Barium enema as a diagnostic aid in children with abdominal pain

Diagnostic barium enema is not a substitution for well executed physical examination, and its use should be reserved only for obscure situations. An abnormal roentgenogram provides valuable information, since the fear of missing acute appendicitis in these children is minimized. When normal, this diagnostic test may bring to early operation those with minimal symptoms or unusual presentations, thus avoiding the possibility of prolonged observation and perforation. In children with known associated severe medical maladies, diagnostic barium enema can serve to reaffirm the diagnosis prior to the hazardous operative intervention. It may also eliminate the need for operation in those conditions which mimic acute appendicitis. The use of diagnostic barium enema in the past three and a half years significantly improved our diagnostic capabilities in children with abdominal pain. There was a corresponding reduction in the number of normal appendixes removed. The efficancy and, above all, the safety of this procedure make it a valuable diagnostic aid in the care of children.     

Closed abdominal trauma: diagnostic and therapeutic orientations

In France, traumas are the third leading cause of mortality. There are no clear statistics concerning abdominal injuries among all traumas. Nevertheless abdominal traumas are directly responsible for 10 to 30% of traumatic death. Over the past few years, improvement in imaging technics has allowed to establish very precise damage toll and to consider new therapy approaches. The development of conservative treatments has led to a reduction in the number of unnecessary coeliotomy. The treatment of such pathologies requires a multidisciplinary, effective and constantly available staff.     

Psychophysiology of pain: diagnostic and therapeutic implications

Pain problems occupy muct of the time and therapeutic efforts of physicians. Nonmedical practitioners and cultists have likewise attracted many people seeking pain relief. In many cases the cultists seem to do as well as the ethical practitioner. A realistic view of pain takes into account the significance of the pain to the individual, the degree of anxiety and/or depression that contributes to the aggravation and prepetuation of the pain, and finally the manipulative and defensive value that the pain may have to the individual. A purely mechanistic approach which would attempt to distinguish "real pain", ie, pain associated with a demonstrable lesion, and "imagined pain" will prove counterproductive. Likewise accusations of consciously pretended pain or malingering tend to be nontherapeutic. A sound therapeutic approach is to regard all pain as real, realizing that the pain of depression may be the most unendurable type of pain. Major psychotropic drugs for relief of anxiety and for treatment of depression have appplication in the management of selected pain problems.     

Chronic orchialgia. A diagnostic and therapeutic hypothesis

OBJECTIVE: The objective of this study is to offer patients with chronic testicular pain and no physico-pathological finding, a likely cause not usually taken into account such as uricemia. The hypothesis of an intracanalicular deposit of uric crystals and/or the resulting alteration in nerve endings is suggested. METHOD: The study involved a total of 60 patients with chronic orchialgia and no detectable testicular pathology seen over a 5-year period. Mean age 35.6 years. They were all evaluated with routine laboratory tests, uricemia, uricosuria and in specific cases uroculture and Stamey's method. Orchidometry, vascular doppler and ultrasound were used in all cases. RESULTS: Presence of hyperuricemia was corroborated in 61.6% cases. Based on figures found, patients were divided into three groups. Patients were treated with a low-purine diet plus Allopurinol 300 mg/day, and symptoms receded in 81.06% cases. CONCLUSIONS: Due to the high incidence of hyperuricemia and the significant symptomatological relief obtained with specific treatment, we believe its determination should become routine.     

Right atrial thrombosis--a difficult diagnostic and therapeutic problem

Right atrial thrombi have been diagnosed more frequently since the widespread use of two-dimensional echocardiography. The authors present current opinions on etiology of right heart thrombi. They can originate from two sources: type A thrombi originate in deep peripheral veins; they have worm-shape and they are extremely mobile or they develop within the right heart chambers-type B-they are then parietal and immobile. Clinical significance, prognosis in both types of thrombi is discussed and the guidelines for treatment are presented. Type A patients are a high risk group because of frequent incidence of severe pulmonary embolism and excessive mortality rate so aggressive therapy is required (surgery or fibrinolysis when surgery is contraindicated). Type B thrombi are much more benign, usually they do not lead to the death and treatment with anticoagulants seems to be sufficient.     

