar. Some patients have a lasting, radiating, invalidating pain, which can be relieved surgically. PMID:9752065

Huikeshoven, F J; Dukel, L

1998-06-27

402

Abdominal surgery. [Radiology, screening techniques  

SciTech Connect

A new art of ''interventional radiology'' has been developed in the past few years. Major applications include postoperative instrumentation of the biliary tract, percutaneous biliary drainage, tumor biopsy, abscess drainage, and intestinal-intubation procedures. Intervention by angiography encompasses injection of such substances as Pitressin (vasopressin), and embolization. These procedures have been of immense value. Fortunately, complications, such as sepsis and bleeding, have been infrequent. Computerized body tomography has also proved extremely important, particularly in the diagnosis of subphrenic abscess and pancreatic and pelvic pathology. /sup 99m/Tc-labeled-erythrocyte scans can be used to detect gastrointestinal bleeding sites. Scans can also identify hepatobiliary disease and splenic injury or differentiate the cause of jaundice. /sup 111/Indium-labeled autologous leukocytes may be useful in differentiating a pancreatic abscess from a pseudocyst. The advantage of indium scans over /sup 67/Ga scans is that a shorter time is required for maximum resolution: gallium requires 48 hours, indium 4. Another advantage is that indium is cleared through the liver and spleen and is not secreted into the bowel. /sup 67/Ga is absorbed by lymphomas and hepatocarcinomas. Nuclear magnetic resonance has many possible uses in abdominal surgery, but so far little information is available. This technique has been used to detect an empyema of the gallbladder that was not diagnosed by ultrasound. Among hepatic lesions, it can easily differentiate tumors from cysts and in that regard is superior to both ultrasound and scan. (JMT)

Welch, C.E.; Malt, R.A.

1983-03-31

403

Managing Chemotherapy Side Effects: Pain  

MedlinePLUS

... services national institutes of health Managing Chemotherapy Side Effects Pain “I was worried about getting addicted to ... to pay for pain medicine. Managing Chemotherapy Side Effects: Pain Keep track of the pain. Each day, ...

404

Psychology and chronic pain  

Microsoft Academic Search

This article will explore some specific psychological responses to pain and outline the historical developments that have led to current treatments. The recognition and treatment of maladaptive psychological responses to pain can lessen distress and the progression of chronic pain states.

Jennifer K. Dietrich

2011-01-01

405

Pediatric Procedural Pain  

ERIC Educational Resources Information Center

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…

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

2006-01-01

406

Ultrasound-guided continuous transverse abdominis plane block for abdominal surgery  

PubMed Central

Introduction: Transversus abdominis plane (TAP) block is a new regional analgesic technique for postoperative pain in abdominal surgery. Its efficacy is not clear, and thus it needs to be explored for its regular utilisation on prolonged period. The objective was to study the continuous local anaesthetic infusion effect on postoperative analgesia. Continuous use of TAP block as an analgesic technique has not been evaluated prospectively in clinical trials. This study evaluates the efficacy of ultrasound-guided TAP block in comparison with PCA fentanyl in major abdominal surgery. Materials and Methods: There were 20 patients in the study, allocated to TAP and control groups. The parameters measured were pain scores on a numerical rating scale (NRS) of 0-10 at various time intervals and the amount of fentanyl used as rescue analgesia. Patient satisfaction scores were recorded in the TAP block group and along with any complications related to the block. Results: The postoperative median pain scores on coughing on day one were 6.0 for control group and 2.0 for the TAP group (P = 0.02); on day two, the equivalent scores were 7.0 and 2.0 (P = 0.01). The fentanyl requirement at one hour was 203 ? for the control group and 78 ?g for the TAP group (P = 0.03); at day one, the control and TAP requirements were 1237 ?g and 664 ?g respectively (P = 0.01). Three TAP patients rated their satisfaction as ‘excellent’, four as ‘satisfied, and two as ‘poor’. Conclusion: TAP block is a promising technique for postoperative analgesia in major abdominal surgeries. Our study demonstrated lower pain scores in the TAP group with reduced fentanyl requirement. Further, a large scale study is needed to establish the efficacy of TAP block in this setting. PMID:21897502

Kadam, Rao V; Field, J B

2011-01-01

407

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

NASA Technical Reports Server (NTRS)

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.

