scholarly journals Alleviation of Abdominal Pain due to Irinotecan-Induced Cholinergic Syndrome Using Loperamide: A Case Report

2021 ◽  
pp. 806-811
Author(s):  
Kazuki Uchiyama ◽  
Yoshitaka Saito ◽  
Yoh Takekuma ◽  
Satoshi Yuki ◽  
Mitsuru Sugawara
Keyword(s):  
Abdominal Pain ◽  
Symptom Relief ◽  
Stage Iv ◽  
Atropine Sulfate ◽  
Intestinal Wall ◽  
Severe Neutropenia ◽  
Anticholinergic Drugs ◽  
Opioid Receptor Agonist ◽  
Peristaltic Movement ◽  
Cholinergic Syndrome

Irinotecan hydrochloride (irinotecan) is a chemotherapeutic agent used in the treatment of solid tumors. In addition to severe neutropenia and delayed diarrhea, irinotecan causes cholinergic syndrome, characterized by abdominal pain and acute diarrhea. The latter symptoms are frequently observed during and after irinotecan treatment. Here, we have discussed the case of a patient who completely recovered from abdominal pain following the administration of loperamide hydrochloride (loperamide) at a dose of 2 mg, before infusing irinotecan. In contrast, anticholinergic drugs were not as effective in alleviating symptoms. A 28-year-old man with stage IV rectal cancer with peritoneal metastasis was prescribed with fluorouracil, irinotecan, and levofolinate calcium (FOLFIRI), in addition to cetuximab. Anticholinergic drugs, such as scopolamine butylbromide (scopolamine) or atropine sulfate (atropine), were administered to treat abdominal pain that was considered as irinotecan-induced cholinergic syndrome, but monotherapy was not effective. Thereafter, oral loperamide (2 mg) with atropine (0.25 mg) was prescribed before irinotecan infusion. Consequently, the patient did not experience any abdominal pain during and after irinotecan treatment. Loperamide is an opioid receptor agonist and decreases the activity of the myenteric plexus of the intestinal wall. It also inhibits the release of both acetylcholine and prostaglandins, resulting in decreased inhibition of peristaltic movement. We assumed that its mechanism solely or in combination contributed to symptom relief. We hypothesized that the synergistic anticholinergic interaction between loperamide and atropine resulted in marked suppression of irinotecan-induced cholinergic syndrome compared to loperamide alone. Thus, loperamide may improve abdominal pain attributed to irinotecan-induced cholinergic syndrome.

MESENTERIC CYSTS IN INFANCY AND CHILDHOOD

PEDIATRICS ◽  
1959 ◽  
Vol 24 (3) ◽  
pp. 469-476
Author(s):  
Ernest E. Arnheim ◽  
Herman Schneck ◽  
Alex Norman ◽  
David H. Dreizin
Keyword(s):  
Abdominal Pain ◽  
Operative Mortality ◽  
Intestinal Wall ◽  
Additional Case ◽  
Diagnosis And Treatment ◽  
Mesenteric Cyst ◽  
Safe Procedure ◽  
Infancy And Childhood ◽  
Mesenteric Cysts ◽  
Radiologic Features

The pathologic, clinical and radiologic features, diagnosis and treatment of mesenteric cysts in infancy and childhood, based upon a study of 82 cases in the literature, are discussed. An additional case of mesenteric cyst is presented. Mesenteric cysts were usually noted in male children from 2 to 10 years of age, presenting with abdominal enlargement and abdominal pain, and revealing characteristic roentgenographic findings. Excision of the cyst was often complicated by adhesions to the intestinal wall; simultaneous resection of the involved intestine has become a safe procedure, with an operative mortality of 7% in recent years.

scholarly journals Analgesic effects of a novel pH-dependent μ-opioid receptor agonist in models of neuropathic and abdominal pain

Pain ◽  
2018 ◽  
Vol 159 (11) ◽  
pp. 2277-2284 ◽  
Author(s):  
Antonio Rodriguez-Gaztelumendi ◽  
Viola Spahn ◽  
Dominika Labuz ◽  
Halina Machelska ◽  
Christoph Stein
Keyword(s):  
Abdominal Pain ◽  
Opioid Receptor ◽  
Receptor Agonist ◽  
Analgesic Effects ◽  
Opioid Receptor Agonist ◽  
Μ Opioid Receptor ◽  
Ph Dependent

scholarly journals Ileocecal Fistula Caused by Multiple Foreign Magnetic Bodies Ingestion

