Abdominal Pain Yields a Devastating Diagnosis

​BY GREGORY TAYLOR, DO, &DIANE KAISER, DOA 41-year-old woman presented to the emergency department with abdominal pain, noting multiple episodes over the past year of intermittent right upper quadrant pain that she described as “achy” and “fullness.” These episodes occurred sporadically with no identifiable exacerbating factors. Associated symptoms included a 20-pound unintentional weight loss over two months with occasional nausea and vomiting. She was a former smoker of 10-pack years and had stopped two months prior to arrival, and she reported drinking two to three glasses of wine a week. She did not have a primary care physician.Her vital signs on arrival were a temperature of 97.7°F, blood pressure of 132/97 mm Hg, heart rate of 98 bpm, 99% pulse ox on room air, respirations of 18 bpm, and weight of 76 kg. A physical exam revealed mild tenderness to deep palpation in the RUQ with appreciable hepatomegaly. Laboratory values were remarkable for a hemoglobin of 12.7 g/dL, mean corpuscular volume of 92, gamma-glutamyl transferase of 382 (9-48 U/L), total bilirubin of 0.6, alkaline phosphatase of 205 (44-147), aspartate aminotransferase of 55 U/L (10-37 U/L), alanine aminotransferase of 33 U/L (8-37 U/L).She was hemoccult-positive on rectal exam. Ultrasound showed multiple lobulated ill-defined masses throughout the liver. (Images A and B.) A CT abdomen/pelvis showed multiple heterogeneously enhancing irregular hepatic masses, with the larges...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research

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The objective of this study was to evaluate the potential analgesic action of 8% capsaicin cream for topical use in patients with myofascial pain syndrome. METHODS: Initially, cream formulations of PLA (Placebo) and CPS (Capsaicin 8%) were developed and approved according to the current requirements of the health authority agency. The 40 participating patients were randomly assigned to the PLA and CPS groups in a double-blind fashion. Before the creams were topically administered, according to the allocation group, the local anesthetic was used for a period of 50minutes directly in the area of interest. The cream was a...
Source: Revista Brasileira de Anestesiologia - Category: Anesthesiology Tags: Rev Bras Anestesiol Source Type: research
CONCLUSION: Costoclavicular brachial plexus block is a good alternative for upper limb anesthesia distal to the elbow, being a safe and effective option for patients who are obese or have other limitations to the use of other upper limb blocking techniques. PMID: 31519300 [PubMed - as supplied by publisher]
Source: Revista Brasileira de Anestesiologia - Category: Anesthesiology Tags: Rev Bras Anestesiol Source Type: research
by Craig Klugman, Ph.D.  “Mental illness and hatred pulls the trigger, not the gun” – President Trump, 4 August 2019 In 2019 (as of September 13), there have been 297 “mass shootings” (4 or more people killed or injured) in the United States resulting in 326 deaths and 1,229 injuries. The reason, according to Trump’s administration is untreated mental illness. According to many mental health specialists, lots of people with mental illness never injure another person and many of the shooters have not been diagnosed with a mental illness.…
Source: blog.bioethics.net - Category: Medical Ethics Authors: Tags: Featured Posts Psychiatric Ethics Public Health Social Justice gun control guns HARPA Source Type: blogs
CONCLUSIONS: Epidemiological figures emerging from this study confirm that trends in Lebanon are in line with a global pattern of decreasing age at menarche. Urban-rural differences suggest that higher caloric content of diet and consequent early overweight, more evident in urban areas, are likely determinants of younger menarche. Evidence from this study calls for an urgent implementation of comprehensive multisectoral obesity prevention in children in Lebanon. PMID: 31519350 [PubMed - as supplied by publisher]
Source: Revue d Epidemiologie et de Sante Publique - Category: Epidemiology Tags: Rev Epidemiol Sante Publique Source Type: research
Publication date: Available online 14 September 2019Source: Molecular Genetics and MetabolismAuthor(s): Farrah Rajabi, Frances Rohr, Ann Wessel, Leslie Martell, Steven F. Dobrowolski, Per Guldberg, Flemming Güttler, Harvey L. LevyAbstractPhenylketonuria (PKU) is an autosomal recessive inborn error of metabolism caused by pathogenic variants in the phenylalanine hydroxylase gene (PAH). The correlation between genotype and phenotype can be complex and sometimes variable but often very useful for categorizing and predicting dietary tolerance and potential outcome. We reviewed medical records for 367 patients diagnosed wi...
Source: Molecular Genetics and Metabolism - Category: Genetics & Stem Cells Source Type: research
ConclusionColorectal specialist awareness of CRS/HIPEC units and accessibility is high. Strategies to improve referring physician/surgeon knowledge on patient selection and indications for CRS/HIPEC should be investigated and instituted to ensure all appropriate patients are referred to specialist units for discussion of suitability.
Source: European Journal of Surgical Oncology (EJSO) - Category: Surgery Source Type: research
Publication date: Available online 14 September 2019Source: Reumatología Clínica (English Edition)Author(s): Manuel Jiménez Ortiz, Alfonso Espinosa Ruiz, Cristóbal Martínez Delgado, Pablo Barrena Sánchez, José A. Salido ValleAbstractBackgroundThe association of depression and chronic pain in knee osteoarthritis is a complex and difficult phenomenon to understand. In fact, establishing the order of appearance of these entities might result in an arduous task.ObjectiveIn addition to analysing the relationship between preoperative anxiety and depression according to the results...
Source: Reumatologia Clinica - Category: Rheumatology Source Type: research
Publication date: Available online 14 September 2019Source: Heart &LungAuthor(s): Zenghui Zhang, Jun GuoAbstractBackgroundLeft ventricular aneurysm (LVA) is a severe complication of ST-elevation myocardial infarction (STEMI) and is associated with poor prognosis due to high mortality. However, predictors of LVA formation in early period are inadequately defined.ObjectivesThe purpose of this study is to determine potential predictors of LVA formation in early period (
Source: Heart and Lung: The Journal of Acute and Critical Care - Category: Respiratory Medicine Source Type: research
ConclusionsEndovascular coil fiducial placement for lung SBRT is associated with high procedural success rates and lower rates of clinically relevant complications than transthoracic marker placement.
Source: Journal of Vascular and Interventional Radiology - Category: Radiology Source Type: research
ConclusionsRAE was feasible and safe. The use of N-butyl-2-cyanoacrylate, presence of coagulopathy, and transfusion of> 10 U of PRBCs were significant factors related to recurrent bleeding. Bilateral inferior mesenteric artery and internal iliac artery angiography is highly recommended in the initial RAE session to achieve a high rate of bleeding control.
Source: Journal of Vascular and Interventional Radiology - Category: Radiology Source Type: research
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