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

We conducted a prospective, longitudinal study to assess the efficacy of a new laparoscopic hysteropexy technique in alleviating pelvic pain. Subjects were 50 women of reproductive age with chronic pelvic pain or dyspareunia in whom the only clinical finding was uterine retroversion who underwent laparoscopic uterine suspension using three-stitch technique. There were no intraoperative complications. The only postoperative complication was abdominal pain in one woman. The technique was effective in relieving symptoms in these patients. Of the 22 women who had associated infertility for longer than 3 years, 10 became pregnant within 1 year after surgery. This benefit, however, is likely due to couples' improved sex life rather than change in surgical axis of the uterus.
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PMID:Laparoscopic uterine suspension using three-stitch technique. 1080 68

Objective: To review the success of conservative management of moderate to severe abdominal/pelvic pain occurring after treatment of ectopic pregnancy with systemic methotrexate, to evaluate prognostic factors for success, and to determine if the overall resolution time was shorter in such patients.Methods: A retrospective chart review of all single-dose methotrexate patients treated from January 1, 1992 to January 1, 1997 who were admitted for observation or evaluated and subsequently discharged after an episode of increased abdominal/pelvic pain unrelieved within 1 hour by 800 mg oral ibuprofen. Before 1992, patients developing such pain generally underwent surgery. Candidates for conservative management were hemodynamically stable and had no more than moderate (confined to the pelvis) free fluid. Mild rebound was not an exclusion. Hospitalized patients had serial abdominal examinations, hematocrits, and hCG titers. Hematocrits, ultrasound findings, hCG levels, time for hCG levels to reach </=15 mIU/mL (resolution time), outcome at discharge, and final outcome were reviewed. Comparison between hospitalized and nonhospitalized patients and between those patients who did or did not ultimately require surgery was performed. Statistical analysis was performed using two-tailed Student t test and chi(2) or Fisher's Exact test. A P value <.05 was considered statistically significant.Results: Fifty-seven patients with 64 episodes of pain severe enough to meet criteria were identified from the 213 patients treated during the study interval. This resulted in 37 hospital admissions and 28 outpatient evaluations. All patients admitted and not requiring surgery were discharged within 24 hours. Eight of the 37 inpatient admissions underwent surgery during that hospitalization while 2 others ultimately required surgery at a later date. Only one outpatient ultimately underwent surgery. Four patients not candidates for conservative therapy also underwent surgery during the study interval. For all patients, the average time of onset of pain significant enough to require evaluation was 8.1 days with a mode of 3 days. When patients hospitalized were compared, there was no significant difference in final hematocrit, presence of free peritoneal cavity fluid, or hCG titers between those who underwent surgery and those who did not. There was a statistical difference in initial hematocrit (P =.04), and the presence of rebound approached significance (P =.04). The mean decline in hematocrit for patients not requiring surgery was 3.54 points +/- SD 2.47. Three of 8 patients underwent surgery for decreasing hematocrit, 2 for hemodynamic instability, 1 each for free fluid in the flanks on ultrasound, increasing abdominal pain, and the presence of a large complex hematoma. There was no difference between patients treated as an outpatient or hospitalized with regard to initial hematocrit, initial hCG, presence or amount of free fluid, or time for hCG to fall to <15 mIU/mL. Patients with rebound were more likely to be admitted (P =.01), and those with greater amounts of free fluid or rebound were more likely to undergo surgery (P =.04 and.02, respectively). There was also no difference in time of hCG resolution when the 28 inpatients in this study who did not require surgery were compared with 154 patients in our methotrexate database who were treated during the same time frame but did not have any significant pain (31.5 +/- SD 14.6 vs 33.1 +/- SD 17.2, P =.57).Conclusion: The data in this study indicate that with careful selection, the majority of patients with separation pain can be managed successfully without surgery either in the hospital with close observation, serial hematocrits and abdominal examinations for severe pain, or as an outpatient for patients with less severe pain.
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PMID:Management of separation pain after single-dose methotrexate therapy for ectopic pregnancy. 1083 25

