The Experts below are selected from a list of 327 Experts worldwide ranked by ideXlab platform
David C. Madoff - One of the best experts on this subject based on the ideXlab platform.
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Celiac Plexus Block and Neurolysis in the Management of Chronic Upper Abdominal Pain
Seminars in interventional radiology, 2017Co-Authors: Joshua Cornman-homonoff, Daniel J. Holzwanger, Kyungmouk Steve Lee, David C. MadoffAbstract:Chronic Upper Abdominal Pain occurs as a complication of various malignant and benign diseases including pancreatic cancer and chronic pancreatitis, and when present may contribute to lower quality of life and higher mortality. Though various Pain management strategies are available as part of a multimodal approach, they are often incompletely effective and accompanied by side effects. Pain originating in Upper Abdominal viscera is transmitted through the celiac plexus, which is an autonomic plexus located in the retroperitoneum at the root of the celiac trunk. Direct intervention at the level of the plexus, referred to as celiac plexus block or neurolysis depending on the injectate, is a minimally invasive therapeutic strategy which has been demonstrated to decrease Pain, improve function, and reduce opiate dependence. Various percutaneous techniques have been reported, but, with appropriate preprocedural planning, use of image guidance (usually computed tomography), and postprocedural care, the frequency and severity of complications is low and the success rate high regardless of approach. The main benefit of the intervention may be in reduced opiate dependence and opiate-associated side effects, which in turn improves quality of life. Celiac plexus block and neurolysis are safe and effective treatments for chronic Upper Abdominal Pain and should be considered early in patients experiencing such symptoms.
Melissa L Mccarthy - One of the best experts on this subject based on the ideXlab platform.
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rapid 13c urea breath test to identify helicobacter pylori infection in emergency department patients with Upper Abdominal Pain
Western Journal of Emergency Medicine, 2013Co-Authors: Andrew C Meltzer, Rebecca Pierce, Derek A T Cummings, Jesse M Pines, Larissa S May, Meaghan A Smith, Joseph Marcotte, Melissa L MccarthyAbstract:Results: A total of 205 patients with Upper Abdominal Pain were tested over 12 months, and 24% (95% confidence interval: 19% to 30%) tested positive for H. pylori. Black subjects were more likely to test positive than white subjects (28% v. 6%, P < 0.001). Other factors, such as age and sex, were not different between the 2 groups. Conclusion: In our ED, H. pylori infection was present in 1 in 4 patients with epigastric Pain, and testing with a UBT was feasible. Further study is needed to determine the risk factors associated with infection, the prevalence of H. pylori in other EDs, the effect of the test on ED length of stay and the costeffectiveness of an ED-based test-and-treat strategy. [West J Emerg Med. 2013;14(3):278–282.]
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rapid 13 c urea breath test to identify helicobacter pylori infection in emergency department patients with Upper Abdominal Pain
Western Journal of Emergency Medicine, 2013Co-Authors: Andrew C Meltzer, Rebecca Pierce, Derek A T Cummings, Jesse M Pines, Larissa S May, Meaghan A Smith, Joseph Marcotte, Melissa L MccarthyAbstract:Results: A total of 205 patients with Upper Abdominal Pain were tested over 12 months, and 24% (95% confidence interval: 19% to 30%) tested positive for H. pylori. Black subjects were more likely to test positive than white subjects (28% v. 6%, P < 0.001). Other factors, such as age and sex, were not different between the 2 groups. Conclusion: In our ED, H. pylori infection was present in 1 in 4 patients with epigastric Pain, and testing with a UBT was feasible. Further study is needed to determine the risk factors associated with infection, the prevalence of H. pylori in other EDs, the effect of the test on ED length of stay and the costeffectiveness of an ED-based test-and-treat strategy. [West J Emerg Med. 2013;14(3):278–282.]
Won Seop Kim - One of the best experts on this subject based on the ideXlab platform.