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

1993-01-01

408

Analgesic efficacy of a combination of hydrocodone with ibuprofen in postoperative pain  

Microsoft Academic Search

Two randomized, double-blind, parallel-group single-dose 2 × 2 factorial analgesic studies compared a single-dose or a 2-tablet dose of a combination of 7.5 mg hydrocodone bitartrate with 200 mg ibuprofen with each constituent alone and with a placebo in women with moderate or severe postoperative pain from abdominal or gynecologic surgery. A nurse-observer recorded patient reports of pain intensity and

Gilder L. Wideman; Marie Keffer; Elena Morris; Ralph T. Doyle; John G. Jiang; William T. Beaver

1999-01-01

409

Ethnic differences in pain and pain management.  

PubMed

Considerable evidence demonstrates substantial ethnic disparities in the prevalence, treatment, progression and outcomes of pain-related conditions. Elucidating the mechanisms underlying these group differences is of crucial importance in reducing and eliminating disparities in the pain experience. Over recent years, accumulating evidence has identified a variety of processes, from neurophysiological factors to structural elements of the healthcare system, that may contribute to shaping individual differences in pain. For example, the experience of pain differentially activates stress-related physiological responses across various ethnic groups, members of different ethnic groups appear to use differing coping strategies in managing pain complaints, providers' treatment decisions vary as a function of patient ethnicity and pharmacies in predominantly minority neighborhoods are far less likely to stock potent analgesics. These diverse factors, and others may all play a role in facilitating elevated levels of pain-related suffering among individuals from ethnic minority backgrounds. Here, we present a brief, nonexhaustive review of the recent literature and potential physiological and sociocultural mechanisms underlying these ethnic group disparities in pain outcomes. PMID:23687518

Campbell, Claudia M; Edwards, Robert R

2012-05-01

410

Abdominal imaging in zinc phosphide poisoning.  

PubMed

Radiography has been proved to be a good diagnostic tool in visualization of many radiopaque xenobiotics in clinical toxicology. Zinc is a potentially radiopaque material which is a constituent of the zinc phosphide (ZN2P3) rodenticide. We report two cases of zinc phosphide poisoning with positive abdominal X-rays in whom the diagnosis was confirmed by abdominal imaging. Positive abdominal imaging was an indication for aggressive management; however, aggressive treatment was not lifesaving in one of them. We aim to emphasize the diagnostic value of abdominal X-rays in zinc phosphide-poisoned patients. We also would like to suggest that zinc phosphide (ZP)-poisoned patients with positive X-rays have more chance to become unstable even if they are symptom free on presentation and should be more aggressively managed. PMID:24477450

Hassanian-Moghaddam, Hossein; Shahnazi, Makhtoom; Zamani, Nasim; Bahrami-Motlagh, Hooman

2014-06-01

411

Intra-abdominal actinomycetoma in a cat.  

PubMed

A 5-year-old, female Ragdoll cat was diagnosed with an intra-abdominal mycetoma involving the ileocaecal region. Diagnosis was obtained via histopathological examination following surgical resection of the mass and an ileocolic anastomosis. The initial surgery was complicated by lymphangiectasia, chylous abdominal effusion and mild bacterial leakage from the anastomosis site. A second, exploratory laparotomy was performed to augment the anastomosis with serosal patching and omentalisation and to investigate a cystic structure observed on follow-up abdominal ultrasound. Initial amoxycillin clavulanate (Clavulox; Pfizer Animal Health) therapy was ineffective, but clindamycin (Antirobe; Pfizer Animal Health) proved successful in resolving the infection. Abdominal actinomycetoma in the cat may be an under-diagnosed condition due to its close resemblance to neoplastic disease. Standard diagnostic and therapeutic regimens are commonly ineffective in Actinomyces species infections. Surgical resection along with adjunctive, long-term, selective antimicrobial therapy is effective and prognosis is good for localised lesions. PMID:19181557

Sharman, Mellora J; Goh, Clara S; Kuipers von Lande, Richard G; Hodgson, Jennifer L

2009-08-01

412

Dancing in pain: pain appraisal and coping in dancers.  

PubMed

This study investigated the relationships between the type of pain experienced (performance pain and injury pain), the cognitive appraisal of pain and pain coping styles in dancers. Fifty-one professional ballet and contemporary dancers (17 males and 34 females), with the mean age of 25.9 years, completed a general pain questionnaire, the Pain Appraisal Inventory, the Survey of Pain Attitudes Control Subscale, and the Sports Inventory for Pain. Multivariate analyses of variance indicated that both the cognitive appraisal of the pain and pain coping styles did not differ according to the type of pain experienced or the pain severity. However, it was found that dancers with performance pain of either low or high severity were more likely to dance in pain than dancers experiencing injury pain. Multiple regression analyses indicated that the appraisal of pain as threatening was predictive of the use of avoidance and catastrophizing pain coping styles. Overall, results indicated that dancers may not differentiate between performance pain and injury pain, or modify their appraisal and coping strategies according to the characteristics of the pain experienced. The study highlighted an opportunity for increased education for dancers in recognizing the difference between pain considered to be a routine aspect of training and pain which is a signal of serious injury. PMID:19618573