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Vittorio Cherchi ◽  
Gian Luigi Adani ◽  
Elda Righi ◽  
Umberto Baccarani ◽  
Giovanni Terrosu ◽  
...  
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Foreign Body ◽  
Clinical Condition ◽  
Correct Diagnosis ◽  
Intestinal Wall ◽  
Accidental Ingestion ◽  
The Us ◽  
Manual Suture ◽  
One Year

The incidence of accidental foreign body (FBs) ingestion is 100,000 cases/year in the US, with over than 80% of cases occurring in children below 5 years of age. Although a single FB may pass spontaneously and uneventfully through the digestive tract, the ingestion of multiple magnetics can cause serious morbidity due to proximate attraction through the intestinal wall. Morbidity and mortality depend on a prompt and correct diagnosis which is often difficult and delayed due to the patient's age and because the accidental ingestion may go unnoticed. We report our experience in the treatment of an 11-year-old child who presented to the emergency department with increasing abdominal pain, vomiting, diarrhea, and fever. Surgery evidenced an ileocecal fistula secondary to multiple magnetic FB ingestion with attraction by both sides of the intestinal wall. A 5-centimeter ileal resection was performed, and the cecal fistula was closed with a longitudinal manual suture. The child was discharged at postoperative day 8. After one year, the patient’s clinical condition was good.

BPI19-010: Febrile Neutropenia Induced by Chemotherapy: Impact of Risk Re-Stratification

2019 ◽  
Vol 17 (3.5) ◽  
pp. BPI19-010
Author(s):  
David da Silva Dias ◽  
Catarina Jorge ◽  
Mafalda Baptista ◽  
Ana Júlia Arede ◽  
Paulo Luz ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Febrile Neutropenia ◽  
Hospital Admissions ◽  
Stage Iv ◽  
Low Risk ◽  
Severe Neutropenia ◽  
Clinical Judgement ◽  
Extended Spectrum Beta Lactamase ◽  
Focal Infection ◽  
Stage Iv Cancer

Introduction: Febrile neutropenia (FN) induced by chemotherapy (ChT) arises until 6 weeks after the last cycle, usually between 5 and 10 days post-ChT. Infection risk is 20%–30%. It is difficult to stratify patients with low risk of complications due to FN. MASCC index is useful but has limitations. This correlates with unnecessary hospital admissions, complications, and costs. Methods: Retrospective study of patients with diagnosis of FN induced by ChT, admitted to our center between 2012 and 2016. Primary goal was to describe this population. Secondary goal was to re-stratify the risk of FN using MASCC and CISNE indexes, clinical judgement, and social/logistic factors. SPSS v23 was used for statistical analysis. Results: 211 patients were included; median age, 66 years. Median hospital stay was 6 days (1–89). 25% were nosocomial admissions. At admission 46% of patients presented with stage IV cancer. 75% were solid neoplasms and 25% were hematologic. Profound neutropenia was observed in 43% and severe neutropenia in 36%. Overall mortality rate was 13%. Sepsis was diagnosed in 24 patients (11%), with a mortality rate of 54%. Only 12.3% of patients had prophylaxis with granulocyte-colony stimulating factor. At admission, 64% of patients had no obvious focal infection; 20% had probable focus; and in 16% a microorganism was identified, most commonly gram-negative Enterobacteriaceae. Most used antibiotics were piperacillin/tazobactam (44%) and its combination with aminoglycoside (34%). This combination showed benefit against some extended-spectrum beta-lactamase (ESBL)–producing strains and multiresistant (MR) Pseudomonas aeruginosa (2.8%). MASCC index identified 31% of patients with low risk FN. After applying the CISNE index, clinical judgement, and social/logistic factors, only 11% were identified as low-risk FN and did not benefit from admission. This translates to an avoidable cost of €48,000 according to the center’s annual report. Conclusion: The combination of β-lactam and aminoglycoside is overused in our practice. It is not recommended in hemodynamically stable patients and contradictory in unstable ones; still it shows some effect versus MR and ESBL strains. A study to evaluate their incidence in our center is now in progress. Low risk FN was observed in 11% of admitted patients. Our center has an internal protocol and has been able to provide a good overall response.

