The rules of acupoint selection and treatment were identified and discovered from the collected ancient acupuncture-moxibustion prescriptions recorded the earliest for epigastric pain. The database of ancient acupuncture-moxibustion prescriptions for epigastric pain was set up using Excel2016 software. After the disease term, etiology, pathogenesis, symptoms and acupoints were normalized, the underlying multi-dimensional correlation among the elements of acupuncture-moxibustion was explored, using the frequency statistics and the association rule of Apriori algorithm. In the ancient time, in treatment with acupuncture-moxibustion therapy for epigastric pain, the acupoints of the high use frequency were sequenced as Zhongwan (CV12), Shangwan (CV13), Zusanli (ST36), Neiguan (PC6), Gongsun (SP4), Pishu (BL20) and Weishu (BL21). The common combinations of acupoints included the pairs of back-shu points, the combination of back-shu points and front-mu points, the combination of front-mu points and yuan-source points and the combination of back-shu points and the lower he-sea points. The highly involved acupoints were those from the conception vessel, pericardium meridian, spleen meridian, stomach meridian and bladder meridian; and they were commonly distributed on the abdomen, the yin parts of the foot and the arm, the yang part of the leg and on the back. Regarding the etiologies such as parasites, food retention, masses, qi stagnation and stomach cold, Zhongwan (CV12) and Shangwan (CV13) were coordinated; and Sanyinjiao (SP6) and Daling (PC7) were highly associated with masses. Besides cold injury, parasites and masses, for the epigastric pain caused by other factors of etiology (qi stagnation, stomach cold and food retention), moxibustion therapy was greatly applicable. For epigastric pain combined with qi reversion in the lower abdominal region, Qichong (ST30), Sanyinjiao (SP6), Tianshu (ST25) and Zusanli (ST36) must be selected. Dadu (SP2) and Taibai (SP3) must be used if the distention in the chest and abdomen accompanied; and Zhongzhu (TE3) be used if back pain involved. Zusanli (ST36) was commonly selected for hiccups. For the other accompanied symptoms, Zhongwan (CV12) was used, which is consistent with the acupoint selection of main symptoms. On the trunk, moxibustion was generally used at Weishu (BL21), Pishu (BL20), Geshu (BL17), Zhongwan (CV12), Juque (CV14) and Qihai (CV6), except Shangwan (CV13). Among the acupoints below the elbows and knees, moxibustion was commonly applicable at Zusanli (ST36), and acupuncture was often used at Gongsun (SP4) and Daling (PC7).
Acupuncture Points ; Humans ; Moxibustion/history* ; History, Ancient ; Acupuncture Therapy/history* ; Data Mining ; Abdominal Pain/history*

Chronic pancreatitis is a debilitating disease characterized by abdominal pain, exocrine insufficiency, and diabetes mellitus and has had great social, economic, and psychological impacts. Traditional definition of chronic pancreatitis has been based on irreversible histological findings such as self-sustaining chronic inflammation, fibrosis, and eventual destruction of ductal, exocrine, and endocrine tissues. In contrast, the traditional characteristics of acute pancreatitis have been thought as a complete recovery of pancreatic function and morphology during the convalescence period. Acute and chronic pancreatitis have been considered separated disease entities. However, the current idea regarding the natural course of pancreatitis is that acute pancreatitis can progress to the intermediate step of recurrent acute pancreatitis, and finally to chronic pancreatitis. This evolution can be characterized by a sequence of necrotic and fibrotic events, or described by sentinel acute pancreatitis event (SAPE) hypothesis. Therefore, chronic pancreatitis is better defined as a progressive inflammatory and fibrotic disease of the pancreas with clinical features of abdominal pain, malnutrition, diabetes mellitus and imaging features of pancreatic parenchymal/ductal calcifications. The complications of chronic pancreatitis include pseudocyst, pseudoaneurysm, fistula, biliary stricture, and duodenal stricture. This review describes the progression from acute to chronic pancreatitis, the mechanisms and nature of abdominal pain, steatorrhea, pancreatogenic diabetes mellitus, pseudocyst, pseudoaneurysm, and biliary stricture associated with chronic pancreatitis.
Abdominal Pain ; Aneurysm, False ; Biliary Fistula ; Constriction, Pathologic ; Convalescence ; Diabetes Mellitus ; Fibrosis ; Inflammation ; Malnutrition ; Natural History* ; Pancreas ; Pancreatitis ; Pancreatitis, Chronic* ; Steatorrhea