Anderson, Ruth; Hanrahan, Stephanie J

2008-01-01

413

An Introduction Significance of Pain  

E-print Network

An Introduction to: Pain #12;Significance of Pain !!Pain is adaptive !!Alerts us to danger !!Motivates escape and avoidance learning !!Motivates recuperation !!Congenital insensitivity to pain !!Pain was killing his buddies all around him. When a shell burst nearby, he felt an excruciating pain

Meagher, Mary

414

Correlation between intra-abdominal pressure and pulmonary volumes after superior and inferior abdominal surgery  

PubMed Central

OBJECTIVE: Patients undergoing abdominal surgery are at risk for pulmonary complications. The principal cause of postoperative pulmonary complications is a significant reduction in pulmonary volumes (FEV1 and FVC) to approximately 65-70% of the predicted value. Another frequent occurrence after abdominal surgery is increased intra-abdominal pressure. The aim of this study was to correlate changes in pulmonary volumes with the values of intra-abdominal pressure after abdominal surgery, according to the surgical incision in the abdomen (superior or inferior). METHODS: We prospectively evaluated 60 patients who underwent elective open abdominal surgery with a surgical time greater than 240 minutes. Patients were evaluated before surgery and on the 3rd postoperative day. Spirometry was assessed by maximal respiratory maneuvers and flow-volume curves. Intra-abdominal pressure was measured in the postoperative period using the bladder technique. RESULTS: The mean age of the patients was 56±13 years, and 41.6% 25 were female; 50 patients (83.3%) had malignant disease. The patients were divided into two groups according to the surgical incision (superior or inferior). The lung volumes in the preoperative period showed no abnormalities. After surgery, there was a significant reduction in both FEV1 (1.6±0.6 L) and FVC (2.0±0.7 L) with maintenance of FEV1/FVC of 0.8±0.2 in both groups. The maximum intra-abdominal pressure values were similar (p?=?0.59) for the two groups. There was no association between pulmonary volumes and intra-abdominal pressure measured in any of the groups analyzed. CONCLUSIONS: Our results show that superior and inferior abdominal surgery determines hypoventilation, unrelated to increased intra-abdominal pressure. Patients at high risk of pulmonary complications should receive respiratory care even if undergoing inferior abdominal surgery. PMID:25029580

de Cleva, Roberto; de Assumpcao, Marianna Siqueira; Sasaya, Flavia; Chaves, Natalia Zuniaga; Santo, Marco Aurelio; Flo, Claudia; Lunardi, Adriana C.; Filho, Wilson Jacob

2014-01-01

415

Thoughts provoked by pain.  

PubMed

Despite the growing interest in the cognitive component of chronic pain, little information has been collected on the variety of thoughts provoked by pain experience. A new assessment instrument (the Cognitive Evaluative Questionnaire--CEQ) has been utilized with 127 chronic pain patients and their cognitions classified into seven discrete clusters. The results confirm the heterogeneity of pain cognitions, the majority of which are likely to play a role in enhancing or perpetuating chronic pain. The relationship of these cognitions to chronic avoidance behavior is discussed. PMID:2775158

Philips, H C

1989-01-01

416

A focus on intra-abdominal infections  

PubMed Central

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

2010-01-01

417

Laparoscopic-assisted abdominal aortic aneurysmectomy  

Microsoft Academic Search

Purpose: The technical elements and early results of laparoscopic-assisted abdominal aortic aneurysmectomy are described. Methods: From February 1997 to May 1999, 60 patients underwent elective laparoscopic surgery for infrarenal abdominal aortic aneurysm. Patients ranged in age from 53 to 87 years (mean age, 70.6 years). The mean aneurysm size was 5.7 cm (range, 4.4-8.0 cm). All patients underwent aortography and

John J. Castronuovo; Kevin V. James; Michael Resnikoff; Edward R. McLean; John K. Edoga