The sooner the better: Analysis of proactive palliative medicine consultation in the medical intensive care unit amongst patients with stage IV malignancy.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 78-78
Author(s):  
Shanna R Levine ◽  
Earle I Bridget ◽  
Wendy S.A. Edwards
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Palliative Medicine ◽  
Symptom Relief ◽  
Stage Iv ◽  
Active Stage ◽  
Trigger Tool ◽  
Goals Of Care ◽  
Rehabilitation Facility

78 Background: Palliative care has been shown to improve quality of life and prolong median survival in patients with advanced cancer. Sadly, patients are still suffering at the end of their lives perhaps secondary to aggressive hospital care. ICU use in the last month of life increased from 24.3% to 29.2% over the last study decade. Our objective was to evaluate and quantify outcomes, including survival, of patients with active stage IV malignancy admitted to an urban university affiliated hospital MICU who had a palliative medicine consult. Methods: A retrospective chart review of patients from 04/2013 - 04/2014 admitted to the MICU with active stage IV malignancy identified via a validated proactive case finding trigger tool. The trigger was based on eight criteria, one of which being active stage IV malignancy. The MICU census was reviewed biweekly. Data collected included pain and symptom relief, clarification of goals of care, length of stay, and disposition (hospice, rehabilitation facility, home and death). Results: Four hundred sixty eight patients were assessed. One hundred and twenty two patients met 1 of the 8 criteria, and 24 patients met the inclusion criteria for review. Three patients were not seen due to attending and/or family preference. Thirty eight percent of patients had improved symptoms and management control, 42% had clarification of goals of care and medically appropriate decision making, and 42% experienced psychosocial spiritual counseling. Eight patients died during their hospital stay, 4 were transferred to inpatient hospice facilities, 3 to rehabilitation facility, 2 went home and the remainder was “other”. The average length of stay of patients seen by palliative care was 20 days compared to 31 days for patients not seen by the palliative team. Conclusions: Nearly 40% of patients with active stage IV malignancy admitted to the MICU died during their hospital stay. We believe this study illuminates the futility of ICU care in this patient population. Consultation from the palliative medicine team using a proactive trigger tool can be beneficial to allow for better symptom control, clarification of goals and psychosocial counseling.

Use of the restrained rat technique for study of the antiulcer effect of drugs

1960 ◽  
Vol 15 (2) ◽  
pp. 291-294 ◽  
Author(s):  
H. M. Hanson ◽  
D. A. Brodie
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Atropine Sulfate ◽  
Gastric Ulcers ◽  
Anticholinergic Drugs ◽  
Potent Drug ◽  
Time Required

Five anticholinergic drugs, atropine sulfate, diphenmethanil, mepiperphenidol, propantheline and scopolamine methiodide, were studied for their effects on gastric ulcers in rats produced by the restraint technique. All the drugs significantly decreased ulceration; scopolamine methiodide appeared to be the most potent drug tested, followed by propantheline, atropine, diphenmethanil and mepiperphenidol. Three central nervous system depressants, chlorpromazine, benactyzine and pentobarbital, all decreased the incidence of ulcers with no differences in potency. Acetazolamide administered daily for 5 days had no effect on ulceration. Prednisolone administered daily was found to increase the time required for recovery from restraint-produced ulcers. Submitted on November 6, 1959

scholarly journals Sarcomatoid carcinoma of the gallbladder: A rare form of gallbladder cancer

2020 ◽  
Vol 8 ◽  
pp. 2050313X2090673
Author(s):  
Mehdi Siddiqui ◽  
Sheetal Hegde ◽  
Tung Nguyen ◽  
Scott DePaul
Keyword(s):  
Abdominal Pain ◽  
Hospice Care ◽  
Abdominal Mass ◽  
Treatment Options ◽  
Sarcomatoid Carcinoma ◽  
Stage Iv ◽  
Large Mass ◽  
Liver Lesions ◽  
Diffuse Abdominal Pain ◽  
Carcinoma Of The Gallbladder

