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

We report about the diagnostic reliability of a new commercially available human chorionic gonadotropin (hCG) test, a simple hemagglutination test (discriminatory value: 75 U/I), which can be easily performed in any laboratory (Neo-Pregnosticon). Urine samples of 457 patients with unexplained lower abdominal pain and/or abnormal bleeding were analysed. The diagnostic sensitivity and specificity of the test gave values of 0.993 and 1.0, respectively. The predictive value for positive results was 1.0, and for negative results 0.997. By means of this test, we could determine hCG in urine of 40 out of 41 patients with ectopic pregnancy, in contrast to the currently used urine test (Pregnosticon, discriminatory value: 1000 U/I) which was positive in only about 50% of the cases. Due to its accuracy, this simple test will probably replace in the future the more laborious radioimmunological methods for determination of hCG.
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PMID:[Ectopic pregnancy: diagnostic reliability of a new hCG-test (Neo-Pregnosticon)]. 692 58

A study was undertaken of 36 patients with viable intrauterine pregnancies who presented in the first trimester with abdominal pain and/or vaginal bleeding, and of 15 patients with ectopic pregnancies, all of whom had at least two human chorionic gonadotropin (hCG) determinations in the same gestation. The mean and lower 25%, 20%, 15%, 5%, and 1% limits of the rate of hCG increase in serum and of the serum hCG at different periods of gestation were determined for intrauterine pregnancy with the use of linear regression analysis, and each was used as a basis for identifying ectopic gestation. It was found that for any given false-positive rate, subnormal rates of hCG increase were more sensitive in identifying ectopic gestations than single "low for date" hCG values. It is suggested that the explanation for this may be that hCG production in many patients with ectopic pregnancies is normal until symptoms develop and falls thereafter as the functional trophoblastic mass is reduced by the shearing off the trophoblast from the tubal wall, which takes place with the development of the pregnancy and of symptoms.
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PMID:Receiver operating characteristic (ROC) curve analysis of the relative efficacy of single and serial chorionic gonadotropin determinations in the early diagnosis of ectopic pregnancy. 706 49

During 13 months from November 1, 1977, through November 30, 1978, 283 patients underwent radioimmunoassay (RIA) for determination of serum beta-subunit of human chorionic gonadotropin (beta-hCG) to rule out ectopic pregnancy. The records of 234 patients were available for statistical analysis and of these, 188 (80%) had negative results, defined as less than 1 ng/ml. The ectopic group comprised 22 patients, all of whom had elevated beta-hCG levels. There were no false-negative results in either group. Patients with suspected ectopic pregnancy had symptoms similar to patients previously reported in the literature with proved ectopic pregnancies. The most common presenting symptoms of those with suspected ectopic pregnancy were abdominal pain (91%), amenorrhea (76%), irregular bleeding (68%), and andexal mass (55%). Seventy-three patients presented with the classic triad of pain, uterine bleeding, and adnexal mass. Only 10 (14%) had ectopic pregnancies. Urine pregnancy tests were found to be of no benefit in diagnosing ectopic pregnancy and confused the clinicians in some instances. In patients with suspected ectopic pregnancy, a negative beta-hCG, by the RIA technique ruled out ectopic pregnancy in 100% of the cases.
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PMID:beta-hCG as a diagnostic aid for suspected ectopic pregnancy. 739 9

Seventeen patients with suspected ectopic pregnancy (EP) were managed as outpatients with single-dose intramuscular methotrexate (MTX) in a community hospital. A nonsurgical method was utilized for evaluation based on transvaginal ultrasonography in combination with serum human chorionic gonadotropin (hCG) determination and performance of dilation and curettage (D&C). The mean pretreatment hCG concentration was 3,320.9 mIU/mL, with a range of 158-12,420. Sixteen of 17 (94.1%) patients responded successfully to therapy, with a mean duration until hCG resolution of 26.4 days (range, 12-55). One patient experienced rupture 14 days after treatment. One of 17 patients (5.9%) complained of increased abdominal pain six days after treatment and was managed without intervention. There were no reports of adverse effects from the chemotherapy. This study demonstrated that nonsurgical evaluation for presumed EP in carefully selected patients may be performed without D&C and managed safely and effectively with well-tolerated, single-dose, systemic MTX. Our approach was designed for community hospitals.
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PMID:Ectopic pregnancy. Nonsurgical, outpatient evaluation and single-dose methotrexate treatment. 760 78

