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

Uterine adenomyosis is a common, almost banal, lesion, since it is found in one uterus out of three by careful histological examination. In a continuous series of 926 hysterectomies for various indications, 246 adenomyosis lesions were demonstrated. In only 65 cases, adenomyosis was the sole histological lesion explaining bleeding or pain, symptoms refractory to routine conservative treatment (haemostatic curettage and/or hormone treatment) and therefore justifying surgical removal of the uterus. The role of adenomyosis in the failure of conservative treatment for diffuse fibromatosis at around the age of the menopause must be remembered. Almost 50% of specimens of hysterectomy for fibroma show evidence of associated histological lesions of internal uterine endometriosis. Whilst the hysterographic diagnosis may be suspected in almost 2/3 of cases, direct appearances of adenomyosis are found in only one case in four.
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PMID:[Uterine adenomyosis (author's transl)]. 60 61

Laparoscopic cholecystectomy (LSC) was attempted in 30 patients and was accomplished in 29 during the nine months between March and November 1991. Twenty eight patients had cholelithiasis with or without adenomyosis, and two had adenomyosis of the gall-bladder. Mean operative time was 219 min and postoperative pain was slight. Two complications (6.9%), including necrosis of the common hepatic duct and subcutaneous emphysema, were encountered. Patients with subacute and severe chronic cholecystitis were included in the cases. Thus this technique is recommended for almost all patients who require the removal of the gall-bladder for benign diseases.
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PMID:Laparoscopic cholecystectomy report of 30 cases. 128 75

Laparoscopic hysterectomy is now being performed in our department in cases where no malignancy is suspected. This study presents the first 10 cases. Indications for hysterectomy were myomas, meno- and metrorrhagia resistant to medical and hysteroscopic treatment, and patients with pain and suspicion of having adenomyosis. No complications have been encountered during the laparoscopic operations, but one patient had a second laparoscopy on the first postoperative day due to postoperative bleeding. Another patient had a postoperative infection leading to a compression of the ureter. This report demonstrates that laparoscopic hysterectomy is a valuable addition to the new procedures in 'minimal invasive surgery', but only after long and appropriate training.
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PMID:Laparoscopic hysterectomy. Initial experience. 131 48

Uterine adenomyosis is a benign lesion but a serious disease for women, because the symptoms are characterized by abnormal bleeding, pain, cramps, and sterility. Thus elucidation of the mechanisms involved in the development of the disease would contribute to improved management and treatment and prophylaxis of this lesion. A mouse model, in which ectopic pituitary isografting is associated with an increase in the plasma level of prolactin, is useful for a rapid and frequent induction of uterine adenomyosis and can be used to study the origin of this lesion.
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PMID:Animal model of uterine adenomyosis: is prolactin a potent inducer of adenomyosis in mice? 185 4

A review of the clinical features, diagnosis and management of primary and secondary dysmenorrhea updates some old views. Dysmenorrhea is painful menstruation, either cramps with no visible cause, primary dysmenorrhea, or secondary to specific pelvic pathology. Primary dysmenorrhea occurs in as many as 50% of young women, only in ovulatory cycles, and usually limited to the first 48 or 72 hours of menstruation. Secondary dysmenorrhea can be caused by any of a dozen or so disorders such as endometriosis, pelvic inflammatory disease, IUDs, irregular cycles or infertility problems, ovarian cysts, adenomyosis, uterine myomas or polyps, intrauterine adhesions or cervical stenosis. Psychological factors are now known not to cause dysmenorrhea, only to add to the reactive component of the pain. The pain is due to uterine cramps, hypoxia or ischemia, due to overproduction of prostaglandins, leukotrienes or vasopressin. Thus, primary dysmenorrhea can be treated with oral contraceptives if the women wishes to take pills for contraception and they are not contraindicated, or with non-steroidal antiinflammatory agents for the full 72 hours after pain begins. Calcium channel-blockers are also used on a research basis; transcutaneous electrical nerve stimulation is sometimes effective. If these treatments are not effective, investigation for causes of secondary dysmenorrhea is indicated, preferably for laparoscopy.
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PMID:Dysmenorrhea. 217 34

Cyclic pelvic pain is a common gynecologic problem caused by relatively few diseases, which usually can be diagnosed and remedied quickly. Some complaints reflect normal physiologic aspects of the menstrual cycle (mittelschmerz, menstrual awareness). Premenstrual syndrome can be diagnosed, but an effective and convenient treatment is lacking. Dysmenorrhea is the commonest source of cyclic pain, diagnosed by its characteristic history and rapid relief on administration of antiprostaglandin agents. Endometriosis is diagnosed surgically and best treated either surgically then, or medically by danazol or GnRH agonists. In contrast, adenomyosis is a problem commonly encountered in later life, and hysterectomy is usually needed for both definitive diagnosis and treatment.
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PMID:Cyclic pelvic pain. 223 52

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

Dysmenorrhea is one of the most common gynecologic complaints of young women, affecting approximately half of menstruating females. Although most patients have primary dysmenorrhea, which although creating much discomfort does not lead to significant physical problems, it is very important to rule out secondary dysmenorrhea to prevent problems with health and fertility. Primary dysmenorrhea is seen only in ovulatory cycles, usually developing within 6 to 12 months of menarche and is characterized by lower midabdominal colicky pain that may radiate to the back and upper thighs. The pain of primary dysmenorrhea starts with the onset of menstrual flow or a few hours following onset and may last for a few hours up to 2 days. The pain of secondary dysmenorrhea usually begins several days before the start of menstrual flow and may be present during much of the menstrual cycle. Pain that occurs with the first menses or after the age of 25 or is associated with anovulatory cycles is more likely to be secondary dysmenorrhea. The causes of secondary dysmenorrhea, such as endometriosis, adenomyosis, complications of intrauterine devices, and congenital abnormalities, will often be associated with abnormalities noted on pelvic examination, and whenever dysmenorrheic patients have any abnormalities, further evaluation is necessary.
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PMID:Dysmenorrhea. 305 62

The charts of 46 patients between the ages 30-50 years having a hysterectomy for a fibroid uterus were reviewed. The diagnosis of adenomyosis was correctly made preoperatively in four patients. The diagnosis was not made preoperatively in 13 patients in whom adenomyosis was demonstrated on pathologic examination of the surgical specimen. The preoperative diagnosis of adenomyosis is difficult. Pain and abnormal bleeding are frequent symptoms. There is uterine enlargement which is demonstrated on pelvic ultrasound. Occasional characteristic findings may be noted on hysterogram. Adenomyosis and fibroids often coexist. The treatment of choice is hysterectomy.
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PMID:The preoperative diagnosis of adenomyosis. 709 17

A series of 231 cases of deep-infiltrating endometriosis of the rectovaginal septum is presented. Laparoscopic procedures with excision of deep fibrotic endometriotic nodules were performed in all cases. In three cases, the bowel lumen was entered. No other peri-operative complications were observed. Three cases of urinary retention were reported. The nodule resection resulted in considerable pain relief. Histologically, the rectovaginal nodule was similar to an adenomyoma. Indeed it was a circumscribed nodular aggregate of smooth muscle and endometrial glands. This form of disease must be considered as a specific disease which originates from the Mullerian rests present in the rectovaginal septum and we suggest that it be called 'rectovaginal adenomyosis'.
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PMID:Rectovaginal septum, endometriosis or adenomyosis: laparoscopic management in a series of 231 patients. 778 44


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