1/16. Postbulbar duodenal ulcer.Postbulbar duodenal ulceration is not common, but when present is difficult to diagnose and treat. Between January 1965 and September 1971, 1,080 patients with duodenal ulcers were treated surgically at St James Hospital. Forty-one ulcers were found at operation to lie distal to the duodenal bulb. Pain was the most common indication for surgery. In six-patients it was clinically indistinguishable from biliary pain, giving rise to diagnostic difficulty. Twelve patients (29%) presented with haemorrhage, a percentage similar to the 25% of bulbar ulcers presenting with this complication over the period of this study. This is contrary to the finding in most other series, that postbulbar ulceration is more frequently complicated by haemorrhage than is bulbar ulceration. Perforation and stenosis are uncommon complications. Postbulbar ulceration is easily overlooked in conventional barium studies. Only one-third of the patients subjected to barium meal x-ray examination had their ulcers identified in the first study. In a further third the presence of an ulcer was suspected, and the remainder required multiple investigations for undiagnosed symptoms before the condition was demonstrated. duodenoscopy was not performed in a sufficient number of patients for its value to be assessed, but other reports indicate that it should be a valuable manoeuvre. The technical difficulties and potential hazards of Polya gastrectomy are discussed and special reference is made to the surgical management of bleeding postbulbar ulcers.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/16. dyspepsia as a somatic expression of guilt: a case report.A 58-year-old woman developed chronic, severe symptoms of heartburn, epigastric pain, and regurgitation that persisted for 2 years. She underwent a thorough evaluation and no organic cause was identified. Therefore, a diagnosis of dyspepsia was made. Her symptoms were refractory to pharmacological treatment. Upon further probing, the patient reported that the onset of her symptoms coincided with the death of her son of cancer 2 years earlier. She blamed herself for the death of her son and admitted to a need for self-punishment. A brief course of treatment using metaphors and hypnosis resulted in a complete resolution of her symptoms, which did not recur during a follow-up of 12 years. This is the first published report of the treatment of dyspepsia using hypnotic methods.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
3/16. review article: managing the dyspeptic patient--an interactive discussion.dyspepsia, a common disorder, can present some difficult clinical dilemmas. physicians should explore some of the more challenging cases of dyspepsia in a setting that fosters interactive dialogue among colleagues, as was the case at the interactive discussion reported below. A panel of experts presented and discussed three case histories. The audience was able to choose from among several options for diagnosis or treatment and recorded their votes by means of an electronic handset. The first case concerned the relationship between continued non-steroidal anti-inflammatory drug (NSAID) use and recurrent upper gastrointestinal (GI) symptoms without ulcer or helicobacter pylori infection. The second was a woman with complex upper GI symptoms including heartburn. The last featured a young man with dyspepsia and no alarm symptoms. The first case showed that a standard dose of proton pump inhibitor (PPI) is the best treatment for patients with gastritis who continue to use NSAIDs. The second case revealed that 24-h pH monitoring can be used to establish a relationship between symptoms and reflux episodes. The third case demonstrated that it can be difficult to make a definitive diagnosis based on clinical symptoms, and that patients with endoscopy-negative reflux disease usually respond well to PPI therapy.- - - - - - - - - - ranking = 0.34267666641915keywords = upper (Clic here for more details about this article) |
4/16. Laparoscopic treatment of Bochdalek hernia without the use of a mesh.Bochdalek hernia is a rare pathology. The preoperative diagnosis is difficult, and few reports are available regarding its treatment. Herein we report the case of a 25-year-old woman referred for symptoms of dyspepsia, dysphagia, and thoracic pain exacerbated by pregnancy. Preoperative radiography, EGD, and CT scan revealed a paraesophageal hiatal hernia. Laparoscopic exploration showed the complete thoracic migration of the stomach through a left posterolateral diaphragmatic foramen. The diagnosis of a Bochdalek hernia was then made. The diaphragmatic defect was repaired without inserting a prosthesis, using five separate non-reabsorbable stitches (Rieder technique). The procedure was completed with a Nissen-Rossetti fundoplication. The duration of the procedure was 150 min. Hospital stay was 12 days. There were no complications. Postoperative Gastrografin radiography of the esophagus and stomach showed a normal-shaped fundoplication and confirmed the subdiaphragmatic location of the stomach. We conclude that the laparoscopic approach represents the gold standard for the diagnosis and treatment of Bochdalek hernia and any associated complications.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
