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

Unlike the proven causal association between oral contraceptive (OC) use and hepatic cell adenoma, the link between OCs and hepatocellular carcinoma remains speculative. The case history of a 53-year-old US woman suggests, however, that hepatic cell adenomas may transform into hepatocellular carcinoma. The patient, who had used Ovral continuously since 1966, presented in 1985 with vague abdominal pain and a palpable right upper quadrant mass. Computed tomography revealed a 12 x 8 cm mass in the right hepatic lobe and 2 small lesions in the left lobe. Serum alpha-fetoprotein and ferritin levels were normal and tests for hepatitis B were negative. A needle biopsy of the right lobe mass indicated benign hepatic adenoma. OC use was discontinued and the patient was examined at bimonthly intervals. Although she continued to report vague pain, there were no significant changes in radiologic findings or levels of alpha-fetoprotein over the next 18 months. At the 18-month follow-up visit, the alpha-fetoprotein level showed an increase to 227 mcg/L and had risen to 2300 mcg/L by the 30-month follow-up visit. At this time, computed tomography showed slight enlargement of the right lobe mass and inhomogeneity, while biopsy revealed sclerosing hepatocellular carcinoma. This is the 3rd case reported in the literature in which there is evidence of a transformation of hepatic cell adenomas into hepatocellular carcinoma in longterm OC users. Thus, the premalignant potential of hepatic cell carcinomas in OC users should be considered by physicians who follow such cases.
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PMID:Transformation of hepatic cell adenoma to hepatocellular carcinoma due to oral contraceptive use. 253 93

This article reports the case of a bleeding ectopic decidual reaction from the serosal surface of the fallopian tube in the absence of pregnancy in a woman who had received a long-acting injectable contraceptive. This complication has not been previously reported as a possible side-effect of progestogen administration. The patient, a 42-year old Chinese woman, received 3 injections of medroxyprogesterone acetate 150 mg at 3-month intervals and then switched to the combined contraceptive Microgynon (.15 mg levonorgestrel and .03 mg ethinyl estradiol). The 2nd course of Microgynon was completed 1 week before her admission to the hospital with right lower abdominal pain and secondary amenorrhea for 9 months. A hematocele was found on the right side of the pouch of Douglas. Decidual reaction is an exaggeration of the normal response of the endometrium to progesterone. In the absence of pregnancy, ectopic decidual changes have been attributed to the stimulation of appropriate cells by progesterone and progesterone-like substances from the corpus luteum or the adrenal cortex.
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PMID:Intraperitoneal bleeding from ectopic decidua following hormonal contraception. Case report. 315 21

To further understand the pathophysiology of arterial diseases induced by oral contraceptives (OCs), a case report is presented of a young woman who died of extensive visceral artery thrombosis. The possible role of estrogens and progestogens and of cigarette smoking as the predisposing factors in this patient are discussed. A 26-year-old woman, who complained of progressive abdominal pain and whose past medical and surgical history was negative, was admitted to the general surgery service. She was the mother of 1 child and had had 2 previous spontaneous abortions. She had received ethinyl estradiol 35 mcg with norethindrone 500 mcg and 1000 mcg for 3 months, but because of a problem with breakthrough bleeding the medication was changed to mestranol 50 mcg with norethindrone 1000 mcg. She had been taking Ortho-Novum 1/50 for 2 1/2 years. She had smoked 25-35 cigarettes daily for about 10 years but denied use of alcohol or other drugs. She was not known to be diabetic, hypertensive, or dyslipidemic, and had no history of atherosclerosis in her family. For 7 months prior to her admission, the patient complained of abdominal pain, which progressively increased in intensity and duration, interrupted by periods of well-being. The patient reported 2 recent, isolated episodes of mild proctalgia but no tenesmus or melena. There had been no fever, but the patient had been anorexic for the past 2 weeks and reported losing 10 kg in the past month. She had no complaints apart from those related to the gastrointestinal system. At an emergency laparotomy, gangrenous acalculous cholecystitis and infarction of the terminal ileum were discovered. A cholecystectomy with resection of the terminal ileum and the right colon was performed. An end-to-end primary anastomosis was performed. On exploration of the superior mesenteric artery, a thrombus was discovered at its origin. As a transverse arteriotomy showed a good retrograde flow, a thrombectomy was performed. There appeared to be an unsatisfactory antegrade flow. The superior mesenteric artery then was transposed in an end-to-end fashion on the abdominal aorta. An immediate postoperative arteriogram showed thrombosis of the celiac axis at its origin. Revascularization failed to improve the condition of the intestine. The patient died. The intent of this case report is to emphasize that the association between smoking and oral contraceptives can cause cardiovascular disease in young women, and a failure to recognize this association can result in delayed diagnosis and worsen the prognosis.
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PMID:Intimal hyperplasia and thrombosis of the visceral arteries in a young woman: possible relation with oral contraceptives and smoking. 337 98