PURPOSE: In the emergency department (ED), identification of the obstetrical and gynecologic history for diagnosis of child-bearing aged women who present with abdominal pain is very important. We compared the usefulness of self-registry using a tablet computer and a traditional paper registry for taking history of child-bearing aged women. METHODS: We reviewed the prospective registries of child-bearing aged women presenting with abdominal pain without underlying disease to the ED of the Seoul Metropolitan Boramae Medical Center. We used a paper version of this registry from April 2008 to April 2011. From May 2011 to October 2012, we used the Smart Medical Registry (SMR), where the patient used a tablet computer to record her own data. The registries of child-bearing aged women included information on the patient's basic information, medical history, gynecologic history, symptoms, physician's examination, and laboratory results. We performed statistical analysis of the difference between the paper registry and SMR. RESULTS: A total of 1193 patients were registered. Among them, 835 patients were registered using the SMR. There were no statistically significant differences in the patients' basic information and diagnostic classification. However, the SMR group reported more recent history of pelvic inflammatory disease (p<0.01), higher number of abortions (p<0.01), and higher number of sexual partners (p<0.01). CONCLUSION: Using the tablet computer based self-survey, patients had a more positive tendency toward answering privacy sensitive items. Therefore, it might be more useful and effective in obtaining sensitive, private information from patients.
Abdominal Pain* ; Classification ; Diagnosis ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Female ; Humans ; Medical History Taking ; Pelvic Inflammatory Disease ; Privacy ; Registries ; Seoul ; Sexual Partners

PURPOSE: In the emergency department (ED), identification of the obstetrical and gynecologic history for diagnosis of child-bearing aged women who present with abdominal pain is very important. We compared the usefulness of self-registry using a tablet computer and a traditional paper registry for taking history of child-bearing aged women. METHODS: We reviewed the prospective registries of child-bearing aged women presenting with abdominal pain without underlying disease to the ED of the Seoul Metropolitan Boramae Medical Center. We used a paper version of this registry from April 2008 to April 2011. From May 2011 to October 2012, we used the Smart Medical Registry (SMR), where the patient used a tablet computer to record her own data. The registries of child-bearing aged women included information on the patient's basic information, medical history, gynecologic history, symptoms, physician's examination, and laboratory results. We performed statistical analysis of the difference between the paper registry and SMR. RESULTS: A total of 1193 patients were registered. Among them, 835 patients were registered using the SMR. There were no statistically significant differences in the patients' basic information and diagnostic classification. However, the SMR group reported more recent history of pelvic inflammatory disease (p<0.01), higher number of abortions (p<0.01), and higher number of sexual partners (p<0.01). CONCLUSION: Using the tablet computer based self-survey, patients had a more positive tendency toward answering privacy sensitive items. Therefore, it might be more useful and effective in obtaining sensitive, private information from patients.
Abdominal Pain* ; Classification ; Diagnosis ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Female ; Humans ; Medical History Taking ; Pelvic Inflammatory Disease ; Privacy ; Registries ; Seoul ; Sexual Partners

A 24-year-old man presented with mental change, fever, abdominal pain, tenderness and palpable mass on the lower abdomen. He was a non-Korean engineer and did not accompany a legal guardian, so medical history taking was difficult due to his mental status. Brain magnetic resonance imaging showed multiple rim-enhanced lesions of the brain, and abdominal computed tomography showed huge paraspinal abscess. Chest X-ray and computed tomography showed poorly defined nodular opacities. We initially thought that this patient was infected with toxoplasmosis with typical cerebral image finding and immunoglobulin laboratory finding of cerebrospinal fluid and serum study. The abdominal abscess was confirmed as tuberculosis through the pathologic finding of caseous necrosis. We used anti-tuberculosis medication and anti-toxoplasmosis medication for almost 4 months, and then his clinical state and radiological findings were considerably improved.
Abdomen ; Abdominal Abscess ; Abdominal Pain ; Abscess ; Brain ; Fever ; Humans ; Immunoglobulins ; Legal Guardians ; Magnetic Resonance Imaging ; Medical History Taking ; Necrosis ; Thorax ; Toxoplasmosis ; Toxoplasmosis, Cerebral ; Tuberculosis ; Young Adult

Abdominal pain is a common chief complaint that brings patients to emergency departments and outpatient offices. The causes of abdominal pain are numerous, ranging from life-threatening to self-limiting disorders. Diagnostic approaches are often difficult because of the nonspecific and overlapping nature of pain, regardless of the underlying cause. A careful medical history taking is the initial diagnostic step. All patients should undergo systematic examinations, regardless of the differential diagnosis suggested by the history. On the basis of the clinical suspicion and laboratory investigations, the physician will consider imaging examinations to help establish the correct diagnosis. Various endoscopic and imaging modalities have important roles in diagnosing many causes of abdominal pain. Diagnostic approaches rely on the likelihood of disease obtaining from histories of patients, physical examinations, laboratory tests, and imaging studies. Furthermore, the evaluation of abdominal pain must be efficient and lead to an accurate diagnosis early in the presentation. It is also important to consider special populations such as women especially during pregnancy and the elderly, because of presentations may differ and are often complicated by coexistent disease.
Abdominal Pain ; Aged ; Diagnosis, Differential ; Emergencies ; Female ; Humans ; Medical History Taking ; Outpatients ; Physical Examination ; Pregnancy

