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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twenty-seven patients with ovarian remnant syndrome were operated on by the author in a 7-year period. All patients presented with pelvic pain as their major symptom. A mass was palpable in 20 patients. In 3 patients, no mass was palpable but a lesion was visible on computed tomographic scanning. In 4 patients, there was no palpable mass and scans were negative, yet an ovarian remnant was found at laparotomy. Segmental bowel resection was necessary to obtain clearance in 8 patients, and partial bladder resection was performed in 2. Previous pelvic operations (mean, 4.3) in this group of patients probably contributed to the development of this syndrome. The ovarian remnant syndrome occurs in a patient who has previously had a bilateral salpingo-oophorectomy. A piece of ovarian tissue remains, and this remnant often produces symptoms, usually pelvic pain and associated dyspareunia. Usually the patient has had a hysterectomy as well as bilateral salpingo-oophorectomy, so that the pain is often dismissed as 'not gynaecological' in origin. This syndrome is not synonymous with residual ovary syndrome, in which an ovary that has previously been intentionally conserved either develops an abnormal pathological process or causes symptoms necessitating its surgical removal (6). Unfortunately, awareness of the problems caused by an ovarian remnant is not widespread, and often these patients have been to many gynaecologists, general surgeons, or even psychiatrists in an attempt to get relief from their symptoms. It is not possible to estimate the incidence of symptomatic ovarian remnants, but certainly when an awareness of the syndrome develops, referral of patients with the problem is common.
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PMID:Ovarian remnant syndrome. 263 78

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

A 12 month follow up study to assess the impact of symptoms suggestive of irritable bowel syndrome in women presenting to gynaecology clinics with pelvic pain is reported. Of 71 women 37 (52%) had symptoms suggestive of irritable bowel syndrome at presentation. A firm gynaecological diagnosis was reached in only three (8%) women positive for irritable bowel syndrome compared with 15 (44%) without (p = 0.002). After 12 months 24 (65%) women with irritable bowel syndrome were still symptomatic compared with 11 (32%) without (p = 0.01). This study shows that women with irritable bowel syndrome frequently attend gynaecological clinics but rarely have gynaecological pathology and the prognosis is poor in terms of resolution of their pain.
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PMID:Gynaecological consultation in patients with the irritable bowel syndrome. 275 94

Women complaining of lower abdominal and pelvic pain were tested for the presence of an ilioinguinal nerve entrapment. Forty-six women were considered to fulfill the requirements for this syndrome, five of them bilaterally. In the 51 nerves tested common findings were hyperaesthesia (88%), dysaesthesia (53%) and pain pressure at the nerve exit (75%); hypoaesthesia was rare (6%). A prerequisite for an operation was a positive result of a block with local anaesthesia. Good to excellent results of an operative approach, usually transection of the nerve, were noted after 39 procedures (76%). Some improvement was reported after six procedures whereas the operation had no effect in six others. A probable cause of the neuralgia could be found in only six women. Ilioinguinal nerve entrapment should be considered early in the differential diagnosis of lower abdominal and pelvic pain.
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PMID:Clinical findings and results of operative treatment in ilioinguinal nerve entrapment syndrome. 280 11

This study analyzed 12-months expulsion rates among women who had Delta IUDs (modifications of the Lippes Loop D and the TCu 220C) inserted immediately after delivery. 122 women received the Delta Loop and 124 received the Delta T IUD. 1 failed insertion and 1 case of mild pelvic pain were reported at insertion for Delta Loop group, whereas 5 women in the Delta T group experienced mild pelvic pain. The proportions of women reporting menstruation-related problems at follow-up were similar for both groups. There were no cases of pelvic inflammatory disease, although 2 women in the Delta Loop group had cervicitis. The 12-month expulsion rate was 3.7 for the Delta Loop and 7.6 for the Delta T. Most expulsions occurred in the 1st month after insertion. The 12-month removal rate for bleeding or pain was 1.1 for the Delta Loop and 1.0 for the Delta T. Continuation rates at 12 months were 93.3 for the Delta LOOP and 90.7 for the Delta T. The 12-month accidental pregnancy rate was 2.1 among Delta Loop users; there were no pregnancies in the Delta T group. These findings suggest that expulsions are minimized and the risks of infection and uterine perforation are not increased when IUD insertion is performed within 10 minutes after delivery of the placenta. The addition of biodegradable suture projections in the Delta devices is considered to signficantly reduce the number of explusions relative to standard loops.
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PMID:A study of delta intrauterine devices in Ankara, Turkey. 286 33