A case of mesenteric vascular occlusion is detailed. The 30-year-old female had abdominal pain, bloody diarrhea, and small bowel changes seen on x-ray. She had begun taking the oral contraceptive Ovral (.5 mg norgestrel, .05 mg ethinyl estradiol) 3 years prior to hospital admission. Symptoms began to disappear when her oral contraception was discontinued on the ninth hospital day. Over the next 5 days abdominal signs and symptons subsided progressively. A follow-up small bowel series showed complete disappearance of previous abnormalities. In the differential diagnosis of acute abdominal pain progressing to bloody diarrhea, especially in young women or oral therapy, acute vascular insult with small bowel ischemia must be considered.
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PMID:Reversible mesenteric vascular occlusion associated with oral contraceptives. 470 Oct 37

An obese 28-year old woman presented at the Royal Victoria Hospital on February 23, 1978 because of upper abdominal pain of 2 days duration. The patient had previously given birth 10 years ago and had since been taking an oral contraceptive (OC) containing 0.25 mg d-norgestrel and 0.05 mg ethinyl estradiol (Ovral). She had iron deficiency anemia at age 12, smoked 3 packs of cigarettes/week, rarely consumed alcoholic beverages and was not under any medication. Physical and laboratory examinations revealed a large liver tumor. Angiography and needle biopsy confirmed the diagnosis of hepatocellular adenoma (HCA). Resection was not indicated because of the size of the tumor. OCs were discontinued. Tubal ligation was performed 2 months later as the patient desired no further pregnancies. Complete regression of the tumor over a 12-month period was confirmed by subsequent scintiscans. This case shows that even large HCAs can regress completely with no therapy other than OC withdrawal, confirming the suggestions of others that simple observation after OC withdrawal may be preferable to resection in minimally symptomatic HCAs. A frequent histologic finding both in OC-associated HCA and in normal liver surrounding HCAs is marked sinusoidal dilatation, which suggests a general effect of estrogen therapy. Further studies should be done to determine the mechanisms by which OCs produce these changes and to define their clinical importance. The role of radionuclide imaging techniques, percutaneous liver biopsy, and angiography in the diagnosis of HCAs are very briefly described.
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PMID:Complete regression of hepatocellular adenoma after withdrawal of oral contraceptives. 627 17

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

102 patients using Trinordiol, a triphasic oral contraceptive (OC) containing ethinyl estradiol and d-norgestrel, were followed for 932 cycles in a study of secondary effects. Follow-up visits were scheduled after 1,3, and 6 months and every 6 months thereafter. 26 patients discontinued use of the pills during the study after using them for a total of 159 cycles. 5 discontinued because of abdominal pain, 1 for breast tenderness, and 1 because of headaches or migraines. 7 discontinued because of metrorrhagia, 4 for weight gain, 3 for amenorrhea, 2 for nausea and vomiting, and 1 each for nervousness, water retention, acne, desire for pregnancy, leaving the country, hypertension, and unknown motivation. the average age of patients was 23.6 years, with a range from 14-48. 76% were aged 15-29 years. 52.9% were nulliparas. 58.8% were Belgian, 21.6% were from Mediterranean Europe, 10.8% were Moroccan, and 7.9% were from black Africa. Only 1 patient, a 37 year old, developed hypertension. 15 patients gained more than 2 kg and 17 lost more than 2 kg. 15.8% complained of spotting during the 1st cycle compared to 3.1% during the 6th cycle, 5.2% during cycle 7-12, and 9.1% during cycle 13-30. Among 35 patients who did not discontinue treatment, 7 complained of amenorrhea and 1 of scanty menstrual bleeding, 14 of pain including 7 cases of pelvic pain, 2 of dysmenorrhea, 3 of breast tenderness, and 2 of headaches, 15 of leukorrhea, 3 of nausea, 2 of dizziness, and 1 each of fatigue, acne, galactorrhea, and cutaneous pruritus. 1 case of myoma at the level of the uterine cornu was identified after 24 cycles of treatment. In all, 61 patients had some complaint, while 41 were totally satisfied. No patient became pregnant during the study.
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PMID:[Clinical study of the secondary effects associated with taking a triphasic anti-ovulatory contraceptive]. 670 4

