Disappearance Of Abdominal Pain Research Articles

Effectiveness of hymecromone monotherapy in treatment of patients with various pathologies of biliary tract

The aim of the study. To evaluate the effectiveness and safety of the use of hymecromone in the treatment of patients with diseases of the biliary tract.Materials and methods 40 patients with various pathologies of the biliary tract were under observation: 20 patients (group 1) with functional disorders of the biliary tract (the diagnosis of functional disorders of the gallbladder was established on the basis of Roman criteria IV) and 20 patients (group 2) with post-cholecystectomy syndrome (the diagnosis was established on the basis of anamnesis data on cholecystectomy surgery and the results of ultrasound examination of the abdominal organs [absence of a gallbladder]). Before the start of therapy with hymecromonum, after the end of treatment and a month after treatment, patients underwent examinations: assessment of complaints (abdominal pain, bitterness in the mouth, constipation, abdominal heaviness, flatulence, appetite), assessment of dyspepsia on the GIS scale and assessment on the visual-analog scales of abdominal pain and general well-being), quantitative assessment of the severity of gastroenterological complaints according to the GSRS questionnaire, assessment of quality of life (SF‑36 questionnaire), ultrasound of the gallbladder with a trial breakfast for the assessment of bile excretion, clinical blood test, biochemical blood test (ALT, AST, bilirubin, alkaline phosphatase, GGTP, glucose, cholesterol), as well as an assessment of side effects. All patients were prescribed a diet necessary in the complex treatment of diseases of the biliary tract and monotherapy: hymecromone 400 mg three times a day 30 minutes before meals for 3 weeks. Statistical processing was carried out using the computer software package SPSS Statistics 17.0.Results. After the treatment with hymecromone there was a significant decrease or complete relief of abdominal pain and dyspepsia, while 47.5 % of the subjects noted the disappearance of abdominal pain, and the remaining patients indicated a significant decrease in pain syndrome with only minor discomfort. The assessment on the visual-analog scales of abdominal pain and general well-being showed a significant reduction in pain (from 65 to 13 points) and an improvement in general well-being (from 65 to 6 points). When assessing dyspepsia on the GIS scale and gastroenterological complaints according to the GSRS questionnaire, there was a significant decrease in the severity of symptoms. The assessment of the quality of life (questionnaire SF-36) showed a significant improvement in the quality of life on all scales. According to the ultrasound of the abdominal organs with a trial breakfast, there was a restoration of the contractile ability of the gallbladder (p < 0.05). When analyzing possible side effects, it was noted that no side effects were observed either clinically or according to the results of blood tests.Conclusions. As a result of treatment, it was found that the administration of hymecromone is highly effective and safe both for patients with functional disorder of the gallbladder and for patients with post-cholecystectomy syndrome. While maintaining a high efficiency, hymecromonum is characterized by a safe choleretic effect, which is especially important when

Percutaneous catheter drainage of uncomplicated amoebic liver abscess: prospective evaluation of a clinical protocol for catheter removal and the significance of residual collections

Patients with amoebic liver abscess (ALA) may require percutaneous catheter drainage (PCD). Once the PCD output is substantially reduced or has ceased along with clinical recovery, residual collections on radiological evaluation may concern the treating physicians. The prevalence and significance of such collections is unknown, and the subsequent approach how to tackle them is unclear. Consecutive patients with one or more uncomplicated ALAs requiring drainage were prospectively enrolled from 3 hospitals and managed based on a standard approach. Catheter removal was attempted after the patients fulfilled all 4 of the following criteria: disappearance of abdominal pain, absence of fever for at least 48h, an improving trend of TLC (documented on 2 consecutive reports), and catheter drain output of < 10ml/day for at least 2 consecutive days. A total of 110 patients (mean age 46.6 ± 10.5years, 93.6% males, 89.1% alcoholics) underwent PCD placement; 69 patients (69/110; 62.7%) met all 4 criteria within 5days of PCD placement (optimal response) and had an uncomplicated course. Patients with suboptimal responses (41/110; 37.3%) were evaluated for local and systemic complications; the appearance of fresh collections (5/110; 4.5%), abscess rupture (2/110; 1.8%), bile leakage (3/110; 2.7%), cholangitis (2/110; 1.8%), thrombophlebitis (2/110; 1.8%) and hospital-acquired infections (2/110; 1.8%) were diagnosed and treated accordingly. Ultimately, PCD removal (based on the fulfilment of all 4 criteria) was universally successful after a median of 5days (IQR, 4-9days). None of the patients had symptom recurrence after PCD removal, although residual collections were still seen in 97.3% of patients at the time of PCD removal and in 92.1% and 84.9% of patients available for follow-up at 1 and 3months, respectively. Based on our clinical protocol, PCD removal in ALA can be successfully expedited even in the presence of residual collections. An inability to fulfill all 4 criteria within 5days of PCD placement warrants further evaluations for local and systemic complications that require additional therapeutic measures.

