Showing papers on "Abdominal pain published in 1982"

Epidemiologic and clinical features of patients infected with Shigella who attended a diarrheal disease hospital in Bangladesh.

Abstract: The epidemiologic and clinical characteristics of 412 patients infected with Shigella from a systematic sample of approximately 100,000 patients attending Dacca Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh, between December 1, 1979, and November 30, 1980, were reviewed. Shigella was isolated from 11.6% of the 3,550 patients in the sample and was the second most common isolate in patients over two years old. Two clinical presentations of shigellosis were found: (I) watery diarrhea occurring in younger children and associated with a shorter duration of illness and with more vomiting and dehydration and (2) dysentery with stool blood and abdominal pain. These different presentations may reflect two mechanisms in the pathogenesis of shigellosis or different stages of the disease. The most useful signs and symptoms for the diagnosis of shigellosis were stool with blood and abdominal pain in all patients and the absence of watery diarrhea and vomiting in patients over one year old. Simple visual inspection of stool for blood correctly identified 44% of all patients infected with Shigella.

Ovarian Sertoli‐Leydig cell tumors with heterologous elements. II. Cartilage and skeletal muscle: A clinicopathologic analysis of twelve cases

Abstract: Twelve ovarian Sertoli-Leydig cell tumors that contained heterologous elements in the form of skeletal muscle (nine cases), cartilage (seven cases) and neuroblastoma (one case) in either the primary of recurrent specimens are reported. Four of the primary tumors also contained foci of gastrointestinal type epithelium with argentaffin cells identifiable in two of them. The age of the patients ranged from 11-48 years (average, 24 years). Ten patients presented with an abdominal mass, one with abdominal pain and one with acute abdominal symptoms. Five of the patients, two of whom were virilized and one of whom was hirsute, had evidence establishing or suggesting androgen overproduction. All the tumors were unilateral. Four had ruptured preoperatively and two ruptured during the operation. The tumors averaged 18.5 cm in greatest diameter and had extensive areas of hemorrhage and necrosis in half the cases. On microscopic examination the Sertoli-Leydig cell component was poorly differentiated in 11 cases and of intermediate differentiation in one case. In two cases the primary tumor was a poorly differentiated Sertoli-Leydig cell tumor and heterologous elements were identified only in a recurrent mass. Follow-up of ten patients revealed that eight of them had died of tumor from five months to seven years postoperatively.

Functional abdominal pain: further evidence that whole gut is affected.

Abstract: The distribution and referral of abdominal pain in 21 patients with functional abdominal pain were investigated by performing balloon distension of the ileum, proximal jejunum, second part of the duodenum, and distal oesophagus. Pain was perceived not just in classically described sites but throughout the abdomen and was referred to several unusual extra-abdominal sites. The presenting pain was reproduced by this technique in 14 patients, in three of whom it was also reproduced by colonoscopic distension. This study emphasises the protean presentation of functional abdominal pain and demonstrates the existence of potentially tender "trigger" areas for the production of abdominal pain in the proximal as well as the distal gut.

Influence of drug treatment on the irritable bowel syndrome and its interaction with psychoneurotic morbidity.

Abstract: Sixty per cent of the patients referred to two gastroenterological clinics and diagnosed as suffering from the irritable bowel syndrome (IBS), were found to have significant psychoneurotic morbidity on the basis of the General Health Questionnaire. A double-blind, completely randomised, placebo controlled comparison of treatment with a combined anxiolytic/antidepressant (Motipress) found a significantly better effect of Motipress than placebo on diarrhoea and abdominal pain. Detailed analysis of the results suggests that there is no direct relationship between psychoneurotic illness and IBS, but the presence of the former has an adverse effect on the short-term outcome of the bowel disorder.

Traumatic Diaphragmatic Hernia

Abstract: † The records of 36 patients with traumatic diaphragmatic hernia (TDH) were reviewed. In 14, acute hernias were diagnosed, but the diagnosis was made one month to 15 years after injury in 22 patients with chronic hernia. Seven acute TDHs were due to blunt and seven to penetrating trauma. Four chronic TDHs were due to blunt and 18 to penetrating trauma. Chest pain, abdominal pain, or dyspnea occurred in each acute case and in 18 of 22 chronic cases. Plain chest roentgenograms were abnormal in 33 of 36 cases. Pleural effusion or abnormal diaphragmatic contour were common abnormal findings. Supradiaphragmatic bowel, pathognomonic of TDH, was evident in seven acute and eight chronic hernias. Celiotomy was routinely employed in acute hernias, celiotomy or thoracotomy in chronic hernias. There were three deaths, two with associated CNS injury and one with chronic pulmonary disease. (Arch Surg1982;117:18-24)

A feasibility study of computer aided diagnosis in appendicitis.