Sarcomatoid carcinoma of the gallbladder or gallbladder carcinosarcoma is an exceedingly rare malignancy. Unfortunately, patients typically present with advanced disease at diagnosis. Symptoms may include abdominal pain, jaundice, anorexia, nausea, weight loss, and a palpable abdominal mass. This malignant tumor has a poor prognosis, and treatment options include surgical resection, radiation, and chemotherapy. We detail the case of a 57-year-old male who presented with diffuse abdominal pain and jaundice. Computed tomography scan of the abdomen and pelvis showed a large mass within the gallbladder, intrahepatic ductal dilation, gastrohepatic lymph node enlargement, and liver lesions concerning for metastatic disease. A core needle biopsy from one of the liver lesions revealed poorly differentiated sarcomatoid carcinoma of the gallbladder. He was assessed to have stage IV disease and deemed not to be a surgical candidate. Palliative chemotherapy was planned; however, treatment was never started due to the development of cholangitis with sepsis. The patient ultimately opted for hospice care and passed away shortly thereafter.

Patient attitude and survival in advanced non-small cell lung cancer (NSCLC): Results of a prospective observational study

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 7148-7148
Author(s):  
S. Altug ◽  
L. Wang ◽  
D. Chu ◽  
K. Park ◽  
H. Hsu ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Symptom Relief ◽  
Stage Iv ◽  
Primary Objective ◽  
Routine Practice ◽  
Patient Attitudes ◽  
Curative Surgery ◽  
Maximum Extension ◽  
Predictive Variables

7148 Background: A physician’s ability to accurately identify a patient’s attitude toward treatment is critical. The primary objective of this study (B9E-AA-JHSH) was to evaluate patient attitudes as predictors of survival independently of currently known predictive variables, and secondarily, whether physician-assessed patient attitudes differed from patient-assessed attitudes. Methods: This was a non-interventional, prospective, observational study of patients from 19 countries of Asia, Central Eastern Europe, and Latin America. Eligible patients had stage IIIB/IV NSCLC not amenable to curative surgery/radiotherapy, gemcitabine and cis/carboplatin as part of treatment, and were chemonaive. Physicians and patients used a 7-item questionnaire to assign patient attitudes to 1 of 4 categories using a pre-defined algorithm: A = Cure; B = Maximum extension of survival with acceptance of high toxicity; C = Maximum extension of survival only if coupled with normal lifestyle; and D = Symptom relief. Enrolled patients were followed until 18 months from enrolment, death, or loss to follow up. Results: From Sept 2002 to Dec 2003, 1,985 patients were enrolled; the majority were male (73.4%), <70 yrs (83.9%), and had stage IV disease (79.2%), PS 0–1 (79.2%), and tumor-related symptoms (89.2%). Distribution of patient-assessed attitudes were A = 0%, B = 55%, C = 25%, and D = 20%. From category B-D, median survival (B = 14.6 months, C = 13.5, D = 12.5) and 1-year survival (B = 57.6%, C = 56.2%, D = 51.2%) both decreased but the differences were not statistically significant. Adjustment for known predictive variables eliminated this decreasing trend. Physician-assessed patient attitudes were lower than patient-assessed attitudes (p < .0001); however, the difference was less for patients with disease-related symptoms (p = .03). Conclusions: This is the largest analysis to date of patient attitudes when treated with gemcitabine and cis/carboplatin. Patient attitudes were not significant predictors of survival; however, physicians do underestimate patients’ desire for extended survival compared to symptom relief. Also, it was interesting to see a comparatively longer median and 1-year survival in routine practice compared to reports in clinical trial settings. [Table: see text]

A case of perforation of the intestinal wall ascaris

2021 ◽  
Vol 20 (7) ◽  
pp. 710-711
Author(s):  
A. E. Aleeva
Keyword(s):  
Abdominal Pain ◽  
Intestinal Wall ◽  
Severe Abdominal Pain ◽  
The Right

On 28 / Ѵ 1924, a 52-year-old patient T. G-va was taken to the hospital, 23 hours after the onset of the disease, with complaints of severe abdominal pain, mainly in the right hypochondrium. From the anamnesis it became clear that the patient had previously suffered from gallstones, and she was offered an operation to remove gallstones.

Sign in / Sign up

Export Citation Format

Share Document