The diagnostic value of symptoms and signs in childhood abdominal pain

Amiodarone is a benzofuran derivative with a chemical structure similar to thyroxine. Originally introduced to treat angina pectoris, amiodarone was found to have antiarrhythmic properties, and in 1985, was approved in the United States for treatment of life-threatening ventricular arrhythmias. It is now used for various ventricular and supraventricular arrhythmias refractory to conventional first-line medications, and as a result, side effects have been observed with increased frequency. The most severe and potentially life-threatening of these side effects is the development of pulmonary toxicity. Typically, amiodarone pulmonary toxicity (APT) is manifested by acute pneumonitis and chronic fibrosis. Amiodarone-associated hemoptysis (AAH) is a rare occurrence. The authors describe a case of AAH successfully treated with cessation of drug and steroid therapy.     

Chronic abdominal pain: role of video-laparoscopic adhesiolysis

Adhesions have been suggested as a possible cause of chronic abdominal pain, but the reports of their etiological role conflict. Lysis of adhesions has been proposed as the therapeutic modality of choice, although the reports of success are controversial. The aim our prospective study was to determine whether laparoscopic adhesiolysis ameliorates chronic abdominal pain in patients with abdominal adhesions. Forty-one patients with chronic abdominal pain lasting for more than 6 months, but with no abnormal findings other than adhesions found at laparoscopy, underwent laparoscopic adhesiolysis. 37 patients (90.2%) were available for follow-up after a median time interval of 18 months (range: 12-41 months). Twenty-two patients (59.4%) were free from abdominal pain and 9 (24.3%) patients reported significant amelioration of their pain. Six (16.2%) patients had no amelioration. In conclusion the laparoscopy is an effective tool for the evaluation of patients with chronic abdominal pain, and laparoscopic adhesiolysis cures of ameliorates chronic abdominal pain in more than 80% of patients.     

Calcifications visible in mammographic examination as a diagnostic problem

Mammography can detect various types of calcification in the breast. Their correct estimation enables detection of the breast cancer in situ. In our research there have been analyzed various types of calcification available on radiograms, which have been placed in publications. The aim was to find out which of them could be characteristic for cancer. Calcifications that are seen in mammography can be divided into: microcalcifications, macrocalcifications in galactophorous ducts, in blood and sympatic vessels. Pathogenesis of microcalcifications is not explained. There exist hypotheses which claim that they are caused by focuses of necrosis, changes in acid mucopolysaccharides in the midst of galactophorous ducts or in mitochondria. Differentiation between microcalcifications and macrocalcifications is based on variations in size, shape and radiological changes which they accompany.     

Cat-scratch disease as a diagnostic problem of lymphadenopathy

Remarkable progress has been made in the treatment of osteosarcoma in the past two decades as a result of the development of effective adjuvant chemotherapy. However, the prognosis is poor in patients with early lung metastases. We review the lactate dehydrogenase release prognostic factor in the development of early lung metastases. This is a retrospective study. Eighteen patients with osteosarcoma were divided in two groups: Group A, patients with normal lactate dehydrogenase and Group B, patients with elevated lactate dehydrogenase. A univaried analysis was established. Ten patients (55%) had elevated levels of lactate dehydrogenase at diagnosis; nine of these patients developed lung metastases in the first twelve months. The difference in patients with normal levels of lactate dehydrogenase was significant (p: 0.02). The value of lactate dehydrogenase as an isolated single factor is limited. It is necessary to consider the tumoral volume, the patient's age and the histologic subtype in the prognosis of these patients, to predict the early development of pulmonary metastatic disease.     

