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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hysterosalpingography provides important information in the evaluation of infertility but is generally considered an uncomfortable and painful procedure. We evaluated various analgesics for decreasing or eliminating the discomfort from this procedure. Two types of analgesia were required to give maximum pain relief during and after the examination in the 180 patients evaluated. The best results were achieved with a combination of naproxen sodium, 550 mg, given orally two hours before the examination, and 20% benzocaine, applied to the cervix.
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PMID:Pain relief in hysterosalpingography. A comparison of analgesics. 235 47

Laparoscopic surgery with the Nd:YAG laser generator and a sapphire probe was performed in 43 women for relief of pain and/or infertility associated with endometriosis and in two other women for treatment of an asymptomatic adnexal enlargement. More than half of the patients had American Fertility Society endometriosis scores of stage III or IV. Results of uterosacral denervation for pain relief were excellent, and eight of 17 patients who were attempting pregnancy with follow-up for 6 months conceived. A touch technique, reduced smoke production, and delivery via a flexible fiber constitute advantages to the surgeon compared with carbon dioxide systems.
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PMID:Laparoscopic laser treatment of endometriosis with the Nd:YAG sapphire probe. 246 65

The neodymium:yttrium-aluminum garnet (Nd:YAG) laser was used via laparoscopy in 84 patients complaining of infertility and/or pelvic pain. All patients in the study had biopsy-proven or visually confirmed pelvic endometriosis. The Nd:YAG laser was used in conjunction with sapphire probes as a touch technique on tissue. Problems usually encountered, such as mirror alignment, beam focus, and smoke plume, with carbon dioxide laser systems were avoided, and use of the laser in a liquid environment was possible. Restoration of fertility was seen in 39.7% with short follow-up; pain relief was excellent, especially in conjunction with uterosacral denervation.
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PMID:Treatment of endometriosis with a Nd:YAG tissue-contact laser probe via laparoscopy. 247 10

This article studies endometriosis diagnosed in patients undergoing laparoscopy for infertility and/or pain from 1982 to 1988. The diagnosis of endometriosis at laparoscopy increased from 42% in 1982 to 72% in 1988. The greatest change is in "subtle" lesions, which increased from 15% in 1986 to 65% in 1988. An increased awareness and histologic confirmation of the protean presentation of endometriosis is associated with a significant increase in the diagnosis of endometriosis at laparoscopy.
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PMID:Laparoscopic appearances of peritoneal endometriosis. 252 27

Thirty-nine infertile patients with laparoscopic diagnosis of endometriosis were allocated randomly to treatment with gestrinone 2.5 mg twice weekly (20 patients) or danazol 600 mg/day (19 patients) for 6 months. If amenorrhea was not obtained after 1 month of treatment, the gestrinone dose was increased to 2.5 mg three times a week (7 patients) and the danazol dose to 800 mg/day (2 patients). One month after the end of the treatment, a repeat laparoscopy was performed only in the women who agreed (7 of the gestrinone treated group, 9 of the danazol group). All of the patients were followed for at least 12 months after the end of the treatment, during which time they attempted to conceive. There was a marked improvement of pain symptoms during the treatment in the patients of both groups. The repeat laparoscopy did not reveal significant differences between the two groups in the reduction of the disease extent. Eighteen months after treatment suspension, the cumulative pregnancy rate was 33% in the patients treated with gestrinone and 40% in those treated with danazol. Pain symptoms recurred during the follow-up in 57% of the gestrinone and 53% of the danazol group. The side effects were more frequent and severe with the danazol treatment, whereas those caused by gestrinone were mostly weight gain and acne. The results of this study suggest that gestrinone is as effective as danazol in the treatment of infertility associated with endometriosis and is better tolerated.
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PMID:Gestrinone versus danazol in the treatment of endometriosis. 252 21

