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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The termination of early pregnancy (less than 56 days amenorrhoea) has been investigated using 16,16-dimethyl-trans-delta 2-PGE, methyl ester in a controlled release preparation. The onset of crampy abdominal pain was seen after 270 +/- 39 minutes and bleeding occurred after 603 +/- 95 minutes. Two (15%) patients required no pain relief during treatment, however 5 (38%) requested oral analgesia, and in 6 (46%) individuals the pain was severe enough to warrant parenteral opiates. The overall success rate for complete abortion was 85%. No serious adverse effects were seen, but vomiting occurred in 2 (15%) women, and diarrhoea in 3 (23%). Although the use of this prostaglandin analogue in slow release form provides an effective treatment method for early abortion using a reduced total dose of prostaglandin, the acceptability of the drug as an agent for menstrual induction continues to be limited by the occurrence of troublesome gastro-intestinal side effects.
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PMID:A controlled release form of 16,16-dimethyl-trans-delta 2-PGE, methyl ester for early abortion. 369 93

Eight patients with choriocarcinoma associated with ectopic pregnancy were treated at the John I. Brewer Trophoblastic Disease Center of Northwestern University Medical School from 1962 through 1981. This represented 4% of the 197 patients with documented choriocarcinoma or 1.7% of all 459 patients with gestational trophoblastic disease treated with chemotherapy at the center during this 20-year period. The presenting signs and symptoms were similar to those classically outlined for ectopic pregnancies: amenorrhea and abdominal pain (88%), irregular vaginal bleeding (75%), positive pregnancy test (100%), and adnexal mass (50%). Six patients (75%) had metastatic disease and four of these six had one or more high-risk factors. Two patients (25%) died of metastatic disease, both of whom had received chemotherapy elsewhere before referral to the center.
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PMID:Choriocarcinoma associated with ectopic pregnancy. 373 45

Abortion was attempted in 39 women in early pregnancy (less than 56 days amenorrhea) with the progesterone antagonist RU486 alone (150 mg per day for 4 days) or in combination with a PG analogue, 16,16-dimethyl-trans-delta2-PGE1 (Gemeprost) in the form of a 1 mg vaginal pessary. Complete abortion was also attempted in 5 women who received RU486 together with 2 x 1 mg PG pessaries. Vaginal bleeding followed by complete abortion occurred in 18 of 19 women who received RU486 + 1 mg PG pessary as compared to only 12 of 20 women who received RU486 alone (P0.01). All women who received RU486 + 2 mg Gemeprost had a complete abortion. The onset of crampy abdominal pain (median: 3 vs 4 days) and vaginal bleeding (3 vs 3 days) was similar in the RU486 and RU486 + PG groups, respectively. Slightly less than 1/2 the patients in both groups had nausea and/or vomiting, but the incidence did not differ from that occurring prior to treatment. The mean duration (range) of vaginal bleeding [RU486 alone: 10 (0,29) days and RU486 + PG: (5,34) days], and the measured blood loss [RU486: 53 (2,227) ml and RU486 + PG: 81 (32,222) ml] did not differ signficantly between the 2 treatments. It is concluded that the combination of RU486 and a single PG vaginal pessary is a highly effective means of inducing therapeutic abortion in early pregnancy and offers an alternative to surgery.
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PMID:Therapeutic abortion in early pregnancy with antiprogestogen RU486 alone or in combination with prostaglandin analogue (gemeprost). 381 30

The use of depot-type injections of the contraceptive medroxyprogesterone acetate (DMPA) was studied in 1132 women for up to 5 1/2 years. Continuation rates, reasons for discontinuation, method failure rates, and bleeding patterns were considered. The women received a dose of 400 mg DMPA in aqueous suspension (injected into the deltoid muscle) every six months. In addition, each patient received an oral dose of .04 mg ethynl estradiol for 10 days each lunar month. Of the original acceptors, 36.4 percent used the method for the full 5 1/2 years. The major reasons for discontinuation of DMPA injections were bleeding problems (including amenorrhea) and such other medical reasons as palpitation, abdominal pain, headache, weakness, and dizziness. A total of 26 women became accidently pregnant while using DMPA during the 5 1/2 years. Advantages of DMPA injections were the simplicity, safety, and effectiveness of the method, and the psychological appeal of an injectable contraceptive.
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PMID:Use-effectiveness of six-month injections of DMPA as a contraceptive. 482 85

