E690 CMAJ, October 1, 2013, 185(14) © 2013 Canadian Medical Association or its licensors A90-year-old man was admitted with acute-onset, pressing retrosternal pain and diffuse abdominal discomfort. Electrocardiography and cardiac troponin levels ruled out an acute coronary syndrome. Plain radiography of the abdomen (Figure 1A) showed multiple air–fluid levels and air in the biliary tree (pneumo...

Biliary-type abdominal pain is common and often presents a clinical challenge for physicians. True biliary colic consists of episodes of steady pain across the right upper quadrant and epigastric regions, lasting from 30 minutes to 6 hours [1]. Such abdominal pain, when it lasts longer than 6 hours, is likely due to complications of gallstone disease such as acute cholecys‐ titis or acute pancr...

We report a case of cholelithiasis followed by gallstone ileus, documented with serial computed tomography (CT) scans, that responded to conservative therapy. An 80-year-old woman was admitted because of abdominal pain and vomiting. Six months previously, she had presented with abdominal pain and nausea of sudden onset. A CT scan showed thickening of the gallbladder wall and a gallbladder stone...

Introduction. Symptoms associated with newly formed gallstones have never been studied in a population unaware of their gallstones. The objective of this population-based cohort study was to determine which debut of abdominal symptoms was associated with newly formed gallstones. Materials and Methods. A cohort study was performed of a random sample from general population of Copenhagen. Partici...

BACKGROUND The uncertainty around true clinical manifestations of gallbladder stone disease is in contrast with the unanimous recommendation that only symptomatic gallstones should be treated. AIM To evaluate the relationship between biliary pain, other gastrointestinal symptoms and gallstones. DESIGN OF STUDY A pragmatic, prospective cohort questionnaire study. SETTING Seventy-five gener...

Background: Primary intra cardiac tumors are rare. In this article, we present papillary fibroelastoma of mitral valve chordae. Case Presentation: A 35-year old man presented with atypical chest pain and palpitation. Physical examination and electrocardiogram were normal. Transesophageal echocardiography (TEE) revealed a mass of 1015 mm attached to chordae of anteromedial papillary muscle of ...

Abstract Background: Tramadol is a centrally acting opioid analgesic used to treat moderate to sever pain. It has more advantage and less opioid adverse effects than conventional opioid analgesia. Case Report: This article reports a patient with tramadol dependency that had psychosis after tramadol withdrawal. Conclusion: By the increase of tramadol usage for relief of chronic pain, t...

background: primary intra cardiac tumors are rare. in this article, we present papillary fibroelastoma of mitral valve chordae. case presentation: a 35-year old man presented with atypical chest pain and palpitation. physical examination and electrocardiogram were normal. transesophageal echocardiography (tee) revealed a mass of 1015 mm attached to chordae of anteromedial papillary muscle of m...