Six hundred and eighteen endometriosis patients out of 2,966 cases diagnosed with laparoscopy were statistically analyzed. The incidence of pelvic endometriosis was 28.3% of infertile cases, 47.2% of infertile cases of etiology unknown sterility, and 53.6% of cases of dysmenorrhea. Initial onset was most common in the sacrouterine ligament and the pouch of Douglas, followed by the ovaries. It was also seen in the vesicouterine pouch. The progress after the initial onset was considered to be due mainly to ovarian lesions, and the progressive rate appeared to be 0.3 point per month according to the R-AFS point system. Cases with stage 3 ovarian lesions were seen up to 7 years after menarche, and there were almost no cases of endometriosis 10 years after menopause. No differences in the average age were seen by stage of clinical progress or R-AFS, and the average age was around 31. The period of infertility showed no definite relation with the stage of the disease in cases of primary sterility, but stage 1 cases were common in patients with secondary sterility. The incidence of dysmenorrhea did not differ depending on the stage of the disease, but severe menstrual pain was common in stage 4 cases. The frequency associated with sterility did not differ in accordance with the stage. Severe pain at the time of endoscopy and induration of Douglas' pouch were common in stage 4 cases, but 31.9% of stage 4 cases showed no abnormal findings in pelvic examination. There was no significant difference between R-AFS points and the incidence of abnormal findings in HSG.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Laparoscopic studies of pelvic endometriosis in relation to sterility]. 253 Feb 92

Endometriosis remains a poorly understood disease. Multiple factors are likely to be responsible for the relative infertility in patients with endometriosis. All therapeutic options should be presented to the patient. Treatment of a patient with endometriosis should be individualized based on symptoms (i.e., pain and/or infertility), extent of disease, age and associated pelvic pathology. Diagnosis continues to require visual documentation with histologic confirmation if possible.
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PMID:Endometriosis: pathophysiology, diagnosis, and treatment. 265 16

This paper summarizes what has been learned over the years about the role of eicosanoids in the pathogenesis of primary dysmenorrhea, endometriosis and menstrual migraine. The role of prostaglandins (PGs) in the pathogenesis of primary dysmenorrhea is inferred from four main observations: firstly, the clinical symptoms of primary dysmenorrhea are similar to those induced by the administration of PGF2 alpha and PGE2 for the induction of labour; secondly, the increased production of PGs by the endometrium during the luteal and menstrual phases of ovulatory cycles is consistent with the occurrence of primary dysmenorrhea mainly in ovulatory cycles; thirdly, the concentrations of PGF2 alpha and PGE2 in the endometrium and menstrual fluid of dysmenorrheic women are significantly higher than in controls; fourthly, certain PG inhibitors have been proved to be effective in the treatment of dysmenorrhea. The change in PG production can explain the major symptoms of primary dysmenorrhea, including the increased uterine contractility, uterine ischemia and the lowering of the pain threshold to chemical and physical stimuli in the pelvic nerve terminals. Moreover, recent experimental data suggest that leukotrienes (LTs) might be among the alternative pathogenetic causes of primary dysmenorrhea. The data which support a relationship between eicosanoids and endometriosis are as follows: endometriotic tissue produces PGs; the peritoneal fluid concentration of PGF2 alpha increases significantly after the induction of endometriosis in laboratory animals; the concentration of PGs in peritoneal fluid of some patients with endometriosis is greater than in controls and, finally, the number and activation of pelvic macrophages which are able to synthesize eicosanoids increase in patients with endometriosis. Possible roles for eicosanoids in the pathogenesis of infertility and secondary dysmenorrhea induced by endometriosis have been suggested. Eicosanoids are probably also involved in the pathogenesis of menstrual migraine. Different types of PGs might play a role both in the initial vasoconstriction during the prodromal phase of migraine and in the vasodilation and sensitization to pain typical of the pain phase.
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PMID:Eicosanoids in primary dysmenorrhea, endometriosis and menstrual migraine. 265 74

