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

This article, reporting 3 case studies of solitary liver nodules, focuses on the discrepancy in the medical literature among various nomenclatures used to describe hepatic lesions and tumors. Case 1 was a 5-year-old girl with an upper abdominal mass; case 2 was a 19-year-old woman, with a 4-month history of contraceptive use, with a hamartoma which was resected; case 3 was a 38-year-old woman, with a 5-year history of oral contraceptive use and a hysterectomized uterus, who presented with abdominal pain 5 years post-hysterectomy. She had a nodule which was biopsied but not resected. All 3 cases, though from dissimilar patient populations, reflected characteristics of focal nodular hyperplasia, and all were reparative in nature. Histologically and vascularly, these nodules appear to be developed from a vascular basis, and the association of these nodules with oral contraceptive use encourages such speculation. Arguments for diagnosing these liver tumors as focal nodular hyperplasia are presented.
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PMID:Solitary liver nodules. 16 1

This paper reviews the literature since 1967 on rupture of the pregnant uterus and presents findings from a series of 47 uterine ruptures (35 of which were complete) managed by the authors. Uterine rupture accounts for 5% of maternal mortality in the US and there is some evidence that its incidence is increasing. The incidence of uterine rupture is 1:1000-1:1500 deliveries in the US but far lower if only cases of spontaneous rupture of the intact uterus are included. In the author's series, spontaneous ruptures accounted for about 25% of the total and only 17% of these occurred before the onset of labor. A uterine scar, particularly one from a previous cesarean section, is the most common predisposing factor. Age and parity are alos related to the incidence of uterine rupture in most series. Ruptures occuring during labor generally involve the lower segment whereas those prior to labor are usually corporal. Symptoms are estremely variable, ranging from none to complete collapse. The amount of intraperitoneal spill, degree of fetal and placental extrusion, condition of the patient, and degree of retraction of the uterine musculature and important factors in symptamatology. The classical clinical picture includes abdominal pain and tenderness, cessation of labor, shock, and vaginal bleeding. Immediate surgical intervention, with institution of appropriate supportive measures to combat shock and hemorrhage, is the cornerstone of treatment of uterine rupture. The choice of surgical procedure depends on the type, extent, and location of the rupture as well as the patient's condition and desire to preserve her childbearing capacity. Hysterectomy is the procedure of choice in cases of spontaneous or traumatic rupture with no uterine scar. It is doubtful that the incidence of spontaneous rupture of the unscarred uterus can be reduced until more is known about its etiology. Traumatic and spontaneous ruptures are most dangerous, with maternal mortality rates of 20% and 8%, respectively. Knowledge of uterine rupture would be significantly enhanced by a collaborative type study collecting data from several institutions over a given time period.
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PMID:Rupture of the pregnant uterus: a review. 34 49

A case report of ovarian pregnancy in a young white nulligravida, with a Copper 7 IUD in situ, was presented. The patient had the IUD inserted 1 year prior to her January 1977 admittance to the hospital for abdominal pain. After the IUD was removed, laparoscopy revealed blood in the abdominal cavity. The uterus, tubes, and left ovary were normal. The right ovary had a hemorrhagic cystic mass. A corpus luteum was visible near the mass. Microscopic examination of a section of the hemorrhagic mass revealed immature chorionic villi and a corpus luteum separated from the villa by ovarian connective tissue. In the literature on ectopic pregnancy, the risk of ovarian pregnancy was defined as 1/40,000 deliveries. Several studies indicated that the risk was considerably higher for IUD users. The manner in which IUDs enhance the risk of ovarian pregnancy is unknown.
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PMID:Ovarian ectopic pregnancy in association with a copper-7 intrauterine device in situ. 45 25

A case of uterine torsion in a mare with colic is described in which an early diagnosis was made and the torsion successfully reduced through a standing laparotomy with survival of both the mare and the foal. This case is used to stress the importance of thorough examination of all pregnant mares with colic in order to differentiate uterine torsion from other causes of abdominal pain, thereby avoiding delay in surgical correction and reducing the risk of fetal and/or maternal death. The advantages of the standing laparotomy are presented in support of this method of treatment of torsion of the gravid uterus.
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PMID:Torsion of the uterus--a cause of colic in the mare. 46 38

Myometrial activity and endometrial blood flow were recorded in a patient with uterine haemorrhage and lower abdominal pain, who turned out to have a tubal pregnancy. The uterine contractions had an amplitude sometimes exceeding 400 mmHg and a duration up to 3.5 min. Thus, strong uterine contractions can appear during pregnancy without the presence of a gestational sac within the uterus. This is contrary to the assumption that processes in the foetal membranes initiate the sequence of events leading to abortion or labour.
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PMID:Myometrial activity and endometrial blood flow in an ectopic pregnancy. 72 82