The objective of the study was to determine the clinical manifestations and diagnostic criteria used to diagnose presumptive pelvic inflammatory disease (PID) at the Sydney Sexual Health Centre (SSHC). The study was a retrospective, case-note review of all women diagnosed with presumptive PID between April 1991 and December 1997. Seven hundred and thirteen women were included. The commonest recorded symptoms were vaginal discharge (68%), lower abdominal pain (65%) and dyspareunia (57%), while adnexal tenderness (83%), cervical motion tenderness (75%) and cervicitis (56%) were the most frequently recorded examination findings. Sixty-two per cent were prescribed doxycycline and metronidazole. The recording of signs and symptoms in women with presumptive PID was poor and only 22% met the current Centers for Disease Control (CDC) diagnostic criteria. It is likely that PID is over diagnosed in this group of women. This may lead to under diagnosis of other conditions causing pelvic pain and may be detrimental to reproductive health.
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PMID:Diagnosing PID--getting the balance right. 1099 Mar 40

With this study, we wanted to determine the incidence of symptom-giving pelvic girdle relaxation during pregnancy and the prevalence post partum, identify predisposing factors, and determine the frequency of sick leave. A total of 1600 pregnant women entered the study. The incidence during pregnancy was 14%, the prevalence two, six, and twelve months post partum was 5%, 4%, and 2%, respectively. Multivariate analysis indicated that the most important predisposing factor was pelvic pain in a previous pregnancy. Other factors were uncomfortable working conditions, lack of exercise, and previous low back and low abdominal pain. At least 37% of the women with symptom-giving pelvic girdle relaxation were on sick leave during pregnancy, on average for twelve weeks. Symptom-giving pelvic girdle relaxation is a considerable problem both in pregnancy and post partum. The occupational risk can possibly be prevented. The syndrome has a great social impact because of the high frequency of sick live.
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PMID:[Pregnancy associated pelvic pain. I: Prevalence and risk factors]. 1099 79

A 34-year-old woman, was admitted to the emergency room of our hospital with a history of symptoms of abdominal pain dating back several years and transitorily related to the menstrual cycle. These had worsened in the days prior to admission. Radiological and clinical examinations detected no signs of peritonitis. During exploratory operative laparoscopy, opted for because of persistence and intensification of the abdominal pain, diffuse peritonitis was found due to an ileal perforation immediately upstream of an ileocaecal mass causing a precaecal stenosis. Laparoscopy enabled us to diagnose the preoperatively undetected complication, to perform a through peritoneal lavage and, following minimal conversion by laparotomy, to perform ileocaecal resection, thereby limiting the severity of the surgical trauma. The definitive pathological diagnosis was ileocaecal endometriosis with signs of transmural fistulisation and the presence of endometrial glandular structures in one of the lymph nodes around the lesion. Perforation is a rare complication on those segments of the intestine most often affected by endometriosis, such as the colon and appendix. However, it is even more unusual when it affects the ileum and no other cases have been reported in the literature. Its genesis is attributed to late diagnosis. The pathological findings highlight the particular characteristics of this case. We would stress the pre-, intra- and postoperative diagnostic difficulties encountered and the importance of a thorough anamnestic assessment when making differential diagnoses in women of child-bearing age with abdominal or pelvic pain and perimenstrual symptoms.
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PMID:Ileal perforation due to ileocecal endometriosis: a case with an unusual clinical and pathological presentation. 1119 May 57

Our patient had a history of chronic endometriosis and pelvic pain and complained of recent onset of right-sided abdominal pain, nausea, and vomiting. Transvaginal ultrasonography revealed a thick-walled mass superior and medial to the right ovary, which was thought to be an inflamed appendix. The woman was not pregnant, and the structure appeared to be anatomically separate from the uterus. Subsequent laparoscopy confirmed the diagnosis of acute appendicitis; uncomplicated laparoscopic appendectomy followed. In the setting of chronic endometriosis, other nongynecologic sources of acute pelvic pain must be considered. Surgical intervention is appropriate whenever clinical suspicion for an acute abdomen is high, and the a priori diagnosis of endometriosis should not result in operative delay.
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PMID:Transvaginal ultrasonographic identification of appendicitis in a setting of chronic pelvic pain and endometriosis. 1121 49

Endometriosis, the presence of endometrial tissue outside the uterus, is a progressive, estrogen-dependent disease and occurs nearly exclusively in menstruating women of reproductive age. Pain syndrome, however, represents the major clinical problem of this disease, manifested as dysmenorrhea, pelvic pain, lower abdominal pain, and dyspareunia. The manifestation of the disease, that is, the pain syndrome, rather than the disease itself currently represents the major indication for both the medical and surgical therapies of endometriosis. The major drawbacks of current medical therapies of endometriosis are sometimes severe side effects. In this review, selective progesterone receptor modulators (SPRMs, mesoprogestins) as a potential therapeutic concept in endometriosis are discussed. Due to endometrial selectivity and favorable pharmacological profile, SPRMs may have advantages over the current medical treatments of this disease. Other emerging therapeutic approaches for this disease are also mentioned.
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PMID:Selective progesterone receptor modulators (SPRMs): a novel therapeutic concept in endometriosis. 1194 64