Abstract: In this study, the hypothesis that computer aided diagnosis could enable a more accurate differentiation between patients with acute appendicitis and those with abdominal pain but normal appendixes was examined. A data base was established by analyzing the records of 476 patients having an emergency measure appendectomy during a five year period. There were 360 or 76 per cent with acute appendicitis, 98 or 20 per cent with normal appendixes and 18 or 4 per cent with other diseases requiring operation. The records were analyzed with regard to history, physical examination and laboratory findings. The data base was then divided randomly into two parts. Part 1 was subjected to univariate discriminant analysis, using the chi-square test. The only quantities which were significantly different between appendicitis and a normal appendix were sex, duration of symptoms, anorexia and vomiting. Multivariate discriminant analysis was used to derive an abdominal pain index which discriminated between appendicitis and a normal appendix with a sensitivity of 0.82 and a specificity of 0.39. Using the abdominal pain index to evaluate the patients in part 2 of the data base, 23 or 40 per cent of the 58 patients with a normal appendix would have avoided operation. However, 31 or 18 per cent of the 169 patients with appendicitis would have not been operated upon; three of those 31 had perforated appendixes. Computer aided diagnosis was no more effective than unaided clinical diagnosis in appendicitis.

Mass hysteria among schoolchildren. Early loss as a predisposing factor.

Abstract: • On May 21, 1979, an outbreak of illness spread swiftly among elementary school students in a Boston suburb. Of 224 boys and girls attending an assembly, 34 were hospitalized with severe dizziness, weakness, hyperventilation, headache, nausea, and abdominal pain. Sudden remission of symptoms, preponderance in girls, and failure of an extensive epidemiological investigation to detect an organic cause indicated mass hysteria. To test the hypothesis that previous loss influenced a child's vulnerability to current loss and predisposed that child to mass hysteria, we compared the incidence of family disruption in the hospitalized children with that in the nonhospitalized children. A significantly higher rate of parental divorce ( P P

Astrovirus-associated epidemic gastroenteritis in Japan.

Abstract: An outbreak of epidemic gastroenteritis associated with astrovirus, the first case reported in Japan, is described. Not only children (5-6 years of age), but also staff members of a kindergarten were affected. the virus particles detected in stools were 28-30 nm in diameter with a circular outline and had the characteristic star-like configuration which allowed identification as astrovirus. Significant immune responses to the virus were confirmed by immune electron microscopy. Out of 84 children, 43 (54.2%) were affected; the common symptoms were vomiting, abdominal pain, diarrhea, and fever. All the patients recovered completely within 48 hours. Occurrence of gastroenteritis due to contact with these patients was observed in 14 of 43 families.

The Couvade Syndrome: An Epidemiologic Study

Abstract: A tracer condition, to be used for clinical epidemiologic examination of psychosociogenic illness, must be common and clearly identifiable, distinguishable from concomitant physical problems, and found in general care. These criteria are met by couvade syndrome, the seeking of care for pregnancy-related symptoms by the mates of expectant women. Records of the mates of 267 postpartum women, representing a systemic sample of all births in a health maintenance organization of 36,000, were rated for the presence of nausea, vomiting, anorexia, abdominal pain, abdominal bloating, and other symptoms. Each patient was his own control. Sixty men (225 of 1000) sought care for couvade syndrome; they had a twofold increase in visits (p less than 0.001); had four times more symptoms than during control periods (p less than 0.001); and received twice as many prescriptions for medication as the men without this syndrome (p less than 0.05). The health care providers did not tend to recognize the "expectant" status of these patients or note the presence of the syndrome.

Potential biobehavioral mechanisms of recurrent abdominal pain in children.

Abstract: To explain why otherwise healthy children experience recurrent episodes of abdominal pain (the recurrent abdominal pain syndrome, or RAP), it has been hypothesized that the child with RAP demonstrates: (1) a deficit in autonomic nervous system recovery to stress, and/or (2) an enhanced behavioral and subjective response to pain. To evaluate the validity of these assumptions, children with RAP (9-14 years) and hospital and healthy controls matched for age, sex, ethnicity and SES were exposed to a cold pressor stimulus (0 +/- 1 degree C). Autonomic (peripheral vasomotor and heart rate), somatic (forearm EMG), subjective (pain intensity and distress), and behavioral (facial expression) responses were recorded during baseline, stressor and recovery periods. At all 4 levels of observation, the cold pressor stimulus resulted in significant autonomic, somatic, subjective and behavioral arousal. However, no significant differential response across the 3 groups was noted for any measure and, in particular, no recovery deficit in autonomic arousal was demonstrated. These findings do not support the assumption of a differential response to an acute laboratory induced stress in children with RAP compared to control children.

