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

The frequency of IUD-associated uterine perforation has been estimated at 0.05-13.0/1000 insertions; 15% of such perforations lead to complications in the adjacent visceral organs, primarily the intestines. This paper describes the case of a 28-year-old gravida 3, para 2 woman with an ileal perforation associated with insertion of a Multiload-Cu 375 IUD at the 3-month postpartum visit. The insertion was noted to be difficult and painful. The woman presented to the clinic 25 days after insertion with abdominal pain and missing IUD strings. The IUD had perforated the full thickness of the anterior fundal uterine wall. The two flexible plastic arms and the vertical copper-bearing limb had completely eroded into the wall of the ileum. Resection of an ileal segment with end-to-end anastomosis was successful. The literature on IUD-related perforations--summarized in a table accompanying this article--reveals a median time interval of 17 months (range, 2 months to 13 years) post-insertion. Thus, the present case represents the shortest documented interval (4 weeks) between IUD insertion and proven bowel injury.
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PMID:Ileal penetration by a Multiload-Cu 375 intrauterine contraceptive device. A case report with review of the literature. 988 85

The objective of this study was to determine the acute gastrointestinal effects caused by the consumption of drinking water containing graded levels of added copper. Sixty healthy, adult women were randomly assigned to receive copper [Cu(II)] at four concentrations in their drinking water following a Latin-square design. Each group (n = 15) received tap water with no added copper, 1, 3, and 5 mg Cu/l of added copper sulfate for a 2-week study period, followed by 1 week of standard tap water. The subjects recorded their water consumption and gastrointestinal symptoms daily on a special form. The average daily consumption of water was 1.64 liters per subject, regardless of the amount of copper added. Final serum copper, ceruloplasmin, and liver enzymes were measured in all subjects and were not different from baseline concentrations. Twenty-one subjects (35%) recorded gastrointestinal disturbances sometime during the study, 9 had diarrhea, some with abdominal pain and vomiting, and 12 subjects presented abdominal pain, nausea, or vomiting. There was no association between copper levels in drinking water and diarrhea. However, nausea, abdominal pain, or vomiting were significantly related to copper concentrations in water. The recorded incidence rate of these symptoms was 5, 2, 17, and 15% while ingesting water with 0, 1, 3, and 5 mg Cu/l, respectively (overall [chi]2 = 11.3, p<0.01; Cu [less than/equal to]1 mg/l versus Cu [Greater than/equal to]3 mg/l, [chi]2, p<0.01). When subjects interrupted their consumption of drinking water with added copper, most symptoms disappeared. We conclude that under the conditions of the study, there was no association between aggregate copper in drinking water within the range of 0-5 mg/l and diarrhea, but a [Greater than/equal to]3 mg Cu/l level of ionized copper was associated with nausea, abdominal pain, or vomiting. Additional studies with sufficient numbers of subjects are needed to define thresholds for specific gastrointestinal symptoms with precision and to extrapolate these results to the population at large.
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PMID:Acute gastrointestinal effects of graded levels of copper in drinking water. 992 6

This article describes a case of uterine perforation which occurred 2 months after the insertion of a Gynefix, a frameless filiform copper IUD inserted into the fundal myometrium. This occurred in 1996 in a 21-year-old female, nulligravida, who was in a stable relationship and was chlamydia-negative. A few weeks after insertion, the patient complained of increasing abdominal pain. Subsequently, the device was not seen in the uterus upon transvaginal echography. Instead, an x-ray showed it to be in the lower abdominal cavity. Laparoscopic removal of the IUD, which was adherent to the colon, had to be performed. The appropriateness or need of assessing echographically the myometrial thickness before IUD insertion and of controlling its correct position after the insertion remains uncertain.
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PMID:Late uterine perforation with an anchored IUD, the Gynefix: a case report. 1054 54

In 1993, the levels of copper (Cu) in much of Nebraska's drinking water exceeded the U.S. Environmental Protection Agency's (EPA) action level of 1.3 mg/L. To determine the association of copper with gastrointestinal (GI) illness in August 1994 the authors interviewed persons living in households with 1993 Cu levels > 3 mg/L (51 households), 2-3 mg/L (54 households), and < 1.3 mg/L (43 households). Cases were defined as persons who had experienced the rapid onset of vomiting or nausea with abdominal pain during the preceding two weeks. To validate their exposure index, the authors immediately resampled drinking water in the households of 25 cases and 27 controls matched for age. Reassessment in December 1994 of the exposure and case status of the original cohort showed no association between copper in drinking water in 1993 and case status in 1994. The risk of GI illness seemed no greater with Cu > 3 mg/L (RR = 1.03; 95% CI = 0.43, 2.49) or 2-3 mg/L (RR = 0.50; 95% CI = 0.18, 1.41) than with Cu < 1.3 mg/L. The 1993 Cu concentrations could not be reproduced in August 1994; resampling in December 1994 again showed no association between GI illness and Cu exposure (RR > 1.3-2.9 mg/L, < or = 1.3 mg/L = 0.25, 95% CI = 0.10, 0.64, and RR > or = 3.0 mg/L, < or = 1.3 mg/L = 0.36, 95% CI = 0.09, 1.49).
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PMID:Copper in drinking water, Nebraska, 1994. 1063 41

