Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A prospective study was performed with 25 patients with ectopic pregnancies (EPs) who underwent treatment with transvaginal administration of methotrexate. Nineteen patients (76%) had positive responses to this treatment, and six (24%) had to undergo surgery: five because of increasing abdominal pain and one because of vaginal bleeding. The ultrasonographic (US) resolution of the EP was long and lagged behind the resolution at testing of levels of beta subunit of human chorionic gonadotropin (beta-hCG) in all patients. The fallopian tube in 12 (63%) of the responding group initially increased in diameter from a mean of 2.22 cm to a mean of 3.84 cm. In 13 (68%) of the responding group, it became more vascular at color Doppler examination. Eleven (92%) of the 12 EPs that increased in size also became more vascular. The increase in tubal size and vascularity, in spite of the falling beta-hCG level, represents a healing process and should cause no concern about the follow-up of these patients.
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PMID:Ectopic pregnancy: evolution after treatment with transvaginal methotrexate. 127 40

The present study reports on new treatment of tubal pregnancies by laparoscope-guided intratubal injection of prostaglandin F2 alpha into the affected tube. In 9 cases treated with PG, the method proved to be successful in 89%, as indicated by reduction of human chorionic gonadotropin (hCG) serum values to less than 20 IU/l. Preoperative serum hCG levels were 137 to 2520 IU/l (mean 1170 IU/l). In 8 women the serum concentration of beta hCG decreased to less than 20 IU/l in a mean time of 12.3 days. One woman needed surgical intervention 8 days after treatment as she continued to have abdominal pain. Hysterosalpingography 3 to 6 months after treatment showed tubal patency on the side of the pregnancy in two of three women who were examined. It is concluded that local prostaglandin F2 alpha treatment is a suitable method for termination of some tubal pregnancies.
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PMID:[Laparoscopic treatment of tubal pregnancy using local administration of prostaglandin F2 alpha]. 138 60

In Holland, infertility specialists at Sophia Hospital in Zwolle administered human menotropins chorionic gonadotropin injections to a 26-year old woman to induce ovulation. Donor artificial insemination resulted in conception. At 8 weeks gestation, ultrasonography revealed 5 fetuses. Since quintuplet pregnancies increase the risk of maternal complications and of perinatal morbidity and mortality, she consented to embryo reduction at 11 weeks gestation, resulting in a twin pregnancy. Between 16-18 weeks gestation, she had some vaginal bleeding. At 22.5 weeks gestation, she suffered lower abdominal pain and fluid loss and delivered a 310 fm female who died within a few hours. The physicians ligated the umbilical cord with vicryl near the cervix. The gestational sac of twin B was sticking out of the internal ostium, but she did not deliver twin B. There were no signs of placental separation or of infection. The woman and her husband agreed to postpone delivery of the 2nd fetus. She remained in bed while receiving iv tocolytic drugs (ritodrine R). The physicians also administered iv antibiotics for 3 days (ampicilline and cefotaxim). Weekly ultrasound examination showed that twin B grew normally. A subfebrile temperature and an increase in the white blood cell count resulted in restart of antibiotic therapy. Health workers gave her intramuscular injections of betamethasone to accelerate development of the fetus' lungs at 26 weeks. 2 days later, she went into labor. The physicians ruptured the membranes and delivered a 710 gm male newborn. She later delivered 3 intact amniotic sacs with autolytic fetuses. She recovered uneventfully. The newborn eventually developed bronchopulmonary dysplasia and dies at 3 months. None of the 1st-born infant in 14 delayed interval delivery cases reported in the literature since 1957 survived. 13 of the 17 later born infants did survive. Tocolytic agents were used to postpone delivery in 10 cases. Cervical cerclage was done in the 7 other cases. All but 1 case received broad-spectrum antibiotics.
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PMID:Delayed interval delivery of two remaining fetuses in quintuplet pregnancy after embryo reduction: report and review of the literature. 148 56

