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

A mechanical noncoagulation obliterative technique - Falope ring or Silastic band - was used for laparoscopic tubal sterilization on 224 patients at the Brookdale Hospital Medical Center for July 1, 1976 through december 31, 1977. Hysterosalpingography under fluoroscopic guidance using Ethiodol was performed on 97 patients, 5-11 months after surgery, and observation laparoscopy was performed on 7 patients, 8-12 months after the initial operation. Tubal transection occurred 15 times in 12 of 224 patients (5.4%). Management included banding, coagulation, and both coagulation and banding. Pain requiring analgesia on the 1st postoperative day or requiring a prescribed analgesia at home was present in 14 patients (6.7%). Infection appeared as salpingitis-peritonitis in a patient whose IUD was removed immediately prior to banding. Pregnancy occurred in 2 patients. The incidence of complications was low.
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PMID:Silicone band sterilization with radiographic and laparoscopic evaluation. 15 20

313 patients with ectopic pregnancy were treated at Chicago Lying-In Hospital in 1968-1975, for a frequency of 1 in 72 deliveries. Historical and physical findings, diagnostic procedures, causative factors, and patient management were reviewed for 284 of these patients. 97.5% of the pregnancies were tubal. 25% of the patients were nulliparas and 31.7% were primiparas. 34.9% had had 1 or more previous abortions. The mean age of the patients was 28. Most had been using no contraception, and only 3.9% had an IUD in situ. The most common symptoms were abdominal pain (96.7%) and amenorrhea (73.6%), while the most frequent abdominal findings were tenderness (83.4%), rebound pain (41.2%), and guarding (28.9%). Adnexal tenderness was found in 72.2% and 30% had distinct adnexal masses. An initial misdiagnosis of pelvic inflammatory disease was made in 132 (46.5%) cases. A culdocentesis and slide latex agglutination inhibition pregnancy test performed in 167 and 102 patients, respectively, gave 82.6 and 73.5% positive rates. Diagnostic laparoscopy was used routinely after 1970 on all nonacute patients in whom ectopic pregnancy was suspected, and this led to a significant drop in the rate of ruptured pregnancies (63% pre-1970 and 45% post-1970). 25% of patients were sterilized, but the treatment of choice was salpingectomy unless the opposite tube was absent or damaged. Gross evidence of pelvic inflammatory disease was noted in 36% of patients and 31% had salpingitis. The most common postoperative complication was fever (42.2%). 3 deaths occurred in the series (2 due to acute pulmonary edema resulting from fluid overload), for a maternal death rate from ectopic gestation of 13.83/100,000 live births. No fetuses survived.
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PMID:Ectopic pregnancy. An eight-year review. 43 84

A study of oral contraceptive (o.c.) and IUD use among single nulliparae, 14-18 years of age, is presented. 100 women were prescribed a combination preparation, and Copper T IUDs were inserted in 100 women. 33%-40% had not previously used any form of contraception. 9 of the o.c. group and 14 of the IUD group had undergone abortion before. There were no pregnancies in either group throughout the observation period of 955 months for the o.c. group and 1134 months for the IUD group. The most common side effects in the o.c. group were weight gain, depression, nausea, and decreased libido; 44 reported no side effects. Pain increased menstrual bleeding, and fluor were the most commonly reported side effects in the IUD group; 21 reported no side effects. The IUDs were expelled in 17 cases, in 12 of which they were immediately reinserted. 4 cases of salpingitis were reported in the IUD group. 68 in the IUD group said they were satisfied with the contraceptive method, compared to 59 in the o.c. group. The continuation rate was 75% for the IUD group after an average 13.2 months of observation and 55% in the o.c. group after an average 12.7 months of observation.
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PMID:[Comparison between the combined pill and intrauterine device in nulliparae under the age of 19]. 65 57

Based on data collected from 20,000 IUD users in Britain, it is suggested that the device not be the 1st choice of nulliparous women. Rekindled concern with long-term consequences of IUD use, raised incidence of pregnancy, expulsion of the device, bleeding or pain in nulliparous vs. parous users, and raised incidence of pelvic disease are discussed. The link between IUD use and pelvic inflammatory disease is bolstered by data showing a 3-fold increase in salpingitis in IUD users compared with women in general. When controlled for parity, a 7-fold increase in pelvic inflammation exists in nulliparous IUD users vs. nulliparous nonusers. Subsequent miscarriage and ectopic pregnancy in users vs. nonusers are special problems in women using the device as a means of delaying 1st pregnancy. A controlled prospective study is called for, since pelvic infection may affect subsequent fertility.
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PMID:Children's Joint Committee. 67 81

2 cases of unrecognized oviduct pregnancy receiving therapeutic abortion by uterine aspiration are reported. A 29-year-old white female, gravida 4, para 2 with a Dalkon Shield in place for 2 1/2 years and with 6 weeks amenorrhea received a therapeutic abortion. 3 days later the patient complained of fever and severe suprapubic cramps. Minocycline was given in the belief that the patient was suffering from endometritis. 17 days after uterine aspiration the pain increased. At laparoscopy a corpus luteum was seen in the left ovary and blood was present in the pelvis. Histological examination of the oviducts revealed signs of an aborted oviduct pregnant. A 2nd case concerned a 26-year-old white female, gravida 2, para 2, using the Ogino-Knaus method of contraception and who had a normal menses 7 weeks previously. 12 days after uterine aspiration the patient complained of continued vaginal bleeding, lower abdominal cramps, and chills. After uterine aspiration was repeated minocycline therapy was initated. 20 days after the initial aspiration the patient reported a return of vaginal bleeding and lower abdominal pain. Laparotomy revealed a ruptured oviduct. Histology showed salpingitis and fusion of the right fimbria and a large blood clot and trophoblastic villi in the lumen of the right ampulla. In the future it is suggested that histological examination of the aspiration should be performed to aid in finding oviductal or ovarian pregnancies.
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PMID:Case reports: unrecognized oviduct pregnancy and therapeutic abortion by uterine aspiration. 97 19