During the period January 1976--December 1982 laparoscopy was performed on 186 women complaining of pelvic pain of at least 6 months' duration. In all these cases, the routine pelvic examination and other medical and laboratory tests were negative. Laparoscopy revealed pelvic pathology in only 8.2%: in the vast majority (91.8%) entirely normal pelvic organs were seen. Evidence from the literature is compiling as to the psychogenic origin of most cases of chronic pelvic pain. Recently, it has been shown that laparoscopically negative pelvic pain can be relieved or abolished by psychological intervention. Since pathological findings on laparoscopy are of very low percentage and since the pain is psychogenic in most cases, the value of routine laparoscopy in chronic pelvic pain is very low. We propose that all women with chronic pelvic pain and normal pelvic examination should undergo psychological assessment and treatment if necessary. Laparoscopy should then be reserved for only those cases who show no amelioration on psychological intervention. Our estimation is that this approach would reduce the rate of laparoscopies performed for chronic pelvic pain by about 90%.
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PMID:The value of laparoscopy in women with chronic pelvic pain and a "normal pelvis". 286 38

One hundred eighty-two women were diagnosed by laparoscopy as having an initial episode of acute pelvic inflammatory disease (PID). The classification of PID was based on a modification of Westrom's criteria. Antibiotic treatment followed recommended protocols established by the Centers for Disease Control (CDC). Each year, the woman is contacted to complete a questionnaire detailing her reproductive history, presence of pelvic pain, and menstrual history, as well as other miscellaneous gynecologic history. The study covers a follow-up interval of six months to 8 years. The results are categorized according to the severity of the acute PID, as well as the time elapsed since the infection. A psychological investigation of post-PID pain was performed, and yielded accurate prediction of whether or not pain had been reported by a patient during the acute phase of the disease. Results indicate an increased incidence of involuntary sterility as the disease progresses in severity. The occurrence of ectopic pregnancy is increased for all stages of PID, but most particularly, following tubo-ovarian abscess. The long-term consequences of a single episode of acute PID are often severe.
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PMID:Acute pelvic inflammatory disease: a clinical follow-up. 288 88

The selective venoconstrictor dihydroergotamine (DHE) was given intravenously to 12 women with evidence of pelvic congestion. In 6 the effect of the drug on pelvic veins was observed by pelvic venography. After DHE there was a mean reduction of 35% in the diameter of the pelvic veins measured and the contrast medium cleared rapidly, with a visible reduction in pelvic congestion. In the other 6 women DHE was given during an acute attack of pelvic pain. The effect of the drug on pain relief was assessed by a single-blind crossover trial with intravenous saline as the placebo and by a visual analogue scale to assess the intensity of pain. Pain was significantly lower post-DHE 4 and 8 h and 2 and 4 days after treatment than after placebo. The results confirm a close association between demonstrable pelvic congestion and pelvic pain.
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PMID:Intravenous dihydroergotamine to relieve pelvic congestion with pain in young women. 288 20

The results of second-look laparoscopy were compared with subjective symptomatology and findings at pelvic exploration in 36 patients who had received conservative treatment for endometriosis. In the 14 patients given pharmacologic treatment, second-look laparoscopy demonstrated active endometriosis in 57.1%, whereas pelvic pain was present in 64.3% and gynecologic examination was positive in 28.6%. In the 22 patients who underwent surgery, active endometriosis was detected by second-look laparoscopy in 31.8%, whereas 40.9% reported pelvic pain and pelvic examination was positive in 31.8%. Thus clinical signs and symptoms were unreliable in the diagnosis of endometriosis recurrence, whereas laparoscopy was indispensable. It should be programmed for 6 months from the end of medical treatment and 12 months after surgery; however, if the pain symptomatology recurs, then laparoscopy is performed immediately.
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PMID:Second-look laparoscopy in the treatment of endometriosis. 290 36

The authors matched gynecologic patients with the abdominal pelvic pain syndrome (N = 41) with other gynecologic patients. They administered to both groups self-rating scales of anxiety, depression, anger-hostility, and somatization of the Hopkins Symptom Checklist and of the Symptom Questionnaire, a questionnaire about disruptions in early home life, and a questionnaire of recent stressful events. Patients with pain rated themselves on the average significantly more anxious, depressed, and hostile, and had more somatic symptoms than other patients; 56% of the patients with pain rated themselves within the normal ranges on all scales. There were no significant differences between the two groups in reports of disruptions of early home life and recent losses. The findings are consistent with the view that patients with the abdominal pelvic pain syndrome are psychologically a heterogeneous group; in many patients, depression and anxiety may be consequences of persistent pain.
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PMID:Anxiety and depression in patients with the abdominal pelvic pain syndrome. 291 19


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