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

This 13-year-old girl presented with a four-day history of increasing lower abdominal pain associated with heavy vaginal bleeding which was now resolving. Her last normal menstrual period was 19 days before this incident, with a history of regular periods. Repeated questioning revealed a history of the patient engaging, for the first time, in consensual sexual intercourse one day prior to the onset of complaints. The abdominal examination revealed mild lower abdominal tenderness without rigidity or guarding. The pelvic examination failed to reveal any active bleeding, laceration, or findings suggestive of pelvic inflammatory disease. Routine laboratory studies revealed an elevated white cell count. As the patient's pain worsened over the next two to three hours, surgical and obstetric-gynecologic consultations were made, and both services advised overnight observation. Over the next 12 hours her abdominal examination revealed increased rigidity, and the patient was taken to the operating room with the a preoperative diagnosis of ruptured appendix. On exploratory laparotomy a hemoperitoneum was found, and approximately 600 ml of blood were suctioned from the peritoneal cavity. A 2-cm posterior vaginal wall laceration was subsequently repaired and a normal appendix removed.
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PMID:Coital injury presenting in a 13 year old as abdominal pain and vaginal bleeding. 889 44

Transvaginal sonography was used in the evaluation of clinically suspected pelvic inflammatory disease (PID). A total of 86 patients with PID were examined by transvaginal sonography within 1-3 days, 14 days and 90 days after hospitalization. The diagnosis of PID was confirmed in 37% of patients by laparoscopy, laparotomy or positive cervical culture of Chlamydia trachomatis or Neisseria gonorrhoea. In the remainder, the diagnosis was based on tenderness of the uterus, fever and lower abdominal pain that responded rapidly to antibiotics. At the time of admission, 31% of patients had a thick-walled (> or = 5 mm) echogenic tube raising the suspicion of pyosalpinx or pyo-ovary. During the following 3 months, 52% of patients developed tubes that were thin-walled (< 5 mm) and poorly echogenic, and hydrosalpinx was suspected. At the first transvaginal sonographic examination, 64% showed no adnexal mass, but 16% of these developed suspected hydrosalpinx during the following 3 months. Of the total of 86 patients, 6% exhibited a hydrosalpinx for the first time after 3 months. C-reactive protein concentrations and sedimentation rate values correlated positively with the ultrasonically determined volumes of pyosalpinx/pyoovaries, cul-de-sac fluid and ovaries. Transvaginal sonography appears to be very useful in the diagnosis of suspected PID and is recommended at least 3 months after symptoms have subsided for those patients with an adnexal mass at the time of the acute episode and for infertile patients.
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PMID:Transvaginal sonography in suspected pelvic inflammatory disease. 890 20

The clinicopathological and immunohistochemical findings in 25 cases of inflammatory pseudotumor of lymph nodes (IPT) are presented. The patients were 13 women and 12 men between 8 and 81 years of age. Clinically, symptoms of prior infection, fatigue, abdominal pain, weight loss, fever of unknown origin, pelvic inflammatory disease, or nausea and night sweats were obtained in 15 patients, whereas six patients presented with asymptomatic lymphadenopathy. In four additional patients, no clinical information was obtained. The involved nodes included cervical, supraclavicular, inguinal, mesenteric, and mediastinal lymph nodes. In two cases, there was synchronous involvement of separate lymph node groups (inguinal and cervical in one case and cervical and mediastinal in another case), whereas in a third patient there was synchronous involvement of the spleen and a paraaortic lymph node. Histologically, the lesions were characterized by a fibrosing/inflammatory process that showed marked heterogeneity and striking variation from case to case. Based on their histological features, the lesions could be classified into three different groups: Stage I was characterized by the appearance of single or multiple small foci containing a spindle cell proliferation admixed with a prominent inflammatory background, with complete preservation of the remainder of the nodal architecture; stage II was characterized by more diffuse involvement of the lymph node with a marked inflammatory response admixed with a prominent myofibroblastic proliferation leading to subtotal effacement of the nodal architecture, often with extension of the process beyond the capsule into perinodal fat; and stage III was characterized by almost complete replacement of the lymph node by diffuse sclerosis with scant residual inflammatory elements and total loss of the normal nodal architecture. Immunohistochemical studies in 20 cases showed a striking number of vimentin- and actin-positive myofibroblastic cells with moderate increase in CD20/CD45+ small lymphocytes and polyclonal plasma cells in the stage I lesions, the emergence of numerous CD68+ histiocytes admixed with lymphocytes, plasma cells, and abundant fibromyofibroblastic cells in the stage II lesions, and only few remaining scattered CD68+ histiocytes and fibroblasts in the stage III lesions. Our findings suggest that inflammatory pseudotumor of lymph node represents an evolving, dynamic process that may adopt different morphological appearances depending on its stage of evolution. Recognition of the various stages of this process may be of importance for differential diagnosis with other fibrosing/inflammatory conditions of lymph nodes.
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PMID:Inflammatory pseudotumor of lymph nodes: a study of 25 cases with emphasis on morphological heterogeneity. 904 98

