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2.
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
3.
Acta Gastroenterol Belg ; 82(3): 441-443, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31566335

RESUMO

We present a case about a 53-year-old man who complained of abdominal pain and constipation. Computed tomography showed a well-described nodular structure of 6cm in size with a central dense core of 0.5cm with compression against the rectosigmoid. The presence of a foreign body was suggested and a diagnostic laparoscopy was performed. Surgery revealed a giant peritoneal loose body measuring 5.5cm in diameter. After the removal, the patient was relieved of his symptoms. Peritoneal loose bodies are usually small and asymptomatic. They are mostly found incidentally during laparotomy. Giant peritoneal loose bodies are a rare entity and diagnosis is difficult. A review of the literature is presented.


Assuntos
Dor Abdominal/etiologia , Calcinose/cirurgia , Constipação Intestinal/etiologia , Laparoscopia , Doenças Peritoneais/cirurgia , Peritônio/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Humanos , Laparotomia , Masculino , Pessoa de Meia-Idade , Doenças Peritoneais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
4.
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
5.
Expert Opin Investig Drugs ; 28(10): 871-889, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31566013

RESUMO

Introduction: Functional dyspepsia (FD), defined as the presence of chronic functional symptoms originating from the gastroduodenal, is one of the most common functional gastrointestinal disorders. FD is subdivided into postprandial distress syndrome (PDS), with meal-related symptoms such as postprandial fullness and early satiation, and epigastric pain syndrome (EPS), with meal-unrelated symptoms such as epigastric pain or burning. Therapeutic options for FD are very limited, probably reflecting the complex pathophysiology which comprises disorders of gastric sensorimotor function as well as low-grade duodenal inflammation.Areas covered: This review summarizes recent and ongoing drug development for FD as identifiedExpert opinion: Proton pump inhibitors (PPIs) are the traditional first-line therapy while potassiumcompetitive acid blockers are being studied. Ongoing drug development focuses on gastric motility with prokinetics (dopamine-2 antagonists and 5-HT4 agonists) and fundus relaxant therapies (acotiamide, azapirones), and on sensitivity with peripherally (guanylate cyclase and cannabinoid agonists) and centrally acting neuromodulators. Drugs under development for gastroparesis may be efficacious in PDS. There are emerging data with pro-and antibiotics and with phytotherapeutic agents. Duodenal low-grade inflammation is a newly emerging target which may respond also to PPIs, histamine and leukotriene receptor blockers.


Assuntos
Dispepsia/tratamento farmacológico , Fármacos Gastrointestinais/farmacologia , Gastroenteropatias/tratamento farmacológico , Dor Abdominal/etiologia , Desenvolvimento de Medicamentos/métodos , Dispepsia/fisiopatologia , Fármacos Gastrointestinais/administração & dosagem , Gastroenteropatias/fisiopatologia , Gastroparesia/tratamento farmacológico , Gastroparesia/fisiopatologia , Humanos , Inflamação/tratamento farmacológico , Inflamação/fisiopatologia , Inibidores da Bomba de Prótons/administração & dosagem , Inibidores da Bomba de Prótons/farmacologia
7.
Magy Seb ; 72(3): 112-114, 2019 Sep.
Artigo em Húngaro | MEDLINE | ID: mdl-31544481

RESUMO

Introduction: Lymphomas are rare entities in the gastrointestinal tract. The so-called Burkitt-like lymphoma belongs to the non-Hodgkin lymphoma group, and it is quite an aggressive, rapid-growing, but potentially curable disease. Surgeons mostly encounter with this tumor as a solid mass which causes abdominal pain, or as a cause of bowel obstruction or perforation. Our aim was to present a case, when Burkitt-like lymphoma caused acute abdominal symptoms without alarming complaints, obstruction or perforation. Furthermore we review and summarize the relevant literature data on this topic. Regarding our case we can claim that histological investigation and multidisciplinary approach are essential to make the diagnosis and to start the treatment as early as possible.


