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1.
Medicine (Baltimore) ; 99(8): e19044, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080079

RESUMO

INTRODUCTION: The purpose of this study is to evaluate the efficacy and safety of acupuncture on relieving abdominal pain and distension in acute pancreatitis. METHODS AND ANALYSIS: We will electronically search PubMed, MEDLINE, Embase, Web of Science, the Cochrane Central Register of Controlled Trial, China National Knowledge Infrastructure, China Biomedical Literature Database, China Science Journal Database, and Wanfang Database from their inception. Furthermore, we will manually retrieve other resources, including reference lists of identified publications, conference articles, and gray literature. The clinical randomized controlled trials or quasi-randomized controlled trials related to acupuncture treating acute pancreatitis will be included in the study. The language is limited to Chinese and English. Research selection, data extraction, and research quality assessment will be independently completed by 2 researchers. Data will be synthesized using a fixed effects model or random effects model depending on the heterogeneity test. The overall response rate and the visual analog scale score will be the primary outcomes. The time of first bowel sound, the time of first defecation, the length of hospitalization, acute physiology and chronic health evaluation II score, and the adverse events will also be assessed as secondary outcomes. RevMan 5 (version 5.3) statistical software will be used for meta-analysis, and the level of evidence will be assessed by Grading of Recommendations Assessment, Development, and Evaluation. Continuous data will be expressed in the form of weighted mean difference or standardized mean difference with 95% confidence intervals, whereas dichotomous data will be expressed in the form of risk ratios with 95% confidence intervals. ETHICS AND DISSEMINATION: The protocol of this systematic review does not require ethical approval because it does not involve humans. We will publish this article in peer-reviewed journals and present at relevant conferences. PROSPERO REGISTRATION NUMBER: CRD42019147503.


Assuntos
Dor Abdominal/terapia , Terapia por Acupuntura/métodos , Pancreatite/terapia , Terapia por Acupuntura/efeitos adversos , China/epidemiologia , Defecação/efeitos dos fármacos , Defecação/fisiologia , Humanos , Tempo de Internação/estatística & dados numéricos , Metanálise como Assunto , Pancreatite/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Escala Visual Analógica
2.
JAMA ; 322(24): 2422-2434, 2019 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-31860051

RESUMO

Importance: Chronic pancreatitis (CP) is a chronic inflammatory and fibrotic disease of the pancreas with a prevalence of 42 to 73 per 100 000 adults in the United States. Observations: Both genetic and environmental factors are thought to contribute to the pathogenesis of CP. Environmental factors associated with CP include alcohol abuse (odds ratio [OR], 3.1; 95% CI, 1.87-5.14) for 5 or more drinks per day vs abstainers and light drinkers as well as smoking (OR, 4.59; 95% CI, 2.91-7.25) for more than 35 pack-years in a case-control study involving 971 participants. Between 28% to 80% of patients are classified as having "idiopathic CP." Up to 50% of these individuals have mutations of the trypsin inhibitor gene (SPINK1) or the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Approximately 1% of people diagnosed with CP may have hereditary pancreatitis, associated with cationic trypsinogen (PRSS1) gene mutations. Approximately 80% of people with CP present with recurrent or chronic upper abdominal pain. Long-term sequelae include diabetes in 38% to 40% and exocrine insufficiency in 30% to 48%. The diagnosis is based on pancreatic calcifications, ductal dilatation, and atrophy visualized by imaging with computed tomography, magnetic resonance imaging, or both. Endoscopic ultrasound can assist in making the diagnosis in patients with a high index of suspicion such as recurrent episodes of acute pancreatitis when imaging is normal or equivocal. The first line of therapy consists of advice to discontinue use of alcohol and smoking and taking analgesic agents (nonsteroidal anti-inflammatory drugs and weak opioids such as tramadol). A trial of pancreatic enzymes and antioxidants (a combination of multivitamins, selenium, and methionine) can control symptoms in up to 50% of patients. Patients with pancreatic ductal obstruction due to stones, stricture, or both may benefit from ductal drainage via endoscopic retrograde cholangiopancreatography (ERCP) or surgical drainage procedures, such as pancreaticojejunostomy with or without pancreatic head resection, which may provide better pain relief among people who do not respond to endoscopic therapy. Conclusions and Relevance: Chronic pancreatitis often results in chronic abdominal pain and is most commonly caused by excessive alcohol use, smoking, or genetic mutations. Treatment consists primarily of alcohol and smoking cessation, pain control, replacement of pancreatic insufficiency, or mechanical drainage of obstructed pancreatic ducts for some patients.