300 cases were selected from Medical Termination of Pregnancy Clinic of Eden Hospital, Medical College, Calcutta, India in order to establish the safety and efficacy of immediate post-abortal insertion of 2 different types of IUDs - the Lippes loop and Cu T. The objective of the investigation was to compare 3 groups of cases in immediate post-abortal period, regarding ease of insertion, insertional bleeding, post-menstrual disturbance, continuation of device, and incidence of pregnancy. The cases were grouped as follows: 1) group A - 100 cases in which no IUD was inserted; 2) group B - 100 immediate post-abortal cases where a Lippes loop (27.5 mm size) was inserted; and 3) group C - 100 immediate post-abortal cases where CuT 200 was inserted. Subsequently, the number of cases having bleeding decreased in group A, where IUDs were not inserted. Between groups B and C duration of bleeding markedly decreased in group C. At 7 days and 1 month after discharge, bleeding varied from light to heavy where Lippes loops were inserted. Cu T has a noticeable improvement in this aspect, but there was some incidence of bleeding varying from light to moderate in comparison to Group A. The incidence of abdominal pain in follow-up cases in group B was more at both 7 days and 1 month following the insertion than in groups C and A. There was a definite increase in leucorrhea and pelvic pain in group B in comparison to groups C and A. In group B there was early onset of menstruation in comparison to groups A and C. There was hardly any difference between groups A and C regarding onset of menstruation. There was an increase in incidence of removal of the device in group B in comparison to group C. There was 1 incidence of expulsion and pregnancy in group C; the expulsion rate was 7% and the pregnancy rate was 1% in group B.
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PMID:Comparative study of Lippes Loop and CuT inserted in immediate post-abortal period. 1215 58

As many as 85% of women with untreated pelvic inflammatory disease (PID) become infertile, almost 20% endure chronic pelvic pain which can be so severe that it prevents women from doing their daily tasks, and the permanent scarring and narrowing of the fallopian tubes caused by the condition increases a woman's risk of having a life-threatening ectopic pregnancy by 7- to 10-fold. Since sexually transmitted diseases (STD) cause most cases of PID, the prompt and effective treatment of STDs as well as preventing future cases can greatly reduce the incidence of PID and its consequences. Women frequently first seek help in primary health care facilities for their ailments. Health care providers at such facilities, however, often erroneously assume that laboratory tests are needed to diagnose and treat women with STDs or lower abdominal pain. Valuable time is lost when such providers refer women unnecessarily to hospitals or STD clinics for diagnosis and treatment. Providers should instead diagnose and treat patients on the basis of groups of symptoms, or syndromes, rather than for specific STDs. This syndromic approach may require treatment for several STDs concurrently since several STDs may cause a particular syndrome. Some guidelines are presented for diagnosing and treating PID. Finally, providing treatment at the primary care level also allows the opportunity for the attending practitioners to encourage monogamy and provide clients with condoms for the prevention of future disease.
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PMID:Health care providers can prevent and treat PID. 1217 15

The use of silicone rings and metal or plastic clips in laparoscopic sterilization is discussed. Sterilization by these techniques eliminate s the risk of accidental burns associated with electrocautery methods. Nonetheless, accidental tubal transection and abdominal pain are potential complications of the ring technique. The incidence of the latter, however, can be markedly reduced by the application of xylocaine jelly to the ring prior to the operation. Experience with the clip technique has shown the procedure to involve more operative difficulties than coagulation techniques. Pelvic pain with the clip technique is reportedly more common than with the electrocautery procedure, while chest or shoulder pain is more frequent with the latter technique. Complication rates for the cautery, clip, and ring methods are similar, though technical difficulties and failures are more common with spring-loaded clips. Trials have shown the laparoscopic approach to sterilization to be safer than other interval sterilization techniques.
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PMID:Silicone rings, metal, plastic clips may eliminate cautery hazards in laparoscopic sterilization. 1230 95


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