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1.
Medicine (Baltimore) ; 99(5): e18927, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000406

RESUMO

Cytomegalovirus (CMV) gastritis is a rare opportunistic infection with diverse clinical manifestations. Our study aimed to investigate the clinical features of Chinese patients with CMV gastritis.Six inpatients diagnosed with CMV gastritis were retrospectively enrolled, based on the finding of inclusion bodies in routine hematoxylin and eosin staining or positive anti-CMV monoclonal antibodies under immunohistochemistry in the gastric biopsy. Data, including demographics, diagnostic measurements, and medications, were collected.Abdominal pain was the most frequently reported symptom, occurring in 4 patients. Five patients were immunocompromised with associated underlying diseases, and 3 patients had decreased leukocyte differentiation antigen 4 positive (CD4) T lymphocyte counts. Only 3 patients had either positive cytomegalovirus (CMV)-immunoglobulin (Ig) M or increased copies of CMV-DNA peripherally. All patients had gastric lesions in the antrum of the stomach, including ulcers or erosions observed by gastroscopy. All patients received ganciclovir by intravenous injection (IV) as the first line anti-CMV therapy, and attained complete (4) or partial remission (2) during the follow-up.CMV gastritis should be taken into consideration in patients with immunocompromised status who have abdominal pain, nausea, or vomiting. Gastroscopy and necessary biopsy are the major diagnostic methods for CMV gastritis. Early diagnosis leads to a better prognosis for these patients.


Assuntos
Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/epidemiologia , Gastrite/diagnóstico , Gastrite/epidemiologia , Dor Abdominal/diagnóstico , Dor Abdominal/tratamento farmacológico , Dor Abdominal/epidemiologia , Dor Abdominal/etiologia , Adulto , Idoso , Biomarcadores/sangue , Biópsia , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/patologia , Feminino , Gastrite/tratamento farmacológico , Gastrite/patologia , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/diagnóstico , Náusea/tratamento farmacológico , Náusea/epidemiologia , Náusea/etiologia , Prognóstico , Estudos Retrospectivos , Estômago/diagnóstico por imagem , Estômago/patologia , Centros de Atenção Terciária , Vômito/diagnóstico , Vômito/tratamento farmacológico , Vômito/epidemiologia , Vômito/etiologia
2.
J Surg Res ; 246: 73-77, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31562988

RESUMO

BACKGROUND: Biliary dyskinesia (BD) is a common indication for cholecystectomy in children. Current literature demonstrates an improvement in symptoms after cholecystectomy in most pediatric patients with an EF <35%; however, data supporting the efficacy of cholecystectomy for hyperkinetic BD (EF >65%) is sparse. We sought to determine whether children with hyperkinetic BD (HBD) had resolution of their symptoms after laparoscopic cholecystectomy at our institution. MATERIALS AND METHODS: We conducted a retrospective chart review of children who had undergone laparoscopic cholecystectomy for HBD at our institution between September 2010 and July 2015. Patients completed a phone survey about symptom resolution, whether they were happy to have undergone cholecystectomy, overall satisfaction on a 1-10 scale, and additional workup for those with ongoing pain. Analysis was performed using STATA statistical software with a P-value < 0.05 as statistically significant. RESULTS: Thirteen patients met inclusion criteria. Median gallbladder ejection fraction was 93% [IQR: 90, 97]. Median postoperative follow-up was 59 d [IQR: 25, 151] at which time 50% reported resolution of symptoms. Eight patients participated in the survey at a median follow-up of 45 mo [IQR: 40, 66]. Fifty percent reported ongoing abdominal pain. Frequency of pain varied among patients with pain, occurring from <1 time per week to a few times per day. Five patients (63%), including one patient with ongoing pain, were happy that their gallbladder had been removed and overall satisfaction rating was 5 on a scale of 1-10. CONCLUSIONS: Only half of children with HBD were asymptomatic at long-term follow-up. Cholecystectomy for HBD may or may not improve symptoms.