The process of identifying and evaluating the common causes of vaginal bleeding during pregnancy changes as the pregnancy progresses to term. The most common identifiable causes of vaginal bleeding during early pregnancy include spontaneous abortion and ectopic pregnancy. Pelvic ultrasound and quantitative beta-human chorionic gonadotropin measurements are used in the evaluation of early-stage bleeding in pregnancy. During the middle and late stages of pregnancy, placental abnormalities become important in the differential diagnosis of vaginal bleeding. Placenta previa classically presents as painless bleeding and is evaluated with ultrasound. Patients with placental abruption may present with abdominal pain and bleeding. As pregnancy progresses to term, bloody show must be considered as a common source of bleeding. Vaginal and cervical lesions can cause vaginal bleeding in any stage of pregnancy.
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PMID:Vaginal bleeding in pregnancy. 786 60

Two case studies are presented which show the damaging effects of self-induced abortion. Both cases involved adolescents who were recently treated in the Emergency Medical Department of the University of Colorado Hospital. Case I involved a 16-year-old indigent girl who arrived with vaginal bleeding and abdominal pain. The self-induced abortion had been attempted with a coat hanger inserted into the cervical os some time in the 3 days before admission to the hospital. The reason for the attempt was lack of money for a therapeutic abortion. The patient presented with a blood pressure of 110/70 tore, pulse of 80 beats/min, respiration of 20 breaths/min, and temperature of 37.5 degrees Centigrade. Pelvic examination revealed muco-purulent drainage with marked cervical and bilateral adnexal tenderness. Laboratory white cell count was 6400 mm, hematocrit was 40.7, and a beta subunit human chorionic gonadotropin pregnancy test was negative. The patient may indeed not have been pregnant. Treatment involved administration of 250 mg ceftriaxone intramuscularly and oral doxycycline for pelvic inflammatory disease. The recovery was uneventful. Case II involved a 17-year-old female who had run into walls, hit herself in the abdomen, and bathed in vinegar and water. Her vital signs were good, physical examination revealed a well-nourished, well-developed gravid female in no acute distress. She was referred to Planned Parenthood, psychiatric counseling, and told to return if pains developed. She had the therapeutic abortion which she thought she could not afford. Of the 6 million pregnancies in the US, 56.5% are unintended. Figures on attempted self-induced abortion are unknown. These 2 cases of low income adolescents draw attention to issues that have not been addressed in medical literature in 15 years. A brief summary is provided on abortion availability and the history of self-induced abortion methods. Discussion is also directed to morbidity and mortality trends, the psychologic impact on the mother, the fiscal impact of illegal abortions and their complications, and future prospects in the US. Concern is raised that restrictive legislation on abortions will lead to increases in unwanted pregnancies and illegal abortions with their inevitable complications. These issues place emergency medicine and physicians in the center of the policy debate.
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PMID:Reemergence of self-induced abortions. 844 94

Chronic ectopic pregnancy is an uncommon form of tubal pregnancy manifested as a pelvic mass with minimal symptoms and a low or absent titer of human chorionic gonadotropin. For this reason, most of the reported cases have been diagnosed only after explorative laparotomy. The value of Doppler ultrasonography for preoperative diagnosis of this entity has not yet been established. We report on a 36-year-old patient who was admitted for intermittent right lower quadrant abdominal pain of 3 months' duration, and a right adnexal mass found on pelvic examination. On Doppler ultrasonography, a right complex adnexal mass was demonstrated, characterized by extensive external vascularization, aberrant vessels and arteriovenous shunting, but with no internal blood flow. Explorative laparotomy revealed a right tubal mass adherent to the omentum, and covered by numerous enlarged and tortuous blood vessels originating in the omentum. Pathological examination of the mass revealed a chronic ectopic pregnancy. The possible contribution of Doppler-specific characteristics for the diagnosis of chronic ectopic pregnancy is described and discussed.
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PMID:Doppler findings in chronic ectopic pregnancy: case report. 920 79