A simple, safe, economical and potentially reversible technique for female sterilization via minilaparotomy is evaluated in 204 patients (not recently pregnant and postpartum). Only light general anesthesia is required, and the procedure is performed with only equipment normally available in any hospital or outpatient clinic. A 2cm circumumbilical or suprapubic incision is made, and the physician manipulates the uterus to bring the fallopian tube in line with the incision. As the cornu passes the incision, the release of intraabdominal pressure at the site of the wound usually pushes the tube out of the peritoneal cavity. A majority of the procedures were performed in less than five minutes. No surgical difficulties were encountered, and no immediate complications or complaints were reported. Patients were usually hospitalized for one or two nights. Early postoperative complications or complaints were reported for 8.4% of the not-recently-pregnant patients and for 4.1% of the postpartum patients at the 7-to-21-day follow-up visit. The most frequently reported complications and complaints were fever and lower abdominal pain. Further studies to determine the effectiveness of this type of sterilization and whether the procedure can be performed safely with local anesthetics and on an outpatient basis are being planned.
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PMID:Female sterilization via minilaparotomy. 95 61

A 25 yr old married woman with complaints of lower abdominal pain for 2 months, was found to have a irregular nontender mass in pelvis, adherent to uterus. Her Papanicolaou smear was inflammatory. To confirm the diagnosis of either ovarian malignancy or pelvic tuberculosis made on the basis of observations during exploratory laparotomy, ovarian biopsy was taken. The imprint cytodiagnosis was tuberculosis. The patient was then managed surgically and the previous diagnosis was reconfirmed by histopathology. Imprint cytodiagnosis appears to be a valuable technique whenever facilities for frozen section are not available.
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PMID:Cytodiagnosis for pelvic tuberculosis. 130 98

Torsion of the pregnant uterus is defined as rotation more than 45 degrees around the long axis of the uterus. Uterine torsion is observed in all age groups of the reproductive period, in all parity groups, and at all stages of pregnancy. Torsion from 60 degrees to 720 degrees has been described. It is not possible to clarify why uterine torsion occurs, but numerous abnormalities have appeared with uterine torsion; most often, abnormal fetal presentation, myoma uteri and uterine malformations. The most usual symptoms of uterine torsion are birth obstruction, abdominal pain, vaginal bleeding, shock, and urinary and intestinal symptoms. Eleven percent are asymptomatic. The treatment in the earlier months of pregnancy is immediate laparotomy and detorsion of the uterus and, if practicable, adjunct surgery to eliminate the possible etiologic factors. Near term or during labor cesarean section is carried out, and elimination of the possible etiologic factors. The fetal and maternal mortality rates since 1976 are 12% and 0% respectively.
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PMID:Uterine torsion in pregnancy. 132 18

A 30-year old primigravida with a history of drug addiction came to the Rigshospitalet in Copenhagen, Denmark for prenatal care at 15 weeks gestation. Physicians did an amniocentesis because of family history of trisomy 21. Ultrasound examinations in the 17th and 18th weeks of gestation indicated a living fetus with the placenta on the right lateral wall of the uterus, but there was an insufficient amount of amniotic fluid. Maternal alpha fetoprotein serum levels were extremely high (298 kIU/L). Physicians predicted a poor fetal prognosis and advised the woman to undergo an abortion. On the first day, they inserted 4 vaginal pessaries of 1 mg gemeprost and administered 25-30 mg bupivacain through an epidural catheter to control abdominal pain. 8 hours after first insertion, they began intravenous (IV) administration of oxytocin. Her cervix remain closed and uterine tension did not increase. 2 hours after beginning the oxytocin IV, she suffered from an abrupt severe abdominal pain which was transferred to the right shoulder. Heart rate and blood pressure remained normal. 4 hours later, her body temperature rose, so she received 500 m pivampicillin 3 times/day. She experienced no vaginal bleeding and no uterine contractions. Her cervix had still no opened. On the third day, health workers inserted 5 more pessaries. On the fourth day, they administered 75 ml isotonic saline/hour transcervically, but she still did not abort. Her temperature vacillated even though she received antibiotics and the pain continued despite epidural analgesics. On day 5, health workers administered 3.75 mcg prostaglandin F2 alpha/minute transcervically. After 6 hours of no progress, they performed a laparotomy and observed a macerated, malodorous fetus in the peritoneal cavity which continued 1200 ml of blood. The medial part of the left fallopian tube an the left uterine corner had ruptured. They removed the fetus via wedge resection; it had no malformations. Physicians should consider ectopic pregnancy when attempts at induced abortion do not succeed.
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PMID:Misdiagnosis of interstitial pregnancy followed by uterine cornual rupture during induced midtrimester abortion. 132 30

About 15-20% of the time uterine surgery via laparotomy is replaced in our department by operative pelviscopy. Of these, in reference to myoma surgery, about 70% were tackled with operative pelviscopy and a laparotomy was avoided. This allows the preservation of the uterus, especially for those women who desire to bear children in the future. Organ-preserving, minimally invasive surgery is the current accepted operative ideal. Postoperative sequelae like adhesion formation, subacute intestinal obstruction, and chronic abdominal pain are thus decreased. The importance of correct and safely functioning equipment and instruments cannot be overstressed for optimal results. A closed drain, i.e., the Robinson drainage system, can be kept in place for at least 12-24 h to check the postoperative ooze. In two cases of extensive ooze, repeat pelviscopy was performed within 12 h and hemostasis was achieved by the use of endosutures and endocoagulation.
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PMID:Pelviscopic uterine surgery. 134 75


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