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Chronic Fatigue: The Fatigue Neurosis
Published in Francis X. Dercum, Rest, Suggestion, 2019
The atonic condition of the stomach is, as might be expected, shared in by the entire intestinal tract. Constipation is the rule. Sometimes there is uncomfortable abdominal distention, meteorism, expulsion of gas.
Diseases of the Hepatobiliary Tree and Pancreas Associated with Fever
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
A 46-year-old male, who had no evidence of immunosuppression or previous liver disease was hospitalized41 in France for fever, chills, and dysuria of 4 days duration. On examination the abdomen was diffusely tender and associated with meteorism; 2 days after admission he went into shock. The serum amylase and aminotransferases were elevated. On a suspicion of an acute abdomen, the patient underwent laparotomy, and succumbed shortly afterwards. At autopsy, massive hepatic necrosis was revealed and found to be due to HSV.
Clinical Manifestation of Mitochondrial Disorders in Childhood
Published in Shamim I. Ahmad, Handbook of Mitochondrial Dysfunction, 2019
Clinical symptoms usually start in adolescence with reccurent attacks of abdominal pain and gastrointestinal dysmotility and pseudoobstruction due to mitochondrial dysfunction of the intestinal smooth muscle. Patients manifest with nausea, dysphagia, vomiting, early satiety, gastroparesis, borborygmi, meteorism, diarrhoea, convulsive abdominal pain, and pseudo-obstruction syndrome resulting in cachexia with mean weight loss of 14 kg between the onset of first clinical symptoms and the time of diagnosis (Hirano, 2016). Gastrointestinal dysmotility is caused primarily by enteric myopathy, progresses slowly over several decades, may affect any part of the gastrointestinal tract (Giordano et al., 2008). Neurological symptoms are often mild in contrast to severe gastrointestinal problems. Most of patients gradually develop periferal neuropathy with paresthesias occur in a stocking-glove distribution, hearing loss, ptosis and external ophtalmoplegia, and glaucoma-like symptoms. Ultimately, almost all patients present with diffuse leukoencephalopathy visible on MRI which is usually asymptomatic (Hirano et al., 1994; Hirano, 2016). Laboratory findings include significantly increased CSF protein, lactic acidemia and common defects are in cytochrome c oxidase (complex IV).
Pancreatic ablation: minimally invasive treatment options
Published in International Journal of Hyperthermia, 2019
Daniele Maiettini, Giovanni Mauri, Gianluca Varano, Guido Bonomo, Paolo Della Vigna, Alberto Rebonato, Franco Orsi
The main limitations of HIFU, are mainly related to the imaging guidance: acoustic shadowing, reverberation, refraction and other acoustic artifacts are specific for the US imaging. However, HIFU itself is affected by the same acoustic artifacts, which may affect both the efficacy and the safety of the treatment. In order to decrease acoustic shadowing artifacts, an adequate bowel preparation for reducing meteorism, is usually required together with a specific slag-free diet. By applying a slight to moderate pressure on the abdominal surface, above the targeted area, bowel loops may also be compressed or displaced, in order to achieve a better and clearer acoustic window, for energy transmission to the target. Very high procedural costs and the treatment length are the main weaknesses for the HIFU, along with the complexity in safely tracking the pancreatic target due to the respiratory artifacts, but technological research and development could lead to cheaper and faster instruments.
Primary care variability in patients at higher risk for colorectal cancer: evaluation of screening and preventive care practices
Published in Current Medical Research and Opinion, 2018
John Peabody, Juan-Sebastien Saldivar, Eric Swagel, Steven Fugaro, David Paculdo, Mary Tran
Nine CPVs were created for this study using a three-by-three case matrix to assess different patient characteristics that may influence physician evaluation of CRC risk. The nine patients crossed three common case types with three common symptom types (Supplementary Online Table S2). The three case types were: (A) patients with an inadequate history of CRC screening (versus adequate screening; defined as having a colonoscopy, fecal occult blood test [FOBT] or fecal immunochemical test [FIT] within guidelines); (B) patients with no or distant screening presenting with CRC symptoms; and (C) patients with no or distant screening presenting with an unrelated complaint but whose CRC symptoms arise during a review of systems (ROS). The three symptom types were: (1) change in bowel habits; (2) abdominal discomfort/meteorism; and (3) unexplained weight loss or bleeding/anemia. Using evidence-based criteria, these nine patients have a higher risk of CRC for which a diagnostic colonoscopy should be recommended. By caring for the simulated cases, we eliminated the uncertainty about patient variability and isolated our data analysis to provider practice variability.
An update on the cutaneous manifestations of coeliac disease and non-coeliac gluten sensitivity
Published in International Reviews of Immunology, 2018
All patients can show abdominal pain, meteorism, changes in bowel habits (such as diarrhoea, constipation and nausea), fatigue, abdominal distension, eczema, blurred vision, depression, anaemia, paraesthesia of the upper and lower limbs, hand and joint pain, decreased quality of life, tiredness, headache, anxiety, “brain fog” or difficulty focusing, weight loss, depression and skin rash [95–97]. Unlike CD, there are no nutrient deficiencies such as iron, vitamin D and vitamin B12 deficiencies in NCGS, and there is also no correlation with autoimmune diseases. Therefore, it is not possible to clinically distinguish CD from NCGS.