Assuntos
Abdome Agudo/etiologia , Linfoma de Burkitt/patologia , Dor Abdominal/etiologia , Humanos , Obstrução Intestinal/etiologia
8.
Niger Postgrad Med J ; 26(3): 169-173, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31441455

RESUMO

Background: Intussusception in adults is considered rare in surgical practice. It is the causative lesion in a small proportion of cases of intestinal obstruction and lower gastrointestinal bleeding. In the last decade, the incidence of adult intussusception appears to be increasing at our centre. Aims: This study aims to document the pattern of presentation and management outcome of adult intussusception at our institution during the last decade. We also observed the occurring trends of this lesion. Patients and Methods: This was a 10-year retrospective study of consecutive adult patients with intussusception seen at our institution from July 2008 to June 2018. Information on biodata, clinicopathological features and management outcome retrieved from case notes and pathology records were analysed on a personal computer using SPSS version 23. Results: Twenty adult patients who had intussusception were seen during this period. There were 9 (45%) males and 11 (55%) females giving a male-to-female ratio of 1:1.2. The mean age of presentation was 45 (range 18-66) years. Clinical features were abdominal pain (85%), abdominal distension (80%), vomiting (70%), rectal bleeding (70%) and palpable abdominal mass (35%). Majority of patients (70%) presented with features of intestinal obstruction. Idiopathic intussusception (55%) accounted for more than half of the cases with the jejunoileal variety (30%) as the most common pathological type. One patient who had intussusception in the postoperative period was treated with manual reduction at laparotomy. Bowel resections were performed in the remaining 19 (95%) patients. Conclusion: Adult intussusception is still uncommon in our general surgical practice. Bowel resection is the mainstay of treatment.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Obstrução Intestinal/etiologia , Intussuscepção/diagnóstico , Intussuscepção/cirurgia , Dor Abdominal/etiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Intussuscepção/patologia , Masculino , Pessoa de Meia-Idade , Nigéria , Estudos Retrospectivos , Centros de Atenção Terciária , Vômito/etiologia , Adulto Jovem
9.
Mymensingh Med J ; 28(3): 681-684, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31391444

RESUMO

Fibromatosis of mesentery is a very rare disease and only a few cases have been reported. Here we report a case of 40 year old man admitted on 16 October, 2017 in the Department of Surgery (Unit-3) of Mymensingh Medical College Hospital with history of recurrent abdominal pain and progressively enlarging intra-abdominal lump for 2 years. Out of different diagnostic dilemmas, finally we came to the conclusion of its being a mass lesion primarily arising from the mesentery and involving the adjoining gut according to the report of CT abdomen. Laparotomy was performed and a lump measuring about 18 cm × 20 cm arising from mesentery was found, in which distal part of jejunum and proximal part of ileum were embedded. The mass was excised with incorporated gut loops and histopathology report revealed fibromatosis of mesentery.


Assuntos
Fibromatose Abdominal , Neoplasias Peritoneais , Dor Abdominal/etiologia , Adulto , Fibromatose Abdominal/complicações , Fibromatose Abdominal/diagnóstico , Humanos , Masculino , Mesentério , Neoplasias Peritoneais/complicações , Neoplasias Peritoneais/diagnóstico
10.
Medicine (Baltimore) ; 98(35): e16895, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464920

RESUMO

RATIONALE: Methotrexate (MTX) is an antimetabolite of folic acid, which is used for management of ectopic pregnancy. MTX-related toxicity may include cutaneous mucosal damage, bone marrow suppression, gastrointestinal disorders (gastritis, diarrhea, hematitis), liver and kidney function damage, pulmonary toxicity, cardiac toxicity, and nerve toxicity. However, it is not usual for vulvar edema induced by low-dose methotrexate. PATIENT CONCERNS: In this case report, we described a patient with severe vulvar edema and oral cavity ulceration and scalp ulceration induced by low-dose MTX treatment for ectopic pregnancy. Her presenting complaints were pain in the vulva, oral cavity, and scalp. DIAGNOSES: The patient was diagnosed based on clinical findings for MTX toxic reactions. INTERVENTIONS: Vulva was disinfectioned with iodide and Kangfuxin solution, her mouth was rinsed with mouthwash. Three compound glycyrrhizin tablets were orally administered (3 times/day). After 10 days, the broken skin and mucous membrane healed. OUTCOMES: The vulvar edema and oral cavity ulceration and scalp ulceration healed. LESSONS: Our study demonstrated that even low-dose MTX can be induced skin and mucosal injury, patients and doctors should timely detection of drug toxicity reactions, immediately rescue, prompt discontinuation of medication, and symptomatic treatment to avoid accidental occurrence.