Perforation of the uterus by an intrauterine contraceptive device (IUD) is a rare, and serious complication, occurring in 1/350 to 1/2500 insertions. Perforation by IUDs can involve several neighboring organs such as the bladder and rectosigmoid. We report two cases of IUD perforations involving the appendix, both inserted during lactation. The first case is an asymptomatic patient in early pregnancy and the second is a woman whose original presentation was chronic lower abdominal pain. The presence of copper in the abdominal cavity can lead to adhesion formation and subsequent abdominal pain, bowel obstruction or infertility. Thus, we believe that when an IUD is located in the abdominal cavity it should be removed even in an asymptomatic patient. In addition, these cases might suggest postponing the use of this contraceptive method in lactating women.
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PMID:Appendix perforation by an intrauterine contraceptive device. 1069 Jun 69

Copper is an essential element for all living beings. Exposure to copper results almost exclusively from the ingestion of food and water. Generally, potable water contains low levels of copper, but high concentrations of this mineral have been found in water from private wells or when water or beverages with low pH have been conducted through copper piping. Some authors have associated acute gastrointestinal symptoms (diarrhea, abdominal pain, nausea, and vomiting) with elevated levels of copper in water or beverages, but without excluding other confounding factors that could produce such symptoms. Recently, various controlled studies have demonstrated that a concentration of 2 mg Cu/L of potable water does not produce an increase in gastrointestinal symptoms in infants, and that in women, only concentrations greater than 3 mg Cu/L increase the number of episodes of nausea, vomiting, and abdominal pain, but not diarrhea. This critical analysis of scientific publications verifies the WHO provisional level for copper in drinking water (2 mg/L) as safe for human health.
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PMID:The gastrointestinal tract and acute effects of copper in drinking water and beverages. 1074 35

The subject of this study to examine the safety and contraceptive efficacy of Norplant, we undertook a 5-year study of follow-up of women initiating use of Norplant, intrauterine device (IUD) or sterilization in eight developing countries. Women attending family clinics were enrolled if they consented and were medically eligible to use Norplant, IUD, or female sterilization. Women who chose to initiate use of IUDs or surgical sterilization served as controls and were frequency matched in 5-year age-bands with women who chose to use Norplant. At admission women had a physical examination, and their medical histories, demographic, and socio-economic characteristics were recorded. Follow-up visits were scheduled in the first 6 weeks after admission and semi-annually thereafter for 5 years irrespective of change of contraceptive method. Incidence rate ratios of health events were estimated for initial and current contraceptive method use. This paper reports reproductive health events and contraceptive efficacy. Altogether, 7,977 women initiating use of Norplant, 6,625 of IUD, and 1,419 of surgical sterilization were admitted. Their mean ages at initiation were 28.5, 28.5, and 29.6 years, respectively. More than 99% were married or cohabiting, and parous. Five-year follow-up was completed by 94.6% of the women. By the end of 5 years, the mean duration of first segment use per initiator was 4.16 years for Norplant, 4.10 years for IUDs, and 4.96 years for sterilization accounting for 39,337 woman-years for Norplant, 31,915 for IUDs, and 7,071 for sterilization. The study accumulated 78,323 woman-years of observation. Pearl pregnancy rates for Norplant, copper IUDs and female sterilization were 0.27, 0.88, and 0.17 per 100 woman-years, respectively. Users of Norplant, copper IUDs, and sterilization had rates of ectopic pregnancy of 0.30, 0.68, and 0.13 per 1,000 woman-years, respectively. Major health events related to the reproductive system were rare. Rates of acute PID were significantly lower among Norplant users than IUD users (p = 0.004). The rate of ovarian enlargement was significantly higher in Norplant users than controls (p <0.001), but not rates of hospitalization for this condition. Vaginitis and vaginal discharge, and low abdominal pain were significantly less frequent in Norplant users than in the other groups. Bleeding disturbances were more frequent among Norplant users than controls but not anemia. The study confirms the high contraceptive efficacy of Norplant, copper IUDs, and female sterilization. The incidence rates of major reproductive health problems were low. There was no significant excess of serious reproductive morbidity among users of Norplant compared to users of IUDs and sterilization.
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PMID:Post-marketing surveillance of Norplant contraceptive implants: I. Contraceptive efficacy and reproductive health. 1137 46