Clinical experience with and adverse effects of methotrexate for the treatment of unruptured ectopic pregnancy are described. Ectopic pregnancy is suspected in the presence of the following: positive results on pregnancy test (e.g., test for beta-human chorionic gonadotropin [beta-hCG]), lower abdominal pain, a normal or slightly enlarged uterus, and a mass on either side of the midline. When laparoscopy is required for diagnosis, surgical correction is done at the same time. However, use of serial beta-hCG titers, vaginal ultrasound examinations, serum progesterone concentrations, and dilation and curettage (when the pregnancy is confirmed to be nonviable) allows earlier detection of ectopic pregnancy without laparoscopy. If rupture has not occurred, i.v. or i.m. methotrexate is administered; usually, i.m. leucovorin is given, on alternate days, to prevent hematologic toxicity. Adverse effects of methotrexate include stomatitis, gastritis, and hepatic enzyme elevation. Use of a single-dose regimen of i.m. methotrexate without leucovorin has been associated with a lower frequency of toxicity. Selection criteria for patients are as follows: (1) an unruptured ectopic pregnancy less than or equal to 3.5 cm in greatest dimension on transvaginal ultrasound, (2) no active renal or hepatic disease, and (3) no evidence of leukopenia or thrombocytopenia. Intramuscular methotrexate therapy is a safe and effective alternative to surgery for the treatment of unruptured ectopic pregnancy.
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PMID:Methotrexate for treatment of unruptured ectopic pregnancy. 153 28

In Ohio, a 33-year old woman who had never had an ectopic pregnancy presented at an emergency facility not physically attached to a hospital with abdominal pain over 24 hours which had become more intense during the preceding 4 hours. She did not have vaginal bleeding, diarrhea, vomiting, or pain while urinating. 2 weeks earlier she had a voluntary intrauterine abortion at 8 weeks' gestation. She had intercourse 1 week before coming to the emergency facility. She had widespread tenderness in her abdomen, especially in the lower areas. Blood cell studies suggested an infection. The attending physician presumed her to have pelvic inflammatory disease (PID) as a result of either sexual intercourse or the elective abortion. The physician called for a urinary beta human chorionic gonadotropin test to determine whether placental tissue remained in the uterus. It was positive. 60 minutes after admission, the supine patient's pain increased and her blood pressure dropped to 80/50 mm Hg from 100/60 mm Hg at admission. After administering Ringer's solution, the health team sat her up and she fainted. A repeat cell count indicated sepsis. Her blood pressure decreased to 60 by Doppler and the physician continued to give her fluids and began dopamine. After the team stabilized her, they transferred her to a hospital. Her private physician examined her and then began surgery. The physician found a tubal pregnancy and removed the affected tube and ovary. She recuperated completely. Combined intrauterine and extrauterine pregnancy occurs once in every 30,000 cases. Previous PID, use of ovulation inducing medication, and in vitro fertilization with embryo transfer increases the likelihood of this type of pregnancy occurring. Physicians should consider this possibility if a woman has any of these histories and a combination of abdominal pain, adnexal mass with pain and tenderness, peritoneal irritation, and an enlarged uterus.
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PMID:Ruptured ectopic pregnancy in a patient with a recent intrauterine abortion. 157 Sep 21

We evaluated the medical history, physical examination, and laboratory tests done on 245 patients with laparoscopically proven ectopic pregnancies. The absence of abdominal pain was the only clinically useful negative predictive value (91%) regarding tubal rupture. Although mean levels of serum human chorionic gonadotropin (hCG-beta subunit) were significantly higher in patients with ruptured versus unruptured ectopic pregnancies (16,612 mIU/mL vs 6406 mIU/mL), no breakpoint excluded the possibility of tubal rupture. In fact, one third of ectopic pregnancies in patients with a serum beta-hCG level below 100 mIU/mL were ruptured. We conclude that clinical symptoms and signs are poor predictors of tubal rupture. In addition, absolute values of serum beta-hCG are not helpful in excluding the possibility of rupture.
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PMID:Ectopic pregnancy in an urban teaching hospital: can tubal rupture be predicted? 174 80

The purpose of this study was to see if color flow Doppler measurements could aid in the positive diagnosis of ectopic pregnancy when no gestational sac can be seen in the adnexa. We examined 148 women with abdominal pain and suspected ectopic pregnancy by abdominal ultrasonography, followed by vaginal ultrasonography and color Doppler when the diagnosis was still uncertain. Seventy-three patients proved to have ectopic pregnancies. Color flow with low resistance and high velocity vascular signals were observed in complex adnexal masses and in some of the corpora lutea. The resistance index for ectopic trophoblast was 0.36 +/- 0.02 SD. Color Doppler had both positive and negative discrimination of adnexal masses (P = 10(-15). The resistance index for the corpora lutea was 0.48 +/- 0.04. A cutoff value of 0.40 or less is proposed as a diagnostic index for suspected trophoblast in the adnexa. In nine cases of ectopic pregnancy, no color flow was noted. In these women, the beta-human chorionic gonadotropin level was less than 1000 mIU/ml. The clinical operative suspicion in these cases was tubal abortion. Sensitivity and specificity were 88% and 97%, respectively, in this highly selective series. Positive and negative predictive values were 97% and 89%. Color Doppler appears to be useful for the positive diagnosis of ectopic pregnancy with ultrasonography when no adnexal gestational sac is observed. Prospective randomized trials will determine the ultimate clinical value of these findings.
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PMID:Ectopic pregnancy: transvaginal color Doppler of trophoblastic flow in questionable adnexa. 176 40