Assuntos
Pâncreas/cirurgia , Pancreatite Crônica , Dor Abdominal/terapia , Alcoolismo/complicações , Diagnóstico por Imagem , Predisposição Genética para Doença , Humanos , Manejo da Dor , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/etiologia , Pancreatite Crônica/fisiopatologia , Pancreatite Crônica/terapia , Prognóstico , Fatores de Risco , Fumar/efeitos adversos
3.
Medicine (Baltimore) ; 98(39): e17017, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574799

RESUMO

BACKGROUND: Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique to modulate cortical excitability and to induce neuronal plasticity. With a wide range of applications in neurological and psychiatric disorders, the efficiency of tDCS is also studied in the treatment of various pain conditions. Treatment with tDCS might accordingly provide pain relief for patients with acute or chronic pain and thus lead to an increase in quality of life. Moreover, applied as an adjunct therapy, tDCS can reduce help to reduce pain medication intake and accompanying adverse events. To this end, this review examines studies evaluating the efficacy of tDCS in pain relief in patients with intra-abdominal pain. METHODS: A structured search of the PubMed medical database was carried out to identify possibly relevant studies. Studies were compared in terms of treatment characteristics, general conditions, and results. Jadad scale was applied for quality analyses. RESULTS: Out of 289 articles that were found initially, 6 studies were identified that met eligibility criteria. Five out of 6 studies reported significant effects for pain reduction in different types of intra-abdominal pain. CONCLUSIONS: Results indicate that tDCS might be able to reduce intra-abdominal pain. However, more randomized-controlled trials with larger sample size are necessary to define clinically relevant effects as well as treatment characteristics such as duration of stimulation.


Assuntos
Dor Abdominal/terapia , Estimulação Transcraniana por Corrente Contínua , Abdome Agudo/terapia , Dor Crônica/terapia , Humanos , Limiar da Dor
4.
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
5.
Adv Exp Med Biol ; 1148: 323-343, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31482505

RESUMO

We describe the rational use of enteric coated and unprotected replacement pancreatic enzymes for treatment of malabsorption due to pancreatic insufficiency and for pancreatic pain. Enteric coated formulations mix poorly with food allowing separation of enzymes and nutrients when emptying from the stomach. The site of dissolution of the enteric coating in the intestine is also unpredictable and enzymes may not be released until the distal intestine. Together, these barriers result in the lack of dose-response such that the strategy of increasing the dosage following a suboptimal effect is often ineffective. The ability to maintain the intragastric pH ≥4 with the combination of proton pump inhibitors and antacids suggests that it should be possible to reliably obtain a good response with uncoated enzymes. We also discuss the recognition, treatment and prevention of nutritional deficiencies associated with pancreatic insufficiency and recommend a test and treat strategy to identify and resolve nutritional deficits. Finally, we focus on mechanisms causing pain that may be amenable to therapy with pancreatic enzymes. Pain due to malabsorbed digestive contents can be prevented by successful therapy of malabsorption. Feedback inhibition of endogenous pancreatic secretion can prevent pain associated with pancreatic secretion but requires use of non-enteric coated formulations.