PURPOSE: To evaluate and analyze the clinical characteristics and history of patients with hemoperitoneum due to ovarian rupture. METHODS: Subjects were fertile females who visited the emergency department between January 2006 and December 2008. We did retrospective chart reviews only for patients diagnosed with hemoperitoneum. We investigated the characteristics and history of enrolled patients. RESULTS: A total of 76 females (mean age = 28 years) were enrolled. Of the 76, 32 (41.8%) were initially checked for coitus history by emergency physicians (EP). Of the 76, 52 (68.4%) were operated on and the remaining 24 (31.6%) were only observed. Only 4 patients had knowledge of a history of ovarian cysts. CONCLUSION: Coitus history and ovarian cyst history should be done by EPs during the initial examination of fertile females who complain of lower abdominal pain.
Abdominal Pain ; Coitus ; Emergencies ; Female ; Hemoperitoneum ; Humans ; Medical History Taking ; Ovarian Cysts ; Retrospective Studies ; Rupture

Isolated dissecting aneurysm of the superior mesenteric artery (SMA) is a rare condition. Although aneurysms of the SMA are frequently classified with other splanchnic aneurysms, dissecting SMA aneurysms are quite different in terms of their etiology and natural history. Therefore, independent consideration is warranted during their treatment. In this case report, a dissecting aneurysm was accompanied by burst fractures of the first and third lumbar spines at the same height. We treated the patient, who was suffering from chronic post-prandial intermittent abdominal pain after falling down. The patient stopped displaying repeated episodes of abdominal pain did not recur after the false lumen entry was closed by a short exclusion stent graft, and there were no procedural complications. The stent graft remained patent, and the patient has remained free of symptoms during the 16 months follow-up period. We present here the case of a traumatic isolated SMA dissecting aneurysm that was successfully managed by endovascular treatment.
Abdominal Pain ; Aneurysm ; Aneurysm, Dissecting* ; Blood Vessel Prosthesis ; Follow-Up Studies ; Humans ; Mesenteric Artery, Superior ; Natural History ; Spine*

Isolated dissecting aneurysm of the superior mesenteric artery (SMA) is a rare condition. Although aneurysms of the SMA are frequently classified with other splanchnic aneurysms, dissecting SMA aneurysms are quite different in terms of their etiology and natural history. Therefore, independent consideration is warranted during their treatment. In this case report, a dissecting aneurysm was accompanied by burst fractures of the first and third lumbar spines at the same height. We treated the patient, who was suffering from chronic post-prandial intermittent abdominal pain after falling down. The patient stopped displaying repeated episodes of abdominal pain did not recur after the false lumen entry was closed by a short exclusion stent graft, and there were no procedural complications. The stent graft remained patent, and the patient has remained free of symptoms during the 16 months follow-up period. We present here the case of a traumatic isolated SMA dissecting aneurysm that was successfully managed by endovascular treatment.
Abdominal Pain ; Aneurysm ; Aneurysm, Dissecting* ; Blood Vessel Prosthesis ; Follow-Up Studies ; Humans ; Mesenteric Artery, Superior ; Natural History ; Spine*

PURPOSE: Nodular duodenitis is defined as two or more erythematous nodules in the duodenum, with surrounding inflammation and with or without apical erosions. But the clinical features and natural history of nodular duodenitis remain largely undefined, therefore we examined clinical, endoscopic and pathologic features of nodular duodenitis in children to find about its natural history, relationship between endoscopic and pathologic findings, relationship between Helicobacter pylori and nodular duodenitis as well as clinical response to antisecretory therapy. METHODS: Forty-nine children presented with chronic abdominal pain, chronic diarrhea, vomiting and indigestion showed nodular duodenitis on gastroduodenoscopic examinations at the Department of pediatrics of Hangyang University Hospital from January 1995 to August 1997. Endoscopic and pathologic findings were graded and the correlation coefficient between endoscopic and pathologic grades were analyzed. Clinical responses to therapy were compared between Helicobacter pylori (H. pylori)-associated and non H. pylori-associated children. RESULTS: The chief most common complaint was chronic abdominal pain and this disease was most commonly developed in females and in school-aged children. In endoscopic examinations, Grade 1 was the most commonly noted, while in pathologic examinations, Grade 2 was most common. The correlation coefficient between endoscopic and pathologic findings was 0.278 (P= 0.053). Clinical symptoms were improved by H2-blocker or anti-H. pylori therapy in most patients. CONCLUSION: There was no significant correlation between endoscopic and pathologic grades. H. pylori infection may be an etiologic factor of nodular duodenitis in some cases.
Abdominal Pain ; Child* ; Diarrhea ; Duodenitis* ; Duodenum ; Dyspepsia ; Female ; Helicobacter pylori ; Humans ; Inflammation ; Natural History ; Pediatrics ; Vomiting