A case of extragenital choriocarcinoma which produces human chorionic gonadotropin (HCG) in the small intestine of a 48-yr-old Japanese women is reported. Only seven such cases have been reported. The patient complained of postprandial upper abdominal pain and vomiting of 5 months' duration. Nine years before, right upper lobectomy was performed because of lung undifferentiated carcinoma. Double-contrast examination of the small intestine showed irregular ulceration in the lower jejunum. Celiac angiography demonstrated a hypervascular tumor stain in the branch of the jejunal artery. The serum HCG level was elevated. Gynecological examination revealed nothing abnormal. A small intestinal neoplasm was diagnosed, and a partial resection of the jejunum was performed. Endoscopy on the operating table showed a large, irregularly shaped sessile ulcer. Histologically the tumor was diagnosed as choriocarcinoma, composed of syncytiotrophoblastic cells and cytotrophoblastic cells. Immunohistochemical staining for HCG was positive. No metastasis was present. Although extragenital choriocarcinoma in the small intestine is rare, it should be included in the differential diagnosis of small intestinal neoplasm.
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PMID:A case of extragenital choriocarcinoma in the jejunum. 185 45

A 23-year-old man was admitted with progressively disturbed vision and easy fatigability. CT scans demonstrated an enhanced mass in the sellar region. Physical and endocrinological examinations revealed atrophy of both optic nerves, temporal field cuts in both eyes, and panhypopituitarism. Concentrations of human chorionic gonadotropin (HCG) in the serum and cerebrospinal fluid were 12 and 33IU/L, respectively. On November 11, 1987, the tumor was partially removed using the transsphenoidal approach. The histological diagnosis was germinoma with syncytiotrophoblastic giant cells. Following postoperative craniospinal irradiation (whole brain, 30Gy; local, 18Gy; spinal canal 28Gy), CT scans showed no residual tumor and the HCG levels decreased until they were undetectable. Eighteen months later, the patient complained of abdominal pain. His serum HCG level had increased to 2,554 IU/L. CT scans of the abdomen revealed multiple low density areas in the liver. Chest X-ray was negative. A Ga scintigram disclosed only liver metastasis. Administration of a chemotherapy was started on June 26, 1989. Cisplatin and etoposide in doses of 20mg and 40mg respectively were given for 5 consecutive days in one course. Following four courses of the combined chemotherapy, the tumor entirely disappeared on CT scans and the HCG level returned to normal. The patient is now able to work well without evidence of recurrence. Multiple liver metastases of an intracranial germ cell tumor had been fatal in previous reports. This may be the first case with liver metastases in which the victim is still alive. The present case indicates that combined chemotherapy with cisplatin and etoposide is effective for extraneural metastases of an intracranial germ cell tumor.
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PMID:[Multiple liver metastases of a suprasellar germ cell tumor treated with combined chemotherapy of cisplatin and etoposide]. 189 Oct 59

A rapid sensitive urine pregnancy test (SPT) using monoclonal antibody against human chorionic gonadotropin and a conventional urine pregnancy test (GPT) were performed in 364 women attending 'Gynecological Emergencies' for lower abdominal pain and/or vaginal bleeding, aiming at early detection of ectopic and intra-uterine pregnancy-related disorders. The overall incidence of a positive test was 24%. In 42 patients, with histopathological evidence of ectopic pregnancy, SPT was positive in 41 (98%), while GPT only in 19 (45%). In 47 patients with evidence of intra-uterine pregnancy-related disorders, SPT was positive in 45 (96%), while GPT in 33 (70%). The sensitive urine pregnancy test can improve significantly the efficiency of the early diagnosis of ectopic and intra-uterine pregnancy-related disorders, and can be used as a screening method for patients having even in the slightest way suspect of having an ectopic pregnancy.
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PMID:Clinical evaluation of a sensitive urine pregnancy test in the gynecological emergencies. 205 Feb 52


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