2000-01-01

418

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

PubMed Central

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

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

2013-01-01

419

Genes and Abdominal Aortic Aneurysm  

PubMed Central

Abdominal aortic aneurysm (AAA) is a multifactorial disease with a strong genetic component. Since first candidate gene studies were published 20 years ago, nearly 100 genetic association studies using single nucleotide polymorphisms (SNPs) in biologically relevant genes have been reported on AAA. The studies investigated SNPs in genes of the extracellular matrix, the cardiovascular system, the immune system, and signaling pathways. Very few studies were large enough to draw firm conclusions and very few results could be replicated in another sample set. The more recent unbiased approaches are family-based DNA linkage studies and genome-wide genetic association studies, which have the potential of identifying the genetic basis for AAA, if appropriately powered and well-characterized large AAA cohorts are used. SNPs associated with AAA have already been identified in these large multicenter studies. One significant association was of a variant in a gene called CNTN3 which is located on chromosome 3p12.3. Two follow-up studies, however, could not replicate the association. Two other SNPs, which are located on chromosome 9p21 and 9q33 were replicated in other samples. The two genes with the strongest supporting evidence of contribution to the genetic risk for AAA are the CDKN2BAS gene, also known as ANRIL, which encodes an antisense RNA that regulates expression of the cyclin-dependent kinase inhibitors CDKN2A and CDKN2B, and DAB2IP, which encodes an inhibitor of cell growth and survival. Functional studies are now needed to establish the mechanisms by which these genes contribute to AAA pathogenesis. PMID:21146954

Hinterseher, Irene; Tromp, Gerard; Kuivaniemi, Helena

2010-01-01

420

Urolithiasis presenting as right flank pain: a case report  

PubMed Central

Background: Urolithiasis refers to renal or ureteral calculi referred to in lay terminology as a kidney stone. Utolithiasis is a potential emergency often resulting in acute abdominal, low back, flank or groin pain. Chiropractors may encounter patients when they are in acute pain or after they have recovered from the acute phase and should be knowledgeable about the signs, symptoms, potential complications and appropriate recommendations for management. Case presentation: A 52 year old male with acute right flank pain presented to the emergency department. A ureteric calculus with associated hydronephrosis was identified and he was prescribed pain medications and discharged to pass the stone naturally. One day later, he returned to the emergency department with severe pain and was referred to urology. He was managed with a temporary ureteric stent and antibiotics. Conclusion: This case describes a patient with acute right flank and lower quadrant pain which was diagnosed as an obstructing ureteric calculus. Acute management and preventive strategies in patients with visceral pathology such as renal calculi must be considered in patients with severe back and flank pain as it can progress to hydronephrosis and kidney failure. PMID:23483000

Chung, Chadwick; Stern, Paula J.; Dufton, John

2013-01-01

421

Common medical pains  

PubMed Central

Pain in infancy and childhood is extremely common. Sources of pain include illness, injury, and medical and dental procedures. Over the past two decades, tremendous progress has been made in the assessment, prevention and treatment of pain. It is important for the paediatric health care provider to be aware of the implications and consequences of pain in childhood. A multitude of interventions are available to reduce or alleviate pain in children of all ages, including neonates. These include behavioural and psychological methods, as well as a host of pharmacological preparations, which are safe and effective when used as indicated. Many complementary and alternative treatments appear to be promising in treating and relieving pain, although further research is required. The present article reviews the most common sources of pain in childhood and infancy, as well as current treatment strategies and options. PMID:19030348

Jacobson, Sheila

2007-01-01

422

Pain syndromes in children.  

PubMed

The pediatric rheumatologist cares for children who may have a wide variety of causes of musculoskeletal pain. These include such diverse conditions as arthritis, low-back pain, hypermobility, metabolic bone pain, and amplified pain syndromes such as complex regional pain syndrome and fibromyalgia. This review examines the recent literature on these and other conditions causing musculoskeletal pain in children and adolescents. Overall, headway is being made, but differentiating soma from psyche remains a problem. This is perhaps due to the marked and unique effect pain brings to each of us. Children are different from adults in causes, presentations, and outcome. Vigilance in history, physical examination, and judicious use of laboratory investigations are usually sufficient in establishing a diagnosis, as well as an appreciation for the variety of presentations each condition can manifest. PMID:11123080

Sherry, D D

2000-08-01

423

Postsurgical pain outcome assessment.  