Assuntos
Dor Abdominal/terapia , Terapia Enzimática , Enzimas/farmacologia , Insuficiência Pancreática Exócrina/terapia , Humanos
6.
Dan Med J ; 66(7)2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31256781

RESUMO

INTRODUCTION: Although not supported by evidence, there may be a risk of overlooking pathological findings at patients' return visit after emergency admission for non-specific abdominal pain (NSAP). The primary aim of this study was to evaluate the risk of missed acute pathology in patients primarily discharged with NSAP and re-admitted within three months. METHODS: This was a retrospective review of hospital records within a three-month period (1 September-30 November, 2014) in a university hospital with unrestricted referral of abdominal emergency patients. Patients fulfilling the criteria for NSAP were included in the study. RESULTS: Among the 1,474 patients admitted with acute abdominal pain, 390 (26%) were discharged with NSAP; 16% of the patients who were discharged with NSAP were re-admitted for abdominal pain. At their return visit, 39% received a verified specific diagnosis, corresponding to 6% of all patients with the NSAP diagnosis. A total of 40% of the early re-admissions of patients with NSAP were related to the biliary tract (cholelithiatis, cholangitis and cholecystitis). Co-morbidity, nausea, vomiting and increased white blood cell count at the primary admission were significantly associated with a risk of missing a specific diagnosis (p < 0.05). CONCLUSIONS: This study found that only 6% of the patients who were admitted for acute abdominal pain and were discharged with no diagnosis had a somatic condition. However, risk of pathological findings at the return visit was relatively high among patients discharged with NSAP. FUNDING: none. TRIAL REGISTRATION: not relevant.


Assuntos
Abdome Agudo/diagnóstico , Dor Abdominal/diagnóstico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Abdome Agudo/etiologia , Abdome Agudo/terapia , Dor Abdominal/etiologia , Dor Abdominal/terapia , Adulto , Dinamarca , Diagnóstico Diferencial , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Exame Físico , Recidiva , Encaminhamento e Consulta , Estudos Retrospectivos
7.
World J Gastroenterol ; 25(24): 3079-3090, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31293343

RESUMO

BACKGROUND: Pediatric functional gastrointestinal disorders (FGIDs) are common and well-accepted to be etiologically complex in terms of the contribution of biological, psychological, and social factors to symptom presentations. Nonetheless, despite its documented benefits, interdisciplinary treatment, designed to address all of these factors, for pediatric FGIDs remains rare. The current study hypothesized that the majority of pediatric patients seen in an interdisciplinary abdominal pain clinic (APC) would demonstrate clinical resolution of symptoms during the study period and that specific psychosocial variables would be significantly predictive of GI symptom improvement. AIM: To evaluate outcomes with interdisciplinary treatment in pediatric patients with pain-related FGIDs and identify patient characteristics that predicted clinical outcomes. METHODS: Participants were 392 children, ages 8-18 [M = 13.8; standard deviation (SD) = 2.7], seen between August 1, 2013 and June 15, 2016 in an interdisciplinary APC housed within the Division of Gastroenterology in a medium-sized Midwestern children's hospital. To be eligible, patients had to be 8 years of age or older and have had abdominal pain for ≥ 8 wk at the time of initial evaluation. Medical and psychosocial data collected as part of standard of care were retrospectively reviewed and analyzed in the context of the observational study. Logistic regression was used to model odds of reporting vs never reporting improvement, as well as to differentiate rapid from slower improvers. RESULTS: Nearly 70% of patients followed during the study period achieved resolution on at least one of the employed outcome indices. Among those who achieved resolution during follow up, 43% to 49% did so by the first follow up (i.e., within roughly 2 mo after initial evaluation and initiation of interdisciplinary treatment). Patient age, sleep, ease of relaxation, and depression all significantly predicted the likelihood of resolution. More specifically, the odds of clinical resolution were 14% to 16% lower per additional year of patient age (P < 0.001 to P = 0.016). The odds of resolution were 28% to 42% lower per 1-standard deviation (SD) increase on a pediatric sleep measure (P = 0.006 to P < 0.040). Additionally, odds of clinical resolution were 58% lower per 1-SD increase on parent-reported measure of depression (P = 0.006), and doubled in cases where parents agreed that their children found it easy to relax (P = 0.045). Furthermore, sleep predicted the rapidity of clinical resolution; that is, the odds of achieving resolution by the first follow up visit were 47% to 60% lower per 1-SD increase on the pediatric sleep measure (P = 0.002). CONCLUSION: Outcomes for youth with FGIDs may be significantly improved by paying specific attention to sleep, ensuring adequate skills for relaxation, and screening of and referral for treatment of comorbid depression.


