Showing papers on "Abdominal pain published in 1978"

Towards positive diagnosis of the irritable bowel

Abstract: A questionnaire to establish the presence of 15 symptoms thought to be typical of the irritable bowel syndrome (IBS) was given to 109 unselected patients referred to gastroenterology or surgery clinics with abdominal pain or a change in bowel habit or both. Review of case records 17--26 months later established a definite diagnosis of IBS in 32 patients and of organic disease in 33. Four symptoms were significantly more common among patients with IBS--namely, distension, relief of pain with bowel movement, and looser and more frequent bowel movements with the onset of pain. Mucus and a sensation of incomplete evacuation were also common in these patients. The more of these symptoms that were present the more likely was it that the patient's pain or altered bowel habit, or both, was due to IBS. We conclude that a careful history can increase diagnostic confidence and reduce the amount of investigation in many patients with chronic abdominal pain.

Inflammatory fibroid polyp of the gastrointestinal tract.

Abstract: Details of 13 new cases of inflammatory fibroid polyp of the gastrointestinal tract and of 76 patients recorded in the literature (total 89) are described and analysed. The lesion is always benign, may occur at any age but is commonest in the sixth and seventh decades, and involves the stomach most frequently. Abdominal pain, often related to obstruction, is the principal symptom. Eosinophilia of the peripheral blood does not occur. The lesions are sessile or polypoidal, originate in the gut submucosa, vary greatly in cellularity, and have a wide range of tissue eosinophilia. Some are very vascular, many of the larger vessels having a notably broad zone of connective tissue about them. The aetiology of the condition is discussed and reasons for distinguishing it from eosinophilic gastroenteritis, with which it is frequently confused, are given. The precise nature and aetiology of the inflammatory fibroid polyp remains undetermined.

Hereditary pancreatitis in England and Wales.

Abstract: Information from 72 patients from 7 families in England and Wales confirms that hereditary pancreatitis is inherited as an autosomal dominant conditions with limited penetrance. The degree of penetrance is approximately 80%. These patients have had recurrent attacks of abdominal pain starting from childhood or young adult life. The mean age of onset in the 7 families studied was 13.6 years. There were two peaks, with maximum numbers at 5 years and 17 years. The second peak was thought to represent genetically susceptible individuals having pain brought on by alcohol rather than representing evidence of genetic heterogeneity. Five of the 7 families had members with both childhood and adult ages of onset. Only 4 patients out of 72 had life-threatening disease and in the majority of cases the attacks of pain were of nuisance value only. Hereditary pancreatitis was implicated in only 1 patient's death and this was not definite. Patients appear to get better after a period of symptoms usually as they approach middle age, or after a severe attack. In older patients alcohol, emotional upsets, and fatty food appear to precipitate attacks. Pancreatic insufficiency (5.5%), diabetes mellitus (12.5%), pseudocysts (5.5%), and haemorrhagic pleural effusion are uncommon complications. Portal vein thrombosis occurred definitely in 2 patients and was suspected in 3 others. Carcinoma of the pancreas was not found in any of 72 patients studied in detail; however, 2 members from a family not visited personally had chronic pancreatitis and malabsorption going on to carcinoma. They may have suffered from a different disease. Genetic linkage information was too slight for many definite conclusions. However, there was no suggestion of linkage with any of the markers tested.

Is nasogastric suction necessary in acute pancreatitis

Abstract: Fifty-eight patients with mild to moderately severe acute pancreatitis were randomly allocated to treatment with or without nasogastric suction (27 and 31 patients respectively). Intravenous fluids and pethidine hydrochloride were also given. The two groups were comparable clinically at the start of the study. There were no differences between the two groups in the mean duration of the following features: abdominal pain or tenderness; absence of bowel movements; raised serum amylase concentration; time to resumption of oral feeding; and days in hospital. Prolonged hyperamylasaemia (serum amylase greater than 0.33 mU/l) occurred in one patient in the suction group and in three patients in the non-suction group. A mild recurrence of abdominal pain after resumption of oral feeding occurred in three patients in the suction group and in two patients in the non-suction group. Two patients in the suction group developed overt consumption coagulopathy and two others pulmonary complications. No patient in the non-suction group had complications. The findings suggest that most patients with mild to moderately severe acute pancreatitis do not benefit from nasogastric suction. The procedure should be elective rather than mandatory in treating this condition.