PubMed

Reliable and valid measures of pain are essential for conducting clinical trials of pain treatments. Perhaps the most important aspect of a pain measure's validity is its sensitivity, or ability to detect changes in pain over time and due to treatment. Several factors may affect a measure's sensitivity, including the complexity of the rating task for the measure, the number of pain intensity levels assessed by the measure, the dimension of pain assessed (e.g. pain intensity vs. pain relief), and the number of individual ratings (e.g. single rating vs. composite score) used to create the measure. The purpose of this study was to compare the relative sensitivity of three measures of outcome and a composite made up of all three measures for detecting analgesic effects in two samples of persons participating in a randomized controlled trial. One hundred and twenty-three patients who had undergone knee surgery and 124 women who had undergone a laparotomy were given one of three medications in the day after their surgery: morphine, ketorolac, or placebo. Two measures of pain intensity (a visual analog scale (VAS) and a 4-point verbal rating scale (VRS)) were administered at baseline, and these measures plus a 5-point VRS of pain relief were administered at 16 additional time points up to 24 h following surgery. As predicted, we found variability in the sensitivity of the outcome measures used in these studies, with the 4-point VRS showing less sensitivity than the VAS or relief ratings. However, contrary to our prediction, a composite measure of outcome made up of all three measures was not consistently superior to the individual measures for detecting treatment effects. Finally, we found that pain relief ratings were related to, but also distinct from, change in pain intensity as measured by changes in pain intensity ratings from baseline to each postmedication assessment point. These findings have important implications for the assessment of pain in clinical trials. PMID:12237188

Jensen, Mark P; Chen, Connie; Brugger, Andrew M

2002-09-01

424

Accepting Pain Management or Seeking Pain Cure: An Exploration of Patients’ Attitudes to Chronic Pain  

Microsoft Academic Search

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

Kathryn A. Clarke; Ron Iphofen

2007-01-01

425

Pain Control After Surgery: Pain Medicines  

MedlinePLUS

... pain medicine given? Medicines can be given by mouth (liquid or pill), through the rectum (suppository) or injected ... Aspirin, ibuprofen or codeine can be taken by mouth. Pills and liquids cause less discomfort than shots into a muscle ...

426

[Osteoporosis and pain or is osteoporosis painful?].  

PubMed

Osteoporosis as a disease is characterized by skeletal quantitative and qualitative abnormalities, leading to an increased fragility. Classically the disease is painless. The complications of the disease, that is bone fractures, cause a well-known acute symptomatology. Subsequent chronic pain is the consequence of skeletal deformities, joint incongruences and tensions on musculo-tendineous structures. Pain management includes pharmacological, physio- and ergo-therapeutical measures and stabilisation maneuvers. PMID:16117031

Uebelhart, B; Rizzoli, R

2005-06-22

427

The genetics of pain and pain inhibition.  

PubMed Central

The present review summarizes the current state of knowledge about the genetics of pain-related phenomena and illustrates the scope and power of genetic approaches to the study of pain. We focus on work performed in our laboratories in Jastrzebiec, Poland; Portland, OR; and Los Angeles, which we feel demonstrates the continuing usefulness of classical genetic approaches, especially when used in combination with newly available molecular genetic techniques. PMID:8610166

Mogil, J S; Sternberg, W F; Marek, P; Sadowski, B; Belknap, J K; Liebeskind, J C

1996-01-01

428

Advancements in pain research.  

PubMed

After the publication of the First Edition of this book in the series of Methods in Molecular Medicine (volume 99 in the series) in 2004, pain research continues its rapid acceleration until 2009, during which it experienced a plateau of growth that likely resulted from the economic downturn started in 2008 (Fig. 1.1). This rapid growth in pain research could be the driving force for an impressive 66% increase in new randomized, double-blind, placebo-control trials for neuropathic pain medications in the past 5 years compared with the last four decades. Unfortunately, little improvement in pain medications has been obtained [1] due to primarily our limited understanding of mechanisms mediating different pain states, especially that for chronic pain. It is highly possible that the growth in pain research will continue for decades to come due to three main reasons. First, there is an urgent need for more efficacious and safer pain medications that are necessary for better and individualized pain management. The increase in life expectancy of the general population and patients due to improvements in quality of health care and medicine is likely to increase the demand for better pain medications for improving the quality of daily life of those living with pain. It is estimated that the continuous increase in percentage of patients suffering from chronic pain (pain conditions lasting more than 6 months) arranges from 11 to 47% between 40 and 75 years of age [2], which will inevitably and continually increase the demand for better pain medications. Second, the cost of pain conditions to our society is high, estimated $55 billion per year in loss of productivity from full-time workers alone [3], so better pain management can significantly help economic growth and stability. Third, the swift advancement in technologies and our better understanding of sensory circuitries and pain pathways serves as a driving force for timely drug discovery research and development at an unprecedented pace to meet the demand for better pain medications. PMID:22351079

Luo, Z David

2012-01-01

429

Pain in cancer survivors.  