Ingestion of drinking water with a high copper content may induce acute gastrointestinal effects, mainly nausea and vomiting, rarely diarrhea and abdominal pain. The objectives of this study were to define nausea threshold in apparently healthy adult volunteers who received graded concentrations of copper and to explore how individual thresholds were modified by delivering copper in an orange-flavored drink. Sixty-one healthy subjects received 200 mL of a copper-containing solution in purified water, at concentrations 0, 2, 4, 6, 8, 10, and 12 mg/L, as copper sulfate, in random order. Nausea threshold concentration for first response was established and then this threshold was confirmed. Subsequently, following the same design, subjects received the same copper concentrations (up to 12 mg/L), delivered in an orange-flavored drink, starting at the confirmed threshold concentration found in water. Mild nausea shortly after ingestion of copper-containing water was the most frequent finding (33/61 subjects), starting at 4 mg/L; vomiting was observed in 7 individuals, starting at 6 mg/L. The NOEL for copper in purified water was 2 and 4 mg/L for nausea and vomiting, respectively. When copper was provided as an orange-flavored drink, 11 subjects (18%) reported nausea, starting at 8 mg Cu/L, and no subjects vomited up to 12 mg Cu/L. It is concluded that after consumption of copper in purified water, the NOEL is 2 mg Cu/L and the LOAEL 4 mg Cu/L for nausea, while tolerable intake is between 2 and 4 mg Cu/L in water depending on whether apparent or confirmed nausea is used as the criterion to define critical effects.
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PMID:Nausea threshold in apparently healthy individuals who drink fluids containing graded concentrations of copper. 1140 30

A prospective, double-blind controlled study was designed to determine the acute no-observed-adverse-effect level (NOAEL) of nausea in an apparently healthy population of 179 individuals who drank copper-containing water as the sulfate salt. Subjects were recruited at three different international sites and given a blind, randomly selected dose (0, 2, 4, 6, or 8 mg Cu/L) in a bolus of 200 ml (final total copper dose was equivalent to 0, 0.4, 0.8, 1.2, and 1.6 mg) once weekly over a consecutive 5-week period. Gastrointestinal (GI) symptoms of nausea, abdominal pain, vomiting, or diarrhea were screened for a period of up to 24 h. Nausea was the most frequently reported effect and was reported within the first 15 min of ingestion. For the combined trisite population (n=179), 8, 9, 14, 25, and 44 subjects responded positively to one or more GI symptoms at 0, 2, 4, 6, and 8 mg Cu/L, respectively. Analysis of the data demonstrated a clear dose response to the combined positive GI effects and to nausea alone. Statistically significant greater reporting of effects occurred at 6 and 8 mg Cu/L. Therefore, an acute NOAEL and lowest-observed-adverse-effect level of 4 and 6 mg Cu/L (0.8 and 1.2 mg Cu), respectively, were determined in drinking water for a combined international human population.
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PMID:Determination of an acute no-observed-adverse-effect level (NOAEL) for copper in water. 1160 56

The aim of this study was to determine whether total copper or soluble copper concentration is associated with gastrointestinal signs and symptoms. Forty-five healthy adult women (18-55 years of age), living in Santiago, Chile, ingested tap water with 5 mg/L of copper containing different ratios of soluble copper (copper sulfate) and insoluble copper (copper oxide) over a 9-week period. Three randomized sequences of the different copper ratios (0:5, 1:4, 2:3, 3:2, and 5:0 mg/L) were followed. Subjects recorded their water consumption and gastrointestinal symptoms daily on a special form. Mean water consumption was similar among groups. Serum copper levels, ceruloplasmin, and activities of liver enzymes were within normal limits. No differences were detected between the means of biochemical parameters at the beginning and at the end of the study. Twenty subjects presented gastrointestinal disturbances at least once during the study, 9 suffered diarrhea (with or without abdominal pain and vomiting), and the other 11 subjects reported abdominal pain, nausea, or vomiting. No differences were found in incidence of abdominal pain, nausea, vomiting, and diarrhea regardless of the ratio of copper sulfate to copper oxide. In conclusion, both copper sulfate (a soluble compound) and copper oxide (an insoluble compound) have comparable effects on the induction of gastrointestinal manifestations, implying that similar levels of ionic copper were present in the stomach.
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PMID:Gastrointestinal effects associated with soluble and insoluble copper in drinking water. 1167 25


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