Assuntos
Dor Abdominal/terapia , Depressão/terapia , Gastroenteropatias/terapia , Clínicas de Dor/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Dor Abdominal/epidemiologia , Dor Abdominal/etiologia , Adolescente , Criança , Comorbidade , Prestação Integrada de Cuidados de Saúde/organização & administração , Depressão/diagnóstico , Depressão/epidemiologia , Feminino , Seguimentos , Gastroenteropatias/complicações , Gastroenteropatias/epidemiologia , Humanos , Comunicação Interdisciplinar , Masculino , Encaminhamento e Consulta , Terapia de Relaxamento , Estudos Retrospectivos , Sono/fisiologia , Resultado do Tratamento , Adulto Jovem
8.
BMJ Case Rep ; 12(7)2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31308185

RESUMO

We describe the case of a man with chromophobe renal cell carcinoma (chRCC) and numerous metastatic lesions restricted to the liver. Despite extensive courses of various systemic targeted chemotherapies, progressive disease was noted on CT and MRI and the patient suffered from persistent abdominal pain associated with his metastatic lesions. The liver lesions and associated symptoms were effectively palliated with serial transarterial chemoembolisation (TACE). While it is unclear if TACE has impacted his overall survival, this case encourages the use of TACE for palliative intent for patients with metastatic chRCC.


Assuntos
Quimioembolização Terapêutica/métodos , Neoplasias Renais , Neoplasias Hepáticas/secundário , Dor Abdominal/etiologia , Dor Abdominal/terapia , Adulto , Carcinoma de Células Renais/secundário , Humanos , Neoplasias Hepáticas/terapia , Masculino , Cuidados Paliativos , Resultado do Tratamento
9.
Rev Med Suisse ; 15(655): 1209-1212, 2019 Jun 12.
Artigo em Francês | MEDLINE | ID: mdl-31194294

RESUMO

Bariatric and metabolic surgery is the only effective long-term treatment for morbid obesity. The three main practiced surgeries during the last 30 years are the Roux-en-Y gastric bypass (RYGB), the sleeve gastrectomy (SG) and the laparoscopic adjustable gastric banding (AGB). These surgeries can lead to long-term complications of a functional or of a surgical nature. Rapid management in a specialized setting where appropriate investigations can be done is essential. Abdominal pain after bariatric surgery are frequent, multiple and difficult to apprehend. They should not be trivialized because the risks of severe complications without an adequate and quick management are important.


Assuntos
Dor Abdominal , Cirurgia Bariátrica , Derivação Gástrica , Gastroplastia , Obesidade Mórbida , Dor Abdominal/etiologia , Dor Abdominal/terapia , Gastroplastia/efeitos adversos , Humanos , Estudos Retrospectivos , Perda de Peso
10.
J Clin Nurs ; 28(19-20): 3641-3650, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31190406