Pyogenic hepatic abscess in infancy and childhood

Abstract: Five cases of childhood pyogenic hepatic abscess at Milwaukee Children's Hospital and 61 cases in the literature were reviewed. Hepatic abscess occurred most often in infants who had sepsis or umbilical infection. Cases in older children were associated with underlying host defense defects, particularly chronic granulomatous disease (CGD) and leukemia. Common clinical findings were fever, abdominal pain and hepatomegaly. Radionuclide scan was useful in diagnosis of lesions larger than 2 cm. Small or microscopic lesions were diagnosed at autopsy. Staphylococcus aureus was the most common etiologic agent. Mortality in all evaluable cases was 27% in patients with CGD and 42% in those without CGD. Open drainage and appropriate antibiotic therapy is the treatment of choice and should lower the mortality of this infection.

Cryptic mycotic abdominal aortic aneurysms: diagnosis and management.

Abstract: The incidence of cryptic mycotic abdominal aortic aneurysms has relatively increased since antibiotic therapy has become available. The causative organism is the salmonella group in about 50 per cent of cases. This diagnosis should be strongly entertained in patients with fever of unknown origin, vague abdominal pain, and progressive appearance of a pulsatile abdominal mass. Aortography may be helpful in establishing the diagnosis. Some postoperative graft infections may be due to unrecognized cryptic mycotic infection of the aorta and not from external contamination, as previously supposed. Construction of an axillofemoral bypass graft through clean tissue is advised for the successful treatment of the grossly infected infrarenal aortic aneurysm. Three surviving patients with cryptic mycotic abdominal aortic aneurysms are added to the sixteen surviving patients already reported in the literature.

Spontaneous Retroperitoneal Hemorrhage in Chronically Hemodialyzed Patients

Abstract: Patients maintained on chronic hemodialysis have an increased incidence of spontaneous bleeding from various parts of the body. In this paper we describe 5 patients who developed spontaneous retroperitoneal hemorrhage. All patients were receiving anticoagulants (Coumadin and/or heparin) at the time of bleeding. Clinically, retroperitoneal hemorrhage was evident in the interdialytic period. Presenting symptoms and signs included sudden and progressive onset of pain in the abdomen, flank, back, thigh or hip associated with a drop in blood pressure and hematocrit in the absence of obvious blood loss. Subsequently ecchymosis, swelling and/or mass were observed. Abdominal X-rays showed absent psoas shadows. Treatment included blood transfusions, discontinuation of Coumadin and/or heparin, the use of regional heparinization for hemodialysis and occasionally peritoneal dialysis. Surgical exploration was not required in any case and all 5 patients recovered. Anticoagulation therapy and platelet dysfunction may be contributory causes.

Sulfasalazine toxic reactions. Hepatitis, fever, and skin rash with hypocomplementemia and immune complexes.

Abstract: SINCE its discovery in 1942, sulfasalazine (Azulfidine) has been the most commonly used sulfonamide for the treatment of inflammatory bowel disease. Its merit has been well established in ulcerative colitis, and it possibly has a place in the treatment of Crohn's disease. Although minor adverse effects (anorexia, nausea, vomiting) are recognized frequently, serious reactions are considered rare. In recent years, however, severe adverse reactions to sulfasalazine therapy have been reported with greater frequency.1,2We report a generalized allergic reaction with fever, skin rash, arthralgias, lymphadenopathy, and hepatitis coincident with the administration of this drug. This reaction was accompanied by decreased complement levels and circulating immune complexes. Report of a Case A 26-year-old man was seen because of a three-year history of intermittent cramping abdominal pain, diarrhea, and a 9-kg weight loss. A sigmoidoscopy, small bowel series, and barium enema examination showed Crohn's disease involving the terminal ileum and rectum.

Lipoma of the Colon

Abstract: • Lipoma, an uncommon tumor in the gastrointestinal tract, occurs most often in the colon. The majority are asymptomatic but may cause abdominal pain, obstruction, or bleeding. The diagnosis can be made roentgenographically but is usually not made until operation is performed. Small lipomas may be removed by colonoscopy or followed conservatively after biopsy via colonoscopy. The treatment for symptomatic or large lipomas is surgical excision. (Arch Surg113:897-899, 1978)

The Budd-Chiari syndrome in sarcoidosis.