Assuntos
Dor Abdominal/cirurgia , Discinesia Biliar/cirurgia , Colecistectomia Laparoscópica/efeitos adversos , Dor Pós-Operatória/diagnóstico , Medidas de Resultados Relatados pelo Paciente , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adolescente , Discinesia Biliar/complicações , Discinesia Biliar/fisiopatologia , Feminino , Seguimentos , Vesícula Biliar/fisiopatologia , Vesícula Biliar/cirurgia , Humanos , Masculino , Medição da Dor , Dor Pós-Operatória/etiologia , Satisfação do Paciente , Estudos Retrospectivos , Autorrelato/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento
3.
Gastroenterology ; 158(1): 123-136, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31470006

RESUMO

BACKGROUND & AIMS: Peppermint oil is frequently used to treat irritable bowel syndrome (IBS), despite a lack of evidence for efficacy from high-quality controlled trials. We studied the efficacy and safety of small-intestinal-release peppermint oil in patients with IBS and explored the effects of targeted ileocolonic-release peppermint oil. METHODS: We performed a double-blind trial of 190 patients with IBS (according to Rome IV criteria) at 4 hospitals in The Netherlands from August 2016 through March 2018; 189 patients were included in the intent-to-treat analysis (mean age, 34.0 years; 77.8% female; 57.7% in primary care), and 178 completed the study. Patients were randomly assigned to groups given 182 mg small-intestinal-release peppermint oil, 182 mg ileocolonic-release peppermint oil, or placebo for 8 weeks. The primary endpoint was abdominal pain response, as defined by the US Food and Drug Administration: at least a 30% decrease in the weekly average of worst daily abdominal pain compared with baseline in at least 4 weeks. The co-primary endpoint was overall relief of IBS symptoms, as defined by the European Medicines Agency. Secondary endpoints included abdominal pain, discomfort, symptom severity, and adverse events. RESULTS: Abdominal pain response did not differ significantly between the peppermint oil and placebo groups: 29 of 62 patients in the small-intestinal-release peppermint oil group had a response (46.8%, P = .170 vs placebo), 26 of 63 patients in the ileocolonic-release peppermint oil group had a response (41.3%, P = .385 vs placebo), and 22 of 64 patients in the placebo group had a response (34.4%). We did not find differences among the groups in overall relief (9.7%, P = .317 and 1.6%, P = .351 vs 4.7% for placebo). The small intestinal peppermint oil did, however, produce greater improvements than placebo in secondary outcomes of abdominal pain (P = .016), discomfort (P = .020), and IBS severity (P = .020). Adverse events, although mild, were more common in both peppermint oil groups (P < .005). CONCLUSIONS: In a randomized trial of patients with IBS, we found that neither small-intestinal-release nor ileocolonic-release peppermint oil (8 weeks) produced statistically significant reductions in abdominal pain response or overall symptom relief, when using US Food and Drug Administration/European Medicines Agency recommended endpoints. The small-intestinal-release peppermint oil did, however, significantly reduce abdominal pain, discomfort, and IBS severity. These findings do not support further development of ileocolonic-release peppermint oil for treatment of IBS. Clinicaltrials.gov, Number: NCT02716285.


Assuntos
Dor Abdominal/tratamento farmacológico , Analgésicos/administração & dosagem , Síndrome do Intestino Irritável/tratamento farmacológico , Óleos Vegetais/administração & dosagem , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Administração Oral , Adolescente , Adulto , Idoso , Analgésicos/efeitos adversos , Cápsulas , Método Duplo-Cego , Feminino , Humanos , Mucosa Intestinal/efeitos dos fármacos , Síndrome do Intestino Irritável/complicações , Síndrome do Intestino Irritável/diagnóstico , Masculino , Pessoa de Meia-Idade , Países Baixos , Medição da Dor , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
4.
S D Med ; 72(10): 478-484, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31816211

RESUMO

Acute abdominal pain is considered to be one of the most elusive and common complaints among patients presenting to the emergency department and primary care settings across the U.S. Owing to the clinical complexity of this seemingly non-specific complaint, it often becomes difficult to determine which patients require extensive evaluation of their illness and when specialized consultation should be obtained. The aim of this article is to address generalizable principles which can be utilized by the clinician in the cost-effective and expedient evaluation of acute abdominal pain.


