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

Silastic implants containing the progestin, levonorgestrel, were tested as long-term contraceptives in 101 women. After three full years of exposure and 2,998 woman-months of use, no pregnancies had occurred. The continuation rates were 87% at 12 months, 79% at 24 months and 66% at 36 months. The most important side effect was excessive or irregular bleeding during the first year. No treatment was offered for this side effect other than vitamins and iron or change of method, with the exception of 3 cases where ethinyl estradiol was used one time for 2 weeks each. Bleeding disturbances led 8 patients to ask for removal of implants. Other side effects were headache, acne and lower abdominal pain. Blood and urine analysis tested 17 different parameters and all but plasma cortisol remained within normal limits throughout the study. A general tendency toward lowered cortisol values was observed and two subjects had more than one value below the normal limit for the population during the study. Glucose tolerance tests during the second year were abnormal in two women with familial diabetes but they returned to normal values spontaneously at the next test. It is concluded that levonorgestrel implants offer effective protection against pregnancy during the first three years of continuous use. Their acceptability and few side effects justify larger trials, especially if treatment of bleeding irregularities is introduced.
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PMID:A three-year clinical trial with levonorgestrel silastic implants. 38 43

A 15-year old Black teenager came to a clinic at the University of Alabama's School of Medicine in Tuscaloosa requesting oral contraceptives (OCs). The physical examination indicated that she was in good health and the physician prescribed an OC (1 mg norethindrone and .035 mg ethinyl estradiol). 21 months later she returned complaining of yellow eyes for 3 weeks. The oral mucosa was also jaundiced. She had considerably high levels of bilirubin and alkaline phosphatase. She had no hepatitis virus antibodies. 5 months later she returned for the physical examination required to renew the OC prescription. She did not have jaundice at this time. 10 months later she complained of malaise and muscular pain. Her alkaline phosphatase level was high, but her bilirubin level was normal. She had mild hepatosplenomegaly without focal defects. After reviewing her medical records, the physician diagnosed intrahepatic cholestasis and discontinued her OC prescription. Liver function tests were normal within 3 months. 14 months later, she returned complaining of malaise and reported taking OCs obtained at another clinic 3 months earlier. The physician advised her about the complications of OCs and about other contraceptive methods. The same physician also examined a 32-year-old Black woman who had intermittent epigastric and right-upper quadrant abdominal pain for 2 weeks. Eating worsened the pain, which lasted for up to 15 minutes. She had used an OC for 12 years. Ultrasound revealed a 4.2 cm hypoechoic mass in the left upper lobe of the liver. The physician discontinued the OCs. The tumor regressed over 12 months. Active liver disease is a contraindication to OC use. Women who had cholestatic jaundice while pregnant or have first degree relatives with cholestatic jaundice of pregnancy should not use OCs. Physicians may introduce OCs to closely monitored women with a history of liver disease whose liver function tests are normal. Women with a family history of biliary excretion defects should not use OCs.
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PMID:Hepatobiliary complications of oral contraceptives. 133 97

The sudden drop of circulating estrogen in the premenopausal phase causes somatic and psychosomatic symptoms in women around the age of 40, which necessitates hormonal substitution and also reliable contraception because of the risk of pregnancy owing to irregular cycles. At this age the risks of pregnancy-related thrombosis, hypertension, and diabetes, perinatal mortality congenital anomalies, and maternal mortality are higher. Only 6.3-7.3% of women giving birth are over 35 years of age in Austria, but still 26% of women having an abortion are 36 years old or older. The rate of conception ranges between 2% and 5%, and when it falls below 1%, contraception is no longer necessary (around age 45-49). The IUD is acceptable and safe, and pelvic inflammatory disease does not play a significant role at this age. The most frequent side effects are spotting, hypermenorrhea, lower abdominal pain, and difficulties with intercourse. The introduction of micropills with an ethinyl estradiol dose of under 50 mcg and several agents, such as desogestrel, gestoden, and norgestimate, has made it possible to use them over the age of 40, provided no risk factors, such as metabolic disorders or smoking, are present. However, prior determination of lipid status is required. Sterilization is a final form of contraception when an increase of family size is no longer desired; whether the husband or the wife should be sterilized also poses a question. For female sterilization laparoscopy is used almost exclusively with bipolar diathermy, thermocoagulation, or binding with clips or rings. Hysterectomy is recommended in the case of myomatous uterus with cycle irregularities and hypermenorrhea. The condom, the diaphragm, or the natural temperature, Billings, or symptothermal methods have much higher failure rates. The physician has to advise women about the most suitable method.
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PMID:[Contraception and the climacteric]. 262 31