Assuntos
Metotrexato/administração & dosagem , Metronidazol/administração & dosagem , Gravidez Ectópica/tratamento farmacológico , Vaginite por Trichomonas/tratamento farmacológico , Doenças da Vulva/induzido quimicamente , Dor Abdominal/etiologia , Administração Oral , Adulto , China , Feminino , Ácido Glicirrízico/administração & dosagem , Ácido Glicirrízico/uso terapêutico , Humanos , Injeções Intramusculares , Materia Medica/administração & dosagem , Materia Medica/uso terapêutico , Metotrexato/efeitos adversos , Metronidazol/uso terapêutico , Gravidez , Gravidez Ectópica/diagnóstico , Resultado do Tratamento , Hemorragia Uterina/etiologia , Doenças da Vulva/tratamento farmacológico
11.
Rozhl Chir ; 98(8): 326-327, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31462055

RESUMO

INTRODUCTION: The umbilical vein can become recanalised due to portal hypertension in patients with liver cirrhosis but the condition is rarely clinically significant. Although bleeding from this enlarged vein is a known complication, the finding of thrombophlebitis has not been previously described. CASE REPORT: We report the case of a 62-year-old male with a history of liver cirrhosis due to alcoholic liver disease presenting to hospital with epigastric pain. A CT scan of the patients abdomen revealed a thrombus with surrounding inflammatory changes in a recanalised umbilical vein. The patient was managed conservatively and was discharged home the following day. CONCLUSION: Thrombophlebitis of a recanalised umbilical vein is a rare cause of abdominal pain in patients with liver cirrhosis.


Assuntos
Dor Abdominal , Tromboflebite , Veias Umbilicais , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Hemorragia , Humanos , Masculino , Pessoa de Meia-Idade , Veia Porta , Tromboflebite/complicações , Tomografia Computadorizada por Raios X
15.
Mikrobiyol Bul ; 53(3): 262-273, 2019 Jul.
Artigo em Turco | MEDLINE | ID: mdl-31414628

RESUMO

Helicobacters have wide host diversity due to the their particular virulence and environmental factors and may cause infections in humans. As they live in and around the stomach the group is called as gastric helicobacters which particularly consists of Helicobacter pylori and Helicobacter heilmanni, Helicobacter felis, Helicobacter salomonis and many other species, as well. In this study, it was aimed to evaluate 195 patients (119 urban and 76 rural residents, 121 female and 74 male individuals between 18 and 93 years of age) in terms of gastric Helicobacter (H.pylori, H.felis and H.heilmanii) who have admitted to the Health Research and Application Center of Kafkas University Endoscopy Unit of the General Surgery Department with the complaints of abdominal pain. For this purpose, biopsy specimens obtained from various parts of the stomach (corpus and antrum) by endoscopy were analyzed with histopathological examination and PCR. Histopathological analysis sections were stained with May-Grunwald-Giemsa and spiral-shaped helicobacters attached to the surface of the epithelium were investigated. For the direct analysis of Helicobacter in biopsy samples, 16S rRNA gene based genus-specific and urease B gene based species-specific PCR methods were used. Out of the 195 cases that were histopathologically evaluated 163 (83.58%) were found to be positive for gastric Helicobacter, while five were suspected and 27 were negative. Helicobacter spp. DNA were detected in 107 (54.87%) samples, of these samples 91 were histopathologically positive, 13 were negative and three were suspicious samples. Eighty seven (44.61%) of the samples were identified as H.pylori by species-specific PCR. H.felis and H.heilmannii could not be detected in any of the samples; meanwhile genus-specific PCR positive 20 samples were not identified. In this study, 42.85% of the individuals living in urban area and 47.36% of those living in rural area were identified as H.pylori positive. 46.28% of women and 41.89% of men were positive for H.pylori. The age range of H.pylori positive individuals were as follows: 60% of the individuals were between 15-24 years, 60.27% of the individuals were between 25-44 years, 34.66% of the individuals were between 45-64 years and 29.72% of the individuals were 65 and over. 42.64% of the cat or dog owners were found as H.pylori positive whereas H.pylori was positive in 45.66% of the individuals who do not own animals. No significant relationship was found between these determinants and the prevalence of the disease (p> 0.05). However, the positivity of H.pylori was higher in the 25-44 active working age group due to the increased agent exposure (p<0.05). This study is the first study on the prevalence of H.pylori in humans and analysis of possible risk factors in the region and hoped to provide useful information for the researchers working in this field.