The clinical presentation of ectopic pregnancy is explored in this study along with the most constant predisposing factors among Saudi women. The medical records of 68 cases of suspected ectopic pregnancies were reviewed. Only 45 of the 68 cases, those that were finally diagnosed as ectopic pregnancies, constitute the basis of this study. The incidence of ectopic pregnancy was 1:742 pregnancies. 39 of the 45 patients with ectopic pregnancies were para 1-5; only 1 and 5 patients were reported to be nulliparous and grandmultipara, respectively. 27 of the 45 cases were 20-30 years of age. Between 40% and 45% of the 45 patients had positive histories of pelvic infection, abdominal or pelvic surgery, or infertility. 1 case each of an IUD in situ and of a recurrent ectopic pregnancy were reported. Amenorrhea with lower abdominal pain and tenderness were the most constant features of ectopic pregnancy. Vaginal bleeding was present in about 51% of the cases; fainting attacks and shoulder tip pains were late manifestations. Duration of amenorrhea was 6-8 weeks in about 63% of the cases; 36% had amenorrhea lasting 12-16 weeks. Only 1 patient presented with amenorrhea of longer duration (20 weeks), and she proved to have a cervical pregnancy. Laparoscopy was the only reliable diagnostic procedure. In all cases of clinically suspected hemoperitoneum, laparotomy was performed as a mandatory procedure. Pelvic examinations performed with the patient under anesthesia and also culdocentesis were both unreliable and inconclusive as diagnostic measures. Of the 40 cases of tubal ectopic pregnancy seen at laparotomy, 21 had already ruptured, 15 were still intact and 4 were cases of tubal abortion. The incidence of ectopic pregnancy is modified by age, parity, race, socioeconomic factors, sexual habits, contraceptive used and pelvic infection. The part played by 1 or more of those factors is unknown but definitely variable. In this study there were 40 tubal (88.8%), 1 cervical (2.2%), and 2 ovarian pregnancies (4.4%).
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PMID:A study of 45 cases of ectopic pregnancy. 610 59

This article examines causal factors of ectopic pregnancy, discusses management with emphasis on tubal conservation, and updates information on diagnosis, fertility maximization, and minimization of risks of recurrent ectopic gestations. The common factor in ectopic gestations appears to be a delay in the transport of the fertilized ovum to the uterus, allowing the embryo to develop invasive trophoblast. Factors that appear to have increased the incidence of ectopic pregnancy over the past include increased sexual exposure, more effective theraphy for pelvic inflammatory disease, IUDs, tubal surgery, and surgical sterilization reversals. 77% of extrauterine gestations occur in the middle and distal thirds of the fallopian tube, with clinical manifestations largely determined by the site of implantation. Abdominal pain, amenorrhea/vaginal bleeding, and a pelvic mass are the classic signs of an ectopic pregnancy. Newer diagnostic procedures including serum human chorionic gonadotropin-beta subunit assay pregnancy testing supported by ultrasonography and laparoscopy have allowed the vast majority of tubal pregnancies to be diagnoses before rupture, permitting surgery to be undertaken more for the purpose of preserving fertility than for saving the mother's life. Factors in selecting candidates for conservative surgery include medical stability of the patient, parity, desire for future pregnancy, age under 35, mid or distal tubal gestation, prior ectopic gestation or tubal surgery. Considerations influencing the surgical approach for appropriate candidates include location of the pregnancy, condition of the involved and contralateral tube and ovary, pelvic anomalies, previous surgery, and need for ancillary procedures. If the ectopic gestation is located in the mid to distal segment of the fallopian tube, a segmental resection or salpingostomy using microsurgery should give a good anatomic and functional result. A review of the literature indicates that, contrary to prevailing opinion, recurrent etopic gestations are not more common in patients undergoing tubal conservation than in those undergoing more radical procedures. Recent data have shown term pregnancy rates of 40-55% and recurrent ectopic pregnancy rates of 5% in patients with conservative procedures, the improved rate being attributed to availability of microsurgical techniques, finer suture and minimal surgical trauma, which lead to less adhesions and scarring. tudies have indicated that use of Dextran minimizes pelvic adhesion formation, decreasing anatomic distortion leading to subsquent infertility or ectopic pregnancy.
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PMID:Tubal conservation with ectopic gestations. A reappraisal. 623 72

Ten women with endometriosis (stages I to IV) were treated with twice-daily subcutaneous injections of 200 micrograms of (D-Ser[TBU]6-des-Gly-NH2(10] luteinizing hormone-releasing hormone ethylamide (Buserelin) for 5 days followed by 400 micrograms intranasally three times daily for 25 to 31 weeks. Serum follicle-stimulating hormone levels returned to basal values on the second day of treatment, and serum luteinizing hormone levels progressively decreased to normal within 4 weeks. Serum estradiol decreased below early follicular phase levels within 7 to 30 days and continued to decrease to castrate levels. Light to moderate estrogen withdrawal bleeding was followed by amenorrhea with occasional bleeding or spotting in four women. Abdominal pain and dyspareunia disappeared or were ameliorated after 2 months of treatment. Resorption of endometrial implants was demonstrated by laparoscopy, and endometrial biopsy revealed atrophy or weak proliferation. Ovulation returned within 45 days, and two of four sexually active women became pregnant during cycles 3 and 5. The treatment was well accepted in spite of the expected hot flushes and vaginal dryness. Safety laboratory tests during and after treatment did not reveal any abnormalities. Reversible down-regulation of pituitary/ovarian function using repetitive luteinizing hormone-releasing hormone agonist administration can be a worthwhile approach to medical treatment of endometriosis.
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PMID:Reversible hypogonadism induced by a luteinizing hormone-releasing hormone (LH-RH) agonist (Buserelin) as a new therapeutic approach for endometriosis. 642 19