Abstract: To the Editor.— Hepatic involvement by sarcoidosis is well known. The most common manifestation is a noncaseating granulomatous hepatitis. 1 Associated findings may include chronic intrahepatic cholestasis, periportal fibrosis, and eventual development of a micronodular cirrhosis. 1 To our knowledge, hepatic-vein thrombosis (Budd-Chiari syndrome) has not been encountered as a complication of sarcoidosis. We recently studied a patient with sarcoidosis in whom acute hepatic-vein thrombosis occurred in the absence of other underlying causes. Report of a Case.— A 19-year-old black man was admitted for evaluation of abdominal pain, weight loss, night sweats, and an abnormal chest roentgenogram. Systems review showed a history of sickle cell trait but no prior sickle cell crises or prior abdominal trauma. Physical findings included hepatomegaly, splenomegaly, and a maculopapular, hyperpigmented rash on the chest and legs. Chest roentgenograms showed bilateral hilar lymphadenopathy. Pertinent laboratory values included alkaline phosphatase, 315 IU; total bilirubin, 2.8 mg/dl; hematocrit,

Pancreaticojejunostomy for chronic pancreatitis. Two- to 21-year follow-up.

Abstract: • Between 1954 and 1975, 80 pancreaticojejunostomies were performed on 77 patients for intractable pain of chronic pancreatitis. All patients had a history of chronic alcoholism. Drainage operations done primarily for pseudocysts were excluded. Operative procedures included seven caudal pancreaticojejunostomies, 42 longitudinal pancreaticojejunostomies with splenectomy and implantation of the pancreas into the jejunum, and 31 side-to-side pancreaticojejunostomies. Eighty-one percent of the patients noted substantial improvement or complete resolution of their abdominal pain on follow-up that ranged up to 21 years. The operative mortality was 5%. Thirty-two patients died during the period of the follow-up. Continued alcohol abuse, carcinoma, and cardiovascular disease were the leading causes of mortality. Data from this review confirm the effectiveness of pancreaticojejunostomy in relieving the pain of chronic relapsing pancreatitis. ( Arch Surg 113:520-525, 1978)

Alpha heavy chain disease (report of 18 cases from Iraq).

Abstract: The clinical and pathological features of 18 new patients with alpha heavy chain disease seen at two referral centres in Baghdad, Iraq, are described. The series included 14 males and four females ranging in age from 14 to 47 years. Almost all patients presented because of long-standing abdominal pain and diarrhoea. The tissue diagnosis and extent of the disease were established at laparotomy in most patients. Peroral jejunal biospy was used in a number of patients, mainly for follow-up. The serological abnormality was confirmed by immunoselection technique. Most of the patients had extensive thickening of the bowel wall and/or tumour masses of the small intestine and mesenteric nodes. Histopathological sections showed muscularis. Preliminary results of the treatment, including two long remissions, are reported. In general, our observations agree with those made by other authors, mostly from the Middle East and Africa. We believe that a high index of clinical suspicion, routine use of the immunoselection, and recognition of the early pathological changes may hopefully lead to the detection of more cases before the frank neoplastic phase of the disease.

Primary neoplasms of the small bowel

Abstract: The treatment of thirty-one malignant and eleven benign neoplasms of the small intestine is reported. The most common symptom was abdominal pain followed by vomiting, diarrhea, weight loss, constipation, and gastrointestinal bleeding. In four cases small bowel perforated. Intestinal obstruction occurred in 31 per cent of patients. Preoperative diagnosis was made in 19 per cent of patients. All eleven patients with benign neoplasms were curatively treated by resection and primary anastomosis. Eighteen of the thirty-one patients with malignant tumors had curative resection, five had palliative resection, and eight had laparotomy and biopsy only. The most common benign tumor was leiomyoma. The most common malignant tumor was lymphoma (67 per cent) followed by adenocarcinoma (16 per cent), carcinoid (10 per cent), and leiomyosarcoma (3 per cent). Twenty-four patients were available for follow up; thirteen remain alive and eleven died, seven within one year and four within two years.