Assuntos
Dor Abdominal/etiologia , Dor Abdominal/microbiologia , Infecções por Helicobacter , Animais , Biópsia , Gatos , Cães , Feminino , Infecções por Helicobacter/complicações , Infecções por Helicobacter/diagnóstico , Helicobacter pylori , Humanos , Masculino , RNA Ribossômico 16S/genética , Medição de Risco
18.
Intern Med ; 58(14): 2025-2028, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31308342

RESUMO

A 37-year-old man developed abdominal pain and the frequency of severe abdominal pain steadily increased to once a month. He was therefore admitted to our hospital. Abdominal CT showed bowel obstruction. It revealed transient stenosis in the small intestine. There were no symptoms such as fever or weight loss, it seemed unlikely that the patient had inflammatory bowel disease. Considering the history of recurrent abdominal pain, Familial Mediterranean Fever (FMF) was considered. As a result, a genetic analysis revealed mutations in exons 3 and 8 of the MEFV gene. We herein report the first known case of FMF with transient small bowel stenosis in Japan.


Assuntos
Febre Familiar do Mediterrâneo/diagnóstico , Febre Familiar do Mediterrâneo/genética , Pirina/genética , Dor Abdominal/etiologia , Adulto , Constrição Patológica , Análise Mutacional de DNA , Febre Familiar do Mediterrâneo/complicações , Febre/genética , Humanos , Obstrução Intestinal , Intestino Delgado , Japão , Masculino , Mutação
19.
BMC Infect Dis ; 19(1): 649, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331271

RESUMO

BACKGROUND: Despite the greater sensitivity of the new dengue clinical classification proposed by the World Health Organization (WHO) in 2009, there is a need for a better definition of warning signs and clinical progression of dengue cases. Classic statistical methods have been used to evaluate risk criteria in dengue patients, however they usually cannot access the complexity of dengue clinical profiles. We propose the use of machine learning as an alternative tool to identify the possible characteristics that could be used to develop a risk criterion for severity in dengue patients. METHOD: In this study, we analyzed the clinical profiles of 523 confirmed dengue cases using self-organizing maps (SOM) and random forest algorithms to identify clusters of patients with similar patterns. RESULTS: We identified four natural clusters, two with features of dengue without warning signs or mild disease, one that comprises the severe dengue cases and high frequency of warning signs, and another with intermediate characteristics. Age appeared as the key variable for splitting the data into these four clusters although warning signs such as abdominal pain or tenderness, clinical fluid accumulation, mucosal bleeding, lethargy, restlessness, liver enlargement and increased hematocrit associated with a decrease in platelet counts should also be considered to evaluate severity in dengue patients. CONCLUSIONS: These findings suggest that age must be the first characteristic to be considered in places where dengue is hyperendemic. Our results show that warning signs should be closely monitored, mainly in children. Further studies exploring these results in a longitudinal approach may help to understand the full spectrum of dengue clinical manifestations.


Assuntos
Dengue/etiologia , Aprendizado de Máquina não Supervisionado , Dor Abdominal/etiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Algoritmos , Brasil , Criança , Pré-Escolar , Estudos Transversais , Dengue/diagnóstico , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Estudos Retrospectivos , Processos Estocásticos
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