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

The objective of this study was to evaluate a progesterone cutpoint of 5.0 ng/mL ability to identify abnormal pregnancy (abnormal intrauterine pregnancy and ectopic pregnancy) as well as ectopic pregnancy alone in 2 subclasses of indeterminate ultrasounds. This was a prospective observational study of emergency department patients with abdominal pain or vaginal bleeding and an indeterminate transvaginal ultrasound. Two subclasses of indeterminate ultrasounds were eligible: those with an empty uterus and a beta-human chorionic gonadotropin value <3,000 mIU/mL and those with a nonspecific fluid collection. Patients were enrolled if a progesterone assay was collected the day of the emergency department visit. Patients were excluded if lost to follow-up. One hundred sixty patients were enrolled. Of these, 24 were diagnosed with ectopic pregnancy. The sensitivity and specificity of progesterone identifying abnormal pregnancy were 84% and 97%, respectively. The sensitivity and specificity of progesterone identifying ectopic pregnancy were 88% and 40%, respectively. In the 2 subclasses, the progesterone cutpoint was both sensitive and specific in identifying abnormal pregnancy and was sensitive but only moderately specific for identifying ectopic pregnancy.
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PMID:Progesterone as a predictor of ectopic pregnancy when the ultrasound is indeterminate. 1244 32

Gonadal tumours are rare in children. Benign tumours are more frequent in girls than in boys (3 cases among 4 cases in girls and 1 case among 2 or 3 cases in boys), due to the prevalence of functional ovarian pathology (functional cysts, ovarian torsion). Whatever the clinical presentation of these tumours (mainly abdominal pain or mass in girls, scrotal mass in boys) and even before an emergency procedure, radiological investigations (abdominal x-rays, ultrasound scans) and biological ones (alpha-foeto-protein and human chorionic gonadotropin dosages) should be performed in order to precise the diagnosis. In benign tumours (mature teratoma, cystadenoma), a conservative surgical procedure (tumorectomy with ovarian preservation) should be attempted. Malignant or potentially malignant tumours (malignant germ cell tumours, stromal tumours) have an excellent prognosis, only if they are treated with a close collaboration between surgeons and oncologists.
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PMID:[Gonadal tumours in children]. 1282 43

Molar pregnancy is a rare complication of pregnancy and the diagnosis is usually confirmed with a markedly elevated beta-hCG and a "snowstorm" appearance on pelvic ultrasound. Patients frequently present with a positive pregnancy test, vaginal bleeding, nausea and vomiting. A 23-year-old woman presented to our Emergency Department with a history of 7 weeks of intermittent vaginal bleeding and 1 h of peri-umbilical abdominal pain. She reported that 7 weeks before this visit she was diagnosed with a miscarriage. The bedside qualitative urine human chorionic gonadotropin (hCG) test that we performed was negative, but the quantitative serum hCG was markedly elevated. Ultrasound and operative findings confirmed the diagnosis of molar pregnancy. We conclude that rapid urine qualitative hCG assays may not be reliable in the presence of markedly elevated hCG levels found in molar pregnancy.
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PMID:Qualitative beta-hCG urine assays may be misleading in the presence of molar pregnancy: a case report. 1521 3

Choriocarcinoma is one of the most serious forms of gestational trophoblastic tumor. It is a malignant tumor from the epithelium of the chorionic villi. The most frequent location site is the uterus. Associated with ectopic pregnancy, it is extremely rare and in general, very aggressive. In 75% of the cases, it items from distant metastasis; therefore, a histological examination of the tubes must be performed in all ectopic pregnancies. Our patient was a 33-year-old woman who was admitted to emergency room (ER) with an intense pain in the right, iliac cavity, and limited genital bleeding. During the exploration, there was abdominal pain, with doubtful signs of peritoneal irritation. The vaginal ultrasound offered an image that was compatible with an extra uterine pregnancy in the left appendages. At emergency, right salpingectomy was performed via laparotomy. The patient was treated with polychemotherapy and contraceptives for a year, with no recurrence of the disease. Control follow-up was performed using beta-human chorionic gonadotropin (HCG) testing on a weekly basis during the first month and then bi-monthly during the first year of follow-up.
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PMID:Primary tubal choriocarcinoma. 1536 Dec 23

Point of care testing (POCT) is widely viewed as possibly improving ED care and reducing length of stay (LOS). However reports are mixed, and regulatory barriers complicate considerations. We studied a simple urine pregnancy assay (human chorionic gonadotropin-HCG). LOS was evaluated when HCG was moved from central lab (HCGLab) to POCT (HCGED) in 2 pre-post 3-month periods (958 HCGLab and 1075 HCGED). HCG patients were compared with a similar control group, and staff perceptions were evaluated. There was no change in LOS for HCG patients (36.8 v 50.85 min, P = .33), although there was one marginal finding of improved LOS for patients presenting with abdominal pain diagnosed as pregnant (P = .17). Staff (28/53 physicians, 18/81 nurses) reported HCGED as positive. POCT does not improve LOS for broad groups of patients, although POCT does change the ED environment. Further study is needed to evaluate how the information flow of POCT changes patient care.
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PMID:Point of care pregnancy testing provides staff satisfaction but does not change ED length of stay. 1552 Sep 40