Recurrent abdominal pain and Helicobacter pylori in a community-based sample of London children

Alternative anthropometric indexes were compared for their ability to discriminate between 35 Atlanta men with sudden coronary death and 81 male controls. With or without adjustments for age, race, and body mass index, the abdominal diameter index (supine sagittal abdominal diameter divided by midthigh circumference) was associated with sudden coronary death more strongly than the waist/hip ratio or waist/thigh ratio of circumferences.     

Helicobacter pylori and hypergastrinemia in children with recurrent abdominal pain

Recurrent abdominal pain (RAP) is a significant problem in the pediatric population, and there has been much recent interest in the role that Helicobacter pylori (Hp) might play in this disorder. In this case control study, the authors aimed to determine whether Hp is an agent responsible for RAP, and to assess fasting gastrin concentrations in children with and without RAP in the Hp-positive and -negative groups. The study was conducted in 42 patients with RAP and 50 healthy children attending routine day-case surgery as a control group, aged 3 to 15 years, over a 12-month period. Of the 42 children with RAP, 30 were seropositive (71.4%) for Hp IgG, and of 50 children in the control group, 32 were seropositive (64%) for Hp IgG (P > 0.05). We found that Hp infection was as high in healthy children as in children with RAP. The mean fasting gastrin levels in 62 Hp-seropositive children (60.4 ng/l) were not different from those in 30 Hp-seronegative children (57.3 ng/l) and those in 42 children with RAP (58.2 ng/l) were also not significantly different from those in 50 healthy children (62.9 ng/l). Thus, no association between childhood Hp infection, hypergastrinemia, and RAP was found in our Turkish population.     

Serous otitis in children: diagnostic approaches and therapeutic problems]

The Authors describe 132 cases of sequential treatment of cholecysto-choledochal lithiasis by videolaparoscopic cholecystectomy after endoscopic Common Bile Duct (CBD) clearance and 3 endoscopic sphincterectomy and CBD stone extraction during laparoscopic cholecystectomy. No complications occurred during the procedure. Even though the second one is not a routine method undoubtedly represents the best solution when the surgeon meets an unexpected choledocholithiasis. However, laparoscopic CBD exploration requires a good experience of the surgeon and currently there are not sufficient data to support this procedure.     

Carotid sinus massage as a diagnostic and therapeutic tool for atrial flutter-fibrillation

Alterations in vagal tone can influence the atrial fibrillatory process by changing the atrial refractory period. We observed in a patient with paroxysmal atrial fibrillation (AF) that carotid sinus massage (CSM) changed a "coarse" type of fibrillation into a "fine" type, followed by termination of the arrhythmia. Although coincidental conversion of AF into sinus rhythm could not be excluded, we concluded that it is worth while to try CSM in every patient presenting with AF prior to other interventions to restore sinus rhythm.     

UL-scanning of children with recurrent abdominal pain--a diagnostic gain?

Treatment of hypertension has reduced the incidence of stroke, heart failure and renal failure. However, the incidence of coronary heart disease is not reduced to the same degree. Many of the drugs advocated as first-line drugs in the step-wise therapy have been shown to cause carbohydrate intolerance and it is an independent risk factor in the development of coronary heart disease. It is thus important to identify the antihypertensive drugs that may cause deterioration in glucose tolerance. Cicletanine, the first derivative of the furopyridines, is a new class of antihypertensive agents. It acts directly on vascular endothelium cells by increasing prostacyclin synthesis. It also decreases intracytosolic calcium levels in smooth muscles. The purpose of this study is to evaluate the effects of Cicletanine on insulin release in rat isolated pancreas by the perfusion technique adapted from Loubatieres and co-workers (1972). Doses used were based on therapeutic peak plasma concentration. Diazoxide was used as a positive control ie a known insulin suppressant. Cicletanine at 1/10 and equivalent therapeutic concentrations (0.5 microgram/mL and 5.0 micrograms/mL) did not suppress insulin release. However, at concentration exceeding 10X its therapeutic levels (50 micrograms/mL) it begins to suppress insulin release. In conclusion, Cicletanine did not inhibit insulin release at concentrations within the therapeutic range.