RESUMO

AIM AND OBJECTIVES: To describe managers' perspectives on the care of patients with acute abdominal pain and explore how they influence the care. BACKGROUND: Patients with acute abdominal pain form a common group of patients who often report poor pain management. Managers are key actors in ensuring that patients receive high-quality care. This stresses the need to deepen the understanding of their perspectives on these patients, in order to provide high-quality fundamental care across the acute care chain. DESIGN: Qualitative descriptive semi-structured interview study, with an inductive approach. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was used. METHODS: Individual interviews were conducted with managers (n = 17) from ambulance services, emergency departments and surgical departments at four hospitals in Sweden, representing managers at the micro- and macrolevels across the acute care chain. RESULTS: The patient group was described as a challenging heterogeneous group, with a focus on medical care, shaped by clinical practice guidelines, for which others were responsible. Managers with a physician background expressed that nursing care was important for the outcome of the care, while managers with a nursing background focused solely on the medical care. Additionally, the managers described that they affected the care by providing resources and serving as role models. CONCLUSIONS: The solely medical perspective is worrying. By being a stakeholder, the managers' responsibility should be to highlight the patient perspective in the care and promote and support all health professionals in redesigning the care, where achieving higher quality both in nursing and in medical care for patients with acute abdominal pain becomes a shared goal. RELEVANCE TO CLINICAL PRACTICE: Managers should use their leadership to bridge the gap between medicine and nursing care by highlighting patients' need for fundamental care, and to support health professionals in providing evidence-based and high-quality care.


Assuntos
Dor Abdominal/terapia , Atitude do Pessoal de Saúde , Papel do Profissional de Enfermagem , Qualidade da Assistência à Saúde , Cuidados Críticos/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Liderança , Pesquisa Qualitativa , Suécia
11.
Rev Bras Anestesiol ; 69(3): 284-290, 2019.
Artigo em Português | MEDLINE | ID: mdl-31080008

RESUMO

BACKGROUND: Computerized tomography-guided celiac plexus neurolysis has become almost a safe technique to alleviate abdominal malignancy pain. We compared the single needle technique with changing patients' position and the double needle technique using posterior anterocrural approach. METHODS: In Double Needles Celiac Neurolysis Group (n = 17), we used two needles posterior anterocrural technique injecting 12.5 mL phenol 10% on each side in prone position. In Single Needle Celiac Neurolysis Group (n = 17), we used single needle posterior anterocrural approach. 25 mL of phenol 10% was injected from left side while patients were in left lateral position then turned to right side. The monitoring parameters were failure block rate and duration of patient positioning, technique time, Visual Analog Scale, complications (hypotension, diarrhea, vomiting, hemorrhage, neurological damage and infection) and rescue analgesia. RESULTS: The failure block rate and duration of patient positioning significantly increased in double needles celiac neurolysis vs. single needle celiac neurolysis (30.8% vs. 0.13.8±1.2 vs. 8.9 ± 1; p = 0.046, p ≤ 0.001 respectively). Also, the technique time increased significantly in double needles celiac neurolysis than single needle celiac neurolysis (24.5 ± 5.1 vs. 15.4 ± 1.8; p ≤ 0.001). No significant differences existed as regards visual analogue scale: double needles celiac neurolysis = 2 (0-5), 2 (0-4), 3 (0-6), 3 (2-6) and single needle celiac neurolysis = 3 (0-5), 2 (0-5), 2 (0-4), 4 (2-6) after 1 day, 1 week, 1 and 3 months respectively. However, visual analogue scale in each group reduced significantly compared with basal values (p ≤ 0.001). There were no statistically significant differences as regards rescue analgesia and complications (p > 0.05). CONCLUSION: Single needle celiac neurolysis with changing patients' position has less failure block rate, less procedure time, shorter duration of patient positioning than double needles celiac neurolysis in abdominal malignancy.


Assuntos
Neoplasias Abdominais/complicações , Dor Abdominal/terapia , Dor do Câncer/terapia , Bloqueio Nervoso/métodos , Dor Abdominal/etiologia , Idoso , Plexo Celíaco/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Agulhas , Fenol/administração & dosagem , Estudos Prospectivos , Tomografia Computadorizada por Raios X
12.
Lancet ; 393(10188): 2322-2330, 2019 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-31036336