To determine whether serum antibody to Chlamydia trachomatis antigens alters the risk of C. trachomatis pelvic inflammatory disease (PID), 280 female sex workers were prospectively evaluated over a 33-month period for incident C. trachomatis and Neisseria gonorrhoeae cervical infection and for clinical PID. At enrollment, women were tested for antibody to C. trachomatis elementary bodies by an indirect microimmunofluorescence assay and to recombinant chlamydial hsp60 (Chsp60) by an ELISA format. At each follow-up visit, women were tested for cervical chlamydial and gonococcal infection and were identified as having clinical PID if they complained of lower abdominal pain and were found to have uterine and adnexal tenderness on pelvic examination. The data demonstrate that antibody to Chsp60 predicts a 2- to 3-fold increased risk for C. trachomatis PID.
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PMID:Antibody to chlamydial hsp60 predicts an increased risk for chlamydial pelvic inflammatory disease. 912 79

Classic teaching has stated that women who have undergone bilateral tubal ligation (BTL) are not susceptible to pelvic inflammatory disease (PID). The purpose of this study was to confirm the existence of PID in patients with BTL and to compare clinical parameters of these patients with PID patients who have not had BTL. A retrospective chart review of emergency department (ED) patients diagnosed with PID over a 1-year period at a large urban university hospital found 209 patients who fulfilled the criteria for a definition of PID. Of the 209 patients with PID, 24 (11.7%) had undergone BTL. Patients with and without BTL were compared with respect to age, white blood cell count (WBC), temperature, admission rate, length of hospitalization, prior history of PID, culture results, presence of bilateral abdominal pain, presence of rebound tenderness, and complications of tubo-ovarian abscess (TOA) and hydrosalpinx. Patients with BTL had lower WBCs (11,100/microL v14,700/microL) and were 2.5 times less likely to be hospitalized compared to those patients without BTL. These results show that PID in the setting of a prior BTL not only exists but occurs with surprising frequency and deserves further study. Patients with BTL and PID may have a clinically milder form of PID than those patients without BTL.
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PMID:Pelvic inflammatory disease in patients with bilateral tubal ligation. 914 84

Tuboovarian abscess is a serious consequence of pelvic inflammatory disease, especially in the adolescent population. Early diagnosis and treatment are essential to prevent further sequelae including infertility, ectopic pregnancy, and chronic pelvic pain. Not all patients, however, present with pelvic pain, pelvic mass, fever, and leukocytosis. We present the case of a sexually active 15-year-old black girl who presented with mild abdominal pain and excessive vaginal bleeding without pelvic mass, fever, or leukocytosis. Erythrocyte sedimentation rate was 66 mm/h. Pelvic ultrasound revealed bilateral complex ovarian masses. At laparoscopy, the patient had bilateral tuboovarian abscesses with extensive adhesions to the pelvic side walls. This case illustrates the need for a high index of suspicion of tuboovarian abscess in sexually active adolescents.
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PMID:Tuboovarian abscess in the adolescent. 917 5

An assessment of gynecological morbidity among 385 married mothers of children 6-12 months of age from a district in South India's Karnataka State revealed a high burden of reproductive tract infections. Research methods included clinical examination, laboratory tests, and self-reports. A total of 152 women reported 226 gynecological complaints to a social worker, primarily vaginal discharge with bad odor and itching or irritation (22%), lower abdominal pain or vaginal discharge with fever (16%), and menstrual bleeding disorders or pain (15%). Under more extensive probing by a gynecologist, the proportion of women reporting menstrual problems rose to 62%. At medical examination, 36% of women had at least one clinically diagnosed reproductive tract infection, including pelvic inflammatory disease (11%), cervical ectopy (10%), and genital prolapse (3%). More than half had endogenous infections. The two most common infections, identified by laboratory tests, were bacterial vaginosis (18%) and mucopurulent cervicitis (37%). Sexually transmitted diseases, primarily trichomonal vaginalis, were diagnosed in 10%. Women residing in town, those with 6 or more years of schooling, and women with 4 or more pregnancies were significantly more likely to report menstrual problems. Laboratory-detected vaginosis was significantly higher among urban and sterilized women. There were no significant associations between demographic/socioeconomic status variables and the other reproductive health problems analyzed. Finally, severe anemia was present in 17% and chronic energy deficiency in 12%. The combination of widespread undernutrition/malnutrition and reproductive tract infections revealed in this study indicates an urgent need to take steps to implement the reproductive health strategy outlined at the 1994 Cairo Conference in South India.
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PMID:Levels and determinants of gynecological morbidity in a district of south India. 921 30