Assuntos
Dor Abdominal , Serviço Hospitalar de Emergência , Dor Abdominal/diagnóstico , Diagnóstico Diferencial , Humanos , Atenção Primária à Saúde , Encaminhamento e Consulta
5.
Medicine (Baltimore) ; 98(51): e14222, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860943

RESUMO

RATIONALE: Patients with gastrointestinal stromal tumors (GISTs) are often found to have liver metastases at their 1st presentation. Most patients need preoperative treatment to reduce the size of the liver metastases to increase the possibility of surgical resection. Currently, imatinib mesylate is the drug of 1st choice for preoperative treatment and sunitinib malate (SM) is seldom used. Here we report a case of GIST with liver metastases where SM was used as a preoperative treatment. PATIENT CONCERNS: A 56-year-old worker presented with intermittent abdominal pain and eating difficulties. DIAGNOSES: An enhanced computed tomography scan showed a 15 × 15 × 10 cm malignant mass in the upper abdomen, and 2 metastases (15.1 × 13.1 cm and 14.8 × 8.8 cm) in the liver. The postcaval and middle hepatic veins were compressed by the liver metastases, making radical resection very difficult. INTERVENTIONS: First the primary tumor in the jejunum was resected, and then SM was used as a preoperative treatment to reduce the size of the liver metastases to improve the possibility of surgical resection. OUTCOMES: Both liver metastases regressed considerably in size and it was then possible to perform a radical resection. LESSONS: The SM has the potential to be used as preoperative therapy for GIST with large liver metastases. This method provides a new option for the preoperative treatment of GIST with liver metastases.


Assuntos
Tumores do Estroma Gastrointestinal/tratamento farmacológico , Tumores do Estroma Gastrointestinal/patologia , Neoplasias do Jejuno/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Sunitinibe/uso terapêutico , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Seguimentos , Tumores do Estroma Gastrointestinal/cirurgia , Hepatectomia/métodos , Humanos , Neoplasias do Jejuno/patologia , Neoplasias do Jejuno/cirurgia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Cuidados Pré-Operatórios/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
6.
Medicine (Baltimore) ; 98(51): e18141, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860961

RESUMO

RATIONALE: Peliosis hepatis (PH), which is characterized by blood-filled cavities in the liver, is a rare disease. Its diagnosis depends on postoperative pathological examinations and immunohistochemistry. PATIENT CONCERNS: A 44-year-old female complained of right-middle upper abdominal pain and distension for 1 month, with occasional vomiting and fever. DIAGNOSIS: Because of the similar imaging features, the patient was initially misdiagnosed as cystic echinococcosis (CE). The immunoassay of echinococcosis was negative. Irregular hepatectomy was performed. Eventually, the patient was diagnosed with PH based on postoperative histopathology and immunohistochemistry. INTERVENTIONS: The patient underwent hepatectomy. Then, the cystic lesion was collected for intraoperative pathological examination. Thus, the blood liquid was extracted from the cystic lesion. Pringle maneuver was administered to prevent bleeding, and then the whole cystic lesion was removed. OUTCOMES: She recovered smoothly and there was no relapse occurred during 6 months' follow-up. LESSONS: It is difficult to differentiate PH from CE and other hepatic diseases due to the lack of special imaging features. Pathological examinations and immunohistochemistry can provide a confirmed diagnosis of PH.