The irritation of the nerves of the anterior abdominal wall (nervi intercostals X-XII) may imitate salpingitis, appendicitis or intraabdominal adhesion. By gentle palpation of the wall of the lower abdomen, spec. in the region of the lateral part of the musculus rectus, the points of pain are to be localized. Xylocaine-injection may give a pain-relieve for a short period of time. Mostly, there must be an operation to loosen adhesions and to dilate the nerve-exits from the lateral part of the musculus rectus.
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PMID:[Irritation of the anterior nerves of the abdominal wall--Ibrahim syndrome]. 148 88

Pelvic inflammatory disease continues to be a common finding in young women with lower abdominal pain. Typical emergency room pelvic inflammatory disease, with classic symptoms of pain, fever, and a history of high-risk sexual behavior, is easily diagnosed with a high degree of specificity. However, the majority of patients with pelvic inflammatory disease have atypical symptoms, and their condition may be incorrectly diagnosed and treated. Careful attention to the physical signs of pelvic infection and the evaluation of the vaginal secretions for leukocytes improves diagnostic accuracy. Liberal use of diagnostic laparoscopy to confirm the possibility of acute salpingitis is recommended in young women, who have much to lose from a case of untreated salpingitis. Outpatient treatment with a beta-lactam antibiotic followed by a course of doxycycline adequately treats patients with N. gonorrhoeae and C. trachomatis infections. However, patients with suspected anaerobic upper genital tract infection such as those infections associated with tubo-ovarian abscess or IUD use should be admitted for parenteral antibiotic therapy and observation. Laparotomy and extirpative surgery should be reserved for seriously ill patients with generalized peritonitis associated with rupture of a tubo-ovarian abscess and for patients who do not respond to antibiotic therapy. Sound judgment regarding the extent of extirpative surgery, taking into consideration the wishes of the patient with respect to future fertility and hormone production, will lead to an acceptable outcome.
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PMID:Surgical considerations in the diagnosis and treatment of pelvic inflammatory disease. 183 38

463 patients (109 nulliparae, 354 uni- and multiparae) were fitted with a new intrauterine device (IUD), Sof-T, and observed during 6,624 cycles. Two independent centres participated in the study. The T of Sof-T is made of flexible polyethylene, the two occlusion bodies, of medically approved silastic. If the Sof-T is correctly placed, they lie in the uterine horns. A copper wire of a total surface of 360 mm2 is winded around the vertical branch. The echogenicity of the occlusion bodies facilitates their visualization by ultrasound, thus improving the safety of the new Sof-T. The softness and the adaptability of these occlusion bodies to the cavity of the uterus decreased trauma, and thus hemorrhage and pain, compared to 16 other studies on IUDs. The small number of salpingitis recorded in our study of the Sof-T may be attributed to the fact that the pathogens transported and transmitted by sperm could probably not penetrate into the uterine tubes because they were stopped by the occlusion bodies.
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PMID:[Pearl index of the new Sof-T spiral in relation to ultrasound follow-up]. 185 99

23 women with lower abdominal pain and Chlamydia trachomatis in the cervix, urethra, or both sites were studied. Laparoscopy was done with sampling of the endometrium and fallopian tubes for detection of C trachomatis. 11 women had laparoscopic evidence of pelvic inflammatory disease (PID); C trachomatis was detected in the upper genital tract of 8, but not in the upper tract of 5 who had laparoscopy again after treatment. The organism was also found in the upper genital tract of 9 of the 12 women without laparoscopic evidence of PID. Most of the women with abdominal pain or tenderness had tubal or endometrial C trachomatis infection, although only half had laparoscopic evidence of salpingitis. This finding suggests that antibiotic treatment should be given as soon as chlamydial infection is detected in the cervix and that pain does not necessarily point to C trachomatis in the upper genital tract. Laparoscopy may miss important pathogens in the upper genital tract, unless the procedure is complemented with detailed microbiological investigation.
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PMID:Chlamydia trachomatis in the fallopian tubes of women without laparoscopic evidence of salpingitis. 197 3

We report a retrospective series of 20 cases of peri-hepatitis diagnosed using the laparoscope. They were all young women who were nulliparous or primiparous. In eight cases, the dominant clinical picture was of acute cholecystitis. In the other cases, asymptomatic peri-hepatitis was discovered when the laparoscope had been used to try to diagnose acute salpingitis. Chlamydia trachomatis is the principal aetiological agent (in 18 cases) and it has overtaken the gonococcus which was the common one in early publications but here was responsible for only one case. Treatment with tetracyclines or quinolones always brings about a cure. Whenever a young woman complains of pain in the right hypochondrium, one has to think of this infection as well as diagnosing and treating the associated salpingitis early.
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PMID:[Chlamydia trachomatis perihepatitis (Fitz Hugh-Curtis syndrome). Apropos of 20 cases]. 214 4


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