Groove Pancreatitis Vs Pancreatic Adenocarcinoma: A Review of 8 Cases

IntroductionGroove pancreatitis (PS) is an uncommon clinical situation and radiologically it can mimic carcinoma of the periampullary area. The aim of this paper is to study a series of 8 patients who underwent surgery with preoperative diagnosis of pancreatic head mass and subsequent pathological diagnosis of PS. MethodsIn our series, 6 were men and 2 were women, with an average age of 51.9 years. Before surgery, all patients had epigastric abdominal pain requiring analgesia at high doses. The preoperative analytical CEA and Ca 19.9 were normal in all patients. Imaging studies showed intrapancreatic solid lesions in 6 of the 8 patients, and in the remaining 2 one papillary mass of 5 and 6cm, respectively, that caused stenosis in the duodenal luz. EUS neoplastic cells were negative in all patients. ResultsThe immediate postoperative evolution was satisfactory, there are no complications. In our series, no patients have died. The long-term follow-up, in 7 of the 8 patients, has been excellent with disappearance of abdominal pain and improvement of nutritional status. The remaining patient had frequent recurrent episodes of acute pancreatitis, and at 60 months, presented a pseudocyst that has required a Roux-en-Y cystojejunostomy. ConclusionsPS must be included in the differential diagnosis of pancreatic lesions, which may include carcinoma of the periampullary area and other causes of chronic pancreatitis.

Pancreatitis del surco versus adenocarcinoma de páncreas: a propósito de 8 casos

IntroductionGroove pancreatitis (PS) is an uncommon clinical situation and radiologically it can mimic carcinoma of the periampullary area. The aim of this paper is to study a series of 8 patients who underwent surgery with preoperative diagnosis of pancreatic head mass and subsequent pathological diagnosis of PS. MethodsIn our series, 6 were men and 2 women, with an average age of 51,9 years. Before surgery, all patients had epigastric abdominal pain requiring analgesia at high doses. The preoperative analytical CEA and Ca 19.9 were normal in all patients. Imaging studies showed intrapancreatic solid lesions in 6 of the 8 patients, and in the remaining 2 one papillary mass of 5 and 6cm, respectively, that caused stenosis in the duodenal luz. EUS neoplastic cells were negative in all patients. ResultsThe immediate postoperative evolution was satisfactory, there are no complications. In our series, no patients have died. The long-term follow-up, in 7 of the 8 patients, has been excellent with disappearance of abdominal pain and improvement of nutritional status. The remaining patient had frequent recurrent episodes of acute pancreatitis, and at 60 months, presented a pseudocyst that has required a Roux-en-Y cystojejunostomy. ConclusionsPS must be included in the differential diagnosis of pancreatic lesions, which may include carcinoma of the periampullary area and other causes of chronic pancreatitis.

The effects of ageing on the onset and disappearance of unexplained abdominal pain: a population‐based study

The population ≥65 years is rapidly increasing, but remarkably little is known about the natural history of abdominal pain with ageing. To prospectively evaluate the natural history of abdominal pain (severity and frequency) in a US population, and evaluate potential risk factors (including somatisation) for the onset and disappearance of abdominal pain with increasing age. Between 1988 and 2004, valid self-report questionnaires that recorded gastrointestinal symptoms including severity and frequency of abdominal pain were mailed to randomly selected cohorts of community residents followed over time. This study identified all respondents who answered abdominal pain questions at an initial and follow-up survey. One thousand nine hundred and thirteen subjects were included (mean age in years at first survey: 48 ± 12 (SD), mean age at second survey: 59 ± 13 (SD); 53% female). The onset and disappearance rate of abdominal pain over the follow-up were 18% (95% CI, 16, 20) and 47% (43, 50) respectively. The rates of increasing vs. decreasing abdominal pain score were 18% (16, 20) vs. 21% (20, 23) respectively. While younger age at initial survey was associated with the onset of abdominal pain {vs. subjects without abdominal pain, [OR 0.9 (0.7, 1.0)]}, older age at initial survey and times between surveys were associated with the disappearance of abdominal pain {vs. subjects with abdominal pain, [OR 1.2 (1.0, 1.5)]}. Female gender (OR 1.4 [1.0, 2.1]), higher somatisation scores (OR 5.3 [3.2, 8.7]) and larger changes in somatisation score (OR 2.1 [1.4, 3.2]) were positively associated with the onset of abdominal pain. Increasing age is associated with the disappearance of abdominal pain in the community.