A survey of physicians in private practice in Jamaica was conducted between March and September 1993 to provide a descriptive analysis of the occurrence of patients with sexually transmitted diseases (STDs) seen in their practices. Questionnaires were delivered to 371 physicians of whom 127 (34%) responded, completing 683 (men 353, women 330) individual patient questionnaires. Each physician collected data over a period of one week. The median ages of the men and women were 27 years and 26 years, respectively. 464 (68%) patients were being seen for the first time for symptomatic STDs, and the visit was a follow-up for 132 (19%) who had been previously diagnosed; 40 (6%) patients were asymptomatic contacts referred by a sex partner, and 12 (2%), who were asymptomatic, asked for a 'checkup'. A history of previous STD was given by 358 (52%) patients. 470 (69%) patients had a genital discharge (M, 65%; F, 73%; p = 0.017), 52 (8%) had anogenital lesions (M, 10%; F, 5%; p = 0.013) and 45 (7%), inguinal lymphadenopathy (M, 10%; F, 3%; p = 0.002). Among women, 131 (40%) had lower abdominal pain on examination and 105 (32%) had cervical excitation tenderness or pain suggesting pelvic inflammatory disease (PID). A working diagnosis of gonorrhoea was made in 273 (40%) patients, trichomoniasis in 121 (18%), nongonococcal infection in 114 (17%), syphilis in 60 (9%), herpes genitalis in 20 (3%) and chancroid in 11 (2%). PID was diagnosed in 121 (37%) women and nongonococcal urethritis in 98 (28%) men. The most frequently prescribed treatments were for chlamydia, gonorrhoea and trichomoniasis. In general, working diagnoses correlate well with clinical observations and treatment given, matched with diagnosis according to national guidelines. A comparison of the STD burden between the public and private sectors was not possible because of sample bias.
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PMID:Survey of patients with sexually transmitted diseases seen by private physicians in Jamaica. 926 May 33

This report presents the first case described in the English literature of dual infection with Cryptococcus neoformans and Streptococcus pneumoniae in the cerebrospinal fluid of an AIDS patient. The patient was a 32-year-old, HIV-positive South African woman who had been diagnosed with disseminated tuberculosis 5 months prior to the index admission. Her chief complaints at presentation were abdominal pain, chronic diarrhea, and vaginal discharge, suggesting a diagnosis of pneumonia and pelvic inflammatory disease. Persistence of confusion led to a lumbar puncture; gram-positive and budding yeasts were observed and subsequent India-ink staining revealed capsulated yeast typical of C. neoformans. S. pneumoniae and C. neoformans were cultured 24 and 48 hours, respectively, after incubation. The woman died within 24 hours of hospital admission, precluding further investigation. It is presumed that this woman already had disseminated cryptococci at the earlier presentation, but was incorrectly diagnosed as having tuberculosis. The finding of pneumococci, in the absence of inflammatory cells in cerebrospinal fluid, suggests the terminal event was fulminant pneumococcal meningitis in the setting of chronic cryptococcal meningitis. This case supports the importance of performing both the Gram- and India-ink stains and cryptococcal antigen test on cerebrospinal fluid specimens from immunocompromised patients, even when biochemical and cellular parameters are normal.
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PMID:Meningitis due to a combined infection with Cryptococcus neoformans and Streptococcus pneumoniae in an AIDS patient. 957 Jun 64

Endometritis are upper genital tract infections. They are part of the Pelvic Inflammatory Diseases and are often difficult to differentiate from salpingitis. C. trachomatis, a sexually transmitted micro-organism, is a major pathogen of the genital tract. Most of the time, the upper genital tract infections are polymicrobial and C. trachomatis can be combined with other aerobes (E. coli, streptococci...) and anaerobes. Diagnosis of chlamydial endometritis is difficult since the clinical symptoms--lower abdominal pain, cervical discharge--often lack specificity or can be completely absent. Bacteriological studies from intra-uterine or intra-cervical samples are necessary. A laparoscopy can be useful to ascertain the integrity of Fallopian tubes. The treatment requires broad spectrum antibiotics effective against C. trachomatis and other probable pathogens, for 2 to 3 weeks.
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PMID:[Chlamydia trachomatis endometritis]. 981 Jan 39


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