Acute torsion of the gall bladder in the aged: a re‐emphasis on clinical diagnosis

Abstract: Three cases of torsion of the gall bladder in the aged are presented. From a review of the clinical features of these cases and the cases reported in the literature, a definite clinical pattern emerged. The clinical features can be grouped into three triads: a triad of the patient's characteristics which consists of a thin, old patient with chronic chest disease or a deformed spine; a triad of symptoms which consists of typical abdominal pain, early onset of vomiting and a short history; and a triad of physical signs which consists of an abdominal mass, a lack of toxaemia or jaundice and a discrepancy in the pulse and temperature. If most, if not all, of these features are present, torsion of the gall bladder should be presented. We re-emphasize that a clinical suspicion or diagnosis of torsion of the gall bladder is possible. The treatment is early cholecystectomy.

Prognosis of acute nonspecific abdominal pain. A prospective study.

Abstract: In a prospective study of 230 patients followed up for 5 years after hospital admission for acute non-specific abdominal pain, 21 patients (9 patients) could not be traced, and 11 (5 percent) had died. Only one death was related to symptoms from the first admission. Of the remaining 198 patients, 77 percent were healthy and free of any symptoms during the observation period. Fourteen patients (7 percent) had been hospitalized once more due to acute abdominal pain; 5 had acute appendicitis. The others had diagnosed recurrences of nonspecific abdominal pain. Sixteen percent complained of continuing of intermittent abdominal symptoms, mainly of benign colonic or gynecologic origin, while malignant disease developed in 1 percent (or 4 percent of patients over 50 years of age). It is concluded that control of these patients is generally unnecessary, but when symptoms recur further examinations, especially for colonic or gynecologic disease, should be carried out. In patients over 50 years old, the possibility of malignant disease should be kept in mind.

Patients with Psychogenic Abdominal Pain: Six Years Observation in the Medical Setting

Abstract: The author presents data on 24 patients with psychogenic abdominal pain who were followed by nonpsychiatric physicians for up to 6 years. Twenty were women, many of whose symptoms related to loss. Several personality patterns were observed, including histrionic personality, depression, pain-prone personality, and hypochondriasis. No patient sought psychiatric care, although 4 patients eventually required psychiatric hospitalization. Two patients had medical disorders that contributed to the symptoms, and 1 patient died of carcinoma. Pain resolved in only 1 of the patients, but psychosocial functioning improved in half. Those with a shorter duration of pain and no abnormal personality patterns had a better prognosis.

Evaluation of Plain Abdominal Radiographs in the Diagnosis of Abdominal Pain

Abstract: In an effort to develop referral criteria for the ordering of abdominal radiographs for patients presenting with abdominal symptoms, we prospectively studied the relation between clinical ...

Does uncomplicated diverticular disease produce symptoms

Abstract: A questionnaire dealing with bowel symptoms was administered to 97 outpatients referred for air-contrast barium enema. Subsequenlly, the barium enema was interpreted by a radiologist who did not know the results of the questionnaire. Forty-nine had normal x-rays, and 27 had uncomplicated diverticular disease. Weight loss, rectal bleeding, abdominal pain, and pain at night were as common in those with a normal examination as in those with diverticula. Symptoms of colon dysfunction included abdominal pain relieved by defecation, altered stool frequency and consistency with pain onset, abdominal distension, feeling of incomplete evacuation after defecation, and mucus in the stool. These were equally prevalent in both groups. Therefore, no symptoms could be ascribed to the presence of diverticula

Pancreatic Cystadenoma in Von Hippel–Lindau Disease: An Unusual Cause of Pancreatic and Common Bile Duct Obstruction

Abstract: Pancreatic cystadenoma is an unusual lesion of the pancreas, typically occurring as an isolated lesion in a middle-aged woman with abdominal pain or an asymptomatic epigastric mass. Jaundice is unusual. Two types of pancreatic cystadenoma are distinguished: microcystic and mucinous; the latt

Myelolipoma: An unusual surgical lesion of the adrenal gland

Abstract: The clinical and pathologic features of three cases of surgically removed myelolipoma of the adrenal gland are presented. As with 18 previously reported cases, the lesions were found in obese, middle-aged persons; two of three had chronic, systemic disease (vasculitis and lymphoma, sustained hypertension). The only symptom possibly attributable to the neoplasm was nonspecific abdominal pain, and each lesion was identified by inferior renal displacement on intravenous urography. As computed tomography becomes widely available, the authors expect more myelolipomas to be detected that require surgical exploration, since there are no satisfactory, specific radiographic criteria to differentiate adrenal myelolipoma from adrenocortical carcinoma.