Assuntos
Equinococose/diagnóstico , Hepatectomia/métodos , Peliose Hepática/diagnóstico , Peliose Hepática/patologia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Biópsia por Agulha , Diagnóstico Diferencial , Equinococose/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Imagem por Ressonância Magnética/métodos , Peliose Hepática/diagnóstico por imagem , Peliose Hepática/cirurgia , Doenças Raras , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
7.
Rev Med Chil ; 147(8): 1073-1077, 2019 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-31859974

RESUMO

In lupus enteritis, circulating pathological immune complexes and thrombosis of intestinal vessels may occur, resulting in acute abdominal pain. We report a 24-year-old woman without a history of systemic lupus erythematosus (SLE), admitted for abdominal pain. An exploratory laparotomy found an appendicitis along with ascites. An appendectomy was performed, and the patient was discharged from the hospital two days later. Three days after discharge, the patient was admitted to another hospital due to the persistence of abdominal pain. An abdominal computed tomography scan showed diffuse mesenteric congestion, concentric bowel loops (double halo or target sign) and the presence of free fluid in the peritoneal cavity. Suspecting a rheumatic disorder, the diagnosis of SLE was confirmed by immunological studies. The patient was treated with pulses of methylprednisolone with good results.


Assuntos
Enterite/diagnóstico , Lúpus Eritematoso Sistêmico/diagnóstico , Dor Abdominal/diagnóstico , Apendicite/diagnóstico , Diagnóstico Diferencial , Enterite/tratamento farmacológico , Feminino , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Metilprednisolona/uso terapêutico , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
8.
BMC Surg ; 19(1): 167, 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31711457

RESUMO

BACKGROUND: Abdominal cocoon is a rare peritoneal lesion and is difficult to diagnose because of its lack of special clinical manifestations. Until now, there is no case report of abdominal cocoon combined with cryptorchidism and seminoma. CASE PRESENTATION: A case of abdominal cocoon with cryptorchidism and seminoma was diagnosed and treated in our hospital. The patient had no symptoms except occasional abdominal pain. He underwent laparoscopy because of bilateral cryptorchidism and seminoma in the right testis. During the surgery, he was diagnosed with abdominal cocoon due to the thick fibrous tissues which was tightly adhered and encased part of intestine like a cocoon. Enterolysis and bilateral cryptochiectomy were performed after the diagnosis and nutritional and symptomatic support was provided after the surgery. The patient recovered well and was discharged soon. The postoperative pathological examination confirmed the presence of bilateral cryptorchidism and seminoma in the patient's right testis. CONCLUSION: There are only a handful of cases where a patient has both abdominal cocoon and cryptorchidism. Since the etiologies of both diseases remain unknown, further research is required to investigate effective diagnosis and treatment for the diseases and explore the potential connection between the two diseases.


Assuntos
Criptorquidismo/diagnóstico , Seminoma/diagnóstico , Neoplasias Testiculares/diagnóstico , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Criptorquidismo/complicações , Criptorquidismo/cirurgia , Diagnóstico Diferencial , Humanos , Laparoscopia/métodos , Imagem por Ressonância Magnética , Masculino , Escroto , Seminoma/complicações , Seminoma/cirurgia , Neoplasias Testiculares/complicações , Neoplasias Testiculares/cirurgia , Ultrassonografia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
9.
BMC Surg ; 19(1): 168, 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31711462

RESUMO

BACKGROUND: Appendiceal inversion with neoplasia in adults is an extremely rare event with a reported incidence of < 0.01%. Preoperative diagnosis is very important for surgical treatment; however, it is very difficult to be exact. CASE PRESENTATION: The patient was a 60-year-old woman with complaints of intermittent abdominal pain. Computed tomography and colonoscopy revealed a cecal mass, which was diagnosed as a tubulovillous adenoma in the preoperative colonoscopic biopsy. At surgery, the appendix was found to be completely inverted into the cecum. The cecum was partially resected, and surgical pathology examination confirmed a tubulovillous adenoma of the appendix with local high-grade intraepithelial neoplasia. CONCLUSIONS: Although preoperative diagnosis of appendiceal inversion with neoplasia may be often difficult due to its non-specific symptoms, clinicians should consider this disease entity when they encounter an intraluminal protruding cecal mass without visualization of the normal appendix on CT and colonoscopy.


