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

During the past decade, the development of various gonadotrophin-releasing hormone (Gn-RH) agonists, which induce reversible hypo-oestrogenism has opened a new area in the medical management of endometriosis. In an open, multicentre phase III study, the efficacy, tolerance and safety of the Gn-RH agonist leuprorelin acetate were tested. The preliminary results of 104 women treated in seven German centres are presented. Pelvic endometriosis was diagnosed by laparoscopy and classified according to the American Fertility Society scoring system: 33% of patients had minimal, 22% mild, 28% moderate and 8% severe endometriosis and in 9% no pathological results were obtained. The patients' mean age was 30 +/- 6 years and 66 had infertility problems. Treatment was started within the first 3 days of the menstrual cycle and consisted of a subcutaneous injection of leuprorelin acetate 3.75 mg, repeated once monthly over 24 weeks. A follow-up period of 12 months after the last injection has been completed in 70 patients, including a second laparoscopy. At all visits, symptoms were evaluated, physical examinations performed, and blood samples collected for haematological screening, serum chemistry determinations and measurement of the gonadotrophins oestradiol and progesterone and leuprorelin acetate. The median score at laparoscopy fell from 12 before operation to 8 after operation and 2 after treatment with leuprorelin acetate. Of the total number of patients, 89% had improvements in their endometriosis, 8% a deterioration and 3% no change. Patients reported improvement in the following: dysmenorrhoea 93%, dyspareunia 62% and pelvic pain 70%. However, all women complained of at least one of the following symptoms: hot flushes 86%, sleep disturbance 62%, sweating 61%, headache 41%, nausea 32% and depression 20%. Fifty-five percent of patients reported additional side effects such as vaginal dryness, fatigue and lower abdominal pain. After the third injection, amenorrhoea persisted in 94% of the women. Four weeks after the first leuprorelin acetate injection median concentrations of oestradiol fell from 45 pg/ml to 11 pg/ml, follicle-stimulating hormone from 7 U/L to 3 U/L and luteinising hormone from 5 U/L to 1 U/L and remained almost unchanged over the observation period. During the 6 months' treatment, laboratory parameters showed no significant deviations from normal; only total cholesterol, high-density lipoprotein cholesterol and alkaline phosphatase increased. Treatment results were judged as good and satisfactory in 82% and 11% of cases, respectively. On the basis of this study, it can be concluded that leuprorelin acetate treatment is safe, well tolerated and effective in the medical management of endometriosis and endometriosis-related complaints.
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PMID:Treatment of endometriosis with leuprorelin acetate depot: a German multicentre study. 153 21

A group of 1542 premenopausal Caucasian women were assessed prospectively to investigate the prevalence of endometriosis. The women either underwent laparoscopy because of infertility (n=654), because of laparoscopic sterilization (n=598), because of chronic abdominal and pelvic pain (n=156), or underwent abdominal hysterectomy for dysfunctional uterine bleeding (n=134). Endometriosis was seen more frequently among women being investigated for infertility (21%) than among those undergoing sterilization (6%). For those experiencing chronic abdominal pain, the incidence of endometriosis was 15%, while among those undergoing abdominal hysterectomy it was 25%. In all groups, the total duration of combined pill usage was significantly higher in those who had normal pelvis compared with those with endometriosis. It is suggested that among susceptible women, both fertile and infertile, a prolonged period of regular spontaneous menstruation may play a causative role in the etiology of endometriosis.
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PMID:Prevalence and genesis of endometriosis. 191 5

The painful bladder syndrome (PBS) is a progressive and painful disease of the bladder that may lead to fibrosis, contracture and reduction of bladder capacity. The usual symptoms are urinary urgency, frequency, nocturia, chronic pelvic pain and lower abdominal pain upon filling of the bladder. A retrospective analysis was performed on 21 women with PBS between March 1987 and March 1988. The patients were treated weekly with a bladder pillar block, bladder distention and dimethyl sulfoxide instillation. Symptomatic relief was observed in 80% of the patients so treated. The maximum bladder volume increased from 185 to 475 mL (P less than .01). The side effects were minimal.
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PMID:A practical approach to the painful bladder syndrome. 221 43

This study aims to determine the prevalence of sexual and physical abuse among women seen in a gastroenterology clinic. A total of 206 patients, who completed a self-administered questionnaire, were included in the analysis. Results indicated that 89 patients (44%) reported a history of sexual abuse or physical abuse in childhood or later in life; and all except one of the physically abused were also sexually abused. Among them, only 17% had informed their doctors about the abuse. Moreover, the 75 patients (36%) with functional gastrointestinal disorders were more likely than those with organic disease diagnosis to report a history of forced intercourse, frequent physical abuse, chronic or recurrent abdominal pain, and more lifetime surgeries. They were also more likely to be receiving psychological counseling for emotional concerns. Furthermore, abused patients were more likely than nonabused patients to report pelvic pain, multiple somatic symptoms, and more lifetime surgeries. In conclusion, this study discovered that there is a high prevalence of a history of sexual and physical abuse among women seen in a referral-based gastroenterology clinic, particularly those with functional gastrointestinal disorders.
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PMID:Sexual and physical abuse in women with functional or organic gastrointestinal disorders. 224 Aug 98

The authors describe one case of rectal stenosis complicating chronic salpingitis in a patient carrying an intrauterine device. This observation is peculiar in that the inflammatory fibrous reaction is very intense, spreading all over the pelvis and forming a pseudotumoral mass sheathing the rectum. The clinical signs were mainly digestive, including a rectal syndrome: cramplike pelvic pain before defecation, tenesmus, constipation, abdominal pain and induration of the anterior aspect of the rectum observed during the clinical examination. Radiological examinations (barium enema, ultrasound, CT) show a tissue mass within the pelvis, with considerable thickening of the rectal wall. Ultrasound-guided biopsy in the pelvis yielded only nonspecific inflammatory signs with dominant fibrosis. The diagnosis of rectal stenosis caused by chronic salpingitis complicating the presence of an IUD was made only during surgery.
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PMID:[Rectal stenosis. A rare complication of chronic salpingitis caused by an intrauterine device]. 231 25