Endometriosis is one of the most common conditions encountered in gynecology and the field of infertility. The clinical presentation depends on the location and the extent of disease, but the severity of symptoms does not correlate directly with the extent of disease. Symptoms of genital endometriosis may be categorized as menstrual dysfunction, ovulatory dysfunction, and reproductive dysfunction. With menstrual dysfunction, the frequent clinical symptoms are cyclic pelvic pain, dysmenorrhea, and dyspareunia. Endometriosis is commonly found to be the cause in younger patients with pain and dysmenorrhea, particularly when the clinician is aware of the appearance of atypical lesions. Types of ovulatory dysfunction reported to be associated with endometriosis include anovulation, premenstrual spotting, luteal phase defects, and LUF syndrome. The data are not sufficient to determine the prevalence of endometriosis, luteal phase defects, and hyperprolactinemia. With LUF syndrome, there are data to support an association, but more data on the frequency of LUF in consecutive normal cycles compared to consecutive cycles in women with endometriosis would be beneficial. A higher rate of infertility is reported in couples with endometriosis. Two approaches are used to evaluate spontaneous abortions and endometriosis. In retrospective studies, the abortion rates are higher in couples with endometriosis; however, when the pregnancy outcomes in untreated couples are studied, there is less evidence to support the association of a higher spontaneous abortion rate. Formerly, the diagnosis of endometriosis depended on the appearance of typical lesions. With the recognition of early or atypical lesions the histologic confirmation of glands and stroma is assuming a more prominent role. Noninvasive techniques such as assays of endometrial antibodies or CA-125 have certain limitations in terms of producing false-positive results and lacking predictability in early stages of disease. Ultrasonography and MRI give additional and confirmatory information. Most noninvasive techniques are ancillary in diagnosis and management. It still needs to be determined whether their routine use will give enough added information to justify their cost. Currently, the diagnosis of endometriosis is best made by histologic evidence of glands and stroma.
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PMID:Clinical presentation and diagnosis of endometriosis. 266 21

In Riyadh, Saudi Arabia, physicians took endocervical swab examples from 325 women and urethral swab samples from 85 men to determine the extent of Chlamydia trachomatis infections and to compare an enzyme immunoassay (EIA) for the detection of C. trachomatis with the standard cell culture. All the men had urethritis. The women included pregnant, postnatal, and nonpregnant women. EIA positive tests were used to indicate C. trachomatis infection. 22.4% of all men had chlamydia infection (17.2% of symptom free men, 26% of men experiencing pain when urinating and/or urethral discharge, and 75% of men with postgonococcal urethritis). 8.6% of all pregnant women had cervical C. trachomatis infection (8.5% of asymptomatic pregnant women and 16.7% of pregnant women with vaginal discharge). 11.4% of all postnatal and nonpregnant women tested positive for C. trachomatis. The rates among these women were 66.7% for those who had pelvic inflammatory disease (PID), 50% for those with a history of abortion. 50% for those with a herpetic lesion, 25% for those using oral contraceptives (OCs), 16.3% for nonpregnant women with pain during urination and/or vaginal discharge, 11.4% for those with no symptoms, 8.1% for those with infertility, 7.7% for postnatal women having pain during urination or vaginal discharge, and 4% for those using IUDs. The EIA's sensitivity rates ranged from 75% for women with infertility to 100% for symptomatic men and those with postgonococcal urethritis, symptomatic pregnant women, symptomatic postpartum women, women with PID, and women using OCs. Specificity rates were higher and ranged 92.9-100%. EIA's high sensitivity and specificity along with its rapid performance make it a valuable diagnostic test in clinics where incidence of C. trachomatis infection tends to be high, e.g., sexually transmitted disease clinics. Clinicians could also use it in low risk settings, but they should be careful when interpreting results.
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PMID:Enzyme immunoassay in the diagnosis of Chlamydia trachomatis infections in diverse patient groups. 267 Nov 55


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