Thickened colon wall in follicular lymphoma

A 57-year-old woman was admitted to our emergency room for severe pain in the lower abdomen and lower right thigh. Twenty days previously, she had visited another hospital, which performed fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/ CT) to test for systemic lymphadenopathy. The PET/CT scan revealed systemic lymph node swellings, subcutaneous tumor of the lower right thigh, and diffuse thickened colon wall with high uptake of FDG (Fig. 1). From a tumor specimen from her lower right thigh, she was pathologically diagnosed with follicular lymphoma (FL) grade 2 (Fig. 2a), as immunohistochemical staining was positive for CD10 (Fig. 2b), CD20, and bcl2; partially positive for Ki-67 (15–20 % of tumor cells); and negative for CD3 and CD5 (data not shown). Combination chemotherapy consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone was immediately initiated. After the first cycle of chemotherapy, she achieved partial remission with disappearance of abdominal pain (Fig. 3). As she had severe lower abdominal pain and a significant risk of colonic perforation was expected prior to the chemotherapy, we did not perform endoscopic examination. Although we did not obtain a pathological specimen from the colon lesion, chemotherapy was equally effective for the lymph nodes, the subcutaneous tumor of the thigh, and the colon lesion. Thus, we judged the colon lesion to be an involvement of lymphoma. FL typically involves the lymph nodes, spleen, and bone marrow, and its stage is frequently stage III or IV at diagnosis. Although the duodenum and terminal ileum are considered to be the most commonly affected sites in FL of gastrointestinal tract origin, approximately 70 % of patients have multiple lesions throughout the entire intestine. Patients present with vague symptoms, usually abdominal pain or nausea; however, the largest number of patients has no symptoms. Multiple polypoid lesions of various sizes have been reported, infrequently, in cases of colonic involvement (2 of 80 patients with FL). To our knowledge, there have been no reports describing thickened colon wall as observed in the present case. The course of FL is highly variable, with differences in clinical presentation, histological appearance, clinical course, and response to therapy. Clinically, cases of FL can be divided into those with a prolonged indolent course ‘‘low-grade’’ and those with a more aggressive course ‘‘high-grade’’, although there is no clear demarcation between the two. Our present case might be classified under ‘‘high-grade’’. Physicians should be encouraged to consider the possible involvement of FL when treating patients with diffuse colonic wall thickening and systemic lymphadenopathy.

SCHÖNLEIN-HENOCH PURPURA AFTER PANCREATODUODENECTOMY-A CASE REPORT-

A case of schonlein-Henoch purpura (SHP) after pancreatoduodenectomy in a 64-year-old woman is reported. The initial symptoms were purpura and arthritis. When abdominal pain occurred first, a thickening of wall of the jejunum which was brought to the porta hepatis through the transverse mesocolon for reconstruction was revealed on abdominal ultrasonography (US). At the second onset of abdominal pain, US revealed a thickening of the intestinal wall covering from the terminal ileum to ascending colon and ascites. With added CT, the whole image of the intestine with thickened wall was able to grasp. A biopsy of skin of the left leg showed numerous neutrophile, nuclear debris, and a small number of acidocytes in the vicinity of vessels ranging from superficial to middle layers of the dermis. The definite diagnosis of SHP was made. The patient was treated with fasting, total parenteral nutrition, and administration of steroid, and symptomatic remission was achieved. The time trends of wall thickening was observed by US, and the thickening decresed with disappearance of abdominal pain and purpura. It is thought that US and CT are useful for diagnosis of SHP with abdominal pain and evaluation of the therapeutic effects.