Assuntos
Dor Abdominal/etiologia , Apêndice/diagnóstico por imagem , Doenças do Ceco/diagnóstico , Dor Abdominal/diagnóstico , Dor Abdominal/cirurgia , Apendicectomia/métodos , Apêndice/cirurgia , Doenças do Ceco/complicações , Doenças do Ceco/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Laparoscopia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos
10.
Surg Clin North Am ; 99(6): 1163-1176, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676055

RESUMO

Patients with inflammatory bowel disease (IBD) will often require abdominal surgical intervention for indications not directly related to their IBD. Because these patients often have a history of multiple previous abdominal operations and/or ostomies, they are at increased risk for incisional and parastomal hernias. They may also have develop symptomatic cholelithiasis, chronic pain, or desmoid disease. All of these potentially surgical issues may require special consideration in the IBD population.


Assuntos
Colecistectomia Laparoscópica/métodos , Neoplasias do Sistema Digestório/cirurgia , Hérnia Ventral/cirurgia , Doenças Inflamatórias Intestinais/cirurgia , Reoperação/métodos , Dor Abdominal/diagnóstico , Dor Abdominal/cirurgia , Colecistectomia Laparoscópica/efeitos adversos , Neoplasias do Sistema Digestório/diagnóstico , Feminino , Fibromatose Agressiva/diagnóstico , Fibromatose Agressiva/cirurgia , Hérnia Ventral/diagnóstico , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Masculino , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Prognóstico , Medição de Risco , Telas Cirúrgicas , Resultado do Tratamento
11.
Pediatr Emerg Med Pract ; 16(9): CD1-CD2, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31687792

RESUMO

The pediatric appendicitis score predicts the likelihood of a diagnosis of appendicitis in pediatric patients with abdominal pain.


Assuntos
Dor Abdominal/diagnóstico , Apendicite/diagnóstico , Tomada de Decisão Clínica/métodos , Exame Físico/métodos , Dor Abdominal/etiologia , Apendicite/complicações , Criança , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Humanos , Índice de Gravidade de Doença
12.
Pediatr Emerg Med Pract ; 16(9): CD5-CD6, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31687793

RESUMO

The pediatric appendicitis risk calculator quantifies appendicitis risk in pediatric patients with abdominal pain, possibly better than the pediatric appendicitis score.


Assuntos
Dor Abdominal/diagnóstico , Tomada de Decisão Clínica/métodos , Exame Físico/métodos , Índice de Gravidade de Doença , Dor Abdominal/etiologia , Algoritmos , Criança , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Humanos
13.
Medicine (Baltimore) ; 98(44): e17791, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689854

RESUMO

RATIONALE: Pulmonary embolism (PE) is one of the serious cardiopulmonary diseases that can endanger life. Early diagnosis and timely treatment are key factors to reduce its high mortality rate. Abdominal pain is not currently included in the symptoms of PE in textbooks and guidelines. PATIENT CONCERNS: A 49-year-old man was hospitalized for an exacerbation of right upper quadrant abdominal pain and sudden left upper quadrant pain that lasted for 2 hours. DIAGNOSES: The patient was initially misdiagnosed as cholecystitis and pneumonia, and later was diagnosed as PE by computed tomography pulmonary angiography (CTPA). INTERVENTIONS: The patient received low molecular weight heparin for anticoagulant therapy. OUTCOMES: His abdominal pain disappeared after one week. The patient was later discharged. LESSONS: Sometimes abdominal pain may be the only manifestation of PE. However, most clinicians do not think of the possibility of PE in patients with abdominal pain. This might have contributed greatly to the rate of misdiagnosis of PE in the past. We hope to improve the alertness of the diagnosis of PE in clinical practice. In patients with abdominal pain, the possibility of PE should be considered to avoid mis- or under-diagnosis.