PubMed

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

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

430

Mefenamic Acid  

MedlinePLUS

... heartburn, vomit that is bloody or looks like coffee grounds, blood in the stool, or black and ... pain vomit that is bloody or looks like coffee grounds black, tarry, or bloody stools slowed breathing ...

431

Management of Pain in the Cancer Patient.  

National Technical Information Service (NTIS)

Contents: Cancer pain management--diagnosis and evaluation; Cancer pain management--multidisciplinary pain clinics; Cancer pain management--psychologic technics; Cancer pain management--pharmacologic technics; Cancer pain management--neurosurgical technic...

1984-01-01

432

Gender role expectations of pain: relationship to experimental pain perception  

Microsoft Academic Search

The primary purpose of this study was to investigate the influence of an individual's Gender Role Expectations of Pain (GREP) on experimental pain report. One hundred and forty-eight subjects (87 females and 61 males) subjects underwent thermal testing and were asked to report pain threshold, pain tolerance, VAS ratings of pain intensity and unpleasantness, and a computerized visual analogue scales

Emily A Wise; Donald D Price; Cynthia D Myers; Marc W Heft; Michael E Robinson

2002-01-01

433

Painful diabetic polyneuropathy: epidemiology, pain description, and quality of life  

Microsoft Academic Search

A prospective survey study was performed in patients with painful diabetic polyneuropathy (PDN) to assess the nature and scope of their pain. Pain associated with diabetic neuropathy is commonly encountered in clinical practice. Yet, little is known regarding the pain experience and impact on quality of life in persons with painful diabetic neuropathy. These 105 patients noted an average of

Bradley S. Galer; Ann Gianas; Mark P. Jensen

2000-01-01

434

Thoracic spinal anesthesia is safe for patients undergoing abdominal cancer surgery  

PubMed Central

Aim: A double-blinded randomized controlled study to compare discharge time and patient satisfaction between two groups of patients submitted to open surgeries for abdominal malignancies using segmental thoracic spinal or general anesthesia. Background: Open surgeries for abdominal malignancy are usually done under general anesthesia, but many patients with major medical problems sometimes can’t tolerate such anesthesia. Regional anesthesia namely segmental thoracic spinal anesthesia may be beneficial in such patients. Materials and Methods: A total of 60 patients classified according to American Society of Anesthesiology (ASA) as class II or III undergoing surgeries for abdominal malignancy, like colonic or gastric carcinoma, divided into two groups, 30 patients each. Group G, received general anesthesia, Group S received a segmental (T9-T10 injection) thoracic spinal anesthesia with intrathecal injection of 2 ml of hyperbaric bupivacaine 0.5% (10 mg) and 20 ug fentanyl citrate. Intraoperative monitoring, postoperative pain, complications, recovery time, and patient satisfaction at follow-up were compared between the two groups. Results: Spinal anesthesia was performed easily in all 30 patients, although two patients complained of paraesthesiae, which responded to slight needle withdrawal. No patient required conversion to general anesthesia, six patients required midazolam for anxiety and six patients required phenylephrine and atropine for hypotension and bradycardia, recovery was uneventful and without sequelae. The two groups were comparable with respect to gender, age, weight, height, body mass index, ASA classification, preoperative oxygen saturation and preoperative respiratory rate and operative time. Conclusion: This preliminary study has shown that segmental thoracic spinal anesthesia can be used successfully and effectively for open surgeries for abdominal malignancies by experienced anesthetists. It showed shorter postanesthesia care unit stay, better postoperative pain relief and patient satisfaction than general anesthesia.

Ellakany, Mohamed Hamdy

2014-01-01

435

Reduced Postoperative Analgesic Demand After Inhaled Anesthesia in Comparison to Combined Epidural-Inhaled Anesthesia in Patients Undergoing Abdominal Surgery  

Microsoft Academic Search

We studied the effect of epidural\\/general combination anesthesia, in comparison to inhaled anesthesia, on postoperative pain and analgesic consumption in pa- tients undergoing upper abdominal surgery. Anesthe- sia was induced with propofol and maintained with en- flurane in 70% N,O as necessary to maintain arterial blood pressure within 20% of baseline. Group I received bupivacaine 0.25% 0.2 mL\\/kg and sufentanil

Michael G. Rockemann; Wulf Seeling; Svenja Pressler; Peter Steffen; Michael Georgieff

1997-01-01

436

Views You Can Use Fig. 1. Abdominal CT Fig. 2. PET 3 D projection Fig. 3. Sagittal PET  