Pneumatosis Intestinalis Associated With Fatal Childhood Dermatomyositis

Abstract: Gastrointestinal complications are frequent in childhood dermatomyositis. 1 Pneumatosis intestinalis has been reported only twice and both children had a benign course. 2,3 We now report a boy in whom the appearance of pneumatosis intestinalis preceded colonic perforation, peritonitis, and death. CASE REPORT A boy 8½ years of age presented with a one-month history of muscle pain, weakness, dysphagia, and periorbital swelling. A diagnosis of dermatomyositis was established by elevated muscle enzyme levels and an abnormal electromyogram and muscle biopsy specimen. Despite prednisone therapy (60 mg/day), respiratory impairment developed and intravenous methotrexate (1 mg/kg/wk) was added, resulting in clinical improvement. During the next nine months the patient was hospitalized twice for respiratory weakness and a third time for abdominal pain, for which he underwent a third time for abdominal pain, for which he underwent a laparotomy with an incidental appendectomy.

Prevalence of giardiasis

Abstract: The prevalence of giardiasis was assessed in 1000 consecutive adult patients undergoing upper-gastrointestinal endoscopy for the usually accepted indicatins. Ptients with upper-gastrointestinal bleeding were excluded. The diagnosis was established by examination of duodenal aspirate and duodenal mucosal impression smears. In 21 patients (2.1%) trophozoites were detected both in the duodenal juice and stained mucosal impression smears. All were treated with metronidazole or tinidazole. In 14 of 16 patients who had subsequent duodenal intubation, eradication of the parasite was onformed. In five patients previously existent abdominal pain disappeared with clearing of the parasite, and no other cause for their abdominal pain was discovered. A search for Giardia lamblia infestation may be a worthwhile additional procedure at the time of endoscopy when no other cause for abdominal pain is found.

Colorectal infarction following resection of abdominal aortic aneurysms

Abstract: Infarctions of the colon and rectum (incidences approximately 1 and 0.5 per cent, respectively) are caused by compromised collateral circulation to the colon and rectum, usually as a result of arteriosclerotic disease of the superior and inferior mesenteric arterial systems, as well as the hypogastric arteries Patients who have colorectal ischemia after operations for abdominal aortic aneurysms have diarrhea (sometimes bloody), abdominal pain, and distention. The diagnosis may be established by sigmoidoscopic examination. Treatment includes surgical removal of the compromised bowel and creation of a temporary or permanent end colostomy. Prevention of this complication is aided by preservation of primary and collateral circulation, avoidance of hypotension, and preoperative bowel preparation.

Amebic Liver Abscess: 1966-1976

Abstract: A 10-year retrospective analysis of 15 patients with amebic liver abscess is reviewed and represents a continuation of the previous 2-decade experience at our institution (37 patients). Records were studied to determine the population affected, presenting symptoms, physical and laboratory findings, type and response to therapy. Most patients were rural males of lower socioeconomic status in the third to fifth decade of life. They presented as a febrile illness with abdominal pain for an average of 2 1/2 months duration. Significant physical abnormalities were tender hepatomegaly (93%), right-sided pulmonary changes (40%), and fever (66%). All patients had abnormal liver scan, positive amebic serology, and hypoalbuminemia. All patients promptly responded to amebicidal therapy except one whose therapy was delayed. Clinical suspicion, liver scanning, serologic testing, and response to therapy are the keys to diagnosis.

Aftermath of abortion. Anniversary depression and abdominal pain.

Abstract: Two case histories of significant psychopathology resulting from theraputic abortion are presented. In both cases, pregnancy was motivated by restitution of a loss. One woman experienced psychogenic abdominal pain related to an unconscious pregnancy fantasy. The patient was a 23-year-old nurse's aide who developed cramping with occasional nausea and vomiting during the same month her pregnancy would have been delivered. A 40-year old married housewife also became symptomatic at the time of delivery of a pregnancy she had aborted. Both pregnancies, the physical and the psychosomatic, occurred after the death of the patient's father. Multiple factors, not just therapeutic abortion, led to neurotic depression.