The clinical and pathological features of 125 juvenile granulosa cell tumors of the ovary were analyzed. The patients ranged in age from newborn to 67 years (average 13 years). Forty-four percent were 10 years of age or younger, 34% between 11 and 20 years, 18% between 21 and 30 years, and 3% over 30 years of age. Eighty-two percent of the prepubertal patients presented because of isosexual pseudoprecocity. In the remainder of the children and in most of the older patients, the presenting manifestation was usually abdominal pain or swelling. Fifteen patients in the reproductive age group had menstrual irregularities or amenorrhea, and one of the two postmenopausal women presented with uterine bleeding. Two patients had Ollier's disease and two had Maffucci's syndrome. Laparotomy revealed unilateral involvement in 122 cases and involvement of both ovaries in two cases; bilateral tumors were found at autopsy in one case. Two tumors were Stage IIb and one Stage IIc; the remainder were Stage I. In 13 cases (11%), rupture had occurred before or during operation and ascites was present in 11 cases (9%). The tumors ranged from 3 to 32 cm in diameter (average 12.5 cm). Forty-nine percent of them were solid and cystic, 37% solid, and 14% cystic. Microscopic examination disclosed diffuse and follicular patterns, with the former predominating in most of the cases. The follicles varied in size and shape and characteristically contained basophilic or eosinophilic secretion, which often stained positively for mucin. The granulosa cells were typically luteinized to varying degrees and had dark round nuclei without grooves; a theca cell component of variable extent was present in many of the cases. The mitotic rate ranged from less than 1 to 32/10 high-power fields, with an average of 7. Nuclear atypicality varied from Grade 1 to 4. Follow-up information of at least 1 year's and up to 21 years' (average 5 years') duration was available for 95 patients, 87 of whom (92%) were alive and free of disease. One patient with Maffucci's syndrome died of chondrosarcoma 11 years after removal of the ovarian tumor (corrected survival--93%). The seven remaining patients died as a result of their tumor from 7 months to 3 years postoperatively; one of the clinically malignant tumors was Stage Iai, one Stage Iaii, two Stage Ic, two Stage IIb, and one Stage IIc.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Juvenile granulosa cell tumor of the ovary. A clinicopathological analysis of 125 cases. 646 18

This paper reports the case of a 30-year old woman, para 2, with mesenteric venous occlusion associated with inadvertent oral contraceptive (OC) use during pregnancy. The patient presented with vomiting, diffuse abdominal pain, and dysuria. Despite a 4 month history of amenorrhea, the patient continued OC use (Ovral)(. Ultrasonography revealed a fetus of 14 weeks gestation. Despite treatment, the patient's condition deteriorated and thrombotic occlusion of the mesenteric veins with hemorrhagic infarction of the intestine was noted. A resection of the damaged small bowel was performed, followed by an end to end enteroenterostomy. It is suggested that the hypercoagulable state normally found during pregnancy was aggravated in this case by the hormonal intake. In addition to OC use, this patient had another risk factor for mesenteric venous thrombosis: heavy cigarette smoking. The risk of venous thromboembolic disease associated with OC use declines within 1 month to the level found among nonusers of OCs. Thus, patients at risk of this condition (those who suffer from collagen disease or are obese and heavy smokers) should be advised to avoid pregnancy in the 1st month after OC discontinuance.
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PMID:Mesenteric vein thrombosis associated with oral contraceptive administration during pregnancy. 652 63

The incidence, clinical presentation, diagnosis, and treatment of 2 problems of early pregnancy--spontaneous abortion and ectopic pregnancy--are reviewed. The incidence of spontaneous abortion is reported to be 10-20% of all pregnancies and may be decreasing. Abnormal development of the pregnancy, unsuccessful implantation, maternal disease, noxious agents, previous surgery, abnormalities of the genital tract, and psychological stress have all been implicated in the etiology of spontaneous abortion. The clinical presentations include threatened, inevitable, incomplete, complete, missed, septic, and habitual abortion. The management of threatened abortion has changed from strict limitations of activity and the use of progestational agents to more liberal recommendations regarding activity and the avoidance of progestins. Combined use of radioimmunoassay for the beta subunit of human chorionic gonadotropin and ultrasound examination of the pelvis can lead to accurate prediction of the pregnancy outcome in patients with 1st trimester bleeding. Evacuation of the uterus is the treatment of choice in inevitable or incomplete abortion. Clinicians should be aware of the guilt feelings, grief reactions, and fears about future pregnancies that often follow spontaneous abortion. Reports of the incidence of ectopic pregnancy have ranged from 1 in 250 to 1 in 70 pregnancies, and the rate has been increasing. The significant morbidity and mortality associated with this condition make early diagnosis essential. The 3 most common symtoms are abdominal pain, amenorrhea, and abnormal vaginal bleeding. Ultrasonography and new methods of measuring human chorionic gonadotropin facilitate early diagnosis. Culdocentesis remains the definitive method of diagnosis. Earlier diagnosis has led some physicians to advocate salpingostomy via laparoscopy rather than salpingectomy for treatment in selected cases.
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PMID:Spontaneous abortion and ectopic pregnancy. 655 28


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