Assuntos
Dor Abdominal/diagnóstico , Embolia Pulmonar/diagnóstico , Dor Abdominal/etiologia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/complicações
14.
Medicine (Baltimore) ; 98(48): e18165, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770263

RESUMO

RATIONALE: Crossed renal ectopia (CRE) is a rare congenital anomaly that is frequently associated with gastrointestinal, cardiovascular, genital and bone malformations. To the best of our knowledge, only 35 cases of crossed renal ectopia involving calculi and 30 cases of CRE associated with renal carcinoma have been reported to date. PATIENT CONCERNS: Here, we present 2 cases of crossed renal ectopia. A 59-year-old woman with diabetes presented to our hospital with abdominal pain. The second patient was a 24-year-old woman who complained with abdominal pain with a duration of 1 day. DIAGNOSES: On the basis of abdominal ultrasonography, we suspected a solitary kidney both in the two patients. Combined with retrograde pyelography and 3D computed tomography, case 1 was diagnosed as an S-shaped right-to-left crossed-fused ectopic kidney with many stones in the left (normal) renal pelvis and case 2 was confirmed to have lump right-to-left crossed-fused renal ectopia with two 3-mm stones in the renal pelvis of the 2 kidneys. INTERVENTIONS: Case 1 underwent percutaneous nephrolithotomy while case 2 refused to undergo surgery and underwent conservative treatment for pain relief. OUTCOMES: Two patients have been followed up and have no stones recurrence. LESSONS: Crossed fused renal ectopia is easily misdiagnosed as a solitary kidney. CRE is so rare that the recognition of the disease needs to be improved and effective treatment should be taken timely. According to the two cases and literature review, minimally invasive surgery has become increasingly common to treat CRE with stones and carcinoma.


Assuntos
Dor Abdominal , Rim Fundido , Cálculos Renais , Rim , Nefrolitotomia Percutânea/métodos , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Diagnóstico Diferencial , Erros de Diagnóstico/prevenção & controle , Feminino , Rim Fundido/complicações , Rim Fundido/diagnóstico , Rim Fundido/fisiopatologia , Humanos , Rim/anormalidades , Rim/diagnóstico por imagem , Rim/cirurgia , Cálculos Renais/complicações , Cálculos Renais/diagnóstico , Cálculos Renais/fisiopatologia , Cálculos Renais/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ultrassonografia/métodos , Urografia/métodos
15.
Medicine (Baltimore) ; 98(48): e18182, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770271

RESUMO

RATIONALE: Rupture of an unscarred uterus after in vitro fertilization-embryo transfer (IVF-ET) in a primiparous woman is rare. Assisted reproductive technology (ART)-induced rupture of an unscarred uterus is usually attributable to increased dizygotic twinning rates. Salpingectomy can result in cornual scarring and increase the risk of uterine rupture as well as the mortality rate in a subsequent ectopic pregnancy. Here, we present the first reported case of a spontaneous, third-trimester, uterine rupture in a primiparous woman after IVF-ET due to a history of bilateral salpingectomy because of bilateral oviduct and ovarian cysts; the patient did not have an ectopic pregnancy or any cornual or other uterine scarring during this pregnancy after IVF-ET. PATIENT CONCERNS: A 24-year-old woman with a history of IVF-ET and bilateral salpingectomy was admitted to our hospital with unexplained acute upper abdominal pain during the third trimester. DIAGNOSIS: The fetal heart rate was abnormal. Abdominal ultrasonography was negative. Computed tomography revealed a small amount of abdominal and pericardial effusion. Laboratory tests revealed increased white blood cells. A diagnosis of pregnancy complicated by acute abdomen was considered. Emergent exploratory laparotomy revealed a uterine rupture at the right fundus adjacent to the right cornual area. INTERVENTIONS: The patient was successfully managed with simultaneous exploratory laparotomy and lower-segment cesarean section. The rupture site was repaired. OUTCOMES: Two live infants were uneventfully delivered. Follow-up assessments of the mother and the female baby on the 42nd postpartum day yielded normal results. The male infant was diagnosed with left hydronephrosis and required an operation. LESSONS: We conclude that the ART-associated increase in dizygotic twinning rates may be a neglected risk factor for spontaneous rupture of the unscarred uterus, especially in patients who have undergone salpingectomy. Uterine rupture should be considered in a patient with multiple pregnancy following IVF-ET who presents with acute abdominal pain and abnormal fetal heart rate. Timely exploratory laparotomy is the key to a good prognosis.