We report herein the clinicopathological, immunohistochemical and ultrastructural studies on 13 female patients and one male patient with papillary cystic tumors of the pancreas. Their ages ranged from 12 to 60 (mean 25) years. Most patients complained of abdominal mass or abdominal pain. Following complete resection of the tumor, all have remained well for between 3 months and 19 years (maen 5 years). In one patient the tumor was malignant and, 10 years after the initial partial resection, there was a recurrence with involvement of the colon, metastasis to the lymph nodes and venous invasion. Immunohistochemically, most tumor cells were positive for neuron specific enolase, synaptophysin, alpha-1-antitrypsin and vimentin and sometimes for the estrogen receptor related antigen, ER-D5, and the oncogen product of c-Ha-ras, c-Ha-ras P21. Ultrastructurally there were zymogen-like intracytoplasmic granules, intercellular junctions and intercellular spaces. These results support the hypothesis that the tumor originates from undifferentiated cells capable of differentiation toward acinar, endocrine or ductular cells. Estrogen and the c-Ha-ras oncogene presumably are linked to the development.
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PMID:Papillary cystic tumor of the pancreas: an immunohistochemical and ultrastructural study of 14 patients. 273 63

A 36 year old obese and hypertensive woman visited her family physician because she felt dizzy and generally weak for 3 days. Even though she had been advised to stop taking the combined oral contraceptive (OC) containing 50 ug ethinyl estradiol and .5 mg norgestrel, at the time she consulted the physician she had been using it for 6 years. Upon admission to a South Carolina hospital, she stopped taking the OC. After appropriate treatment, her condition soon stabilized. The next day, however, she had a fever of 39.44 degrees Celsius, abdominal pain, generalized abdominal tenderness, and rebound tenderness. These symptoms continued through a 2nd day and a laparotomy was warranted. A 15x10 cm hepatic cell adenoma on the right lobe of the liver caused hemorrhaging in the peritoneal cavity. In addition, a 5-6 cm mass was found on the inferior surface of the left lobe. A liver spleen scan 3 weeks following surgery indicated diminished activity at the tumor site on the right lobe. 1 1/2 years later, physicians excised the now reduced tumor (4x2 1/2 cm) on the left lobe and the right lobe adenoma had necrotized and regressed. 15 months following excision of the left lobe tumor, a needle liver biopsy showed a mild, fatty change in the liver. No further liver problems have developed. Research demonstrates that prolonged use of OCs predisposes women to the development of hepatic cell adenoma, and large multiple tumors are associated with especially lengthy use. Research also indicates that when OC use stops, these tumors regress, but can reoccur if OC use or any estrogen therapy is reinstituted or if pregnancy occurs.
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PMID:Liver tumor in long-term user of oral contraceptives. 284 28

2 cases of functional ovarian cysts are described to illustrate an increasingly common but little studied complication of progestin-only or phasic oral contraceptives. A 20-year-old woman without previous pathology who had used a pill containing .35 mg norgestrienone for 6 months suddenly developed violent lower abdominal pain. Sonography revealed a mass that was believed to result from extrauterine pregnancy, and surgery was performed. In the 2nd case, a 39-year-old woman taking a triphasic containing levonorgestrel and ethinyl estradiol had unexplained lumbosacral pain. Sonography again revealed an ovarian cyst. The triphasic was discontinued and the cyst disappeared over the next several days. A review of the literature suggested that such cysts are common but only about 1 in 6 are painful. They appear to result from the inhibition of pituitary luteinizing hormone by the progestin while follicle stimulating hormone secretion persists. Follicular secretion of estraiol may or may not reach significant levels. The complication should be known by physicians because the pain and adnexal mass should not be mistaken for a surgical emergency. Oral contraceptive package inserts should indicate that functional ovarian cysts may occur in women using progestin or phasic pills.
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PMID:[Follicular ovarian cysts appearing during progestin or estroprogestin oral contraception at low doses]. 305 84

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


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