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

Sarcoma of the uterus accounts for less than 1 per cent of uterine neoplasms but is responsible for more than 15 per cent of deaths. However, histological or clinical malignancy features are poorly understood, in particular those which differentiate sarcomas from leiomyomas. This study involved 16 cases, seen during 8 years in two gynecology clinics in Iasi (Rumania) and chosen according to histological diagnosis. Ten leiomyomas were also chosen for comparison of symptomatology. The malignancy criteria studied--vascular invasion, cellular density, number of mitoses and histological type (most often leiomyosarcoma: 8 out of 16)--were used to compare sarcomas with suspect leiomyomas. The mean age was 50, 7 cases being diagnosed after the menopause. The commonest symptom was metromenorrhagia (11 cases out of 16), but pain was more frequent in leiomyomas (9 out of 10). Treatment was above all surgical, total hysterectomy having the best prognosis (3 deaths out of 8 patients operated upon). Other methods (in particular radiotherapy) not being used immediately after surgery, they could not be studied. In terms of its difficult diagnosis and its high degree of malignancy (9 deaths out of 16), sarcoma must remain an argument in favour of total hysterectomy.
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PMID:[Malignancy of uterine sarcoma in comparison with suspect leiomyoma. An anatomo-clinical study of 16 cases]. 147 Aug 17

There is a 24% complication rate after first trimester induced abortions using traditional methods. This rate increases significantly in women who have a history of severe gynecological diseases (SGDs), e.g., uterine myoma, scars on the uterus, and developmental defects of the genitals. The goal of this investigation was to shed light on the effectiveness of miniabortion among pregnant women with SGDs. 61 patients aged 21-43 years with SGDs (33 with uterine myomas, 22 with scars, and 6 with uterine developmental defects) who underwent abortion by vacuum aspiration were studied. All women had had 1-3 births and 1-11 abortions. Only one patient with scars required dilatation of the cervix to Hegar 6. 85% of the patients tolerated the operation well, while 15% either had lower abdominal pain or vertigo, which abated soon after the procedure. 3-10 days after the operation slight menstruation reactions developed in 97% women that lasted 1-3 days. In 11% of cases the menstruation reaction was accompanied by pain. In two patients with uterine myoma the bleeding did no stop within 5 days after the abortion. One of these patients had profuse bleeding with clots, and 13 days after abortion she developed postabortal endometritis. One patient with scars became pregnant. The rate of complications amounted to 3.3%. The high risk of postabortal complications owing to the defects of the myometrium necessitated the administration of weak uterine drugs, such as ergotal. Trihopol was also administered for the prevention of inflammation. Starting the fifth day after the beginning of menstruation-like reactions, the patients were started on estrogen-gestagen preparations for contraception for three menstrual cycles. After the end of the menstrual reaction, they were enrolled in rehabilitative physiotherapy: electrophoresis or ultrasound applied to the area of the uterus. Regular menstruation usually resumed 20-30 days after the beginning of the menstrual reaction. The highly effective miniabortion curettage is recommended because of negligible risk of trauma.
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PMID:[A method of vacuum aspiration in early pregnancy in women with a history of severe gynecologic diseases]. 147 26

Controversy exists over whether pregnancy is a risk factor for gallstone formation; however, changes in hepatobiliary function do occur during pregnancy to create a lithogenic environment; these changes include gallbladder stasis and secretion of bile with increased amounts of cholesterol and decreased amounts of chenodeoxycholic acid. In women with existing gallstones, pregnancy may bring out symptoms, including pain and even acute cholecystitis. This may be more common during the postpartum period than during pregnancy itself; however, the overall occurrence of symptomatic biliary disease in association with pregnancy is low. The effects of pregnancy, if any, on pancreatic exocrine function are undefined. Acute pancreatitis can occur during pregnancy but does not appear to do so with either increased or, alternatively, decreased frequency. The concept of pancreatitis caused by pregnancy per se is not valid, although in susceptible women with lipid disorders, hypertriglyceridemia can occur and serve as an etiologic factor. Gallstones are a common cause of pancreatitis, but in contrast to nonpregnant women, alcohol is unusual as a cause. Although the presentation of both acute cholecystitis and acute pancreatitis may be similar to that in the nonpregnant state, the differential diagnosis of both these disorders is expanded because of unique pregnancy-related conditions and the shift of abdominal viscera by the enlarging uterus. The diagnosis is clinical and supported with conventional laboratory studies and ultrasound; management is supportive and in most patients successful. Cholecystectomy is seldom necessary during pregnancy, either for acute cholecystitis or gallstone pancreatitis, but can be safely performed if necessary after the first trimester. Endoscopic papillotomy and stone removal for choledocholithiasis are possible during pregnancy and may be the treatment of choice for this unusual condition. Specific enteral or parenteral nutrition may be necessary in women with pancreatitis associated with hypertriglyceridemia.
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PMID:Gallstone disease and pancreatitis in pregnancy. 147 36