RESUMO

BACKGROUND: International guidelines advise laparoscopic cholecystectomy to treat symptomatic, uncomplicated gallstones. Usual care regarding cholecystectomy is associated with practice variation and persistent post-cholecystectomy pain in 10-41% of patients. We aimed to compare the non-inferiority of a restrictive strategy with stepwise selection with usual care to assess (in)efficient use of cholecystectomy. METHODS: We did a multicentre, randomised, parallel-arm, non-inferiority study in 24 academic and non-academic hospitals in the Netherlands. We enrolled patients aged 18-95 years with abdominal pain and ultrasound-proven gallstones or sludge. Patients were randomly assigned (1:1) to either usual care in which selection for cholecystectomy was left to the discretion of the surgeon, or a restrictive strategy with stepwise selection for cholecystectomy. For the restrictive strategy, cholecystectomy was advised for patients who fulfilled all five pre-specified criteria of the triage instrument: 1) severe pain attacks, 2) pain lasting 15-30 min or longer, 3) pain located in epigastrium or right upper quadrant, 4) pain radiating to the back, and 5) a positive pain response to simple analgesics. Randomisation was done with an online program, implemented into a web-based application using blocks of variable sizes, and stratified for centre (academic versus non-academic and a high vs low number of patients), sex, and body-mass index. Physicians and patients were masked for study-arm allocation until after completion of the triage instrument. The primary, non-inferiority, patient-reported endpoint was the proportion of patients who were pain-free at 12 months' follow-up, analysed by intention to treat and per protocol. A 5% non-inferiority margin was chosen, based on the estimated clinically relevant difference. Safety analyses were also done in the intention-to treat population. This trial is registered at the Netherlands National Trial Register, number NTR4022. FINDINGS: Between Feb 5, 2014, and April 25, 2017, we included 1067 patients for analysis: 537 assigned to usual care and 530 to the restrictive strategy. At 12 months' follow-up 298 patients (56%; 95% CI, 52·0-60·4) were pain-free in the restrictive strategy group, compared with 321 patients (60%, 55·6-63·8) in usual care. Non-inferiority was not shown (difference 3·6%; one-sided 95% lower CI -8·6%; pnon-inferiority=0·316). According to a secondary endpoint analysis, the restrictive strategy resulted in significantly fewer cholecystectomies than usual care (358 [68%] of 529 vs 404 [75%] of 536; p=0·01). There were no between-group differences in trial-related gallstone complications (40 patients [8%] of 529 in usual care vs 38 [7%] of 536 in restrictive strategy; p=0·16) and surgical complications (74 [21%] of 358 vs 88 [22%] of 404, p=0·77), or in non-trial-related serious adverse events (27 [5%] of 529 vs 29 [5%] of 526). INTERPRETATION: Suboptimal pain reduction in patients with gallstones and abdominal pain was noted with both usual care and following a restrictive strategy for selection for cholecystectomy. However, the restrictive strategy was associated with fewer cholecystectomies. The findings should encourage physicians involved in the care of patients with gallstones to rethink cholecystectomy, and to be more careful in advising a surgical approach in patients with gallstones and abdominal symptoms. FUNDING: The Netherlands Organization for Health Research and Development, and CZ healthcare insurance.


Assuntos
Dor Abdominal/terapia , Colecistectomia/estatística & dados numéricos , Tratamento Conservador/estatística & dados numéricos , Cálculos Biliares/terapia , Dor Abdominal/etiologia , Dor Abdominal/fisiopatologia , Adulto , Feminino , Cálculos Biliares/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor
13.
Semin Pediatr Surg ; 28(2): 118-121, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31072460

RESUMO

After a diagnosis of omphalocele during pregnancy, questions regarding long-term prognosis are of primary importance for parents. It is imperative that their questions are answered with substantiated data to promote confident decisions for their children. They frequently express concerns regarding long-term survival, quality of life, need for more operations, feeding issues, motor and cognitive development, cosmesis, and the unique difficulties of giant omphaloceles. The available outcome studies that address these questions are discussed.