Assuntos
Dor Abdominal , Cesárea/métodos , Transferência Embrionária , Fertilização In Vitro , Frequência Cardíaca Fetal , Ruptura Espontânea , Ruptura Uterina , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Transferência Embrionária/efeitos adversos , Transferência Embrionária/métodos , Feminino , Fertilização In Vitro/efeitos adversos , Fertilização In Vitro/métodos , Monitorização Fetal/métodos , Humanos , Gravidez , Resultado da Gravidez , Terceiro Trimestre da Gravidez , Gravidez de Gêmeos , Fatores de Risco , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/etiologia , Ruptura Espontânea/cirurgia , Salpingectomia/efeitos adversos , Ruptura Uterina/diagnóstico , Ruptura Uterina/etiologia , Ruptura Uterina/cirurgia , Adulto Jovem
17.
Am Surg ; 85(10): 1104-1107, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657303

RESUMO

Chronic abdominal pain of unknown origin is a challenging diagnosis encountered by clinicians. Patients often undergo an extensive workup and long periods of uncertainty without the establishment of a definitive diagnosis. Diagnostic laparoscopy is a relatively safe procedure that can be used as an effective diagnostic and therapeutic tool in treating this disease. This was a retrospective, single-institution study exploring the efficacy of diagnostic laparoscopy in treating chronic abdominal pain of unknown origin. More than 90 per cent of laparoscopies resulted in a positive finding, with adhesions being the most common. A total of 50 per cent of patients experienced resolution of symptoms on follow-up. Patients were overwhelmingly satisfied with their postoperative outcomes and willing to undergo the procedure again with their outcomes in mind.


Assuntos
Dor Abdominal/diagnóstico , Dor Abdominal/cirurgia , Dor Crônica/diagnóstico , Dor Crônica/cirurgia , Laparoscopia , Dor Abdominal/epidemiologia , Dor Abdominal/etiologia , Dor Crônica/epidemiologia , Dor Crônica/etiologia , Feminino , Humanos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos , Fatores de Tempo , Aderências Teciduais/complicações , Aderências Teciduais/diagnóstico , Aderências Teciduais/cirurgia , Resultado do Tratamento
18.
Medicine (Baltimore) ; 98(41): e17574, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593144

RESUMO

RATIONALE: Approximately 5000 species of wild mushroom are reported worldwide, of which 100 are documented as poisonous and <10 are fatal. The clinical picture of patients with wild mushroom intoxication depends mostly on the type of ingested mushroom, ranging from mild gastrointestinal symptoms to organ failure and death. PATIENT CONCERNS: We report 2 children, sister and brother admitted in our clinic for gastrointestinal symptoms: abdominal pain, nausea, vomiting, and diarrhea after wild mushroom ingestion. DIAGNOSIS: The laboratory tests revealed hepatic cytolysis syndrome, hyperbilirubinemia, impaired coagulation status, hypoalbuminemia, hypoglycemia, and electrolytic unbalances in both cases. Abdominal ultrasound showed hepatomegaly and ascites. INTERVENTION: After admission, both cases received penicillin by vein, activated charcoal, liver protectors, glucose, and electrolytes perfusions. Nevertheless, their status worsened and required the transfer to the pediatric intensive care unit for appropriate supportive measure. Therefore, therapeutic plasma exchange was initiated along with N-acetyl cysteine and hemostatic drugs. OUTCOMES: Despite all these therapeutic interventions, both cases developed hepatorenal syndrome and died after a couple of days from ingestion. LESSONS: Mushroom poisoning remains a public health problem in developing countries. Preventable strategies and education regarding the consumption of wild type mushrooms are essential for decreasing the morbidity and mortality rates in these areas.