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Celiac plexus block in a patient with Upper Abdominal Pain caused by diabetic gastroparesis
Korean journal of anesthesiology, 2014Co-Authors: Young Bok Lee, Won Seop KimAbstract:Diabetic gastroparesis is characterized by delayed gastric emptying, which stems from long-standing diabetic neuromyopathy. The symptoms of gastroparesis include early satiety, nausea, vomiting, postprandial fullness and Upper Abdominal Pain [1]. Here, we present the case of a patient with a 20-year history of diabetes mellitus and a 2-year history of gastroparesis. The patient was suffering from frequent nausea, vomiting and Upper Abdominal Pain, which remained unresponsive to medical treatments. A 40-year-old woman was referred to our Pain clinic by the department of nephrology with a chief complaint of intractable Upper Abdominal Pain. She had been given a score of 9-10 on the visual analogue scale (VAS). The Pain was described to be cramping and bitter as the patient remained in a knee-chest crouched position. She presented a known case of juvenile diabetes which had first been diagnosed at the age of 13. As the age of 38, she had diagnosed with diabetic gastroparesis. She had been admitted for 3-4 days each month for Upper Abdominal Pain management. At the time of the referral, her blood pressure was 120/80 mmHg and her pulse rate was 100 /min. Her height and body weight were 151 cm and 38.4 kg, respectively. The laboratory examinations revealed the following, HbA1c, glucose, BUN/creatinine and albumin levels; 7.1%, 131 mg/dl, 50/2.3 mg/dl and 4.8 g/dl, respectively. At the time of her final admission, the intractable Pain overshadowed nausea and vomiting. As the Pain characteristics showed a visceral origin, we decided to perform a thoracic epidural block in an attempt to block the sympathetic nerve in the Upper Abdominal area. The thoracic epidural block was performed using a paramedian approach at the T7-T8 level with 10 ml of 1% mepivacaine. The patient fell asleep 5 minutes after the end of the nerve block procedure. After a 2-hour sleep, she was returned to the ward with no Pain complaint. She was discharged Pain-free the next day but returned to the hospital for recurrent Abdominal Pain 2 weeks later. On this admission, her VAS score was 6-7. She was referred to our department for a more sustainable form of Pain control. This time, we decided to perform celiac plexus block with alcohol. A left celiac plexus block was performed with 10 ml absolute alcohol first. The right-side celiac plexus nerve was suspended for the significant Pain reduction. She was discharged from the hospital with no complications after 2 days. She experienced significantly reduced Pain thereafter and was only been admitted to the hospital twice for recurrent nausea and vomiting over the 6-month follow-up period. Gastroparesis is a functional disorder presenting delayed emptying of the gastric contents which is more prevalent in women. GI symptoms are present in 76% of diabetic patients, and 34% of patient reports Abdominal Pain [2]. The origin of this Abdominal Pain is a source of debate, but it is suggested that the symptoms are related to a neurogenic disturbance at the enteric nervous system level or the spinal/brain level [3]. Our patient had been suffering from nausea, vomiting and Upper Abdominal Pain for 2 years. She had received strong Pain medications including intravenous tramadol and meperidine on her admissions. To control the Abdominal Pain, opioids, tricyclic antidepressants, gabapentin and pregabalin had been suggested. Our patient was already suffering from chronic gastroparesis symptoms and was referred to our Pain clinic for her intractable Upper Abdominal Pain. This was our first experience with a patient suffering from intractable Abdominal Pain caused by diabetic gastroparesis. First, we decided to perform a thoracic epidural sympathetic nerve block to manage the Pain. The thoracic epidural block has the advantage of blocking the nociceptive afferent fibers while maintaining the function of the craniosacral parasympathetic efferent fibers [4]. After remaining free from severe Pain for 2 weeks, the patient returned to our hospital for recurrent Abdominal Pain. Following consultation with the nephrologist, a celiac plexus block using alcohol was performed for a more sustainable form of Pain control. This procedure had a satisfactory Pain control outcome and an acceptable level of Pain was subsequently maintained. Nevertheless, it did not prevent or help manage the nausea and vomiting. The celiac plexus block has been shown to increase GI motility in addition to blocking the Pain while in severe cases, hypermobility of the GI tract has led to diarrhea. We expected that the celiac plexus block would alleviate all of the symptoms of diabetic gastroparesis; however, the block only resulted in Pain reduction. This could be a result of the chronicity of the symptoms in our patient. Parasympathetic neuropathy can also be contributing to these symptoms. Therefore, a splanchnic nerve block can also improve the Upper Abdominal Pain [5]. In conclusion, we recommend further studies on the mechanism of Abdominal Pain in diabetic gastroparesis as it is imperative to maintain intensive Pain management in these patients.
S Dymarkowski - One of the best experts on this subject based on the ideXlab platform.
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small bowel diverticulosis imaging findings and review of three cases
Gastroenterology Research and Practice, 2009Co-Authors: B De Peuter, I Box, R Vanheste, S DymarkowskiAbstract:Complicated small-bowel diverticulosis is a rather uncommon cause of Upper Abdominal Pain. It may lead to symptoms presenting with an acute onset or to chronic and nonspecific complaints. As the presentation is often similar to other pathologies (acute appendicitis, pancreatitis, or acute cholecystis) and in many cases diagnosis is made on basis of surgical findings, careful analysis of the imaging landmarks may be warranted to aid in the early stages of detection. In this report, we present clinical and morphological findings in three patients where small-bowel diverticulitis was surgically proven. The relevant literature is reviewed, and typical imaging properties are discussed.
Joshua Cornman-homonoff - One of the best experts on this subject based on the ideXlab platform.
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Celiac Plexus Block and Neurolysis in the Management of Chronic Upper Abdominal Pain
Seminars in interventional radiology, 2017Co-Authors: Joshua Cornman-homonoff, Daniel J. Holzwanger, Kyungmouk Steve Lee, David C. MadoffAbstract:Chronic Upper Abdominal Pain occurs as a complication of various malignant and benign diseases including pancreatic cancer and chronic pancreatitis, and when present may contribute to lower quality of life and higher mortality. Though various Pain management strategies are available as part of a multimodal approach, they are often incompletely effective and accompanied by side effects. Pain originating in Upper Abdominal viscera is transmitted through the celiac plexus, which is an autonomic plexus located in the retroperitoneum at the root of the celiac trunk. Direct intervention at the level of the plexus, referred to as celiac plexus block or neurolysis depending on the injectate, is a minimally invasive therapeutic strategy which has been demonstrated to decrease Pain, improve function, and reduce opiate dependence. Various percutaneous techniques have been reported, but, with appropriate preprocedural planning, use of image guidance (usually computed tomography), and postprocedural care, the frequency and severity of complications is low and the success rate high regardless of approach. The main benefit of the intervention may be in reduced opiate dependence and opiate-associated side effects, which in turn improves quality of life. Celiac plexus block and neurolysis are safe and effective treatments for chronic Upper Abdominal Pain and should be considered early in patients experiencing such symptoms.