Contained rupture of abdominal aortic aneurysms: sonographic and CT diagnosis.

Abstract: Autopsy studies of patients who died with untreated abdominal aortic aneurysms have indicated that about 30% of the deaths were due to aneurysm rupture [1 -2]. Operative mortality of ruptured aneurysms has averaged 40%-60% [2-3]. The classic symptoms of rupture are excruciating abdominal pain, shock, and an expanding abdominal mass [1 -4]. However, in the absence of this symptomatic triad, diagnosis may be delayed by consideration of other diseases causing similar symptoms (i.e. , renal colic, herniated disc, diverticulitis, or appendicitis). We report three cases of contained rupture of an abdominal aortic aneurysm evaluated by sonography and computed tomography (CT). Rapid diagnosis in two patients prompted immediate surgery with a successful outcome.

Primary mesenteric venous thrombosis.

Abstract: To elucidate further the characteristics, optimal management and ultimate outcome of patients with primary mesenteric venous thrombosis, the records of nine such patients were analyzed. There were seven male and two female patients, with a mean age of 47 years. Abdominal pain, vomiting, fever and hematochezia were the characteristics presenting complaints. Tenderness, distention and diminished intestinal sounds were the prominent abdominal physical findings and were often associated with tachycardia and hypotension. No one of the laboratory findings were specifically diagnostic for mesenteric venous thrombosis, but leukocytosis and hemoconcentration were commonly found. Roentgenographic findings were consistent with intestinal obstruction in six patients. Thrombosis of the mesenteric veins could not be attributed to any specific cause in these nine patients, thereby warranting the classification of primary. At operation, all nine patients were found to have a segment of infarcted small intestine--132 +/- 105 centimeters--with obvious thrombosis of the mesenteric veins but with patent mesenteric arteries. Five patients had bloody ascites. Two deaths occurred in the immediate postoperative period, both being due to sudden and unexpected cardiopulmonary arrest. Neither of these two patients received anticoagulant therapy. Two patients had undergone segmental resection at other hospitals and were referred to our institution because of a recurrence of acute abdominal signs and symptoms. Neither of these patients received anticoagulant therapy. At reoperation, both had recurrent segmental mesenteric venous thrombosis. Familiarity with this condition is essential in making the correct diagnosis, so that resection may be undertaken promptly. Heparin should immediately be administered intravenously after establishing the diagnosis of mesenteric venous thrombosis to prevent recurrent thrombosis and other possible thrombotic complications. If these steps are taken expeditiously, the prognosis of mesenteric venous thrombosis is often favorable.

Symptoms in irritable bowel syndrome.

Abstract: In a consecutive study of 101 patients with IBS and at least one year of complaints, the presence of somatic and mental symptoms were measured By definition all patients had abdominal pain and/or disturbed bowel function in the absence of organic disease The most prominent symptom of indigestion was abdominal distension Many patients also had complaints of food intolerance and avoided bulk forming agents such as fruits and vegetables Symptoms associated with the upper gastrointestinal tract such as burning sensations in the epigastrium nausea and acid regurgitation were seen in a majority of the patients Mental symptoms were seen in almost all patients A majority had complaints of inner tension, worrying over trifles, autonomic disturbances and muscular tension Symptoms referred to the neurasthenic syndrome were also frequently seen, such as fatiguability and irritable and hostile feelings Common depression symptoms were sadness and feelings of helplessness Other mental symptoms of importance were phobias, sleep disturbances, reduced sexual interest, loss of appetite and obsessive-compulsive symptoms Our conclusion is that patients with IBS frequently have upper gastrointestinal and mental symptoms which should be taken into account searching for more rational methods of treatment

Clinical course and autopsy findings in acute and chronic pancreatitis.

Abstract: A retrospective study of 314 patients hospitalized for pancreatitis in the period 1972-1973, showed that 74 (24%) had died in the course of five years. The aim of the study was to elucidate the etiology and the course of the pancreatitis and the immediate cause of death in the 61 cases where an autopsy was performed. There were three types of histopathological findings at autopsy concerning the pancreas: acute hemorrhagic pancreatitis, chronic pancreatitis and one group with no or minimal changes in the pancreas. The last group had had typical clinical symptoms of pancreatitis with abdominal pain and elevated urine and/or serum amylase, in many patients a very marked rise. Alcoholism was the dominant predisposing factor, regardless of the type of histopathological findings, but when the first attack of pancreatitis appeared at advanced age, biliary tract disease and cancer were the dominant causes. Liver damage was a common finding in alcoholic pancreatitis.