Assuntos
Hérnia Umbilical/complicações , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Dor Abdominal/terapia , Criança , Desenvolvimento Infantil , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Dor Crônica/terapia , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/terapia , Hérnia Umbilical/diagnóstico , Hérnia Umbilical/fisiopatologia , Hérnia Umbilical/cirurgia , Herniorrafia , Humanos , Lactente , Recém-Nascido , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/etiologia , Transtornos do Neurodesenvolvimento/terapia , Prognóstico , Qualidade de Vida , Resultado do Tratamento
14.
World Neurosurg ; 128: e649-e652, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31054337

RESUMO

BACKGROUND: Neuromodulation is an evolving therapy for chronic pain. Aiming to meet the limitations of traditional spinal cord stimulation, dorsal root ganglion (DRG) stimulation targets pain in a dermatomal distribution at the site of pain transmission. Despite these advantages, lead migration is a significant complication that hinders the long-term efficacy of DRG stimulation. This study aims to identify risk factors for lead migration requiring revision in DRG stimulation. METHODS: We performed a retrospective review of all subjects who had DRG stimulators implanted at T10-S2 by a single physician over a 2-year period. Their history was reviewed for the following: age, sex, diagnosis, lead placement, reported symptom relief, complications, and postoperative activity. RESULTS: In total, 19 cases of DRG stimulator implantation were identified. All patients reported pain relief, with 84.2% (16/19) describing >50% relief. In total, 31.6% of patients (6/19) developed lead migration and 15.8% of total implanted leads (9/57) migrated. Of the migrated leads, 4% (4/9) occurred at S1 and 33.3% (3/9) occurred at L4. The underlying etiology of lead migration was clear and preventable in 66.7% of patients (4/6). All patients who developed lead migration were women. CONCLUSIONS: Premature activity, hardware manipulation, and female sex appear to be associated with an increased risk for lead migration. Leads on the S1 and L4 locations may be more likely to migrate. Large trials are necessary to gain a more conclusive understanding of these risk factors for lead migration.


Assuntos
Síndromes da Dor Regional Complexa/terapia , Exercício , Gânglios Espinais , Neuroestimuladores Implantáveis , Falha de Prótese , Dor Abdominal/terapia , Adolescente , Adulto , Idoso , Causalgia/terapia , Terapia por Estimulação Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Implantação de Prótese , Distrofia Simpática Reflexa/terapia , Reoperação , Fatores de Risco , Estimulação da Medula Espinal , Adulto Jovem
15.
Radiol Clin North Am ; 57(4): 705-715, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31076027

RESUMO

Acute abdominopelvic pain, a common symptom in emergency department patients, is challenging given the spectrum of differential diagnoses encompassing multiple organ systems, ranging from benign self-limiting to life-threatening and emergent. Diagnostic imaging is critical given its high accuracy and management guidance. A contrast-enhanced computed tomography (CT) scan is preferred given its widespread availability and speed of acquisition. MR imaging may be appropriate, usually performed for specific indications with tailored protocols. It is accurate for diagnosis and may be an alternative to CT. This article discusses the advantages and disadvantages, protocols, and appearances of MR imaging of common diagnoses.


Assuntos
Dor Abdominal/etiologia , Doenças do Sistema Digestório/diagnóstico por imagem , Doenças do Sistema Digestório/terapia , Emergências , Imagem por Ressonância Magnética/métodos , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/terapia , Doença Aguda , Doenças do Sistema Digestório/complicações , Humanos
16.
Medicine (Baltimore) ; 98(17): e14981, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027051

RESUMO

BACKGROUND/AIMS: Gelidium elegans (GE) is known to have antiobesity effects and beneficial effects on functional bowel symptoms in preclinical studies. The aim of this study was to determine the efficacy and safety of GE intake on bowel symptoms in obese human adults. METHODS: This 12-week single-center randomized double-blind placebo-controlled study was performed from September 2016 to May 2017. Consecutive obese subjects were randomly assigned (1:1) to either GE (1 g) or placebo (1 g) once daily group for 12 weeks. Patients' bowel symptoms were evaluated using the Bristol Stool Form Scale, Constipation Scoring System (CSS), and Patient Assessment of Constipation-Symptoms (PAC-SYM) questionnaire. RESULTS: The stool symptom score of PAC-SYM significantly improved in the GE group compared with the placebo group after the 12-week treatment (P = .041). Abdominal discomfort score of CSS significantly decreased at 12 weeks compared to that at baseline in the GE group (P = .003), but not in the placebo group (P = .398). In addition, abdominal discomfort score of CSS slightly decreased in the GE group compared with the placebo group after the 12-week treatment (P = .060). However, stool consistency, total CSS score, and PAC-SYM score did not change significantly in both GE group and the placebo group over the 12-week treatment period. CONCLUSIONS: GE treatment for 12 weeks improved the stool symptom score on the PAC-SYM and abdominal discomfort score on the CSS in obese adults. However, further research is needed in large-scale human studies.