E-print Network

This 73-year-old man was complaining of abdominal pain without swallowing difficulty. A CT of the abdomen was obtained which showed multiple hepatic masses suggestive of metastatic disease (Fig. 1). No primary lesion was seen in the abdomen. An FNA of the liver was performed. Cytology showed metastatic adenocarcinoma consistent with a gastric primary tumor. A PET scan was obtained which showed: • Sub-total replacement of the liver with tumor

Incidental Lung Cancer

437

Postoperative abdominal complications after cardiopulmonary bypass  

PubMed Central

Background To summarize the diagnostic and therapeutic experiences on the patients who suffered abdominal complications after cardiovascular surgery with cardiopulmonary bypass(CPB). Methods A total of 2349 consecutive patients submitted to cardiovascular surgery with CPB in our hospital from Jan 2004 to Dec 2010 were involved. The clinical data of any abdominal complication, including its incidence, characters, relative risks, diagnostic measures, medical or surgical management and mortality, was retrospectively analyzed. Results Of all the patients, 33(1.4%) developed abdominal complications postoperatively, including 11(33.3%) cases of paralytic ileus, 9(27.3%) of gastrointestinal haemorrhage, 2(6.1%) of gastroduodenal ulcer perforation, 2(6.1%) of acute calculus cholecystitis, 3(9.1%) of acute acalculus cholecystitis, 4(12.1%) of hepatic dysfunction and 2(6.1%) of ischemia bowel diseases. Of the 33 patients, 26 (78.8%) accepted medical treatment and 7 (21.2%) underwent subsequent surgical intervention. There were 5(15.2%) deaths in this series, which was significantly higher than the overall mortality (2.7%). Positive history of peptic ulcer, advanced ages, bad heart function, preoperative IABP support, prolonged CPB time, low cardiac output and prolonged mechanical ventilation are the risk factors of abdominal complications. Conclusions Abdominal complications after cardiovascular surgery with CPB have a low incidence but a higher mortality. Early detection and prompt appropriate intervention are essential for the outcome of the patients. PMID:23046511

2012-01-01

438

Painful Peripheral Neuropathies  

PubMed Central

Peripheral neuropathies are a heterogeneous group of diseases affecting peripheral nerves. The causes are multiple: hereditary, metabolic, infectious, inflammatory, toxic, traumatic. The temporal profile includes acute, subacute and chronic conditions. The majority of peripheral neuropathies cause mainly muscle weakness and sensory loss, positive sensory symptoms and sometimes pain. When pain is present, however, it is usually extremely intense and among the most disabling symptoms for the patients. In addition, the neurological origin of the pain is often missed and patients receive inadequate or delayed specific treatment. Independently of the disease causing the peripheral nerve injury, pain originating from axonal pathology or ganglionopathy privileges neuropathies affecting smaller fibres, a clinical observation that points towards abnormal activity within nociceptive afferents as a main generator of pain. Natural activation of blood vessels or perineurial nociceptive network by pathology also causes intense pain. Pain of this kind, i.e. nerve trunk pain, is among the heralding symptoms of inflammatory or ischemic mononeuropathy and for its intensity represents itself a medical emergency. Neuropathic pain quality rekindles the psychophysical experience of peripheral nerves intraneural microstimulation i.e. a combination of large and small fibres sensation temporally distorted compared to physiological perception evoked by natural stimuli. Pins and needles, burning, cramping mixed with numbness, and tingling are the wording most used by patients. Nociceptive pain instead is most often described as aching, deep and dull. Good command of peripheral nerve anatomy and pathophysiology allows timely recognition of the different pain components and targeted treatment, selected according to intensity, type and temporal profile of the pain. PMID:18615140

Marchettini, P; Lacerenza, M; Mauri, E; Marangoni, C

2006-01-01

439

Pain of urogenital origin  

Microsoft Academic Search

Chronic nonmalignant pain syndromes (longer than 6 months duration) of urogenital origin are well described but poorly understood\\u000a focal pain syndromes. Pain in these areas of the body is usually very embarrassing for the male and female patient, who may\\u000a be afraid to discuss his or her symptoms with family members, friends, and health care providers. Except in those cases

Ursula Wesselmann; Peter P. Czakanski

1999-01-01

440

Acceptance of chronic pain  

Microsoft Academic Search

The experience of chronic pain can be associated with significant distress and disability; however, this is not always the\\u000a case. Although attempts to control or reduce pain can be helpful for many pain sufferers, on some occasions this is not an\\u000a effective option and a different response is required. This different response can include a fiexible mix of control and

Lance M. McCracken; Kevin E. Vowles

2006-01-01

441

Personalized treatment of pain.  