A case study of a woman taking Ortho-Novin (2 mg norethisterone and .1 mg mestranol) who presented with what was eventually diagnosed as a rare complication called mesenteric vein thrombosis is presented. Her complaints were of acute or chronic abdominal pain. Coagulation studies were performed and gave the folowing results: prothrombin time, 13.5 seconds, fibrinogen 500 mg percent, fibrin degradation products 60-80 mcg/ml, factor V 120%, factor VII 180%, factor VII 380%, factor X 200%, and an activated PTT of 21 seconds with no significant change in fibrinolytic activity. At laparotomy it was discovered that she had almost total small bowel infarction, and end-to-end anastomosis was performed. For nutritional supplementation after the almost complete resection of her bowel, shunts were inserted to assure intravenous infusion of adequate calories, trace elements, and vitamins. A doctor whose patient presents with abdominal symptoms and in on oral contraception and shows similar coagulation-study results should consider that she may be suffering from the small, small bowel syndrome.
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PMID:The pill, mesenteric vein thrombosis and the short, short bowel syndrome. 738 23

This was an open-label multicenter study to compare the cycle control and effect on well-being of two oral contraceptives containing gestodene and one containing desogestrel. A total of 2419 healthy women < or = 41 years of age were randomized to receive oral contraceptives containing monophasic gestodene (Minulet; n = 806, mean age 24.5 years), triphasic gestodene (Tri-Minulet; n = 808, mean age 24.6 years) or monophasic desogestrel (Mercilon; n = 805, mean age 24.6 years). Subjects were to participate in the study for up to 13 treatment cycles. A modified Moos Menstrual Distress Questionnaire was used to evaluate menstrual symptoms and to assess overall well-being. A total of 698 women were withdrawn from the study, 154 due to adverse events. Cycle control with gestodene was superior to that with desogestrel at almost all time points, particularly for breakthrough bleeding and/or spotting, which occurred significantly less frequently with gestodene than with desogestrel at cycles 1-7 and 9-11 (p < 0.05). Generally, the proportion of subjects with breakthrough bleeding and/or spotting was almost twice as great with desogestrel as with gestodene. The duration of bleeding was not consistently different between the gestodene and desogestrel groups; however, the intensity of bleeding was greater with gestodene at all time points (p < 0.05). The latent period before withdrawal bleeding was significantly longer for monophasic gestodene at cycles 1-5 and 8-10 (p < 0.05). Treatment significantly improved overall well-being at cycles 6 and 9 with triphasic gestodene and at cycle 13 with desogestrel; however, no statistically significant differences among treatment groups in overall well-being scores or individual factors of well-being could be identified. All three treatments were well tolerated. The most common drug-related adverse events were headache (14.2%), breast pain (6.2%), nausea (4.1%), metrorrhagia (3.9%) and abdominal pain (3.5%). The incidence of adverse events in all treatment groups was similar, with the exception of metrorrhagia, which occurred in more patients in the desogestrel group than in the gestodene treatment groups (p < 0.05).
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PMID:A comparison of cycle control and effect on well-being of monophasic gestodene-, triphasic gestodene- and monophasic desogestrel-containing oral contraceptives. Gestodene Study Group. 1083 95

We report a unique case of a 28-yr-old woman with a gonadotroph adenoma secreting FSH, presented with ovarian hyperstimulation, without elevation of serum estradiol. She presented with abdominal pain and large ovaries (both 10 cm in diameter) with multiple follicular cysts shortly after discontinuing oral contraceptive pills. She had a supranormal PRL level of 71 microg/liter (normal, <20), FSH of 8.4-9.2 IU/liter (normal for follicular phase, 2.4-10), LH of 0.01 IU/liter (normal, 1.6-9.3), estradiol of 108 pmol/liter (normal for follicular phase, 80-790), and free alpha-subunit level of 0.11 microg/liter (normal, <1.8). A nuclear magnetic resonance study revealed invasive pituitary macroadenoma, 30 mm in diameter. Dopamine agonist (cabergoline) treatment normalized serum PRL but had no affect on FSH levels. A transsphenoidal surgery was performed, and most of the adenoma was resected. One month after surgery the patient resumed menstruation, and the hormonal profile included serum FSH of 6.3 IU/liter, LH of 2.1 IU/liter, estradiol of 156 pmol/liter, and PRL of 10 microg/liter. The excised adenoma tissue exhibited intense immunostaining for FSH and secreted this hormone to culture medium. Stimulation with TRH (both in vivo preoperatively and in vitro study of the excised tumor) had no effect on FSH secretion from the adenoma. Estradiol did not suppress FSH release from cultured adenoma cells. Patient serum samples showed significant FSH bioactivity when tested in a human granulosa cell line. This case is remarkable because the ovarian hyperstimulation related to the FSH-secreting adenoma was not associated with high levels of serum estradiol, probably due to insufficient LH production by the normal pituitary. Thus, it supports the two-cell, two-gonadotropin theory, that both FSH and LH are necessary for normal ovarian estrogen production.
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PMID:Ovarian hyperstimulation without elevated serum estradiol associated with pure follicle-stimulating hormone-secreting pituitary adenoma. 1150 89


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