Assuntos
Dor Abdominal/terapia , Constipação Intestinal/terapia , Fibras na Dieta/administração & dosagem , Obesidade/terapia , Rodófitas , Adulto , Fibras na Dieta/efeitos adversos , Método Duplo-Cego , Fezes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Resultado do Tratamento
17.
Clin J Gastroenterol ; 12(5): 473-478, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30997671

RESUMO

Rupture of abdominal aneurysms associated with median arcuate ligament syndrome (MALS) is a serious condition and requires accurate diagnosis in a clinical setting. We examined three patients with this condition: two women aged 45 and 71 years, and a 61-year-old man. They complained of abdominal pain and had fluid collection around the duodenum. Plain computed tomography (CT) of the fluid collection revealed hyper density, which suggests the presence of blood. Moreover, contrast-enhanced CT revealed aneurysms in the pancreatic head area. Angiography revealed aneurysms of the branches of the gastroepiploic artery, which were treated by endovascular embolization in all patients. Thus, patients with abdominal pain and high-density fluid collection around the duodenum on plain CT may suffer from hemorrhage following rupture of MALS-associated aneurysms.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Hemorragia/diagnóstico por imagem , Síndrome do Ligamento Arqueado Mediano/diagnóstico por imagem , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Dor Abdominal/terapia , Idoso , Aneurisma Roto/etiologia , Aneurisma Roto/terapia , Angiografia por Tomografia Computadorizada , Embolização Terapêutica/métodos , Feminino , Artéria Gastroepiploica/diagnóstico por imagem , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Masculino , Síndrome do Ligamento Arqueado Mediano/complicações , Pessoa de Meia-Idade , Pâncreas/irrigação sanguínea , Tomografia Computadorizada por Raios X
20.
Medicine (Baltimore) ; 98(10): e13416, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30855432

RESUMO

RATIONALE: Rhabdomyosarcoma (RMS) has known as a highly malignant soft tissue sarcoma, representing 5% to 10% of all solid tumors in childhood. Alveolar rhabdomyosarcoma (ARMS) of the retrorectal-presacral space is an extremely rare lesion for adult, no study has been reported in the English literature. PATIENT CONCERNS: A 51-year-old male presented with abdominal pain for 1 month, significantly worse when having a bowel movement. DIAGNOSIS: Computed tomography (CT) and magnetic resonance imaging (MRI) of the pelvis showed a solid-cystic, enhancing lesion of dimension located in retrorectal-presacral space. The surgical specimen was reported as ARMS after pathological evaluation. INTERVENTIONS: The tumor was complete surgical resection, and after surgery, the patient was treated with combination chemotherapy. OUTCOMES: At 23 months follow up, the patient was asymptomatic with no evidence of metastases or local recurrence. LESSONS: Improvements in imaging in addition to early surgical intervention and chemotherapy treatment are crucial to improve survival chances against RMS.


Assuntos
Neoplasias Abdominais/diagnóstico por imagem , Neoplasias Abdominais/terapia , Rabdomiossarcoma Alveolar/diagnóstico por imagem , Rabdomiossarcoma Alveolar/terapia , Neoplasias Abdominais/complicações , Neoplasias Abdominais/patologia , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Dor Abdominal/terapia , Terapia Combinada , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Rabdomiossarcoma Alveolar/complicações , Rabdomiossarcoma Alveolar/patologia
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