Mifepristone (an antiprogesterone) and misoprostol (a synthetic analogue of prostaglandin E1) were administered to 60 women diagnosed with missed abortion or anembryonic pregnancy (gestation sac present but no developing embryo) equivalent to 13 weeks' gestation or less who were recruited after counselling. The median age was 227 (range 15-44), and the median duration of amenorrhoea was 71 (42-110) days. 25 of the women had been referred for ultrasound scanning because of bleeding in early pregnancy, while the rest were diagnosed by routine scanning. 29 patients had anembryonic pregnancies, and 31 had a missed abortion. Each patient received a 600 mg single oral dose of mifepristone, and 36-48 hours later misoprostol 600 mcg was given orally (400 mcg and, 2 hours later, 200 mcg). If the products of conception were not expelled within 4 hours, vaginal ultrasonography was performed. 8 patients aborted with mifepristone alone, 43 aborted after taking 600 mcg of misoprostol, and 5 more aborted after receiving a 2nd divided dose of 600 mcg misoprostol. In 3 patients the treatment failed, and they underwent evacuation of the uterus under general anaesthesia. Exploratory curettage was performed in 2 other patients at 14 and 22 days after treatment with misoprostol, but no products of conception were obtained. The median time from administration of misoprostol to abortion was 4 (1-11) hours. The median duration of bleeding after abortion was 10 (2-22) days. Side effects included nausea, vomiting (5 patients received antiemetic drugs), and diarrhoea (7 patients) from misoprostol treatment. 39 women did not want any pain relief, 13 asked for oral analgesia, and 7 obtained parenteral analgesia.
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PMID:Medical management of missed abortion and anembryonic pregnancy. 148 4

Intestinal occlusion is a rare pathologic event during pregnancy occurring mostly in the second and third trimenon when increased volume of the uterus and the consequent displacement of abdominal organs cause complications of pathologies which would otherwise escape notice, such as intestinal adhesions, to become manifest. Diagnosis is difficult for a number of reasons. Vomiting during the first trimenon and mild abdominal pain during the third are often neglected or considered to be part of the normal course of pregnancy; pain is sometimes referred to atypical sites due to the displacement of abdominal organs; in other cases, the high endorphin tonus is apt to reduce the customary defence reaction. All this should not cause time to be lost, and whenever intestinal occlusion is suspected all the necessary diagnostic procedures must at once be carried out and appropriate therapy must speedily be started so as to reduce the risk of mortality and morbidity for mother and fetus. Management of ileus in pregnancy is identical to that for the non pregnant woman, except for the need to empty the uterus in cases in which it prevents treatment or if the fetus has reached a sufficient degree of pulmonary maturity. The paper describes a case of ileal volvulus and revisits the literature analyzing the diagnostic and therapeutic options suggested.
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PMID:[Intestinal volvulus in pregnancy]. 149 64

Imperforate hymen should be considered in girls of menarcheal age with a history of amenorrhea and vague abdominal discomfort, particularly if associated with symptoms of urinary obstruction or constipation. Patients may present with severe dysmenorrhea and localized pain mimicking appendicitis if hematocolpometra is due to unilaterally imperforate hymen with duplicate vagina and didelphic uterus. Although this condition is exceedingly rare, the case presented stresses the importance of a careful history and physical examination of an adolescent girl presenting with symptoms of abdominal pain associated with menstruation.
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PMID:Didelphic uterus and unilaterally imperforate double vagina as an unusual presentation of right lower-quadrant abdominal pain. 149 48

Uterine activity may be defined in terms of the frequency of contractions of the uterus and the pressure generated by these contractions. Most studies that report an effect of analgesia on labor are retrospective, and, if prospective, are nonrandomized. Drug effects on uterine activity and labor progress are probably dose related, but are also influenced by a myriad of other factors including, but not limited to, the mother's emotional state, degree of cervical change, uterine contractility pattern, phase of labor, and individual differences in pharmacokinetics and drug sensitivity. The latest phase of labor may be prolonged by excessive narcotic or inappropriate timing of regional analgesia. The normal active phase tends to be resistant to the inhibitory effects of the usual amount of any analgesia. A brief period of decreased uterine activity often follows institution of analgesia. This may effectually accelerate labor in some patients by decreasing maternal anxiety and serum concentrations of catecholamines. A combination of sedation epidural blockade, and subsequent oxytocin use may prove effective in correcting a dysfunctional or hyperstimulatory pattern during the active phase. The second stage of labor may be slightly prolonged by effective epidural analgesia, but this delay is not necessarily harmful as long as the fetal heart rate tracing is normal, maternal hydration is adequate, and maternal pain relief is sufficient.
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PMID:Effects of analgesia on labor. 152 75

Most gynaecological operations can now be performed laparoscopically. The results for patients are a reduction in pain, less time spent in hospital and in convalescence and cost savings. For some procedures the risk of infection and adhesion formation is also reduced. This pelviscopic surgery requires extra training in special surgical skills to overcome the risks that include incomplete surgery resulting from poor access to a pelvic lesion or trauma to organs as a result of poor technique. Most patients with ectopic pregnancy, pelvic adhesions, endometriosis, ovarian cysts and fibromyomata can be treated by this advanced laparoscopic surgery. Hysteroscopic endometrial resection can replace hysterectomy for most patients with menorrhagia who have a normal size uterus.
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PMID:Minimally invasive gynaecological surgery. 153 74

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

Two cases of endometriosis causing ureteral stenosis are reported. Case 1. A 46-year-old woman was hospitalized with the complaint of right flank pain. Intravenous pyelography showed right hydronephrosis and retrograde pyelography revealed ureteral stenosis at the distal third ureter. Exploration revealed an abnormal periureteral mass, which was excised together with the distal part of the ureter. A right ureteroneocystostomy was performed with the Boari technique. Case 2. A 39-year-old woman was hospitalized with the complaint of pain in the left lower quadrant. A left retrograde pyelography showed stenosis of the ureter at 4 cm proximal of the bladder. An exploratory laparotomy revealed blue berry spots on the left side of the uterus and dense fibrous tissue around the ureter, which was successfully dissected out. The pathological diagnosis of both cases was extrinsic ureteral endometriosis. Ureteral endometriosis has rarely been described and the literatures on 30 cases reported in Japan were reviewed.
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PMID:[Ureteral obstruction caused by endometriosis: a report of two cases]. 156 57


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