Ectopic pregnancy is a high-risk condition that occurs in 1.9 percent of reported pregnancies. The condition is the leading cause of pregnancy-related death in the first trimester. If a woman of reproductive age presents with abdominal pain, vaginal bleeding, syncope, or hypotension, the physician should perform a pregnancy test. If the patient is pregnant, the physician should perform a work-up to detect possible ectopic or ruptured ectopic pregnancy. Prompt ultrasound evaluation is key in diagnosing ectopic pregnancy. Equivocal ultrasound results should be combined with quantitative beta subunit of human chorionic gonadotropin levels. If a patient has a beta subunit of human chorionic gonadotropin level of 1,500 mIU per mL or greater, but the transvaginal ultrasonography does not show an intrauterine gestational sac, ectopic pregnancy should be suspected. Diagnostic uterine curettage may be appropriate in patients who are hemodynamically stable and whose beta subunit of human chorionic gonadotropin levels are not increasing as expected. Appropriate treatment for patients with nonruptured ectopic pregnancy may include expectant management, medical management with methotrexate, or surgery. Expectant management is appropriate only when beta subunit of human chorionic gonadotropin levels are low and declining. Initial levels determine the success of medical treatment. Surgical treatment is appropriate if ruptured ectopic pregnancy is suspected and if the patient is hemodynamically unstable.
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PMID:Diagnosis and management of ectopic pregnancy. 1677 Sep 19

A 32-year-old Japanese man was admitted complaining of palindromic fever and abdominal pain. Computed tomography (CT) revealed retroperitoneal mass and positron emission tomography (PET) demonstrated massive radiotracer uptake in this tumor. Serum levels of alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) were 4,760 ng/ml, 6,000 mIU/ml, respectively. Biopsy specimen from the tumor showed non-seminomatous germ cell tumor. The International Germ Cell Cancer Collaborative Group (IGCCCG) staging system indicated this case as an intermediate prognosis group. After three cycles of bleomycin, etoposide and cisplatin (BEP) therapy, CT revealed a degenerated residual mass. Serum levels of tumor markers were normalized completely and PET showed no radiotracer uptake in the retroperitoneal lesion. Although he did not receive further chemotherapy and lymph nodes were not dissected, he was free of disease for two years.
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PMID:Usefulness of positron emission tomography (PET) in a retroperitoneal primary non-seminomatous germ cell tumor: a case report. 1697 25

Omental pregnancy is a very rare form of abdominal pregnancy, and can be life threatening in cases of rupture, which may lead to massive hemorrhage. A 28-year-old woman in the ninth week of amenorrhea had severe abdominal pain, and showed unstable vital signs caused by intraperitoneal hemorrhage. Emergency laparoscopy revealed large amounts of blood and blood clots in abdominal cavity, and active bleeding was observed from the right ovary. Uterus, left ovary, and bilateral fallopian tubes were grossly free. However, serum beta-human chorionic gonadotropin level increased after the operation, and histopathologic results did not show evidence of pregnancy in either right ovary or endometrium. Abdominal magnetic resonance imaging was performed and revealed a well-defined cystic mass at the lateral side of the ascending colon, suggested to be the focus of ectopic pregnancy. The patient was approached laparoscopically and consequently underwent partial omentectomy.
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PMID:Laparoscopic management of early omental pregnancy detected by magnetic resonance imaging. 1831 99

Three women, aged 21, 28 and 37 years, respectively, were diagnosed with interstitial pregnancies. The first patient presented with lateral abdominal pain, the second patient was asymptomatic and consulted the physician for a routine first trimester scan and the third patient had painless vaginal bleeding in the first trimester. Each was treated with systemic methotrexate in a multiple dose regimen, which was successful in the latter two patients. The first patient was discharged in good condition after her last methotrexate injection, but developed severe abdominal pain and collapsed at home after the interstitial pregnancy had ruptured. She underwent surgery and recovered. Today, the incidence of ectopic pregnancy in the Netherlands is around 8 per 1000 live births. Interstitial pregnancies, which nidate in the portion of the fallopian tube embedded in the uterine wall, account for 2-3% of all ectopic pregnancies. A urinary pregnancy test should be performed for any fertile woman with abdominal pain or abnormal vaginal bleeding. If the result is positive, the patient should be referred to a gynaecologist for transvaginal ultrasound to exclude ectopic pregnancy. In case of a pregnancy of unknown location, one should search for specific ultrasound markers of non-tubal ectopic pregnancy and assess serum human chorionic gonadotropin (HCG). Interstitial ectopic pregnancy should be considered if the serum HCG level is above 2000 U/l.
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PMID:[Interstitial pregnancy: a rare type of ectopic pregnancy]. 1849 19

This report describes the case of 74-year-old man who had a gastric yolk sac tumor complicated with beta human chorionic gonadotropin (beta hCG) producing metastases. He was a heavy drinker. He was admitted to the hospital for abdominal pain and fullness. Based on computed tomography and gastric endoscopy he was diagnosed to have gastric cancer that had metastasized to the liver, lung and lymph nodes. The level of serum alpha fetoprotein (AFP) was high at 523 ng/mL. He died of multiorgan failure six days after admission. The autopsy revealed the stomach tumor to be an AFP-positive yolk sac tumor. Lymph node metastases showed the same characteristics as the stomach tumor. However, the lesions on the liver and lung were negative for AFP and positive for hCG. The yolk sac tumor seemed to have retrodifferentiated to form an hCG-producing tumor in the metastatic lesions. A gastric yolk sac tumor is extremely rare and only eight cases of gastric yolk sac tumors have been previously reported in the literature. To avoid a misdiagnosis, careful attention should be paid to the above-mentioned morphological features and immunohistochemical findings, in addition to the clinical findings.
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PMID:Gastric yolk sac tumor complicated with beta-human chorionic gonadotropin-producing metastases. 1907 40


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