5/16. Primary benign ulcer of the gall bladder.It is sometimes impossible to come to a final diagnosis in patients with dyspepsia and upper abdominal pain in spite of extensive investigation. Such patients are usually given vague diagnoses like "non-ulcer dyspepsia" and they represent an important diagnostic challenge.- - - - - - - - - - ranking = 4.711726937452keywords = abdominal pain, pain, upper (Clic here for more details about this article) |
6/16. Morgagni's hernia.Congenital diaphragmatic hernias, including Morgagni s hernia, usually present in early childhood and are treated by surgical repair. This case report is about an unusual Morgagni s hernia, presenting with dyspepsia and chest pain, at the age of 45 years. For many years the diagnosis remained a dilemma because patient s chest x-ray was not done and she was treated for "angina " and "dyspepsia". diagnosis was obvious once a chest x-ray was done, however, barium studies were performed for further confirmation.- - - - - - - - - - ranking = 1.3191589515111keywords = pain, chest (Clic here for more details about this article) |
7/16. Unusual manifestations of taenia solium infestation.We present two rare cases of unusual manifestations of taenia solium infestation. Taenia infestation usually causes abdominal pain and diarrhea in humans. But there have been no clinical reports of ascites, chronic diarrhea, and malabsorption due to taenia solium without evidence of the ova or larvae of the parasites in stool examinations. Our first unusual case was in a 30-year-old woman with spontaneous pneumothorax, pleural effusion, and ascites; the second case was in a 67-year-old man with a 3-year history of diarrhea, weight loss, and indigestion. Both patients showed blood eosinophilia and positive serologic tests for taenia solium. After antiparasitic agent administration, their symptoms resolved successfully.- - - - - - - - - - ranking = 4.5403886042425keywords = abdominal pain, pain (Clic here for more details about this article) |
8/16. irritable bowel syndrome, functional dyspepsia, and functional abdominal pain syndrome.Recurrent or chronic abdominal pain is a description and not a diagnosis. The clinician should consider both disease and functional pain. In the absence of obvious disease, adolescents fulfilling symptom-based criteria for functional gastrointestinal disorders can be treated for their problems without initially performing extensive diagnostic studies. Most of these patients will have symptoms resembling IBS, functional dyspepsia, or functional abdominal pain syndrome. It is imperative that the clinician takes a biopsychosocial approach in dealing with these patients. Although the clinician still evaluates for biologic disease, he or she maintains an appreciation that psychosocial events may have a profound impact on physiology and symptom production.- - - - - - - - - - ranking = 28.242331625455keywords = abdominal pain, pain (Clic here for more details about this article) |
9/16. Acute pancreatitis induced by traditional acupuncture therapy.Although rare, it is possible for acute pancreatitis to develop after blunt or penetrating abdominal trauma. We report here a very rare case of acute pancreatitis induced by traditional acupuncture therapy. A 42-year-old woman with a low body mass index had suffered from functional dyspepsia for one year. She visited an acupuncture clinic and underwent long needle (13 cm) and gold thread needle (3 mm) acupuncture therapy. Five hours later, she presented at our emergency room complaining of severe periumbilical pain. Levels of serum amylase (1162 U/l, normal <220 U/l), and lipase (5195 IU/l, normal <60 IU/l) were high, and an abdominal computed tomography scan showed a diffusely swollen pancreas and ill-defined infiltration of the peripancreatic fat, indications of possible acute pancreatitis. Multiple small acupunctured gold thread needles were also found on the anterior abdominal wall and back muscles. After excluding other possible causes of pancreatitis, traumatic pancreatitis was diagnosed as an adverse effect of the long acupuncture needle therapy.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
10/16. Reversal of gastric electrical dysrhythmias by cisapride in children with functional dyspepsia. Report of three cases.Three children (ages 5, 7.6, and 8 years), with recurrent unexplained upper abdominal symptoms such as vomiting, epigastric pain, anorexia, early satiety and without structural or mucosal abnormalities of gastrointestinal tract, underwent electrogastrography (EGG)--recording of gastric electrical activity using cutaneous electrodes positioned on the epigastric region and connected to a recording polygraph. Frequency of EGG signals was analyzed by fast Fourier transform. Significant changes of fasting and fed gastric myoelectrical activity (tachygastria, bradygastria, flatline pattern) were recorded in the three patients; furthermore, gastric emptying (GE) of a solid-liquid mixed meal, measured by ultrasonography, was significantly prolonged in them. A follow-up study was carried out after an eight-week course with oral cisapride: in all patients symptoms improved, GE time normalized, and EGG analysis showed normal electrical rhythm. It is suggested that gastric dysrhythmias can play a pathogenetic role in patients with functional gastrointestinal symptoms and that symptomatic improvement is accompanied by normalization of gastric electrical rhythm.- - - - - - - - - - ranking = 1.1713383332096keywords = pain, upper (Clic here for more details about this article) |
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