PubMed

Despite advances made in its understanding and treatment, chronic pain remains an unsolved and all too common problem. One of the main obstacles to successful management of pain is the high variability of many patients regarding both response to treatment and susceptibility to adverse effects, which curtails the utility of therapeutic intervention. Understanding the causes of this variability is an important challenge which may lead to a new era in rational pain management. As described in this review, however, there currently seems to be more than one possible explanation of this variability. Rational personalized pain management must take into consideration both ever-increasing knowledge of pharmacogenetics and pharmacokinetics and a broad, clinically based attitude incorporating co-morbidities, both physical and psychiatric, and concomitant medications. Novel models for testing in-vivo pain processing, for example assessment of conditioned pain modulation (CPM), are also promising approaches to use of rational data for empirical treatment of pain. Last, listening to the patient and understanding the context in which pain has affected his or her life is an important part of maintaining the personal nature of therapeutic interaction with patients suffering from pain. PMID:23292814

Ablin, Jacob N; Buskila, Dan

2013-01-01

442

NECK AND SHOULDER PAIN  

PubMed Central

Neck and shoulder pains are presenting or incidental symptoms in a large variety of conditions. There may be similarities in the anatomicophysiological mechanism of pain production and in the clinical picture in many of these conditions. Many of the vague and refractory cases of neck and shoulder pain and of migraine may be due to cervical disc disease. Scalenus anticus syndrome and cardiac disease can be diagnosed or differentiated from cervical disc syndrome only by thorough investigation. Proper treatment of neck and shoulder pain is dependent upon correct diagnosis through complete history, physical examination and laboratory tests, as described in this presentation. PMID:18131684

Fields, Albert; Hoesley, John

1949-01-01

443

Alternative medicine - pain relief  

MedlinePLUS

... for: After surgery or labor Arthritis Cancer Fibromyalgia Irritable bowel syndrome Migraine headache Tension headache Both acupuncture and hypnosis are often offered by pain management centers in ...

444

Ultrasound images of groin pain in the athlete: a pictorial essay.  

PubMed

Chronic groin pain in the athlete is a common condition, with, at times, protracted recovery that leads to prolonged disability. There are soft-tissue and bony contributors to pain, with the mechanism of injury usually an acute or chronic overload of the hip adductor tendons, abdominal aponeurosis, hip joint, or symphysis pubis. The complexity of the regional anatomy often necessitates imaging modalities for precise diagnosis and prompt management. Imaging options include magnetic resonance imaging, computed tomography, nuclear bone scan, radiography, and ultrasound. In this report, we present a series of images that represent the value of musculoskeletal ultrasound in the diagnosis and treatment of groin pain in the athlete. PMID:24486919

Ozçakar, Levent; Utku, Burkay

2014-08-01

445

Lubiprostone does not Influence Visceral Pain Thresholds in Patients with Irritable Bowel Syndrome  

PubMed Central

Background In clinical trials, lubiprostone reduced the severity of abdominal pain. Aims The primary aim was to determine whether lubiprostone raises the threshold for abdominal pain induced by intraluminal balloon distention. A secondary aim was to determine whether changes in pain sensitivity influence clinical pain independently of changes in transit time. Methods Sixty-two patients with irritable bowel syndrome with constipation (IBS-C) participated in an 8-week crossover study. All subjects completed a 14-day baseline ending with a barostat test of pain and urge sensory thresholds. Half, randomly selected, then received 48 ug/day of lubiprostone for 14 days ending with a pain sensitivity test and a Sitzmark test of transit time. This was followed by a 14-day washout and then a crossover to 14 days of placebo with tests of pain sensitivity and transit time. The other half of the subjects received placebo before lubiprostone. All kept symptom diaries. Results Stools were significantly softer when taking lubiprostone compared to placebo (Bristol Stool scores 4.20 vs. 3.44, p<0.001). However, thresholds for pain (17.36 vs. 17.83 mmHg, lubiprostone vs. placebo) and urgency to defecate (14.14 vs. 14.53 mmHg) were not affected by lubiprostone. Transit time was not significantly different between lubiprostone and placebo (51.27 vs. 51.81 hours), and neither pain sensitivity nor transit time was a significant predictor of clinical pain. Conclusions Lubiprostone has no effect on visceral sensory thresholds. The reductions in clinical pain that occur while taking lubiprostone appear to be secondary to changes in stool consistency. PMID:21914041

Whitehead, William E.; Palsson, Olafur S.; Gangarosa, Lisa; Turner, Marsha; Tucker, Jane

2011-01-01