Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

253 women aged 18-38 participated in comparative and clinical studies of 3 contraceptive devices in Helsinki during 1983 and 1985. The newest and most experimental device was the intracervical device. (ICD), currently in Phase II clinical trials. The ICD is placed in the cervical canal with its horizontal arm resting in the lower part of the uterus. On its vertical arm is a Silastic rod containing 50% levonorgestrel covered by Silastic tubing. The device releases 20mcg levonorgestrel/day. The advantages of the ICD are that it is independent of the size of the uterus, and its insertion does not require trained medical personnel. The levonorgestrel improves contraceptive efficacy, reduces pain and bleeding, and minimizes risk of infection. The control devices were the Nova-T copper IUD and the levonorgestrel-releasing IUD. The Nova-T is a plastic device with its vertical arm bound with copper wire with a silver Nova-T containing 50% levonorgestrel, released at 20mcg /day. It is currently completing Phase III clinical trials. The final study sample consisted of 98 volunteers using the ICD, 86 randomly selected women using the levonorgestrel IUD, and 69 randomly selected women using the Nova-T. All of the women were previous users of some form of effective contraception; 70-80% had used nonhormonal IUDs, and 1-8% had used hormonal IUDs. The dependent variable was the discontinuation rate during the 12-month test period. At 1st analysis, it appeared that a significantly higher proportion of ICD users (22.4%) discontinued than levonorgestrel IUD users (8.7%). However, these results reflect severe selection bias,since the 98 volunteer were self-selected and predisposed to be dissatisfied with contraceptive methods in general and IUDs in particular. 9 specific variables associated with discontinuation were identified and used to construct and IUD attitude index representing negative attitudes toward prior methods. After adjustment for these group differences through logistic regression analysis, the estimated probability of discontinuing became 11.8% for the ICD, 6.2% for the levonorgestrel IUD, and 7.9% for the Nova-T. These low probabilities of discontinuation indicate that the ICD is likely to be accepted by women and that hormonal IUDs in general are more acceptable than nonhormonal IUDs. The study also showed the importance of attitude, and therefore of counseling, in contraceptive decision-making. The most important implication of the study, however, is meaningful data can be extracted from an experimental study participants were not selected randomly.
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PMID:Acceptability of an experimental intracervical device: results of a study controlling for selection bias. 249 82

As an alternative to hysterectomy 16 women with menorrhagia were treated with hysteroscopic transcervical resection of the endometrium with an unmodified urological resectoscope. Twelve patients requested total resection of the endometrial lining with the intention of producing amenorrhoea, and four chose partial resection and hypomenorrhoea. Surgery was completed successfully in 15; the remaining woman, who had an acutely retroflexed uterus, sustained a uterine perforation during insertion of the rigid hysteroscope. There were no important postoperative complications, and 13 patients were discharged from hospital the day after operation. Follow up for up to six months showed beneficial effects on the duration of menses and the subjective assessment of menstrual blood loss and pain in the treated women, six of them becoming amenorrhoeic after total resection. Hysteroscopy at three months in 13 patients showed fibrosis confined to the upper half of the uterine cavity. Endouterine biopsy specimens showed the presence of microscopic deposits of normal endometrium in 10 women. Although these results are preliminary, transcervical resection of the endometrium may have an important role in managing this common complaint.
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PMID:Transcervical resection of endometrium in women with menorrhagia. 251 58

A 34-year-old woman received and IUD. During insertion of the spiral, the patient experienced mild pain the lower abdomen. One year later, the patient became pregnant. During abortion, an unsuccessful attempt was made to remove the IUD intravaginally. Hysterography indicated extrauterine localization of the IUD, provisionally in the abdominal cavity. Laparoscopic examination showed normal uterus and adnexa and few adhesions in the posterio-uterine space. Using a special clamp introduced through the laparoscope, the uterus was clamped against the muscles of the pelvic floor, and the IUD was visualized at the junction of the uterus and peritoneum. The IUD was then captured by the clamp, transferred into the abdominal cavity, and removed through the laparoscopic window in the pelvic peritoneum. At follow-up examination 1 month later, the patient was in free of gynecologic pathology.
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PMID:[Laparoscopic removal of IUD situated outside the uterus]. 253 64

