Unusual Differential Diagnosis of Upper Abdominal Pain

We here present an interesting unusual case of upper abdominal pain. The patient was a 38-year-oldman, who was admitted to our
hospital complaining of right upper quadrant pain caused by a toothpick that perforated the anterior gastric wall and penetrated
segment I of the liver. After endoscopic removal and an initially uneventful course, computed tomography revealed a perigastric
abscess that was treated by repeated gastroscopic rinsing via an endoscopically placed catheter. After another three uneventful
weeks, a liver abscess with minor tendency to constrict the portal vein was diagnosed, and a segment I liver resection together with
abscess drainage was performed. The peculiarity of this case is the rarity of toothpick ingestion and gastric perforation in a young
and healthy white Caucasian followed by development of a liver abscess after primary uneventful endoscopic removal. In light of
this case, gastric perforation due to ingested foreign bodies such as toothpicks can be considered a rare cause of upper abdominal
pain.


Encuentran el articulo completo en pdf en el siguiente LINK: http://www.hindawi.com/journals/dte/2009/817052.html

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

“The Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure” provides a new
guideline for hypertension prevention and management. The following are
the key messages: (1) In persons older than 50 years, systolic blood pressure
(BP) of more than 140 mm Hg is a much more important cardiovascular
disease (CVD) risk factor than diastolic BP; (2) The risk of CVD, beginning
at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg; individuals
who are normotensive at 55 years of age have a 90% lifetime risk for
developing hypertension; (3) Individuals with a systolic BP of 120 to 139
mm Hg or a diastolic BP of 80 to 89 mm Hg should be considered as prehypertensive
and require health-promoting lifestyle modifications to prevent
CVD; (4) Thiazide-type diuretics should be used in drug treatment for
most patients with uncomplicated hypertension, either alone or combined
with drugs from other classes. Certain high-risk conditions are compelling
indications for the initial use of other antihypertensive drug classes (angiotensin-
converting enzyme inhibitors, angiotensin-receptor blockers,
-blockers,
calcium channel blockers); (5) Most patients with hypertension will require
2 or more antihypertensive medications to achieve goal BP (
140/90
mm Hg, or
130/80 mm Hg for patients with diabetes or chronic kidney
disease); (6) If BP is more than 20/10 mm Hg above goal BP, consideration
should be given to initiating therapy with 2 agents, 1 of which usually should
be a thiazide-type diuretic; and (7) The most effective therapy prescribed by
the most careful clinician will control hypertension only if patients are motivated.
Motivation improves when patients have positive experiences with
and trust in the clinician. Empathy builds trust and is a potent motivator.
Finally, in presenting these guidelines, the committee recognizes that the
responsible physician’s judgment remains paramount.

Articulo completo en este link: http://jama.ama-assn.org/cgi/reprint/289.19.2560v1.pdf