Abdominal Epilepsy: A Cause of Abdominal Pain in Adults

Abstract: Four patients, aged 17 to 47 years, had paroxysmal abdominal pain associated with symptoms suggestive of a CNS disturbance. None had a discernible primary gastrointestinal process, but each had EEG abnormalities and a striking response to anticonvulsant medication. These findings suggest that abdominal epilepsy should be considered in the differential diagnosis of unexplained paroxysmal abdominal pain. ( JAMA 240:2450-2451, 1978)

Primary upper small-intestinal lymphoma and alpha-chain disease. Report of 10 cases emphasizing pathological aspects.

Abstract: Ten cases of primary upper small-intestinal lymphoma associated with alpha-chain protein in serum were discovered in a prospective study of the sera of patients with immunoproliferative small-intestinal disease (IPSID). Patients were mostly young males presenting with abdominal pain, weight loss, and diarrhea and showing laboratory evidence of carbohydrate, fat, and vitamin B12 malabsorption and hypoalbuminemia. The more frequently encountered pathologic abnormality was a diffusely nodular jejunal mucosa produced by a plasmacytic infiltrate of variable cell maturity involving a varible depth of small bowel wall with or without involvement of the mesenteric or para-aortic-lymph node complex and, in one instance, the liver. A less frequent picture included circumferential ulcerative and constrictive transmural tumors of the upper small intestine produced by a malignant lymphoma with involvement of abdominal lymph nodes. Small-intestinal surface epithelial abnormalities, a dense mantle of mature plasma cells overlying the lymphoma, a pronounced follicular lymphoid hyperplasia adjacent to and at distances from the lymphoma were other features of note in our IPSID cases associated with alpha-chain protein.

Clinical experience with the intrauterine progesterone contraceptive system.

Abstract: Clinical experience with the intrauterine progesterone contraceptive system (IPCS) is reported. The major topics include: 1) circumstances associated with insertion (insertion perforations expulsions infection bleeding dysmenorrhea) 2) selection of patients and 3) patients needs for information. Prospective users should be informed that: 1) any entry into the uterine cavity either for sounding or insertion is likely to cause a short period of pain and discomfort or infrequently light-headedness nausea or syncope 2) some change in menstrual patterns is likely 3) some intermenstrual spotting or less often bleeding is likely in the early months of use 4) serious complications are unusual but profuse bleeding severe abdominal pain unusual bleeding or pain associated with fever suspicion of pregnancy or malodorous vaginal discharge must be reported immediately 5) many with moderate early discomfort or bleeding problems eventually adapt comfortably and 6) a 30 to 90 day postinsertion visit is essential.

Abdominal pain and the emotions.

Abstract: Sites in the gut that are related to pain are viewed with respect to the special psychophysiological factors that operate locally. Topics considered are the irritable bowel, appendicitis and appendicectomy, duodenal ulceration and biliary disorders. Psyhcologiocal states that promote the compaint or experience of abdominal pain with the reservation that we still do not know even the main physical mechanisms of pain related to gut disturbance.

Rectus abdominis nerve entrapment syndrome.

Abstract: To the Editor.— Recognition of pain secondary to abdominal wall pathologic conditions may prevent unnecessary laparotomies. Report of a Case.— In February 1978, a 33-year-old woman came to our Pain Control Center with a one-year history of lower left abdominal pain during the midpoint of her menstrual cycle. Over the course of a year, this patient consulted frequently with her gynecologist, who could not relieve her pain with conservative drug or hormonal therapy. After a normal laparotomy in October 1977, the patient was referred to us for evaluation before a planned hysterectomy. While attempting to differentiate between pain of visceral or somatic origin, we noted the pain and tenderness to palpation over the left abdomen was intensified as the abdominal muscles were contracted via leg lift in the supine position. This sign in a patient with chronic pain is strongly suggestive of a nerve entrapment syndrome involving the rectus abdominis

Gastric Duplication Presenting as Cyclic Abdominal Pain

Abstract: number of its causes are overwhelming. A careful history and study of the associated signs and symptoms along with physical and laboratory findings, can often identify the underlying cause. Nevertheless, recurrent abdominal pain of a cyclic nature in an otherwise well three-year-old can be difficult to define under the best of circumstances, and prompts this report of an unusual instance presenting without any associated findings.

Case 25-1978

Abstract: Presentation of Case A 52-year-old woman was admitted to the hospital because of abdominal pain. The patient was a poor historian. She was apparently well until 12 years earlier, when polyarthralgi...