Chronic unexplained pelvic pain in women may arise from either gynaecological or colonic causes. 35 women with pelvic congestion were interviewed with regard to their bowel habits and compared with a population with the irritable bowel syndrome. The results suggest that pelvic congestion and the irritable bowel syndrome are two distinctly different conditions, both of which may cause chronic lower abdominal pain in women.
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PMID:Pelvic pain--pelvic congestion or the irritable bowel syndrome? 237 80

The clinical and pathological features of 25 serous papillary cystadenomas of borderline malignancy of the broad ligament were analyzed. The ages of the patients ranged from 19 to 67 (average, 32) years. The clinical presentation was lower abdominal pain, pelvic pain or both in five cases, accompanied by menometrorrhagia or amenorrhea in three cases. One patient was thought to have an acute abdominal disorder. The tumors of the remaining 19 patients were discovered either on routine gynecological examination or during an evaluation of the pregnancy status of the patient. In 14 cases the tumor was located in the left broad ligament and in 11 cases it was on the right side; all the tumors were entirely separated from the ipsilateral ovary. On gross examination the tumors were 1-13 cm in greatest dimension, had smooth outer surfaces, and contained straw-colored, watery fluid. The inner lining bore single or multiple 0.3-2.5 cm excrescences. Microscopic examination revealed that the cyst walls and their excrescences were lined by simple to pseudostratified, cuboidal to columnar, focally ciliated epithelium. Slight nuclear atypism, very rare mitotic activity, and focal psammoma body formation were also found. The stroma resembled ovarian stroma but no primary follicles or follicular derivatives were identified. Twenty-three of the patients were alive and well from 0.5 to 11 years after excision of the tumor, one patient was disease-free for 8.5 years but died of an open-heart surgical procedure; and two patients were lost to follow-up examination.
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PMID:Serous papillary cystadenoma of borderline malignancy of broad ligament. A report of 25 cases. 339 8

Disorders of urachal remnants are uncommon. While a urachal cyst usually is asymptomatic, infection may mimic a variety of acute intra-abdominal or pelvic processes. We describe 10 patients in 2 distinct age groups (the young child and the young adult) with an infected urachal cyst. The presenting symptoms and signs in most patients included dysuria, severe lower abdominal pain and fever. In 7 patients the correct preoperative diagnosis was made. Diagnoses at referral included Crohn's disease, bladder carcinoma and pelvic inflammatory disease. A single procedure was performed in 7 cases and a staged technique was used in 3. The differential diagnosis of acute abdominal and pelvic pain or a midline lower abdominal mass in the pediatric or young adult age group should include infection of a urachal remnant.
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PMID:Infected urachal cysts: a review of 10 cases. 339 41

A literature review was undertaken of clinical stuides to determine the frequency of menstrual alterations or various psychosocial effects after surgical tubal sterilization. The most frequently mentioned symptoms following bilateral salpingocalsy or salpingectomy are increased menstrual blood loss, dysmenorrhea, dispareunia, pelvic pain, oligemenorrhea, polymenorrhea, and preclimacteric syndrome in some cases. Uribe and colleagues attributed the high frequency of abdominal pain in tubal occlusions achieved with mechanical devices such as rings to the compression pain produced by uncut nerve edings, which do not occur with electrocoagulation or the Pomeroy technique. Alderman and colleagues found that only 6.5% of their patients experienced increased menstrual flow after sterilization, but Rioux found confirmation of menstrual changes to be difficlut and Chamberlain reported change in 2.6-51% of patients, perhaps related to previous use of contraceptives. Radwanska and colleagues found that patients sterilized by electrocoagulation or tubal ligation had a lower average level of serum progesterone in the midluteal cycle phase, 9.4 +or- 4.7 ng/ml compared to 17.4 +or- 7.1 ng/ml for controls. Donnez found that patients sterilized by electrofulguration had an average of 8.5 +or- 6 ng/ml of progesterone in the midluteal phase compared to 15.4 +or- 6.3 ng/ml for those sterilized using Hulka clips. The largest proportion of women with menstrual alterations or pain were younger, lower parity women who were sterilized for medical reasons. Menstrual changes and pelvic symptoms following sterilization are subjective and difficult to evaluate. Some authors cite the rarity of longterm sequelae of sterilization, but others used radioimmunoassay techniques to demonstrate changes in serum progesterone levels that may be linked to alterations in function of the ovaries or corpus luteum following sterilization. Other authors believe that most negative sequelae could be minimized or eliminated with better patient selection and counseling.
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PMID:[Sequelae of tubal ligation]. 398 87

2 case reports involving the use of steroid hormones in the treatment of pelvic infections are presented. The first was a young woman with bilateral salpingo-oophoritis. The patient continued to have low abdominal and pelvic pain and to remain febrile following closure of the posterior cul-de-sac and antibiotic therapy. 2 days after cortisone was added to the treatment the patient was afebrile and after 5 days she was discharged and received diminishing doses of corticosteroid. The second case involved a young married woman with acute salpingo-oophoritis who suffered recurring episodes of salpingitis and urinary tract infection and continued to have disabling abdominal pain, especially with her menses. The infection was treated with sulfasoxisole, and menstruation was suppressed with medroxyprogesterone for 1 year. At the time of writing she had been menstruating regularly for 8 months and was free of abdominopelvic pain.
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PMID:Two unusual uses of steroid hoones in pelvic infections. 579 36


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