Assuntos
Síndrome Hepatorrenal/etiologia , Intoxicação Alimentar por Cogumelos/complicações , Intoxicação Alimentar por Cogumelos/diagnóstico , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Agaricales/classificação , Ascite/diagnóstico por imagem , Criança , Pré-Escolar , Diarreia/diagnóstico , Diarreia/etiologia , Ingestão de Alimentos , Evolução Fatal , Feminino , Hepatomegalia/diagnóstico por imagem , Humanos , Masculino , Intoxicação Alimentar por Cogumelos/patologia , Intoxicação Alimentar por Cogumelos/terapia , Troca Plasmática/métodos , Romênia/epidemiologia , Ultrassonografia , Vômito/diagnóstico , Vômito/etiologia
19.
BMJ Case Rep ; 12(9)2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31537593

RESUMO

ACE inhibitors (ACEi) are common anti-hypertensive drugs that can cause angioedema. Though classic, or facial angioedema is rare, visceral angioedema is even less common. When angioedema occurs, it typically presents early, within 30 days of initiating therapy. Visceral angioedema most commonly presents with nausea, emesis, abdominal pain and diarrhoea, and thus is often mistaken for an episode of gastroenteritis. When a CT scan is obtained, it typically shows characteristic findings, including ascetic fluid, mild mesenteric oedema and thickening of the small bowel. In this case report, we present a patient who did not experience her first episode of visceral angioedema until after she had been on ACEi therapy for 5-7 years. In addition, she experienced recurrent episodes of visceral angioedema that were separated by approximately 4 years at a time. Both of these features make for a particularly unique presentation.


Assuntos
Angioedema/induzido quimicamente , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Lisinopril/efeitos adversos , Vísceras/patologia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Angioedema/diagnóstico por imagem , Angioedema/tratamento farmacológico , Antialérgicos/uso terapêutico , Diagnóstico Diferencial , Diarreia/diagnóstico , Diarreia/etiologia , Feminino , Glucocorticoides/uso terapêutico , Antagonistas dos Receptores Histamínicos H2/uso terapêutico , Humanos , Pessoa de Meia-Idade , Náusea/diagnóstico , Náusea/etiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
20.
World J Gastroenterol ; 25(31): 4414-4426, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31496621

RESUMO

Inflammatory bowel diseases (IBD), Crohn`s disease and ulcerative colitis, are chronic conditions associated with high morbidity and healthcare costs. The natural history of IBD is variable and marked by alternating periods of flare and remission. Even though the use of newer therapeutic targets has been associated with higher rates of mucosal healing, a great proportion of IBD patients remain symptomatic despite effective control of inflammation. These symptoms may include but not limited to abdominal pain, dyspepsia, diarrhea, urgency, fecal incontinence, constipation or bloating. In this setting, commonly there is an overlap with gastrointestinal (GI) motility and absorptive disorders. Early recognition of these conditions greatly improves patient care and may decrease the risk of mistreatment. Therefore, in this review we describe the prevalence, diagnosis and treatment of GI motility and absorptive disorders that commonly affect patients with IBD.


Assuntos
Dor Abdominal/epidemiologia , Constipação Intestinal/epidemiologia , Diarreia/epidemiologia , Dispepsia/epidemiologia , Incontinência Fecal/epidemiologia , Doenças Inflamatórias Intestinais/complicações , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Dor Abdominal/terapia , Constipação Intestinal/diagnóstico , Constipação Intestinal/etiologia , Constipação Intestinal/terapia , Diarreia/diagnóstico , Diarreia/etiologia , Diarreia/terapia , Dispepsia/diagnóstico , Dispepsia/etiologia , Dispepsia/terapia , Incontinência Fecal/diagnóstico , Incontinência Fecal/etiologia , Incontinência Fecal/terapia , Motilidade Gastrointestinal/fisiologia , Humanos , Doenças Inflamatórias Intestinais/fisiopatologia , Doenças Inflamatórias Intestinais/terapia , Prevalência , Índice de Gravidade de Doença
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