A 32 year old woman underwent exploratory surgery because she had severe dysmenorrhea, the physicians found fibroids, and they excised pelvic endometriosis. 1 year later, she sought the assistance of the Center for Fertility and Reproductive Endocrinology at the Columbia Hospital for Women in Washington, D.C. because of continual dysmenorrhea and pain. A physician at the center treated her with Ovulen, a continuous estrogen/progestin therapy, yet her pain worsened. Upon a pelvic reexamination 16 months later, a physician noted a tender, enlarged, and irregularly shaped uterus (16 cm from fundus to cervix and 726g). Further, pelvic sonography detected multiple leiomyomas, 1 being 9x7 cm. The physician did a laparotomy to perform a myomectomy and therefore preserve fertility, but could not establish cleavage planes. Thus she needed to undergo a hysterectomy. Pseudodecidualized adenomyotic islands were found in the enlarged posterior myometrial wall. The results of this woman's use of Ovulen are similar to previous research on prostaglandins' role in which they act as intermediaries in decidual metaplasia. This case report affirms that progestins do not treat adenomyosis and cause significant exacerbation of its symptoms. Based on previous research and this case, the author believes that an undefined luminal component and progestin stimulation causes development of a decidual response in the uterus. Once the stimulus is defined, be it chemical, infectious, or mechanical, researchers could identify other approaches for the symptomatic relief of this debilitating and difficult to diagnose ailment.
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PMID:Exacerbation of adenomyosis symptomatology by estrogen-progestin therapy: a case report and histopathological observations. 257 8

The relationship between the uterus and the IUD was studied selectively with hysterosalpingograms in 18 menorrhagic women previously treated with Meclofenamic acid (M Ac.), a well known anti-inflammatory drug. Major anomalies (embedding, perforation, rotation) were found in 28.6% of those patients who responded positively to M Ac. In contrast, major anomalies were found in 63.6% of those patients who responded negatively to the drug. It is proposed that the negative response to M Ac. might be due to severe macroscopic disturbances of the uterine wall-IUD relationship. The degree of response to M Ac. might contribute to the decision to remove the IUD from menorrhagic women. In addition, 84.7% anomalies (deformities, embedding, perforation) in the uterine-IUD relationship were found in 13 women with a T-shape IUD device. The fact that those anomalies are related to the tip of the horizontal arm justifies future studies using shortened arms to diminish hypermenorrhea induced by T-shape devices or attempts to use IUDs which do not have the conventional plastic frame, as in the Cu-Fix IUD which has been mentioned as particularly useful to prevent bleeding side effects and pain induced by conventional IUDs. The Cu-Fix IUD consists of 6 sleeves made of pure (99.99%) copper, each sleeve with a length of 5 mm and an outer diameter of approximately 2.2 mm, threaded on surgical 00 monofilament polypropylene (ProleneR, Ethicon). The total area of exposed copper is approximately 390 mm2. The sleeves are prevented from sliding off the suture by 2 smaller copper tubules crushed on the thread in both ends of the IUD structure. This thread-type, copper-bearing device has been designed to overcome the most common IUD-related problems, bleeding and pain.
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PMID:Uterine cavity and the location of IUDs following administration of meclofenamic acid to menorrhagic women. A pilot study. 258 68

To assess the safety of insertion of the Copper T IUD after cesarean section, 45 women who underwent this process were followed for a period of 1-3 years. The majority of study participants were 26-30 years of age. 27 were para 1, 17 were para 2, and 1 was para 3. In 37 women, the IUD was inserted in tube postmenstrual phase. Complications occurring in this series were bleeding, pain, leukorrhea, perforation, and infection. The 1 case of perforation was diagnoses 1 1/2 years after IUD insertion when the patient requested removal to achieve pregnancy. The uterus was found to be hyperinvoluted. The case of pelvic infection also was revealed 1 1/2 years after insertion. This patient was treated with antibiotics and conceived 6 months after IUD removal. IUD expulsion occurred in 4 cases--2 within 5 days of insertion and 2 at 3 and 5 months after insertion. During the study period, 5 women had the device removed for reasons that included bleeding, formation of an adnexal lump, and desire for pregnancy. Notable in this series was an excessive bleeding rate of 6.6% compared to rates as high as 15% obtained in studies of IUD insertion after vaginal delivery. There were no ectopic pregnancies or contraception failures among women in this study. In general, it appears that the Copper T IUD is a safe contraceptive choice after cesarean section. However, given the risk of perforation or expulsion, the device is not recommended for women with a hyperinvoluted small uterus.
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PMID:Safety of copper T as contraceptive after caesarean section. 260 Apr 33