Germ cell tumours of the liver are rare neoplasms, with fewer than 20 cases reported in the literature following presentation as teratomas, choriocarcinomas or yolk sac tumours. We report a 52-year-old patient who complained of upper abdominal pain and anorexia. Ultrasonography and computed tomography of the abdomen revealed a large hepatic mass. Among the laboratory values we found elevated levels of alpha-fetoprotein and beta-chorionic gonadotropin. Repeated biopsies via CT scan, laparoscopy and laparotomy disclosed a poorly differentiated adenocarcinoma. Subsequently liver function deteriorated and, on the basis of clinical data highly suggestive of a malignant germ cell tumour, a modified chemotherapeutic protocol (PEI) was initiated. The elevated levels of alpha-fetoprotein and beta-chorionic gonadotropin declined rapidly, but the patient died 10 days later of liver dysfunction and bronchopneumonia. Subsequent autopsy confirmed the initial clinical diagnosis of a multilocular extragonadal malignant germ cell tumour of the liver with components of choriocarcinoma and embryonal carcinoma.
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PMID:Mixed malignant germ cell tumour of the liver. 969 32

A 57-year-old man presented with a 1-month history of progressive abdominal pain and weight loss. A palpable, nonpulsatile, firm abdominal mass was felt below the xiphisternum down to the pelvis. A pregnancy test performed on a urine sample was positive. Testicular examination and testicular ultrasound were normal. Computerized tomography of the abdomen revealed a retroperitoneal mass measuring 30 x 21 x 13 cm. Serum beta-human chorionic gonadotropin (beta-HCG) was serially increased (19.71-22.71 mIU/mL). Results of histopathology tests confirmed the diagnosis of leiomyosarcoma. The level of serum beta-HCG decreased to < 0.2 mlU/mL after chemotherapy. Beta-HCG is usually increased in germ-cell tumors but few reports in the literature describe beta-HCG-secreting leiomyosarcomas. The incidence of increased levels of beta-HCG in sarcomas in general, and its potential role as a tumor marker, is not known. A simple urine pregnancy test may be done in the work-up of abdominal masses.
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PMID:Retroperitoneal leiomyosarcoma and enlarged epididymis associated with a positive pregnancy test. 1218 3

Reports from throughout the world consistently reveal an increasing incidence of ectopic pregnancy that appears to be linked to pelvic inflammatory disease, previous tubal surgery, and IUD use. Ectopic pregnancy generally presents with pelvic or lower abdominal pain, amenorrhea, and vaginal bleeding. Methods of establishing the diagnosis include ultrasonography and laparoscopy; before 5-6 weeks of gestation, these methods may no t be sufficiently sensitive and use of serial monitoring of the beta-chain of human chorionic gonadotropin concentrations in plasma is recommended. Salpingectomy is indicated if the ectopic pregnancy has ruptured and the tube is very swollen. Conservative surgery is a possibility when there has not been rupture and damage to the tube is minimal. A comparison of data from England's Jessop Hospital for Women shows that, while more ectopic pregnancies were treated in 1988-90 than in 1977-79 (109 and 49, respectively), this complication is being diagnosed at an earlier stage, before there is extensive damage to the fallopian tube. The mean gestation of ectopic pregnancies in 1977-79 was 8.1 + or - 2.8 weeks compared to 7.4 + or - 1.7 weeks in 1988-90. As a result, only 4% of the ectopic pregnancies in the earlier period compared to 14% in the more recent period could be treated by conservative surgery.
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PMID:Ectopic pregnancy. 1231 82


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