There is considerable interest in the development of a non-surgical method to terminate early pregnancy. During the three weeks immediately following the first missed menstrual period, several prostaglandin (PG) analogs such as sulprostone, gemeprost and 9-methylene PGE2 have been used to terminate the pregnancy. Prostaglandins, however, at the doses required to induce disruption of the conceptus cause gastrointestinal side effects and uterine pain which are more severe than those subsequent to vacuum aspiration. Treatment with the antiprogestin, mifepristone counteracts the effects of progesterone in pregnancy and thus prevents maintenance of the pregnancy. Mifepristone administered alone causes termination of the pregnancy in most, but not all, cases. In addition to removing the influence of progesterone, mifepristrone also induces regular uterine contractions and significantly increased the sensitivity of the uterus to PG analogs. Mifepristone (50 mg/day) followed by an intramuscular injection of a low dose, (0.25 mg), of sulprostone (approximately 1/6 of the dose of prostaglandin necessary to induce abortion if used alone) was highly effective in terminating early pregnancy, causing complete abortion in 94% of cases. Gastrointestinal side effects were rare and uterine pain significantly less common than if PG analogs were used alone. Subsequently the combination of mifepristone and vaginal administration of gemeprost (0.5-1.0 mg) has been shown to be equally effective Ideally, the PG analog would be administered orally rather than by injection or vaginal administration. Preliminary data indicate that 9-methylene PGE2 but not PEG2 may be suitable for this purpose in combination with mifepristone.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prostaglandins and antiprogestins. 261 97

To detect evidence of aortic compression by the uterus in the supine position during labour, blood velocity in the dorsal pedis artery was recorded using Doppler ultrasound. Twenty-seven women in labour, 16 with an epidural block (epidural group) and 11 with painful contractions (non-epidural group) were studied through several contractions in the lateral and supine position. In the non-epidural group, blood velocities showed large fluctuations, typical of temperature regulation, between contractions. During contractions, velocities were reduced by 80% in both positions, most likely due to vasoconstriction caused by pain. Radial artery measurements illustrated the same fluctuations between, and reductions during, contractions. In the epidural group, blood velocities were steadily high without fluctuations between contractions, illustrating sympathetic nerve blockade. In 14 of the 16 women, velocities remained high during contractions; in the remaining two women velocities decreased, mainly in systole, during contractions in the supine but not in the lateral position without concomitant fetal heart rate pathology.
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PMID:Blood velocities in the dorsal pedis and radial arteries during labour. 264 32

The course of a right ovarian pregnancy advanced up to the 35th week is described. The only pathognomonical symptom was a constant retrocervical tumor which was not identified as the contracted uterus. The analysis of this and 16 further cases of such ovarian pregnancies published between 1950 and 1981 leeds to the following conclusions: 1. Predisponant factors for an ovarian pregnancy occurring in a frequency of ca. 1:30,000 of all pregnancies are inflammatory diseases, surgery of the pelvis and fertility-disorders in the case-history. 2. The course of the ovarian pregnancy progreeded up to the third trimester in around 12% of the cases is characterised by an almost complete lack of symptoms. Vaginal bleedings and pain in the adnex-area may occur. 3. The monitoring as cardiotocography, chemical analysis of the placental function and the ultrasonography do not provide any clear findings to confirm the diagnosis. 4. As essential clinical indications can be considered a tumor in the pelvis of constant size discovered during the pregnancy mainly in combinations with a dislocated cervix of the uterus, a persistent anomaly of the fetal position, and a fetus palpable directly under the abdominal wall. 5. If an ovarian pregnancy is assumed an immediate operative revision is indicated. Exceptionally, in the second half of the pregnancy a delay of the operation can be justified until the fetus is able to survive. 6. The surgery of the advanced ovarian pregnancy should be as conservative as possible and reduced to the removal of the concerning adnexe.
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PMID:[The course and treatment of an ovarian pregnancy in the 3d trimester]. 264 9

Literature data on the mechanism of Laminaria-induced dilatation of the cervix uteri during abortion in the 2nd and 3rd trimesters are reviewed. Laminaria sticks are made of the stems of the algae Laminaria digitata or Laminaria japonica; the standard stick is 6-7 mm in length and 2-3 mm in diameter. Laminaria acts on the cervix uteri by applying the radial force and by removing water from the cervical stroma. One of the mechanisms of action of Laminaria is associated with the stimulation of synthesis and release of endogenous prostaglandins. The most widely used method of sterilization is gammairradiation of individually packaged Laminaria sticks. The thread attached to the proximal end of the stick simplifies its removal. Dilatation of the cervix uteri during 1st trimester requires insertion of 1-4-6 sticks for 6-12-16 hours. The methods of Laminaria insertion during the 2nd trimester vary depending upon the clinical situation. The major disadvantage of Laminaria is acute or spastic pain during insertion. Complications include migration of the Laminaria stick into the vagina or uterus and the risk of infection. Recently developed synthetic Laminaria have a number of advantages over natural Laminaria (guaranteed sterility, uniform shape, more rapid swelling, relative insensitivity to pressure). The most widely used synthetic Laminaria are manufactured from the polyvinyl alcohol (Lamicel, Merocel) and hydrogel polymer (hypan and Dilapan). Merocel and Lamicel are impregnated with magnesium sulfate providing for additional absorption of the fluid.
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PMID:[Termination of pregnancy in the first and second trimester using natural and synthetic laminaria tents]. 265 10


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